Ethical Use of Cognitive Enhancement Drugs

By Jayashree Dasgupta

This post is based off of a presentation given by the author at the 2019 Annual Meeting of the International Neuroethics Society.

Image courtesy of Anders Sandberg on Flickr

Wide-eyed and battling jet-lag at 2 a.m., following a 16-hour flight into the US from India, I decided to turn on the TV in the hope that it would help me sleep. Immediately I was struck by the number of advertisements on drugs claiming they could help improve my memory, make me feel more alert and enhance my cognitive abilities. I must admit, at that hour and with all the fogginess in my brain, they definitely held an uncanny appeal.

Cognitive enhancement drugs, or ‘smart drugs’ as they are commonly known, include drugs, supplements and other substances that may improve cognitive functions like memory, mental alertness and creativity in healthy individuals. These drugs cover a wide range of substances from prescription medications like methylphenidate (used for treatment of ADHD) and modafinil (commonly used for treatment of sleep disorders) to substances like Ashwagandha (a herbal extract used in Ayurvedic medicine) and caffeine.

But how much do we really know about the effect of these drugs and their long term impact on cognition? Although research on the effectiveness of cognitive enhancement drugs is limited, the idea of popping pills to improve one's abilities has already caught public attention, particularly amongst the student community. However, in an increasingly competitive society where educational achievement is viewed as an important stepping stone to success in later life, the use of drugs to enhance a student’s cognitive abilities and academic performance raises several ethical concerns. To begin with, access to cognitive enhancement drugs may differ depending on factors like availability of information, ease of procurement and socioeconomic factors. Would this give particular segments of society with easier access an unfair advantage of being able to enhance their cognitive abilities?

Interestingly, the US and New Zealand are the only two countries where direct-to-customer advertising of prescription drugs is legal¹. This scenario is quite different from India and other parts of the world where such advertising is not allowed, and, where one would assume, public awareness about cognitive enhancement drugs would be lower. On the other hand, many cognitive enhancement drugs which require a prescription can be procured relatively easily in India, such as Modafinil which is freely available over-the-counter, allowing easier access to students who have heard about their benefits. But this is the age of the internet, and one could also argue that information is readily available at our fingertips. With e-commerce cognitive enhancement drugs are available online, from where many people are already procuring them, thereby reducing disparities; at least amongst those who can afford them.

Image courtesy of Gina and Tod on Flickr

But if cognitive enhancement drugs were made more available to students, where would their use be encouraged? ‘Enhancement’ typically refers to improvements made above the normal. However, this definition requires and clear understanding of ‘normal’ which may differ across contexts, such as in low resource settings where circumstances may be very different from high resource settings, and the distinction between ‘enhancement’ and ‘attainment may be blurred.’ For example, in India, a large number of students from lower socioeconomic backgrounds may have sub-optimal academic performance, as a result of limited access to resources which enable them to attain their true cognitive potential. Is it possible that cognitive enhancement drugs could help these students optimize their cognitive potential and improve academic performance? Could this open avenues to greater opportunities and upward socioeconomic mobility in the future?

Although using cognitive enhancement drugs to address social inequalities is probably a stretch of imagination; it is worth considering that the potential uses of cognitive enhancement drugs may vary in different populations. Current scientific research on cognitive enhancement drugs is at a nascent stage and much more needs to be understood about their biological and psychological impact before advocating widespread use. At the same time, it is equally important to understand societal opinions towards their use, particularly in low-resource settings like India, where public awareness about cognitive enhancement may differ from Western contexts. Unfortunately, there is very little research data on this from low resource settings.

Image courtesy of Anders Sandberg on Flickr

In India, anecdotal reports do mention students getting stimulants like methylphenidate from ‘friendly pharmacies,’ and using modafinil to deal with academic stress and improve exam performance². This self-prescription of ‘pharmaceutical drugs’ has raised concerns about the need for better over-the-counter drug regulation, along with concerns about risks of potential overdose or drug-drug interactions. There is also definitely a need to develop safely guidelines and policies, which has been highlighted in a recent report on substance use in Indian children³. However, cognitive enhancement drugs also include substances other than pharmaceutical drugs, like caffeine or herbal extracts, and very little is known about the effectiveness or acceptability of these substances.

A research project that I am involved with hopes to get a better understanding of how cognitive enhancement is viewed in India. We are particularly interested to explore the opinions of parents, teachers and clinicians, whose views on cognitive enhancement and the different techniques are very important to keep in mind if we consider using cognitive enhancement drugs to support children in the future.

References

1. Ventola, C. L. (2011). Direct-to-Consumer Pharmaceutical Advertising Therapeutic or Toxic? P T, 36(10), 669–84.
2. Chaudhuri, U. C. (June 1, 2018). "Modafinil's tightening hold over students". The Caravan. Retrieved January 7, 2020.
3. Dhawan, A., Pattanayak, R. D., Chopra, A., Tikoo, V. K., Kumar, R. (2017). Pattern and profile of children using substances in India: Insights and recommendations. Natl Med J India, 30(4), 224–9.

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Jayashree Dasgupta is a clinical psychologist with a specialization in neuropsychology. She has an interest in research and clinical practice holding an MPhil and PhD from the National Institute of Mental Health and Neurosciences (NIMHANS), India. She is the recipient of a research grant from NeuroGenE (Global Initiative in Neuropsychiatric GenEthics) Neurogene at Sangath where she is exploring the ethical issues around use of cognitive enhancement techniques and access to such interventions in low resource settings. As a Co-Founder of Samvedna Senior Care, she works with older adults to provide cognitive rehabilitation and stimulation therapies.

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Dasgupta, J. (2020). Ethical Use of Cognitive Enhancement Drugs. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2020/03/ethical-use-of-cognitive-enhancement.html