Issue 44 / 12 November 2012

IN a competitive labour market, it’s increasingly important to have an edge, but how far should we be prepared to go to achieve that?

Could CVs soon include information on not just the degrees we have or our work experience, but also the cognitive enhancements we have undergone to improve our memory or processing speed?

A report released this month by a group of British institutions, including the Academy of Medical Sciences, investigates the likely future role of “human enhancement” in the workplace.

From shift workers taking modafinil to help them remain alert despite disrupted sleep patterns, to soldiers using auditory devices to boost their hearing beyond the normal range, the use of such enhancements raises complex ethical and policy questions.

Cognitive boosters used in healthy people are often a by-product of research originally designed to address a particular medical condition or impairment, as the report makes clear.

The attention deficit hyperactivity disorder (ADHD) drug methylphenidate has for example been shown to improve short-term memory and other cognitive measures in healthy volunteers, hence its popularity with students around exam time.

Similarly, studies suggest transcranial electrical stimulation might offer benefits in ADHD, Parkinson disease and schizophrenia, but also that it could enhance learning and cognition in healthy adults, with effects that might last for as long as a year after treatment.

The options for making ourselves smarter are only going to increase, as is the unregulated cyber-marketplace that spruiks them.

One site offering modafinil at $2.09 per pill, for example, promises the drug “helps to preserve workability and high level of intellectual activity with regular change of work shifts (schedules), and thereby contributing the stabilization of mental state and maintaining the ability to assimilate new information”.

The drug doesn’t appear to promote writing skills, but that’s cyberspace for you.

It’s hard to see how regulators can do much about this kind of promotion, but it does seem important that we at least consider the implications of these sorts of enhancements for our working lives.

If drugs — or devices — improve our ability to do our jobs, you could imagine a situation where those who didn’t take up the option, whether out of choice or a lack of financial resources, might be disadvantaged in the workplace.

It’s possible that employers could pressure workers into taking up enhancements that would boost productivity, or even possibly require them to do so especially in professions where public safety is an issue.

The report’s authors thought this could have implications for doctors among others: “It was clear that there would be pressure to permit, encourage or even obligate the use of enhancements if they could be shown to increase the safety of others, for example in the context of medical practitioners or transport workers”, they wrote.

Could future clinical guidelines mandate use of modafinil, or something like it, by doctors who had worked for a certain number of hours without a break?

Of course, coercion can be a great deal more subtle, and therefore more insidious, and it’s important that workers not be pressured into taking on the risks that accompany any medical intervention.

Mind you, cognitive enhancement is not a new phenomenon. I’m not sure how I’d get my neurones firing without my morning dose of caffeine …

Jane McCredie is a Sydney-based science and medicine writer.

Posted 12 November 2012

3 thoughts on “Jane McCredie: Do we need enhancement?

  1. Media Balancing Act says:

    Jane, on 8/11/2012 you wrote an excellent piece titled ‘Media Balancing Act’, wherein you comment on the tendency of the media to place undue emphasis on points of view that are not scientifically sound or validated. It is important that medicine and medical journalism themselves reject this approach, and, as you say, provide evidence-based (as opposed to value-based) evaluation of medical conditions – across the board. It is of concern that you draw attention to some theoretical concerns around the ‘potential’ misuse of stimulant and other medications, when the reality is that the medical profession is in the main ignoring and overlooking ADHD as a valid and impairing medical condition, and applying value-based attitudes to the relevant available treatments. We need to get the balance right and to ensure that we do not further disadvantage and stigmatise people in need of medical care, especially when providing such commentary allied to an evidence-based and highly regarded journal such as the MJA.

    I direct you to the following, which applies also in Australian healthcare:

    Stigma in general and among professionals
    ADHD is an established disorder in childhood with child and adolescent mental health or paediatric services for ADHD available across most of Europe. Yet adult services for people with ADHD remain relatively scarce despite strong evidence for the benefits of diagnosing and treating ADHD in adults (reviewed in [32]). There are still many professionals that are unsure of the diagnosis and the appropriate use of ADHD medications in adult mental health. Some continue to express fears about treating a ‘non-existent disease’ or causing drug addiction with stimulant medication, despite evidence to the contrary [42]. The reasons for this are likely to be based on the historical perception of ADHD as a disorder that is restricted to childhood and the continued presence of stigma and clinical mythology that surrounds the disorder and its treatment; and the traditional separation of adult from child psychiatry. What is clear is that there remains a gulf in the perception of the disorder between those working in paediatric and child and adolescent mental health services and those working in adult mental health, that cannot be explained on the basis of validated evidence based information [43].
    Quoted from:
    Kooij et al. BMC Psychiatry 2010, 10:67

    And the following as a case in point:

    Please note that stimulant medications are Schedule 8 in Australia and hence prescriptions are highly controlled and regulated.

  2. Jayne Lucke says:

    It’s also important not to give the impression that this sort of “cognitive enhancement” is a common, or acceptable practice in Australia. There is limited evidence available about the extent to which Australian students use stimulant medications and other substances for “cognitive enhancement”
    (see…). Getting a study boost from a cup of coffee does not have the same health and legal implications as using diverted prescription stimulants without medical supervision.

  3. Anonymous says:

    “…very little is known about the effects of nonprescription stimulants on cognitive enhancement outside of the student population, although it is frequently reported in newspaper articles. Thus, the rumored effects of “smart drugs” may be a false promise, as research suggests that stimulants are more effective at correcting deficits than “enhancing performance.”
    Shaheen E. Lakhan*, Annette Kirchgessner Article first published online: 23 JUL 2012
    DOI: 10.1002/brb3.78
    This article would be important reading for anybody interested in this topic.

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