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Collateral Damage: The Ethical Implications of Neuroenhancement

Shirley Ge

For Shirley Ge (pronounced “guh”), home is Westford, Massachusetts, where the ice cream is better than Ben and Jerry’s. She plans to pursue a major in Chemistry and a concentration in Medical Humanities. On campus, Shirley is a member of the women’s ultimate Frisbee team, Reformed University Fellowship, and Residence Life Student Staff. Her other interests include art, coffee, hiking, and social change. Shirley composed her essay for Professor Vaz-Hooper’s Writing 101 class, Writing Medicine.

The off-label use of neuroenhancement, or the practice of cosmetic neurology, is when healthy individuals take drugs such as Adderall, Ritalin, or Modafinil to enhance their cognitive abilities. Effects of these medications include heightened concentration, increased energy, and improved memory.  An increasing number of high school and college students are using neuroenhancers without a prescription so that they can become more focused on a test or write a research paper in a matter of hours. Though most schools prohibit students from using cognitive enhancers with a prescription, and classify it as cheating, many students find nothing wrong with the practice. Students concentrate on achieving academic success because they believe that if they do not perform well in school, negative consequences will follow. They see neuroenhancers as a tool to help them realize their ambitions. Others in the culture mirror this casual attitude; for some adults, cosmetic neurology has become a routine practice associated simply with “getting things done.”  The social ethic of achievement based on one’s own merits has become modified–and corrupted–to become achievement by whatever means necessary.

To compete successfully, students are often willing to trade their ethical standards and academic integrity for a kind of blind expediency that drives the use of neuroenhancers. Some go so far as to say that taking cognitive enhancement drugs is ethical under certain circumstances in academia. Gavin Enck, for instance, argues that neuroenhancers are permissible for students who are virtuous, meaning they have a genuine passion for the subject they are studying and have good character, but avers that their use is unethical in students who simply want to finish an assignment on time.1 Drugs enable the so-called “virtuous” students to focus and work quickly so that they can devote more of their precious time and effort to the discipline that they love.2 Enck justifies his claims by saying how a student “still has to do the same amount of academic work, but in augmenting his or her own capacity to focus and concentrate, they are simply using these capacities more efficiently and effectively.”3 However, students almost never pop some of their friends’ ADD medication simply because they have an unquenchable thirst for certain knowledge. They take neuroenhancers so that they can pull all-nighters and maintain a high grade point average. Students feel pressure to medicate themselves so that they may eventually reap rewards such as a secure job and a six-figure salary.4 Competition and materialism rather than a passion to learn is the primary motive for students who use cognitive enhancers.

Students concentrate on achieving academic success because they believe that if they do not perform well in school, negative consequences will follow.

When students take enhancement medication without a prescription, they are not treating an illness.  The original purpose of neuroenhancers was so that students with ADHD could “enjoy the practice of higher education” which “might be denied [to them] without this type of assistance.”5 In contrast, the use of cosmetic neurology is to fulfill the desire to pursue perfection and gain a competitive edge. Instead of trying to achieve a feat that is extraordinary for their individual abilities, students now measure themselves against the impossible standard of absolute perfection. The baseline of performance in school changes because the level of what students can pills-2-225x300 Collateral Damage: The Ethical Implications of Neuroenhancementaccomplish without enhancers is no longer good enough. They believe that their academic records must be flawless in order to realize their ambitions or prestige. What was once an ideal has become a normative expectation as students succumb to what’s known as “cognitive dysmorphic disorder,” marked by unrealistic expectations for the highest of grades.6 In order to meet this new norm, students take neuroenhancers so that they can hyper-concentrate during exams or spend nights cramming for tests. As one researcher puts this, “[they] have become convinced that this will help them achieve academic success,” success meaning nothing short of perfection.7

All in all, this desire for flawlessness invalidates the merits of independent accomplishment since neuroenhancers effectively change who people are under their influence. Neurologist Anjan Chatterjee illustrates a scenario where he prescribes medications to a financial executive for everyday conditions such as the inability to recall a word at the tip of his tongue or occasional forgetfulness. The man then wants to win a contract to represent wealthy clients in Saudi Arabia, so Chatterjee prescribes him some medication so that he can learn Arabic in a crash course and offers him a “travel pack” of cognitive enhancers to take with him abroad.8 In comparison, when students without Attention Deficit Disorder take cognitive enhancers, they are also medicating their normal human response of sleepiness and the attendant inability to focus. Work accomplished under the influence is in a very real sense “not their own,” though it was produced by a single mind.

In this sense, cosmetic neurology compromises academic integrity; “academic doping” is understood by some as a variant of cheating.9 Accomplishments in school are intended to reward our natural intelligence and creativity. Sports achievements are analogous insofar as “the essence of sport is that the person with the best natural abilities. . .should win the competition.”10  When athletes take steroids or other performance-enhancing drugs, they are cheating by unnaturally boosting their physical capacities. Thus, doping corrupts the triumph of the human body’s power. Likewise, the performance of a student who has taken Ritalin (not as a regular prescription) does not truthfully depict his or her aptitude. Academic doping nullifies merit by perverting the accomplishment of the human mind’s pure capacities. According to Columbia University’s National Center on Addiction and Substance Abuse, the off-label use of these drugs has doubled from 1993 to 2003.11 Since more students are now obtaining 4.0 GPA’s, or come close to doing so, the rarity and value of this feat diminishes.  Flawlessness becomes commonplace, and so cosmetic neurology not only invalidates status, but also plays into the hands of our culture’s mythos of perfectibility.

But some commentators do not view the use of cosmetic neurology as a form of cheating. Henry Greely and his colleagues compare neuroenhancement drugs to private tutoring and drinking coffee; drugs are simply an extension of cognitive-enhancing methods already approved.12 Vince Cakic points out that the advantage students gain using neuroenhancers is irrelevant because students already compete on an uneven playing field, each student having access to various resources such as test preparation courses or better nutrition, these related to socioeconomic variables.13.  But even though cosmetic neurology may not be an explicit form of cheating, it is a devious practice that cheapens the learning experience, “[depriving] individuals of the internal goods inherent in those practices.”14 The appeal of enhancement to students is that it makes studying efficient and expedient. But with increased speed comes a loss in comprehension and (perhaps as importantly) a diminishment in the benefits of practice itself. Lamkin likens this to a scenario whereby a helicopter drops a mountain climber off at the summit.

Cosmetic neurology also hinders a student from realizing his or her true potential.  Adderall or Modafinil can induce a feeling of euphoria, attributable to the amphetamines and methylphenidate they contain, giving users an “inappropriate overconfidence about [their] cognitive performance.” 15 Students’ expectations of how well they performed on tests often greatly exceed the reality of the results. Students rely on neuroenhancers because they embrace the mindset that drugs will enable them to achieve academic success otherwise unavailable to them so that some no longer attempt to perform without medication. A civil engineering student at Columbia condemns the off-label use of Adderall because, as pills-2-225x300 Collateral Damage: The Ethical Implications of Neuroenhancementshe puts it, “everyone [at Columbia] is smart. They should be able to get by without the extra help.”16 Yet, many students seem eager to rob themselves of the vital personal benefits of schooling in order to attain academic success. Those who routinely take neuroenhancers indirectly coerce their peers to do the same because “[to] not take advantage of cosmetic neurology might mean being left behind.”17 Another Columbia student describes how he initially believed that studying hard was the key to good grades, but now has succumbed to using neuroenhancers after experiencing the university’s fierce competitiveness for three years. Apparently, in an ironic twist, some students report that not to participate in academic doping is, in effect, a failure of morals will since those not taking the drugs are not doing everything in their power to succeed.

Problematically, the drugs appear to students to be safe. Little data on the long-term effects of cognitive enhancers has been gathered, making it more possible for students to view neuroenhancement as a routine preparation for studying, like making sure that one’s laptop computer is fully charged.  However, some immediate side effects are known since drug companies typically design clinical trials to test a drug’s safety for a short time span.18 Consistent abuse of these prescriptions drugs could very well turn out to be harmless or extremely dangerous. Chatterjee predicts that the military will likely experiment with neuroenhancers to engineer smarter soldiers, a reminder that military approval often drives social acceptance of contested practices. Pharmaceutical companies are also likely to capitalize on the growing trend of off-label use. Since the Food and Drug Administration permits drug companies to advertise directly to consumers, “[it] does not take much imagination to see how advertisements for better brains would affect an insecure public.”19 Marketing campaigns for these medications would certainly persuade many people to see themselves as “intellectually disadvantaged, in need of a pharmaceutical upgrade, and eligible for ever-stronger enhancements.”20

The appeal of enhancement to students is that it makes studying efficient and expedient. But with increased speed comes a loss in comprehension and (perhaps as importantly) a diminishment in the benefits of practice itself.

Ultimately, investing research funds and professional energies in neuroenhancement as a pharmaceutical technology seems ill-conceived, especially since it would cater to a flaws in human character such as procrastination, laziness, or poor time management. Cosmetic neurology does not treat an illness or disorder; it only caters to human weakness. The same might be said of cosmetic surgery, diet pills, or steroids. But with cosmetic neuroenhancers the line between use and abuse seems somewhat more difficult to draw. We admire success, and rarely inquire into the processes required for achieveing it. This is especially so in colleges and universities, where destination seems nearly everything, and the journey mere transit to the prize.

Bibliography

Cakic, Vince. “Smart Drugs for Cognitive Enhancement: Ethical and Pragmatic Considerations in the Era of Cosmetic Neurology.” Journal of Medical Ethics 35, no. 10 (2009): 611-15.

Chatterjee, Anjan. “Cosmetic Neurology: The Controversy over Enhancing Movement, Mentation, and Mood.” Neurology 63, no. 6 (2004): 968-74.

——. “The Promise and Predicament of Cosmetic Neurology.” Journal of Medical Ethics 32, no. 2 (2006): 110-13.

Cheshire, William P., Jr. “Just Enhancement.” Ethics & Medicine: An International Journal of Bioethics 26, no. 1 (2010): 7-10.

Enck, Gavin G. “Ideals of Student Excellence and Enhancement.” Neuroethics 6, no. 1 (2013): 155-64.

Flower, K, et al. “Efficacy, Safety, and Ethics of Cosmetic Neurology Far From Settled.” Clinical Pharmacology and Therapeutics 88, no. 4 (2010): 461-63.

Greely, Henry, et al. “Towards Responsible Use of Cognitive-Enhancing Drugs by the Healthy.” Nature 456, no. 7223 (2008): 702-05.

Jacobs, Andrew. “The Adderall Advantage.” New York Times July 31, 2005.

Lamkin, Matt. “Cognitive Enhancements and the Values of Higher Education.” Health Care Analysis 20, no. 4 (2012): 347-55.

Larriviere, D. and M.A. Williams, “Neuroenhancement: Wisdome of the Masses or False Phronesis?” Clinical Pharmacology and Therapeutics 88, no. 4 (2010): 459-61.

Meyer, Michael J. “Patients’ Duties.” In Biomedical Ethics. edited by Judith R. Cornwell and Tom Holton, 127-30. New York: McGraw-Hill, 1996.

Schermer, Maartje. “On the Argument that Enhancement is Cheating.” Journal of Medical Ethics 34, no. 2 (2008): 85-88.

—–. “Enhancements, Easy Shortcuts, and the Richness of Human Activities.” Bioethics 22, no. 7 (2008): 355-62.

 

 

 

  1. Gavin G. Enck, “Ideals of Student Excellence and Enhancement,” Neuroethics 6, no. 1 ( 2013): 157. []
  2. Ibid., 160. []
  3. Ibid., 161. []
  4. Matt Lamkin, “Cognitive Enhancements and the Values of Higher Education,” Health Care Analysis 20, no. 2 (2012): 352. []
  5. Ibid., 351. []
  6. D. Larriviere and M. Williams, “Neuroenhancement: Wisdom of the Masses or False Phronesis?” Clinical Pharmacology and Therapeutics 88, no. 4 (2010): 461. []
  7. Andrew Jacobs, “The Adderall Advantage,” New York Times, July 31, 2005: 4A, 16. []
  8. Anjan Chatterjee, “The Promise and Predicament of Cosmetic Neurology,” Journal of Medical Ethics 32, no. 2 (2006): 110. []
  9. Vince Cakic, “Smart Drugs for Cognitive Enhancement: Ethical and Pragmatic Considerations in the Era of Cosmetic Neurology,” Journal of Medical Ethics 35, no. 10 (2009): 611. []
  10. M. Schermer, “On the Argument that Enhancement is Cheating,” Journal of Medical Ethics 34, no. 2 (2008): 86. []
  11. Jacobs, 16. []
  12. Henry Greely et al., “Towards Responsible Use of Cognitive-Enhancing Drugs by the Healthy,” Nature 456, no. 7223 (2008): 703. []
  13. Cakic, 612 []
  14. Lamkin, 351. []
  15. K. Flower et al., “Efficacy, Safety, and Ethics of Cosmetic Neurology Far From Settled,” Clinical Pharmacology and Therapeutics 88, no. 4 (2010): 462. []
  16. Jacobs, 16. []
  17. Anjan Chatterjee, “Cosmetic Neurology: The Controversy Over Enhancing Movement, Mentation, and Mood,” Neurology 63, no. 6 (2006): 971. []
  18. Chatterjee, “The Promise,” 111. []
  19. Chatterjee, “Cosmetic Neurology,” 972. []
  20. William Chesire, “Just Enhancement,” Ethics & Medicine: An International Journal of Bioethics 26, no. 1 ( 2010): 8. []
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