Turn on, tune in, stay tuned…

This mantra, a variation on the pithy line created by Timothy O’Leary to promote the counter-culture in the 1960s, appears to be re-emerging. But this time it is not LSD in the fray but cognition enhancement drugs. These are ‘smart drugs, often described as ‘genius pills’, used for enhancing mental performance and potentially also addressing problems related to cognitive performance for any number of reasons.

At the urging of the UK Government, the Academy of Medical Sciences is conducting a review of the report ‘Drugs Futures 2025‘ published by Foresight, which does horizon scanning and futures work for the UK Government. The growing interest is being driven by both the ‘supply’ side i.e. better knowledge base in psychology, pharmacology, neuroscience and greater focus on social policy, as well as the ‘demand’ side i.e. greater and growing consumption particularly of ‘recreational’ drugs, growing issues of mental health including those arising from an ageing population such as dementia, and discouraging mental health statistics including the highest incidence of self-harm in Europe. Recently there has also been concern that modern urban life’s stresses mean few of us get ‘8 hours of sleep’ although that figure itself is often disputed, although the ill-effects of the lack of sleep are rarely doubted. Cognition enhancement drugs are therefore of interest, not just as an economic possibility, a desirable product in our quest for designer-everything from genes to babies, and one with potentially significant social and ethical ramifications.

Some cognition enhancement drugs are already in use. For instance, Modafinil is already used in the United States for treating excessive sleepiness due to narcolepsy. Its promotional website describes it as “a mood-brightening and memory-enhancing psychostimulant which enhances wakefulness and vigilance”. It also claims that it is different from amphetamines, drugs like Ritalin, and cocaine, and does not create anxiety or jitters. Some beta-blockers are also reported to reduce unpleasant memories from stressful experiences.

Neurologist Anjan Chatterjee of UPenn describes these emerging possibilities as ‘cosmetic neurology’ which will raise difficult ethical issues (excellent article through the link, by the way!).

Whenever these drugs become a mass-scale technological feasibility, the real usefulness of these drugs would be in treating real problems of cognition whether due to ageing or due to a real disorder. Especially for elderly patients drawing their pensions, meagre and getting worse by all descriptions, the question of ‘who will pay?’ remains a considerable one for using these cognition enhancement drugs in contexts of dementia and age-related cognitive impairment. Further, the pharmaceutical sector is overwhelmingly focused on developing drugs for lifestyle diseases of the developed world rather than on diseases of the developing world. I would not hold my breath for this field to be any different.

In the context of a publicly funded healthcare service, such as the NHS in the UK, the vanity applications are likely to be rationed out (i.e. disallowed or unavailable) on the NHS, but the possibility that some will have money to buy anything available will mean a new kind of social schism in ‘health equity’ terms.

The interest in cognitive improvement and rewiring is not new, although the press coverage has started to grow thick and fast; but concerted effort to find reliable and safe pharmacological approaches towards it is a sign of our times. In my other blog on obesity, I often review pharmacological and surgical approaches to obesity, but mostly they are serving the demand for a quick-fix to a certain body size and in some cases, bodily perfection through little effort. The usefulness of drugs, in my view, is moving from ‘treating sickness’ to ‘enabling health’ to ‘enabling perfection’.

Cognition enhancement drugs remain a thing to watch closely.

Other readings:

* An interesting, if provocative, read on the drugs and why we may need a new order vis-a-vis them is Griffith Edwards’s 2-volume book ‘Matters of Substance’.

* Nick Bostrom’s paper is also provides a great overview of cognition enhancement.

* This MIT paper provides a good review of internal and external hardware and software.

PS: My thoughts in this direction were inspired by reading Ben Casnocha’s post asking for ideas for a discussion he is moderating on the ethical implications of science.

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