By Esther Juárez
Cognitive enhancers are widely known and they were first developed to treat and counteract the adverse effects of dementia and memory dysfunction among patients who presented with several types of neurological deficits, either due to aging or chronic neuropathologies (Sahakian and Morein). The general mechanism of action of a cognitive enhancer relies on the metabolic interactions with particular neuroreceptors in the brain that interact with a specific drug and promote certain pathways that enhance and promote cognition in neurological diseased patients. A similar metabolic interaction has been addressed in the brain of healthy individuals who attempt to utilize enhancers in order to facilitate memory, retention, and who attempt to improve cognitive abilities. The pharmacological production of neuroenhancers was intended to provide symptomatic relief from neurological impairment and some neurologic deficits in patients because no known treatments have been established for a wide variety of neural disorders.
Genetically, neurodegenerative diseases have been associated with the down regulation of the cholinergic receptor functions in areas of the brain and the existent therapies are known to upregulate the function of these receptors thereby improving patients’ cognitive functions by ameliorating memory and learning; contraresting then the symptoms of neurodegeneration (Narahashi). Neurotransmitter receptors are similarly affected by the use of cognitive enhancers in healthy individuals; which instead of counteracting a possible side effect they abuse it improve the existent cognition quality thereby boosting performance (BMA 2007). The definition of a smart drug (also referred to as a smart pill) began when once it was discovered that they had similar effects in normal people without neurological impairment; however, cognitive function and possible side-effects have not been fully studied in normal subjects and they are yet to be completely characterized, although data suggest that declarative memory and consolidation of memories is made by the use of enhancers (Smith and Farah).
To this day, neuroenhancers have raised ethical concerns about the complete understanding of the mechanism of action with full potential and dangerous side effects in healthy individuals and also society is questioning it they should begin to accept the use of current pharmacological substances to allow a further development in the brain activities and possible acceleration in evolution. Ethical questions arise when these drugs are compared to having the same effects as crank, cocaine and steroids (Schrage). Without a doubt, a smart pill will help the cognition of a person who takes it whether this person is impaired or resides in the normal parameters. Neuroscientist Corneliu Giurgea established his positive view toward the use of smart pills arguing that the evolutionary process will take millions of years before the human being could develop a better brain (Smith and Farah).
Some cognitive enhancers that have gained popularity in the past years due to the high consumption among college students are amphetamine (Adderall), methylphenidate (Ritalin), nootropics like (Piracetam) and additional nootropics including Modafinil (BMA 2007). These drugs are known as stimulants of the central nervous system.
A drug that has been misused and is accounted for the most popular smart drug is Methylphenidate a known psychostimulant. The way that these drugs works as cognitive enhancers because this drug is known to act as a dopamine reuptake inhibitor, and binds to dopamine and norepinephrine transporters blocking their appropriate receptor (Frati et al). The efficacy was made after the drug was tested in rats at high doses of 5 to 10mg/kg intraperitoneally and this caused an interaction and impairment in attention and performance, after attempting a lower dose of .5 to 2mg/kg an improvement in cognition and attention skill appear to develop without affecting the motor activity (Frati et al). Modafinil for example is known as a waking drug used in the treatment of patients with narcolepsy, healthy individuals have used it as anti-fatigue treatment given that no major side effects have been reported with a misuse; however, recent studies have reported that this drug may be subject to addiction and immunologic impairment (Dongsoo). The full characterization of this neuroenhancers has not been fully determined. The ethics behind psychostimulants is accepted in society when as long as the appropriate drugs have been used, however ethical implications as to what determines the right cognition enhancement is still undergoing reflection (Welcher-Andris).
Contrastingly, caffeine has been accepted as a stimulant and is largely consumed worldwide. This is widely to the known benefits of such stimulants that unlike the majority of neuroenhancers have been fully analyzed by researchers that compared coffee consumers and non-consumers with moderate doses and it showed protective results among different cardiovascular diseases (Dong et al). Like any other stimulant caffeine interacts with the central nervous system (CNS), increases energy metabolism in the brain; which induces vigilance and masks the effects of fatigue (Nehlig and Debry). Many side effects of caffeine may be related to the action of the serotonin neurons, but like other stimulants mentioned coffee works for some people and it just does not for others. However, potential risks of taking these prescribed medications represents a risk in all users provided that all the drugs interact with the central nervous system and affect the transmission of neurotransmitter signals. This also opposes a question as to when is right for society to allow the use of a substances.
In the clinical setting, the usage of stimulants of any type is associated with ethical concerns that include, diagnosis, treatment, and prevention of certain neural afflictions and it is correct to allow these patients to receive pertinent treatment to allow the practice of beneficence; do good. Some other perspectives need the attention of those who use neuroenhancers as to what the learning conditions are and the type of learning environment they are exposed to. These questionings allow the standardization of behavior and knowledge. It may seem unethical to allow students to take advantage of neuroenhancers after long periods of non-curricular activities like partying and short period amounts of studying; a matter of common sense. For the use of ADHD medication, rates go between 1.3% and 0.1%, respectively, and from people who answered a survey that included four thousand subjects about 4.3% between the age of eighteen and twenty-five had made misuse of ADHD drugs compared to a 1.3% between the ages of twenty-six and forty-nine. The data suggest that the increment of usage in a younger population is increasing even the healthy individuals are completely unaware of what the effects might be. Ultimately, when there is plenty evidence that a person might actually be in medical need of a neuroenhancer to cope with the difficulties of learning other conclusions work for the healthy and young adults trying to make an unfair advantage of certain drugs (Welcher). A similar comparison has been made recently about how the abuse of cognitive drugs is similar to sports doping, referred to as brain doping to be a cognitive enhancement in the abilities caused by psychoactive substances and different medical interventions (Förstl H 2009).
Cognitive enhancement raised a question among neuroethicists given the fact that they violate the principles of utility and justice because in order to maximize the good, which in this case is the prescription drug, the academic facility should make it available to every student enrolled to maximize the benefit of the drug and its use (BMA 2007). Ethicists have also argued that allowing students to take advantage of certain enhancers violates by definition, the theory of value; in which, a primary component of receiving an education is the perception of a high achievement that should be attained with hard work, conscientious and diligent effort. Ethicists consider the misuse of smart drugs to be a violation of the principle of justice as well because even if the academic setting would make enhancers available for the entire student body, it might be unfair to not consider those people who already obtained their degree, and their means to attaining it, as well as those people studying in other parts of the country where such practices are prohibited by law and punishable by the government. Deontological approaches attempt to answer why the use of enhancers violates this theory as it should be a duty of all students to earn their grade and suffice with endeavor the accomplishment of receiving a degree. Students usually move toward enhancers to prove they are better than others, the results of this behavior satisfies only their interests and not the interests of everyone. In one study, to analyze the prevalence of improvement in cognition a study was made and a total of 40.4% reported to have used methylphenidate, which they acquired through people they knew (Schelle 2015); which suggest that only certain people have access to specific medications. Ethical questionings are being approached as to how these actions are amendable to the rest of the student population who are unaware of such practices.
Since this issue has been globally known in the sports world for quite some time now, a definition was made to establish what it really means the definition of doping; which consequently the word doping was compared to the definition of cheating. Doping is the use of prohibited ways to augment achievement, with the clear objective to acquire a certain advantage among competitors (Petroczi 2007). There have been several attempts in the scientific field to appropriately define what a cognitive enhancer really is and if there are actually benefits to having access to neuroenhancers and if they truly improve academic performance. The use of drugs and other strategies to enhance cognition is nothing new, relatively people have enjoyed the pleasure of drinking coffee, caffeinated drinks in extremely high doses. An example of this is the Starbucks brand that provides doses of coffee at five times higher than a regular cup of coffee (Mehlman).
General ethical issues and questions have been raised about the misusage of these drugs among young individuals who look to improve academic results by taking advantage of the pharmacology behind the drugs. The questioning behind these practices begins when they analyze the inability of other students to gain access to the same resources, the safety of these practices and hence, why this is represents a disadvantage among individuals who prefer not to do it. The full extent of side effects has not yet been proven and the reason as to why they might not work for certain individuals is still being investigated.
Ethically, assuming that cognitive enhancement is achieved by taking prescription drugs illicitly and one could boost a memory just by taking them and actually decreasing the learning process period process; it would be unfair for other students taking the same class, spending even more time preparing for the exam and even being unaware that there are medications that could improve their performance would be sufficiently enough to cause an ethical question about the usage of these drugs (Schermer 2008). Another way to ethically analyze the situation it to examine the concept of what it is considered cheating in an academic setting. The definition of cheating in a possible evolutionary future setting is described as a wide range of improper, deceiving or underhanded traits (Ghoul et al). Making by definition the misuse of cognitive drugs a way of fraudulent behavior because students who use these drugs would never inform instructors or superiors about the consumption of enhancers particularly before a test because it also provided them with a given unfair advantage (Schermer). The ethical focuses to be analyzed are fairness, truthfulness, and justice. Several surveys have been performed among universities to analyze the behavior of students taking unnecessary cognitive enhancement therapy (Schelle et al 2015).
A study that was conducted in an Italian university were a sample of one thousand-six-hundred-fourteen students only thirty-three reported to have used a cognitive drugs for non-medical reasons, but only a very small amount of three students admitted to have used it to study (Castaldi et al). This also raises a question about why people would have a difficulty admitting that they have ever consumed a drug to perform better. Does this mean that unconsciously they perceive their actions as wrongfully and therefore they deny it, or simply they would not think of it as a way of cheating but performing better. Ultimately, the action of taking a medication before a test is not particularly considered cheating in an academic setting but the analysis could lead to judgment of student as this being a fair practice among students.
What is the difference in taking nutritional supplements that also improve or boost the cognitive abilities of an individual, or someone who took a shot of caffeine before an exam. As far as everyone is concerned both are known to improve brain health and provide the perfect stimulatory effect to improve one’s concentration and learning capacity. Similarly, the very well-known publication of use of caffeine or caffeinated drinks that boost attention and wakefulness.
Enhancement cognition is the definition of the use or abuse of drugs and sometime other means to attain and improve cognitive function of healthy individuals who function normally but are in the pursuit of having a better and faster memory, retention, creativity and present with no diagnosed disease that required the prescription cognitive dysfunction (Frati et al). A topic that has raised a question as to how or when cognition enhancement should be allowed. An example is the perception of caffeinated drinks that these days are allowed and seem to contradict the overall understanding of cognitive enhancement.
The use of cognitive enhancers is one of the main recurrent non-prescribed therapies among college student used to be academically competent and that brings into question how fair this practice is among the entire academic population. Many studies of the actual mechanism of these neuroenhancers are uncertain and inconclusive but research is still being developed on the cognitive advantages to these alternative cognitive enhancing methods.
There has been known evidence that these drugs have been used as cognitive enhancers among the university student populations in the recent years. Some people who have attempted to take advantage of certain drugs have reported to have tremendous side effects that were not worth the risk of taking something they did not know how their body would react (Zand). Researchers have found that intelligence comprises a different set of abilities that may go beyond scoring high on tests during academic performance.
Academic performance is not dependent of a high cognitive ability as some intelligent people sometimes lack the most useful strategy in life: common sense (Charlton). While some people argue that cognitive enhancement needs a positive response from society regarding the extensive demand for the use of smart drugs (Greely et al), others argue its true efficacy and considerable side effects are not worth the risk. It is clear that physiology differs among individuals and while some might use to prevent a disease from interfering with their day-to-day activities some other might not be trying to use it for a disease but for a social advancement. The truth is that increasing attention has been given to such enhancers but no actual evidence as to how or why they work from some individuals versus other is quite clear.
The definition of cheating also argues that it is unfair to get an unadvertised advantage over others and the misuse of drugs seem to be exactly what is unethical, the fact that professionals in the field are unaware of such practices. The argument of cheating encompasses the justice principle by the fair distribution of all goods among in this case, the student body. When unfair questionings are not to discussion then the definition of cheating does not apply. Not everyone is able to be enhanced, not everyone has access to medication, and definitely not everyone is willing to suffer permanent damage or unadvertised side effects of drug mechanism that are quite unknown. The risks of addiction represent another downside to the use of neurotransmitter amplifies because they interact with the reward centers of the brain making the use of certain chemicals a danger not only for the person using them but also the people around that person or student who may be aware of the benefits of certain substances in brain development (Smith and Farah). In this sense, a person who is likely to be prescribed a medication to take advantage of neuroenhancers because is intellectually incapable would suffer the addictive effects, however, the benefit counteracts the side effects, and this represent a major gain. In healthy individuals this mechanism would impossible to compensate for because the misuse of the drug is causing the addictive behavior and the person prescribing the medication would violate the principle of non-maleficence.
Many influences have a significant relevance for a person who is attempting to take advantage of these drugs. Medical, cultural, financial and personal disadvantages represent the drive and the motivation of young individuals to make use of certain enhancers in the pursuit of excellence. Personal and societal values that have been imposed through the year by human being do not approve to this day, the use of certain advantages that would put others at a drawback. Higher learning standards should be necessary to compensate for the misuse of drugs to allow the brain to unleash its potential; if it truly is helped by the abuse of medication that was created for the benefit of the medically underprivileged. A stand-back is also triggered because of the unlikeliness of certain research studies taking place in order to allow the non-maleficence principle to be followed to ethically protect the healthy individuals, that could be potentially affected with addiction and permanent changes in what is the most important organ of the body. More significant seems to be the public support of neuroscience research and approval of more natural ways to keep the body healthy and promote knowledge that is based on a health-giving lifestyle, proper nutrition with definitely more prominent social value (Smith and Farah).
BJ, Sahakian, and Morein-Zamir S. “Pharmacological Cognitive Enhancement: Treatment of Neuropsychiatric Disorders and Lifestyle Use by Healthy People.” National Center for Biotechnology Information. U.S. National Library of Medicine, Apr. 2015. Web. 08 Oct. 2016.
“Boosting Your Brainpower: Ethical Aspects of Cognitive Enhancements. A Discussion Paper from the BMA.” British Medical Association (2007). Web. 05 Oct. 2016.
Castaldi S, Gelatti U, Orizio G, Hartung U, Moreno-Londono AM, Nobile M, Schulz PJ. “Use of Cognitive Enhancement Medication among Northern Italian University Students.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Oct. 2016.
Charlton BG. “Clever Sillies: Why High IQ People Tend to Be Deficient in Common Sense.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Nov. 2016.
Dongsoo, Kim.”Practical Use and Risk of Modafinil, a Novel Waking Drug.” Environmental Health and Toxicology. The Korean Society of Environmental Health and Toxicology, 2012. Web. 05 Nov. 2016.
Fallows, Chart Compiled by Zak. “Neurotransmitters and Drugs Chart.” Neurotransmitters and Drugs Chart. N.p., n.d. Web. 05 Nov. 2016.
Frati, Paola, Chrystalla Kyriakou, Alessandro Del Rio, Enrico Marinelli, Gianluca Montanari Vergallo, Simona Zaami, and Francesco P. Busardò. “Smart Drugs and Synthetic Androgens for Cognitive and Physical Enhancement: Revolving Doors of Cosmetic Neurology.” Current Neuropharmacology. Bentham Science Publishers, Jan. 2015. Web. 05 Nov. 2016.
Ghoul M1, Griffin AS, West SA. “Toward an Evolutionary Definition of Cheating.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Oct. 2016.
Greely, Sahakian B, Harris J, Kessler RC, Gazzaniga M, Campbell P, Farah MJ. “Towards Responsible Use of Cognitive-enhancing Drugs by the Healthy.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Nov. 2016.
McDougall, Graham J., Vonnette Austin-Wells, and Teena Zimmerman. “Utility of Nutraceutical Products Marketed for Cognitive and Memory Enhancement.” Journal of Holistic Nursing : Official Journal of the American Holistic Nurses’ Association. U.S. National Library of Medicine, Dec. 2005. Web. 05 Nov. 2016.
Mehlman, Maxwell J. “Cognition-Enhancing Drugs.” Blackwell Publishing, Inc., Sept. 2004. Web. 05 Oct. 2016.
Narahashi, T., Moriguchi, S., Zhao, X., Marszalec, W., Yeh, J. Z., “Mechanisms of Action of Cognitive Enhancers on Neuroreceptors.” National Center for Biotechnology Information. 2004. U.S. National Library of Medicine, n.d. Web. 05 Oct. 2016.
Nehlig, Daval JL, Debry G. “Caffeine and the Central Nervous System: Mechanisms of Action, Biochemical, Metabolic and Psychostimulant Effects.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 5 Nov. 2016.
Petróczi A. “Attitudes and Doping: A Structural Equation Analysis of the Relationship between Athletes’ Attitudes, Sport Orientation and Doping Behaviour.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Oct. 2016.
“Smart Drugs for Cognitive Enhancement: Ethical and Pragmatic Considerations in the Era of Cosmetic Neurology.” National Center for Biotechnology Information. Ed. University of Sydney, Australia. Vincec@psych.usyd.edu.au. U.S. National Library of Medicine, Oct. 2009. Web. 05 Oct. 2016.
Schelle, Kimberly J., Bas M. J. Olthof, Wesley Reintjes, Carsten Bundt, Joyce Gusman-Vermeer, and Anke C. C. M. Van Mil. “A Survey of Substance Use for Cognitive Enhancement by University Students in the Netherlands.” Frontiers in Systems Neuroscience. Frontiers Media S.A., 2015. Web. 05 Oct. 2016.
Schermer. “On the Argument That Enhancement Is “cheating”.” N.p., n.d. Web. 05 Oct. 2016.
Schrage, By Michael. “Performing Poorly? The Solution’s a No-Brainer: Just Pop a Smart Pill! ROGAINE FOR THE BRAIN – April 26, 1999.” Performing Poorly? The Solution’s a No-Brainer: Just Pop a Smart Pill! ROGAINE FOR THE BRAIN – April 26, 1999. N.p., n.d. Web. 05 Nov. 2016.
Shaw, David M. “Neuroenhancers, Addiction and Research Ethics.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Nov. 2016.
Smith, M. Elizabeth, and Martha J. Farah. “Are Prescription Stimulants “Smart Pills”?: The Epidemiology and Cognitive Neuroscience of Prescription Stimulant Use by Normal Healthy Individuals.” Psychological Bulletin. U.S. National Library of Medicine, Sept. 2011. Web. 05 Nov. 2016.
“True and False Concerns about Neuroenhancement: A Response to ‘Neuroenhancers, Addiction and Research Ethics’, by D M Shaw.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Nov. 2016.
Vijay Chandra, Rajesh Pandav, Ramanan Laxminarayan, Caroline Tanner, Bala Manyam, Sadanand Rajkumar, Donald Silberberg, Carol Brayne, Jeffrey Chow, Susan Herman, Fleur Hourihan, Scott Kasner, Luis Morillo, Adesola Ogunniyi, William Theodore, and Zhen-Xin. “Neurological Disorders – Disease Control Priorities in Developing Countries – NCBI Bookshelf.” National Center for Biotechnology Information. U.S. National Library of Medicine, 01 Jan. 1970. Web. 05 Nov. 2016.
Welcher-Andris. “[Ethical Aspects of Pharmacological Cognition Enhancement and the Use of Psychostimulants by Children and Young Persons].” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 05 Nov. 2016.
Zand, Benjamin. “My ‘smart Drugs’ Nightmare.” BBC News. N.p., n.d. Web. 05 Nov. 2016.