Journal Article

Should physicians prescribe cognitive enhancers to healthy individuals?

Racine, Eric, Forlini, Cynthia, Gauthier, Serge

2013

Overview

Various studies have reported that pre- scription stimulants (e.g., methyl- phenidate, dextroamphetamine mixed salts) and other neuropharmaceuticals (e.g., modafinil) are used by some healthy individuals without diagnosed attention deficit disorder to enhance concentration, memory, alertness and mood, a phenomenon often described as \"cog- nitive enhancement\" or \"neuroenhancement.\"12 Recently the term cognitive enhancement has captured the effort to deliberately augment the performance of healthy individuals and has, therefore, been criticized for the implicit assumption that these agents will be beneficial for healthy people. In contrast, the terms \"non- medical use\" and \"prescription drug abuse\" are used in public health literature.3 The prevalence of cognitive enhancer use by students on uni- versity campuses ranges from 1% to 11%.34 This practice raises important ethical and so- cietal questions concerning the freedom of peo- ple to engage in cognitive enhancement and whether this is fair practice in academic and professional environments.5 Box 1 presents landmarks in the debate surrounding the ethics of cognitive enhancement.1311 The American Academy of Neurology was the first professional association to issue spe- cific guidance for physicians on the subject of cognitive enhancement, which has served as a backdrop for further discussion of physician responses and obligations. The academy's posi- tion values the physician-patient relationship as the appropriate locus for addressing and responding to such requests. The academy bases its answers to the initial question \"Can physicians prescribe medications for cognitive enhancement?\" on the moral acceptability of cognitive enhancement within the existing legal and medical frameworks. However, another question is \"Should physicians prescribe cogni- tive enhancers to healthy individuals?\" This question asks whether cognitive enhancement is a morally praiseworthy (not solely acceptable) practice for physicians and summons physi- cians' broader obligations and responsibilities to their profession and the community.17 It is unclear at this point if physicians are willing to integrate cognitive enhancement into their clinical practice and if they think it respects their professional integrity. It has been suggested that cognitive enhancement is within the \"domain of other socially useful practices that are acceptable to the profession and society.\"10 However, a low response rate to a survey of general practitioners on this topic has led to the hypothesis that \"the issues were too foreign to their daily experiences and not perceived as clinically relevant.\"27 In addition, Hotze and colleagues reported that physicians showed \"considerable ambivalence around the issue of enhancement\" when ques- tioned about their willingness to prescribe a hypothetical enhancement intervention.16 In half of the situations, physicians responded that they might prescribe the intervention but with reser- vations. Likewise, Banjo and colleagues29 pre- sented results from a survey of 212 physicians showing that willingness to prescribe existing medications (e.g., methylphenidate, modafinil) for the potential use of enhancement was low (2- 3 on a 7-point Likert scale). These findings sug- gest a less favourable involvement of physicians in cognitive enhancement than was believed.

• Publisher: Elsevier Inc,CMA Joule Inc,CMA Impact, Inc,Canadian Medical Association
• Subject: Analysis / Bioethics / Cognitive ability / Drug Prescriptions / Ethical aspects / Health aspects / History, 21st Century / Human performance / Humans / Medical ethics / Nootropic Agents - history / Nootropic Agents - therapeutic use / Performance-Enhancing Substances - therapeutic use / Physicians / Physicians - ethics / Practice Guidelines as Topic / Prescription drugs / Smart drugs and nutrients / Social aspects