Posted 05 October 2009 - 06:07 AM
My review of the article:
The article introduces the concept of smart drugs, which are known as cognitive enhancers, nootropics and "Viagra for the brain". The goal of nootropics is nothing like that of the objectives of traditional medicine. As nootropics aim is not to cure or treat some sort of disorder or abnormality, but to enhance the mind of perfectly healthy individuals usually through some sort of pharmaceutical action. Much in the same way anabolic steroids are used to enhance the physical attributes of a perfectly healthy person.
The article touches on the ethics of prescribing drugs to an individual whom which nothing is wrong and the ramifications of worse case scenarios, such as abuse, addiction, and death. Since there is nothing wrong with a person, it is hard for a doctor to justify prescribing something to someone who may potentially die from it. That death could lead to lawsuits and ultimately the loss of the doctor's license to practice medicine.
I think the general problem that is motivating this ethical debate is a cultural one. I believe that American people in general do not truly understand the concept of malpractice and informed consent. In the eyes of many Americans, if a doctor prescribes a treatment under accepted medical guidelines for a specific aliment, and the doctor is "granted" informed consent by the patient acknowledging the treatment could have some unfavorable side effects such as death and should any of the side effects happen the doctor is to be held blameless.
Assuming the treatment is carried out correctly and the patient so happens to die that does not give the patient's family the right to sue the doctor. After all, bad things happen, sometimes it is someone's fault, such as, maybe the doctor didn't tell the patient about other possible alternatives, but often the fault does not lie in the doctor, or perhaps no one is at fault. If anything, the fault lies in drug corporations who suppress unfavorable studies on their drugs not because those studies failed to stand up to scientific scrutiny, but because of greed.
As a result of this sue happy attitude, doctors are overly cautious of prescribing anything off label, which these smart drugs would fall under. Is this overly cautious attitude in the best interest of the individual patient? I believe it is not, it is in the best interest of the doctor. Therefore this sort of behavior is unethical, especially to the patient who is not sue happy. But I do understand why a doctor would engage in such behavior and therefore have empathy for them.
The article also profiles a few nootropics, suggesting that they are the mainstream drugs of choice. I did a Wikipedia search on "nootropics" and was surprised to find that that the article fails to even mention a myriad of other nootropics, the majority of them sounding a lot less dangerous then the ADHD drugs profiled. The article seems to have a hidden agenda to suggest that all the current nootropics are dangerous. After all the effects of ADHD drugs are fairly common in the media these days, why rehash the same thing when there is new material that the average person is unaware off? In addition, I felt the article was heavily biased toward western medicine, only mentioning an eastern drug (ephedrine) once, suggesting that it is an impure, therefore lesser form of amphetamine.
The article asserts that science is far off from developing a "good" smart drug that will be able to truly enhance the cognition of people. That such a drug will probably not emerge for at least 10 to 20 years. The article then cites scientific studies in which current smart drugs had little or no effect over placebo in healthy people and for the few which the drugs did enhance were "lower" level thinking and therefore not very useful.
I believe this assertion is ridiculous. The article assumes that the effects of cognitive enhancement can be studied like any other medical illness. For example, it is easy to study the effects an antibiotic has on a certain bacterial infection, since it's very easy to tell if the antibiotic is working or not, and the antibiotic method of action is simple and rather hard to disrupt (unless the bacteria rapidly gains immunity that is).
Taking it another step further is depression. First of all, there is no cure all drug for depression, since unlike a specific bacterial infection no two people's depressions are alike. Therefore, a level of experimenting and tweaking is required to find an effective treatment for a specific individual's depression. It's also somewhat difficult to figure out if a given treatment is working and in the future a treatment that works in a specific individual could stop working for no apparent reason. As a result, the treatment of psychological disorder requires a lot of guessing.
Cognitive enhancement is even more complex then physiological disorders. First of all there is nothing wrong with the person and they share no symptoms aside for wanting to be smarter. Secondly, many psychological disorders can be pinned down to certain parts of the brain, cognitive enhancement can't because in order to have enhancement to be successful the undetectable "disorders" need to be addressed. Thirdly, scientific tests in general are unable to objectivity evaluate higher order thinking such as critical thinking, and as a result have to rely on lower order thinking to access the result of it's testing. Lower order thinking and higher order thinking don't necessarily correlate to each either, for example, one may have amazingly good logic, but have horrible short term memory.
Forth, the results of studies are averaged; I believe cognitive enhancement has a very sharp inverse U relationship in terms of effective gains and dosage. Therefore it is very easy to overdose since the problem (assuming there is one) which needs to be corrected isn't that far off from optimal to begin with. Therefore, it comes as no surprise that the study results show no advantage of over placebo, since the people who were helped by the drug are nullified by the people who received too much therefore overdosed and the people who didn't need any tweaking in that specific area of study.
I believe the best and only way to reasonably test the effectiveness of cognitive enhancers is to use animal clones and begin tweaking to the point where one can say that drugs A, B, C at such and such doses will specifically enhance mouse type 1 over his mouse type 1 clones who didn't get cognitive enhances, the results of this study should be repeatable. Such a study would be closer to proving that the current cognitive enhancing drugs can be used to enhance specific individual assuming enough time is given for the individual to experiment and find out what works. To scientifically prove such a result would require human clones and numerous human's rights violations would have to employ through. So in the end, I think the evaluation of cognitive enhancers in humans will ultimately be left up to philosophy.
