During the past few years considerable debate has arisen within academic journals with respect to the use of smart drugs or cognitive enhancement pharmaceuticals. The following paper seeks to examine the foundations of this cognitive enhancement debate using the example of methylphenidate use among college students. The argument taken is that much of the enhancement debate rests upon inflated assumptions about the ability of such drugs to enhance and over-estimations of either the size of the current market for such drugs (...) or the rise in popularity as drugs for enhancing cognitive abilities. This article provides an overview of the empirical evidence that methylphenidate has the ability to significantly improve cognitive abilities in healthy individuals, and examines whether the presumed uptake of the drug is either as socially significant as implied or growing to the extent that it requires urgent regulatory attention. In addition, it reviews the evidence of side-effects for the use of methylphenidate which may be an influential factor in whether an individual decides to use such drugs. The primary conclusions are that neither drug efficacy, nor the benefit-to-risk balance, nor indicators of current or growing demand provide sufficient evidence that methylphenidate is a suitable example of a cognitive enhancer with mass appeal. In light of these empirically based conclusions, the article discusses why methylphenidate might have become seen as a smart drug or cognitive enhancer. (shrink)

Using medical advances to enhance human athletic, aesthetic, and cognitive performance, rather than to treat disease, has been controversial. Little is known about physicians? experiences, views, and attitudes in this regard. We surveyed a national sample of physicians to determine how often they prescribe enhancements, their views on using medicine for enhancement, and whether they would be willing to prescribe a series of potential interventions that might be considered enhancements. We find that many physicians occasionally prescribe enhancements, but doctors hold (...) nuanced and ambiguous views of these issues. Most express concerns about the potential effects of enhancements on social equity, yet many also believe specific enhancements that are safe and effective should be available but not covered by insurance. These apparently contradictory views might reflect inherent tensions between the values of equity and liberty, which could make crafting coherent social policies on medical enhancements challenging. [Supplementary materials are available for this article. Go to the publisher's online edition of American Journal of Bioethics for the following free supplemental resource(s): An additional table (Table 5) referred to on p. 5]. (shrink)

There is mounting evidence that methylphenidate (MPH; Ritalin) is being used by healthy college students to improve concentration, alertness, and academic performance. One of the key concerns associated with such use of pharmaceuticals is the degree of freedom individuals have to engage in or abstain from cognitive enhancement (CE). From a pragmatic perspective, careful examination of the ethics of acts and contexts in which they arise includes considering coercion and social pressures to enhance cognition. We were interested in understanding how (...) university students, parents of university students, and healthcare providers viewed autonomy and coercion in CE using MPH. We found that perspectives converged on the belief that CE is a matter of personal and individual choice. Perspectives also converged on the existence of tremendous social pressures to perform and succeed. Parents emphasized personal responsibility and accountability for CE choices, and expressed feelings of worry, sadness and fear about CE. Students emphasized the importance of personal integrity in CE, expressed tolerance for personal choices of others, and highlighted the challenge that CE poses to maintaining one’s personal integrity. Healthcare providers emphasized the health consequences of CE. These results illustrate: (1) the importance of understanding how context is viewed in relation to perspectives on autonomous choice; (2) the limitations of individualistic libertarian approaches that do not consider social context; and (3) the ethical implications of public health interventions in a value-laden debate where perspectives diverge. (shrink)