Side note: The ethics of better living through chemistry (and road updates)

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We made the 4800 mi/7600 km journey from Dallas, Texas to London, England.  The differences in language patterns, social interactions, and centres of cultural interest feel quite vast.  After a few days in London, we continued up to Cambridge (60 mi/100 km) where I spoke with some amazing neuropsychologists/psychopharmacologists for the Journey, and then made our way further north to York (160 mi/260 km) + taken a few side trips.  That brings the current mileage total up to 33,700 mi/54,000 km. We touristed enough to catch a speck  of London  (we’ll be back there in a few weeks when I speak with people at UCL and Oxford), were romanced by the beauty and charm of Cambridge, and have been overwhelmed by the bucolic scenery, rolling farms, and absolutely striking history we’ve experienced in Yorkshire.

The Cambridge scholars I spoke with, Drs. Trevor Robbins and Barbara Sahakian, both offered fascinating insights from their lives and scholarship in the area of neuropsychopharmacology. As a part of this journey I’ve been steeped in the aftermath of the cognitive revolution and the explosion of ideas about how our consciousness functions, the processes and structures of neuroscience, and the emergent ideas that now define cognitive science. This past week I needed to transition those brain-behavior-thought interactions to neuropsychopharmacology. This discipline examines the critical influence of pharmacology (drugs) on those brain-behavior relationships. The goal is practical and simple: understand how systems of the brain communicate and then alter those communications with chemicals intended to improve cognition, motor, and/or emotional function. The goal is simple and the doing is incredibly difficult. Does alteration of a chemical signal in one part of the brain influence another part? If so, what side effects will that cause? How does the brain adapt to that new chemical interfering with its processes in the short vs. longer-term? Does a targeted signaling system indirectly influence anything else in the body? What, where, and how? In a brain with a hundred billion neurons interacting by via communications with dozens of chemical systems (e.g., hormones, neurotransmitters, neuromodulators) in trillions of different patterns the simple goals quickly become a dizzying labyrinth of possibilities. The outcomes of the original functioning model of the drug are then multiplied by the variance introduced from individual users genetics, age, sex, and much more.  Finding the best drug for the appropriate behavioral or cognitive result for a particular individual is complex to understand, harder to target, and a long-shot to effect a long-term healthy change in an individual. Nonetheless, over many years, many trials, many drugs, that is exactly what these scholars have done.

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I have heard more than one colleague remark at the astounding achievements we’ve gained with better living through chemistry! It is truly remarkable! We can lower the risks and dangers of depression, alleviate some of the mild-to-moderate symptoms of Alzheimers, improve the recovery of people withdrawing from drug addiction, many things that were science fiction just decades ago! From Adderall to Zoloft the drugs of the current generation are more effectively targeted and safer than ever in human history. We can help children to overcome developmental dysfunctions, help people recovering from strokes regain lost abilities, and help those suffering degenerative disorders to slow and sometimes even reverse the likely pattern of decrements. We can do that and more. But — and this is what has been echoing in my thoughts since I spoke with the good people in Cambridge — we can also give these kinds of cognitive enhancing drugs to people who are not suffering a specific disorder or issue.

A drug that improves memory functioning for someone with Alzheimers might also improve memory for someone without Alzheimers, but who is studying for a test and wants to improve his performance. A drug that improves attention and alertness for a person with ADHD can also improve attention and alertness for someone without any deficit who is struggling to be at the top of her med class and to improve her future job prospects. As things have progressed, we have a capacity to not only improve the cognitive health of those suffering but also to raise the cognitive capacities of people who just want their brains to do more.

Of course, one must ask: should we? Part of the discussions I had with my Cambridge University scholars was the neuroethics of this field. When are drug-related improvements in performance ethical?  Do they ever cross the line? If so, what should that ethical line be between use of drugs for reaching “normal” or “typical” performance to reaching “enhanced” standards of performance. And, when it comes to ethics, does it matter if those enhancements are for personal gain or for public good?

We know that students at competitive high schools and universities have been selling and trading cognitive enhancing drugs: Adderall, Ritalin, Modafinil, Tyrosine and others. These drugs were developed for improving the cognition of those with disorders to aid in memory, learning, attention, pattern perception, and executive function. If taking one of these drugs is the difference that helps a student get into a more prestigious university, to earn a scholarship, to get a better future job, is it the right thing to do to take the drug?  The personal gain for that student is potentially a massive difference in their life both financially and professionally. One should consider the health risks and side effects, which are serious concerns. Notably, the risks have been steadily reduced as our drugs have become more targeted in their effects. And not just students seek cognitive enhancements. Financial traders, scientists, lawyers, truck drivers: lots of people in lots of professions use of enhancements to improve their alertness and to extenuate their capacity for peak cognitive performance while enduring the challenges of limited time, sleep, and the many related challenges that might reduce one’s personal productivity. Time, or at least productive time, is money.

Many others might use cognitive enhancements for public gains. Certainly, this is something the military has invested in over many years: how to help its people perform at high capacity despite highly stressful and fatiguing situations.  We might also consider our doctors and health care professionals. Would it be ethical for a med-student or resident trying to master the vast amount of material while performing on-call at a residency hospital for 70+ hours per week to take an enhancement? In that situation the benefit of using a cognitive enhancement isn’t just for the student, but might just improve the outcome for that resident’s patients. No one is well-served by a health care professional who is too tired to make good judgments.  For people who work long hours and/or under stressful situations towards the public good who take cognitive enhancing drugs to reduce fatigue, improve memory and cognitive processing will have gains but those they serve may experience the greatest benefits.

I think, at the least, the neuroethics of cognitive enhancement are complex. Our society is best served by people behaving thoughtfully and thinking comprehensively. But, should a student lose out on a scholarship because they were outperformed by someone who achieved more with the assistance of cognitive enhancement? The fairness of that is dubious and parallels the moral outrage many of us feel when successful athletes cheat by taking steroids,  HGH, or other performance enhancing drugs. The fairness issue is exacerbated when one considers the cost:  cognitive enhancing drugs are not free, nor freely available. The benefits of cognitive enhancing drugs will favor those with the resources to purchase them adding to the already uneven playing field between socioeconomic divisions.

Furthermore, for those doing public good there are real benefits to consider, but the implications about our society seem dubious.  Why are we pushing health professionals, truck drivers, and so many others to work well past the limits of fatigue and cognitive efficiency? The ethics of creating jobs that regularly tax people beyond their capacity and, instead of offering them relief, offering them drugs to maintain their unsustainable workload isn’t great.  In fact, it directly suggests our devaluation of people’s worth and well-being relative to their productivity.

Consequently, while I am excited at the understanding we’ve gained about how our neural systems function, how they relate to behaviors, and how we can alter those systems to benefit, I also wonder at what this might mean for psychology’s impact on society. It is easy to applaud the benefits we’ve gained that help people overcome dysfunctions and decrements; it is more difficult to interpret how these cognitive enhancing drugs might impact our lives and society.

It has been an exciting visit to England so far and I’m eager to learn more as I speak to a few of the good people at York University!

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Photo credits to Alexis Yael! Photo of me punting up the Cam river (Cambridge), others on the Cam River with views of the college, and a view of Scarborough Castle!

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