Cognitive Enhancers

Imagine that you're on a tight deadline with a project that demands your full concentration. What if you could take a pill that would enhance your ability to stay on task and remember minute details? You can.

Cognitive enhancers—medications to augment the function of the normal brain—are not the wave of the future. They are here, obtainable today to anyone with a credit card and an Internet connection. Their easy availability poses serious safety risks to individuals who use them without medical supervision, though. I caution against taking any of these medications on your own.

We possess the knowledge and the tools to fundamentally alter our internal milieu: our ability to focus our attention in the service of memory; control our sleep and wakefulness; modify our inclination toward social engagement versus hostility or withdrawal; promote or diminish libido and sexual performance; amplify, mute, or otherwise modulate the emotions we experience.

Medications approved for the treatment of brain disorders including Alzheimer's disease, multiple sclerosis, and attention deficit-hyperactivity disorder are beginning to be prescribed offlabel to healthy people who are seeking a competitive edge. Several studies have evaluated the effectiveness of some of the Alzheimer's drugs in middle-aged people with normal memory function and found that the people performed better on cognitive tests, as I discussed in Chapter 8. But this is only the beginning.

Researchers are investigating whether existing medications can affect the physiological underpinnings of normal cognitive function to improve attention, concentration, working memory, con- ,193

solidation, and long-term memory. In addition to cholinesterase inhibitors used in the symptomatic treatment of Alzheimer's disease, medications under study include methylphenidate (used for attention deficit-hyperactivity disorder) and modafinil (a stimulant prescribed for narcolepsy and several other neurological conditions).

Another avenue of cognitive enhancement that is under study is the use of medications that can alter memory for emotional events. We can disrupt memory consolidation through the use of beta-blockers, a type of blood pressure medication. Research is being done with victims of severe psychological trauma to determine if use of these drugs can reduce the risk of developing post-traumatic stress disorder.

But what about using these drugs to eliminate a mildly traumatic memory, such as a job loss or the breakup of a romantic relationship? Or a vaguely annoying experience, such as a slight from a coworker? If we eradicated depression and anxiety in the same way that polio was eliminated, would our society suffer a loss in artistic sensibility? Or emotional attachment and bonding?

The interest in cognitive enhancers is so strong that I have no doubt that they will come into more common use in the years ahead. But the existence of drugs that can extend the capacity of normal cognitive function raises a host of ethical and philosophical questions. Clearly, taking a pill to help you think better is different from laser refractive surgery to improve vision or plastic surgery to enhance physical appearance.

Martha Farah and Anjan Chatteqee at the University of Pennsylvania have written recent excellent reviews regarding the ethical dilemmas posed to individuals, physicians, and society by the forthcoming proliferation of cognitive enhancers. They raise issues regarding the erosion of character and the mutation of personal identity. If we believe that struggling with adversity helps build character, then might not the elimination of adversity result in a downgrading of our societal strength, a lack of grit and forbearance? Aren't pain and emotional struggle essential aspects of 194, being fully human?

What about availability and distribution? Would it be fair to expect the health insurance system to cover the cost for cognitive enhancers? If the answer is no, then only those able to afford them would reap the benefit, widening the gap between the haves and have-nots.

If a colleague at work were using cognitive performance-enhancing drugs, would you feel compelled to follow suit in order to maintain competitive parity and be in position to gain the advantages of superior performance in the form of promotion and remuneration? Would your employer have the right to expect you to use cognitive enhancers in order to be more productive or effective as an employee? What if there was evidence that use of enhancers decreased the risk of making serious errors, as in the case of an airline pilot or a medical resident in the twenty-third hour of a shift?

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