Tuesday, January 5, 2016

Responsibility: Revis(ion)ing brains via cognitive enhancement

By Shweta Sahu

The Statue of Liberty, an iconic symbol of
American opportunity; courtesy of Wikipedia
Most every parent wants their child to grow up to be a neurosurgeon, a lawyer, or the next gen Mark Zuckerberg. That was especially true in my case, as a first generation child. When I was two, my parents came to the United States, "the land of opportunity," seeking the success that they had only heard about in India. I grew up hearing their stories of hardship when they first moved here with an infant, without a car, without any extended family, and knowing very little working English. I witnessed them struggle tirelessly to make a life for themselves and they always said that without education you are nothing and will be no one. As a child, while my friends would go to sleepovers and camping trips with friends, my dad would spend time checking my math problems on the white board at home and my mom would make me spell 50 words correctly every night. But even with all that pressure, I never had the best GPA, I had to work incredibly hard to stay above the class average, and I almost always fell short of their expectations. So given the opportunity, would my parents have tried to enhance my cognitive ability?

Transcranial direct current stimulation (tDCS) is one intervention, particularly in the DIY community, which is becoming increasingly popular in hopes of achieving enhancement of cognition, though it is not available clinically for this express purpose. While it has been deemed safe in the short term from 10,000 trials of adults, studies (like this one and this one) indicate that tDCS does not result in significant enduring improvements in cognitive performance.

To do or not to do

Dr. Anjan Chatterjee asks, “If we have the ability to make brains better, should we do so when there is no acute 'disease?'” He calls such enhancement administered by the neurologist “cosmetic neurology.” In his article, Chatterjee contemplates “ways in which medicine might make bodies and brains function better by modulating motor, cognitive, and affective systems.” The definition of “enhancement” is a moving target: what is deemed worthy of treatment is characterized as disease, whereas that which is only modified is known as enhancement. Ideas about the line between enhancement and therapy are dictated not only by medical professions, but also influenced by culture.

Dr. Chatterjee suggests that one of the ethical dilemmas surrounding the issue of enhancement is manifested in safety, since most medications and treatments have side effects. He notes that “in disease states one weighs risks [like death] against potential benefits,” but asks whether enhancement is worth the risk in healthy patients who simply wish to become even better.

However, in reality, little is known about the long term effects and true benefits of interventions like tDCS in typically-performing (not considered diseased or disabled by the medical community) individuals. Dr. Martha Farah, a renowned cognitive neuroscientist, notes that much of the research currently published on existing pharmacological enhancers may need to be taken with a grain of salt, because a) many studies used small sample sizes that could have easily led to false conclusions and b) enhancement outcomes *in laboratory experiments* differ based on biological and psychological traits of the user.

Schematic of transcranial magnetic stimulation,
courtesy of Wikipedia
Even less is known about effects on children, though there are experiments indicating potential success. In one experiment in London, 12 children with mathematical learning disabilities were given nine 20-minute training sessions, 6 of whom wore the cap (but did not receive stimulation) while the other 6 received transcranial random-noise simulation (tRNS), which is a newer transcranial stimulation method that utilizes a randomly varied current. “In this case, the children moved their bodies from side to side to guide a ball on a screen to land at a certain point on a number line, with the difficulty increasing as they progressed.” Results indicated that “children who received stimulation showed greater progress in performance [and reached a 20% higher level on the game] than did the controls, as well as significant improvements in general mathematics test scores.”

But whose responsibility is it to decide whether one receives treatment?

In their article, Brain stimulation for treatment and enhancement in children: an ethical analysis, Dr. Hannah Malsen et al. argue that because such intervention may include “compensatory trade-offs” or functional cognitive losses, more emphasis should be placed on parental judgment of the child’s best interest if the child has a neurological disease and is in need of treatment. However, in absence of disease, then more weight should be placed on the child’s autonomy, since one cannot justify the need for enhancement as was deemed necessary in the treatment case.

But how do you know a child would have wanted enhancement in the first place? At age 10 is he/she equipped with the information necessary to make such a decisions with such potentially profound impacts? I know I sure wasn’t as a 10 year old. Even now, I still cringe every time class registration time comes around because I know that small choices like what classes to take and when have enduring impacts on my career. Say the child took the opportunity and turned out successful—would he/she be glad he/she received enhancement? Would his or her quality of life be the same or better?

Would the child be the same person, at the end of the day?

This is another dilemma Chatterjee addresses—one of “eroding character” and “altering an individual,” and if “such interventions threaten essential characteristics of what it means to be human.” Taking a step back, most of us can relate to this and wonder, if we do modify a person’s state or prescribe antidepressants and other drugs, then aren’t we fundamentally altering a person and keeping them from being who they are, or are we instead enabling them to become their best selves? When someone is chronically on a drug, who is to say they would make different decisions if they weren’t always on said drug? If we believe that our actions define us, then how do we know that we are not, in fact, slowly changing the person and not just their temperament or their personality? I personally think that prolonged use of a drug does change a person. Take, for example, the case of antidepressants, which are known to protect people from the adverse effects of stress. The prolonged use of antidepressants could cause someone to make different decisions than they normally might have when they felt stress, and if these different decisions lead to different actions, then yes, I think you are altering a person by prescribing them a chronic drug. Others, however, do not share my opinion. In a qualitative case study done by interviewing parents of children with and without cognitive disabilities, it was found that some parents actually justified their child’s use of [ADHD] medication and felt that the “drugs were facilitating the expression of their child’s identity, not changing it.” Again, in the case of enhancing children, we’re led to wonder how we might be altering the trajectory of the development of the child’s personality and temperament: some believe that personality is set at a young age, which leads us to question whether there is an age after which enhancement may be less likely to alter personality, since the brain and personality, are less malleable after youth.

Is the decision to choose something like tDCS actually a choice?

First generation students sometimes feel pressure to succeed
academically; image courtesy of flickr user Tim Pierce
Linda Geddes reports, “There are currently no laws in either Europe or the US to regulate the use of tDCS in people merely hoping to enhance cognition, and companies now sell the tDCS headsets online,” thus enabling those who choose the DIY route. In fact, with a bit of science background, coming up with your very own tDCS invention is a surmountable feat with common household materials, since it is essentially two sponges hooked up to a battery/ power source! In the competitive culture today, might parents feel the need to utilize any intervention they can to improve their child’s chance of succeeding? Perhaps the stakes are too high? Parents raising first generation American children like my own for instance, might feel additional pressures. A first generation student myself, I used to always question why I received so much pressure from my parents. Now, I realize it’s because they just want me to succeed and to not have to struggle the way they did just to put food on the table, so pushing me to succeed in academics was their utmost priority. They knew I wasn’t the brightest Crayon in the box, but given the chance, would they have considered enhancement? Has society influenced our need to enhance ourselves or our children because we know that, as Chatterjee suggests, “to not take advantage of cosmetic neurology might mean being left behind?” Is it a parental responsibility to enhance their children? Are we creating a new culture of millennials who will one day want to similarly enhance their children?

I asked my parents if they would have done so and somewhat surprisingly, they said no. At first they agreed and said there’s always the risk of further complications and you potentially risk more than you can gain. Moreover, they noted that since I didn’t have any known deficits or explicit neurological shortcomings, then no they would not go for it because it wouldn’t be worth it. Finally, my mom stated that every parent’s main wish is that their kids just be safe and happy, and that academic success was only a means to achieve happiness. She would never do anything to threaten that (and she viewed that such enhancement might do so), even if it means having an “ordinary” daughter when she wanted an extraordinary one, because to her, I am extraordinary.


Want to cite this post?

Sahu, S. (2015). Responsibility: Revis(ion)ing brains via cognitive enhancement. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/01/responsibility-revisioning-brains-via.html

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