Neuroenhancement American Academy of Neurology 2

Yesterday I talked about the guidance document for physicians that came from the American Academy of Neurology dealing with the issue of neuroenhancement, which is the prescription of psychotropic medication to healthy individuals who want to enhance their cognitive performance. They concluded that it is ethical for physicians to prescribe medication for these purposes. It is interesting to see their argument and justification for their conclusion.

The argument that they make is that they divide the practice of medicine into three domains, a core domain, a middle domain, and an outer domain. The core domain are those actions consistent with the traditional goals of medicine: to prevent, diagnose, and treat disease or injury, reduce suffering and to help patients die in peace. The outer domain are those actions that are ethically prohibited such as participating in the torture of prisoners and the like. They describe the middle domain as those actions that are not prohibited but fall outside the traditional role of physicians. They use cosmetic surgery as an example of a middle domain action and liken this to cognitive enhancement.


Right now we have three types of medications used for cognitive enhancement; stimulants, the wakefulness agent modafanil, and the anticholinesterase inhibitors used to slow down memory loss in dementia. There will be more to come in the near future so this is an issue that will stay with us.


I do not think that I will participate in the use of medications for cognitive enhancement in healthy individuals. Medications can result in great benefits but have side effects and risks as well. The physician must always balance potential benefit vs. potential risk. For example I would find it hard to justify myself prescribing Adderall to healthy individuals and putting them at risk of addiction or cardiac difficulties.


I would love to get comments or questions on this issue.


Thought for the day


This is the day that the Lord has made. Let us rejoice and be glad in it.

Neuroenhancement American Academy of Neurology

I have not been posting for awhile. I did go on vacation for a week which was quite nice and then surprisingly (for me) I had very little to say for awhile but my mind is back and I will resume posting.

It is amazing how much we forget and distort the past. I indicated in my last post that we had no student loan debt to pay off after medical school. My wife reminded me that we did have some debt (she had to work hard to pay it off!) but it was a small amount compared to what graduating medical students face today.

I want to talk a little bit about the topic of "neuroenhancement". Neuroenhancement refers to the use of psychotropic drugs in mentally healthy individuals to improve cognition to enhance performance. The three main medications that are considered are the stimulants used to treat Attention Deficit Hyperactivity Disorder, modafanil which is a wakefulness agent used to treat narcoplepsy and the cholinesterase inhibitors which are used to slow down the progression of Alzheimer's disease. Stimulants are already widely used on college campuses by students to improve their ability to stay up and study for long hours without losing focus. They work. Modafanil is now starting to be used for the same purpose. It has been clearly shown that these agents enhance cognitive performance. Caffeine has been known for a long time to do this. It is not yet clear whether the cholinesterase inhibitors will improve memory in healthy people but patients are asking their doctors for them. The question is, what are the ethical issues involved in prescribing psychotropic medications to healthy people?

I haven't seen a lot of discussion of this issue but the American Academy of Neurology has recently issued a guidance document for physicians. This is the only organized medical group that has tried to tackle this one. They acknowledge that there is no professional or societal consensus on this issue. Their statement though indicates that they believe the prescription of cognitive performance enhancing medications is ethical for physicians "provided that they adhere to the well known bioethical principles of respect for autonomy, beneficence, and nonmalficience".

I will talk some tomorrow on their reasoning regarding this issue and provide my own ideas.

Thought for the day

We are definitely in the era of better living through modern chemistry.