How many healthy people would take prescription drugs or go through an invasive medical procedure to improve their memory, concentration and other cognitive abilities? In a thought-provoking discussion paper launched today (Thursday 8 November 2007) by the BMA, doctors discuss the ethics of healthy people seeking to improve their cognition and mental performance with pharmaceutical products or even 'medical operations' to help their brains perform better.
The paper 'Boosting your brainpower: ethical aspects of cognitive enhancements1' has been produced by the BMA's Medical Ethics Committee (MEC) to stimulate public debate on this issue. Chairman of the BMA's MEC, Dr Tony Calland, said today:
"This is a fascinating area that has not been debated by the public. On the one hand, it may all seem very harmless - how many of us take omega 3 supplements to prevent memory loss? On the other hand, we need to consider where this search for optimum brain performance will lead. Should drugs or medical procedures that are designed to treat medical conditions be used by healthy people who simply want to be better than normal?
"We know that there is likely to be a demand by healthy individuals for this 'treatment'. However given that no drug or invasive medical procedure is risk free, is it ethical to make them available to people who are not ill? Also, how much brain power is enough? There is a concern that there may be undue pressure, perhaps from employers, to ensure that workers are even more effective and productive. The BMA does not have the answers to these questions but we think it is very important that the issues are debated."
The BMA paper examines the effectiveness of various methods that have been suggested as possible cognitive enhancers, including:
• Nutrition and nutritional supplements - for example omega 3 supplements.
• Pharmaceutical products - for example drugs that are used to treat attention deficit hyperactivity disorder or Alzheimer's disease.
• Brain stimulation and neurotechnology - involving techniques such as transcranial magnetic stimulation (which has been referred to as "botox for the brain") where magnetic pulses are used to stimulate particular areas of the brain or deep brain stimulation (which has been referred to as 'brain-lifts') - an invasive procedure involving the insertion of electrodes into the brain that transmit tiny electrical currents. There is at the moment no evidence that these procedures can improve cognition in healthy people, but the possibility cannot be entirely ruled out. It should be remembered that people are willing to endure major surgery to enhance their visual appearance, so they may be willing to do so to improve their cognitive ability as well, if the techniques prove to be effective.
• The paper discusses the balance of benefits and harms related to cognitive enhancements. There may be individual benefits, in that a person might feel better in themselves and also positional benefits, for example, the modern-day UK is highly competitive with children judged from a young age on the basis of success in tests and exams and so individuals with a competitive edge may do better than others.
• Harms include the side effects of taking prescription drugs long-term. The effects on healthy people of taking these drugs may be very different from someone taking them who has a medical condition that requires treatment.
• There could also be unintended consequences, for example, our brains selectively filter out some information and memories, particularly those that are trivial or traumatic, and we do not know whether drugs to enhance memory will impair this important function. There may be a risk of 'over-enhancement' and someone could be plagued by unwanted and traumatic memories that cause distress or even psychological harm.
• We need to consider how, as a society, we should respond to the promises and challenges of cognitive enhancements, says the report. The BMA hopes that the publication of this paper will begin a public debate on this issue and, to start the process, the Royal Institution of Great Britain is holding a public meeting on this issue on Wednesday 14 November at 7pm2.