2008/12/17

Responsible drugs

Wherein I meander briefly through the loaded topic raised recently on taking drugs to improve our brains. Opinions are not guaranteed to be well argued or even well thought out. In three parts.

Introduction

Nature has recently published an article “Towards responsible use of cognitive-enhancing drugs by the healthy” that discusses the topic of the current illegality of cognitive-enhancing drugs and how they might be used by healthy people for the benefit of society.

Cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world.

My initial impression is: but of course! Drugs to help cognition have my full support. The comments to the paper, which I’ll discuss in more detail below, have some good arguments both for and against this idea.

[It] would also be foolish to ignore problems that such use of drugs could create or exacerbate. With this, as with other technologies, we need to think and work hard to maximize its benefits and minimize its harms.

Others’ comments to the article

Before I write down my own thoughts, I want to quote some of the excellent comments that have been made. At time of writing, this is a cherry-picked selection of basically every reply to the article that I thought added new information to the argument and/or made me think. I tried to trim it down as much as possible, but, as you can see, there’s a lot of good stuff.

Anonymous:

The key to a satisfying and rich life is not to be found in caffeine or nicotine, much less adderall, ritalin, or next generation cognitive boosters. Furthermore, what effect would widespread use of such drugs have on ever-widening global socioeconomic disparities, regardless of how well distribution/development is monitored?!

Terry Kremin

Timothy Leary advocated the same – LSD can be a great cognitive enhancer. Freud thought cocaine was the greatest gift to mankind ever as it was such a fantastic cognitive enhancer. Slave owners found cocaine a great boon in increasing the production from their slaves. Marijuana is great to help those in mundane lives accept their lives and just trudge through without complaining too much – is that ‘cognitive enhancement’? It increases their productivity and lowers their costs.

But what exact ‘cognition’ are you enhancing? Most of the cognitive enhancers have shown great results in cases where a simple response is required, but they tend to inhibit the ability to acquire flexible representations. These compounds have been great at enhancing learning in one specific case – and addiction to the substance, and an inability to now think flexibly and alter their addictive behavior and drug seeking behavior.

It is also said that it is a fine line between genius and lunatic, particularly in the arts. If people learn specific associations even better without the distractions of random and odd association, how important do we really consider thinking outside the box? If say da Vinci increased his focus through these drugs, how productive would that actually have made him? he may have become one of the greatest physicians of his time, at the loss of his art and inventiveness.

College students use many of these to ‘enhance’ their cognitive ability – on tests that overwhelmingly test rote memory – not creative thinking and application of knowledge. If the tests were changed to more reflect application of knowledge in life, would the drugs still be popular? So we need to not only define what we mean by cognitive enhancement, and not limit it to the over used and abused IQ measures, and also what we define as productive. SO then do we take ritalin to increase our focus, and then also take LSD to increase our insight and creativity?

Focus and production are great, for a robot or computer, or assembly line, but do we really want to say emulating those is the greatest endeavor or goal of humanity? […] How about instigating a national exercise program? Fight obesity and increase cognitive abilities all at the same time.

Mark Hammer

There is a fundamental misunderstanding about the nature of cognitive enhancers. […] The fundamental fact is that unlike mood enhancing/altering drugs, cognitive enhancers require your unswerving cooperation to “work” […]. In this respect, as a “drug”, they are less like an antibiotic (which works without you having to do anything strategic other than take them as prescribed), and more like anabolic steroids (which requires you to actually DO something specific in order to produce the intended outcome).

What they need from you in order to work, is a strategic mind, or more specifically, a cognitive strategy and set of habits that the neurochemical system being affected by the drug supports. No drug has ever, or WILL ever substitute for a strategy.

Sadly, while cognitive impairment can be easily produced with specific disruptors, quite independent of the volition of the subject, cognitive enhancement (again, performance above normal expectations) requires significant volition on their part. If you park your car at a mega-mall and don’t bother to take a few moments to commit to memory where it is parked, no amount or type of drug in the world will make recall any more likely BECAUSE THAT’S HOW MEMORY WORKS.

[A] great many people tend to overestimate the cognitive difficulties they may be having relative to others. In that respect, it is a bit like the entire “penis enlargement” industry that makes profits on the backs of sexual insecurity as opposed to real need. Who DOESN’T wonder if they are smart or attentive enough? […] Get thineself a good night’s sleep, and a decent education, and you’ll be in better shape than anything such substances might conceivably be able to do.

Anonymous:

I’d like to begin by voicing that I off-label ‘cognitively enhance’, as I find that occasional metered use can make astounding increases in my ability as a researcher – which results in tangible benefit to society. It’s not a competition, I’m not taking an exam. I’m doing research; research that I hope may one day improve the lives of many. Of course I exercise, sleep, eat well, and I drink coffee. And yet sometimes that significant extra boost allows me to spend 12 hours pushing through math I frustratedly found myself unequal too for weeks previous. Why is this the act of a social criminal?

Mark Hammer:

It is my contention that perhaps the greater challenge is not the development of substances, nor the legal aspects, but rather the conceptualization of how a substance might impact on cogition in a positive direction when the individual has no particular impairment to start with. We KNOW that we can screw up normal cognition with drugs (and there are millions of people in prison, and families of deceased, who can vouch for that). We have SOME evidence that people whose cognition is lacking due to disease-related processes can SOMETIMES be improved upon by taking pharmacological steps to reverse some known neurochemical deficit or dysfunction. But when it comes to regular folks who have no known problems, the manner in which a substance could conceivably render cognition “better” or “improved”, and the classification of current and future substances into some nosology of types of action or cognitive enhancement, truly escapes us.

Peter Tylee

Does this support the need for further research? Certainly. Research targeted at solving real problems, not pandering to the lazy and the elitist or those who imagine that widespread use of ‘enhancing’ agents would so improve the world that the inescapable associated harms would be justified.

Jeffrey Atkinson

Mark Hammer’s Dec 8th reply details accurately what I perceive to be the crux of the matter – that ’cognitive enhancers require your unswerving cooperation to “work” ’. It appears that for these and similar drugs that the benefits are generally small but real. However, this benefit comes to the prepared and dedicated, and so the drugs are unlikely to turn an idiot into a brilliant scholar.

I doubt the current drugs are going to radically change the way students learn, or researchers work. But it most certainly is the time to start thinking about what happens when, inevitably, the drugs or implanted chips get better to the point were NOT having using them will leave you at a distinct disadvantage.

My own thoughts

As always, the line of scientific idealism that I wish I could strongly uphold falls short of practical reality. This is clearly a subtle topic, with several orthogonal arguments that often confuse the issue and make it hard for me to form a coherent opinion when I’m so far away from the actual issue.

Ideally, I think that schools and universities should actively discourage the use of these drugs, since I feel that these are supposed to be places students where students learn how to learn, rather than actually learn some great chunk of knowledge that can be assessed in examination form. Background knowledge is important “on the job”, but the more important aspect is solving problems that one has not seen before.

I think the desire to use cognitive enhancing drugs in schools is a little misguided as to what the purpose of being in school is actually for. And as the comments above say, sleep and food and exercise all contribute to cognitive skills; it stands to reason that if any of these are in deficit then it’s not constructive to prescribe drugs to fix a different problem.

But I’m not against the idea of taking drugs. This seems a little inconsistent given what I just said. So when do I see these sorts of drugs as playing an important rĂ´le in society? Well, like other drugs that have been used in the past to aid artistic progress, cognitive-enhancing drugs should be used when the individual is actively involved in solving problems that involve a degree of cognitive load.

Where that line is drawn in an individual’s life is rather fuzzy. I would not advise taking performance-enhancing drugs to just “get through” a university course, but at some stage there are going to people with real gifts to share that happen to have taken drugs to get in the position they are in. And I’ll be more than happy when that time arrives, if you don’t want to argue that this event hasn’t already happened a long time ago.

I guess I would pay a fairly high price for the advancement of science versus attempting to retain our humanity. But I’d hope that in doing so, we would remain in a situation to appreciate the humanity that we have.