Cognitive Enhancers

In Nature, Greely et al write in support of cognitive enhancers. Justin Barnard responds negatively.

We certainly owe ourselves a frank discussion of the potential individual and societal impacts of the increasing use of cognitive enhancing psychoactives; unfortunately Barnard is not contributing to this. As is often the case for such arguments, Barnard appeals (unclearly) to the idea that cognitive enhancement is "unnatural"; that humans, and human nature, are not to be evaluated solely in terms of information processing ability. But Greely et al do not make such an argument. Their aim is to explore a powerful (and even disruptive) medical technology in terms of expanding its potential benefits, and mitigating its risks. It would be equally incoherent for Barnard to object to improved agricultural technology by saying that there is more to man than satiating hunger. Of course there is. This concern is quite wide of the mark, which is that if we might make our world better with a new technology, we owe it to ourselves to explore that technology.

One problem with arguments like Barnard's about the ethics of self-alteration is that there is always a spectrum. Is it immoral for me to get that third cup of coffee if I'm flagging a little at 3pm? Caffeine is not only a well-established cognitive enhancer, its effect on physical tasks like long-distance running are well-known as well (here's my recent personal experience in a marathon). Was this "unnatural" of me? Or is it unnatural to raise your kids in a house with lots of books, because access to knowledge and reading adults has been shown to boost the kid's achievement later?

Let's look at another field of endeavor where these judgments are made constantly. Competitive cyclists and marathoners train at high altitudes to boost their red blood cell counts. In what way is relocating to a marginal low ppO2 environment for the sole purpose of training "natural"? Athletes who do well in these sports typically have naturally high red blood cell counts to begin with, and high EPO levels (the hormone that triggers blood cell production). So they inherited a few stretches of DNA with less stingy regulatory regions that I did. Is this fair? If it's unnatural for me to just take EPO, how about if I can boost my own endogenous production? This was a nifty trick developed a decade ago by TransKaryotic Therapeutics, a Boston biotech whose transposon technology got locked up by the legal team of EPO-hoard-ward Amgen. Still have the "ick" because it's a drug? Then let's review: going to a mountain so the thin air wrings more red blood cells out of your marrow is okay, but doing the same thing by coaxing your hormone production up (using your own genes!) is not okay. Aren't these distinctions starting to seem arbitrary?

Clearly, whatever the rules are regarding performance enhancement in a sport, they have to be consistent within that sport; and clearly, commonplace ninety-minute marathons will not have the same impact that chemically-induced geniuses will. This is exactly why the Nature paper recognizes that we have to proceed cautiously and safety is paramount - as with any other chemical we develop and ingest to improve our lives. For instance, the currently-available cognitive enhancer Adderall is merely a mixture of amphetamines. It's speed. It's entirely appropriate that access to this addictive psychoactive substance is controlled. It's also entirely appropriate that we explore the ways (if any) it's acceptable for this drug to be used by healthy people as an enhancer. Maybe for Adderall there are no such ways, but every molecule is different. That is to say, it's completely inappropriate to throw out a whole technology because a single tool has too sharp of an edge.

As a more speculative aside, it is my prediction that by the end of the twenty-first century, medicine will run out of diseases which can be treated by waiting until something breaks and then stopping the out-of-control process or aiding an atrophied one. There are many diseases which result from basic design flaws in the architecture of our tissues and the machinery of our cells - accidents waiting to happen - like back problems, hip and knee issues, cancer and autoimmune diseases. Fixes for these problems will require not only germ-line alterations, but even more profound re-engineering of the fundamental cogs and gears of metabolism. Whether we're ready for such an enterprise is a discussion that will likely happen after you and I have both returned to the elements. I make this point to say that I would not necessarily endorse such a move, and Greely et al are clearly not talking about anything so radical either, despite Barnard's anxiety. The Nature paper is advocating a search for better cups of coffee, and a sober discussion about their risk-benefit profile in general. That's all. Before we toss out an entire potential approach to bettering the human condition, the onus is on the advocates of Barnard's position to articulate their counterarguments more clearly, and with fewer appeals to vague romantic intuitions about the meaning of life.