Performance enhancing drugs for the brain

Added: Delecia Hosford - Date: 27.02.2022 03:13 - Views: 34037 - Clicks: 4666

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Performance enhancing drugs for the brain

Learn More. New drugs that enhance cognition in cognitively healthy individuals present difficult public policy challenges. While their use is not inherently unethical, steps must be taken to ensure that they are safe, that they are widely available to promote equality of opportunity, and that individuals are free to decide whether or not to use them.

New drugs to treat Alzheimer's disease and other cognitive deficits also may improve cognition in healthy individuals. This hope presents both opportunities and challenges. This article explores the ethical, legal, and public policy implications of these interventions. After reviewing the potential benefits and detriments, it considers and rejects ethical objections to their general use and concludes with policy recommendations to promote safety and efficacy, fairness and equality, and voluntariness.

Performance enhancing drugs for the brain

The war on Alzheimer's disease and other cognitive ravages of aging is stimulating an intensive effort to develop drugs to improve cognitive functioning. The U. Two aspects of these drugs are noteworthy. The first is that they improve cognition in healthy individuals, not merely in people with Alzheimer's and other diseases. Modafinil is being tested for use by the military and has been shown to improve the simulator performance of helicopter pilots Caldwell et al. Preliminary from federally funded and industry-supported randomized trials on the performance of airline pilots in flight simulators suggest that donepezil improves performance even in highly functioning individuals Yesavage et al.

Second, these drugs may not simply maintain wakefulness or improve recall. The use of drugs and other techniques to enhance cognition is not new, of course. Caffeine has been used as a stimulant for at least a thousand years and is often Performance enhancing drugs for the brain in extremely high dosages.

Nicotine promotes cognitive abilities Rezvani and Levin One study at Duke University, for example, found that nicotine patches ificantly improved age-associated memory impairment Romain Indeed, they have been blamed for friendly fire incidents in Afghanistan Shankar and Duenwald The new crop of cognitive enhancement drugs may not raise substantially greater ethical, legal, or social concerns than these more familiar interventions.

Performance enhancing drugs for the brain

Modafinil does not appear to be ificantly more effective at promoting wakefulness than large doses of caffeine Wesensten et al. In addition, the currently available Alzheimer's drugs have side effects that may discourage their use for enhancement purposes. The Olympics and other sports organizations already have testing regimes deed to prevent the use of stimulants World Anti-Doping Agency But the new enhancement drugs are only a first step.

Scientists have only just begun to understand and manipulate the genetics of cognitive performance. Researchers at the University of Pennsylvania, for example, announced in that they had genetically engineered mice to improve memory and learning Tang et al.

Accordingly, it is entirely possible that far more powerful and highly selective cognitive enhancement interventions will become available in the near future. These discoveries could yield enormous social benefits in addition to their impact on disease and aging. Students could become better learners. Improved memory and problem-solving skills could make workers safer and more productive. Scientific researchers could achieve breakthroughs more quickly. Policymakers could respond more effectively to crises.

Yet the development of Performance enhancing drugs for the brain powerful cognitive enhancements poses serious public policy challenges as well. Future enhancement drugs, like some of their current counterparts, may be accompanied by deleterious side effects, including toxicity and physical or psychological dependence.

These risks may be exacerbated by long-term use, which may be necessary to achieve or maintain the desired enhancement effect. Exotic interventions like genetic engineering could produce especially unusual types of damage. Concerns about the safety of cognitive enhancements will be exacerbated by the lack of safety data. The Federal Food, Drug, and Cosmetic Act requires manufacturers to show that drugs are safe for their intended purposes 21 U. Manufacturers may decide to obtain approval from the U. Food and Drug Administration FDA for enhancement claims for drugs initially developed to treat cognitive disorders, and if they do so, they will Performance enhancing drugs for the brain to submit data showing that the drugs are safe and effective for enhancement use.

The law permits physicians to prescribe drugs approved for one purpose for any other purpose, even though the manufacturer has submitted no safety or efficacy data to the FDA substantiating the so-called off-label use. Organized medicine has staunchly defended this prerogative as an exercise of professional autonomy within the practice of medicine, a realm that the FDA has long acknowledged lies outside the scope of its authority Kessler Many drugs are widely used for off-label, nontherapeutic purposes, including drugs that improve cognition.

Performance enhancing drugs for the brain

According to the manufacturer's own data, for example, almostprescriptions for the alertness drug modafinil are being written in the United States every year, even though the only condition for which it was approved until recently was narcolepsy, which affects only aboutpeople Cephalon Department of Justice demonstrates that the practice nevertheless takes place. Some general safety information about the drugs will be available from studies to support approved uses, but special risks could arise if they were used for enhancement purposes.

Unless manufacturers were forced to conduct clinical studies on off-label uses or the government financed trials of its own, these risks would not be known until people started using the products as enhancements. The FDA does require manufacturers to notify the agency of adverse events caused by drugs, regardless of the purpose for which the drug was being used, but these events are believed to be ificantly underreported Lazarou, Pomeranz, and Corey Physicians might be sued for malpractice if patients were injured by off-label drugs they prescribed, but the burden is on the plaintiff to establish that the physician behaved unreasonably, and this would be difficult to prove in the absence of data from which a jury could conclude that a reasonable physician should have known that the drug was un safe or in effective.

Persons who were injured by drugs used for off-label enhancement use might file product liability suits against the manufacturers, but a recent clarification of the rules of products liability law, which declares drugs unsafe in de only if they are not safe for any group of patients American Law Institutemay reduce the future likelihood of success.

Another reason that safety data may be lacking is that some cognitive enhancements, like gingko biloba, may be sold as dietary supplements. Unlike drugs, whose sponsors bear the burden of proving that their products are safe and efficacious before they may be marketed, the burden is on the FDA to show that a dietary supplement is unsafe before it can stop the product from being sold. Moreover, the law does not require dietary supplement manufacturers to report adverse events, and there is little voluntary reporting U.

General ing Office Even if safety data are available, the experience with performance-enhancing drugs in sports demonstrates that individuals may employ cognitive enhancements notwithstanding the risks if Performance enhancing drugs for the brain expect that the benefits will Performance enhancing drugs for the brain great enough. Athletes use anabolic steroids, for example, despite claims that they can cause serious adverse effects such as heart attacks and liver cancer NIDA One writer reported that more than half of the world-class athletes he interviewed told him they would take a drug that would enable them to win every competition for five years and Performance enhancing drugs for the brain kill them Amateur Athletic Association Newsletter Individuals who are willing to trade health risks in return for cognitive benefits are especially vulnerable to unscrupulous entrepreneurs who misrepresent the effectiveness of their cognitive enhancement products.

Even if ineffective substances are not harmful, their purchase transfers wealth, often from those least able to afford it, to hucksters and frauds. The Federal Trade Commission has the authority to punish advertisers who make false or deceptive claims, but its resources are extremely limited, especially considering the ease with which products can be hawked on the Internet. The experience with performance-enhancing drugs in sports reveals another problem with cognitive enhancements. One reason that athletes take performance-enhancing drugs is pressure from trainers, coaches, teammates, and competitors.

When sprinter Ben Johnson was stripped of his Olympic gold medal, his coach repeatedly stressed that athletes could not succeed in highly competitive environments without using drugs Starkman Similarly, individuals may feel that they are unable to refuse to use cognitive enhancements.

Business journals already speculate that employers will require employees to take smart pills on the job Schrage The military may issue enhancement drugs to soldiers in combat. A naval flight surgeon manual states that although pilots cannot be required to use amphetamines, those who refuse may be denied the opportunity to fly combat missions U. Navy Schools under pressure to improve standardized test scores might distribute pills to pupils. Parents may give them to their children.

Performance enhancing drugs for the brain

Even if the use of cognitive enhancements is not explicitly mandated, people may feel that they must do so in order to succeed or just to stay where they are in competitive endeavors. Another concern raised by cognitive enhancements is the unfairness that would result if they were not widely available and if only some people could get their hands on them. The supply may be limited because of the FDA's restrictions on the shipment of experimental drugs or the Drug Enforcement Administration's controls on the amount of controlled substances that may be produced.

Even if a sufficient supply existed, the FDA would likely require that new Alzheimer's drugs be available only by prescription, and many people, especially those with low incomes, do not have access to a personal physician Gold and Kuo Even if individuals do have access to a physician willing to prescribe a drug Performance enhancing drugs for the brain enhancement use, the cost may be prohibitive.

Obviously, a black market would emerge, but even the street price might be too steep for many to afford. Conceivably, the cost of cognitive enhancements might be borne by health insurance. Physicians might be willing to prescribe therapeutic drugs for cognitively healthy patients and submit claims for treating cognitive impairment. Moreover, it may be hard to distinguish between therapeutic and enhancement use Buchanan et al.

For everyone who had less than the maximum measurable IQ? Since cognitive performance appears at least in part to be a function of one's genetic endowment, should suboptimal cognitive ability be considered a genetic defect? Moreover, many people suffer mild cognitive degradation as they age. Moreover, there is evidence that age-associated cognitive deterioration begins around age 30 Victoroff If so, then everyone beyond that age might Performance enhancing drugs for the brain regarded as cognitively impaired. Health insurers might be willing to accommodate this diagnostic creep and cover cognition-improving drugs for a large percentage of their insureds.

Although persons suffering from cognitive dysfunction might be deemed to have a disability as defined in the Americans with Disabilities Act, the courts have interpreted the law to allow insurers to decline to cover entire classes of individuals with disabilities e.

Mutual of OmahaF. In short, many people who have health insurance may not have coverage for expensive cognitive enhancement drugs. And this does not take into the 40 million or so Americans who lack health insurance altogether.

Performance enhancing drugs for the brain

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