When people think about taking a new drug that can enhance who they are, or consider giving it to their child, their most immediate and appropriate concern centres on the potential health dangers.
While health concerns are obviously important, we need to look beyond these to the ways these drugs may affect the very essence of who we are as people and the nature of the society we live in.
Our current understanding of how the brain generates complex thoughts, emotions and perceptions is still relatively limited. Advances in this area have traditionally come from studies measuring the activity of different brain regions or individual neurons while people experience different thoughts, emotions or perception.
More recently, there has been an explosion of discoveries coming from psychopharmacology – the study of the effect of drugs on the mind – that is leading us to question who we are and who we want to be.
This field of drug development is currently being pushed, by the drug companies eager to make their next billion dollars, and by individual researchers interested in better understanding the role the brain’s natural chemicals play in both healthy and abnormal mental functioning.
The bulk of this research and drug development will be aimed at improving treatment outcomes for patients. But, through intention or accident, a handful of drugs will end up providing some benefit to healthy people, too.
As with many fascinating discoveries in science, the increased development and understanding of drug action brings with it ethical and philosophical dilemmas for individuals and society.
Feel no fear
Lets take as an example recent experiments using propranolol. This drug has been known for some time to block the body’s natural fear response.
One interesting and debilitating aspect of fearful memories is that imagining or remembering a terrifying event can cause the same extreme responses of the mind and body that were triggered during the original event. This acts to reinforce the original fear association with the object or event – if you have a panic attack every time you fly or think of flying, the idea that flying is a terrifying, horrible experience will be reinforced even if the plane doesn’t fall out of the sky.
Researchers have shown it now might be possible to break this cycle. They basically showed people images of spiders that induced fear responses (because they had previously electrocuted people every time they saw a spider).
Half the participants were then given propranolol and shown the spider images again. In contrast to those given no drug, these participants were able to “erase” the fear memory by learning a new association between the spider images and the calm feeling created by the drug.
But important questions are now being asked about potential downsides. Might we be fundamentally changing our identities or sense of self if we tamper with the emotional content of our memories?
Concerns are also being raised about whether the ability to reduce the fear and long-term suffering experienced by victims of crime will reduce their rights for compensation, and reduce the eventual punishments in the criminal and civil courts for the perpetrators of those crimes.
Taking it on trust
Researchers in a series of other studies have tried to artificially induce trust. They found people would report greater feelings of trust towards complete strangers, made larger donations to charities and were willing to risk more money in strategic financial games after having oxytocin squirted up their nose.
Oxytocin – a hormone that occurs naturally in the brain and released during breast-feeding and maternal bonding – is now being tested clinically for conditions such as autism and social anxiety.
But might it also provide greater confidence for people that feel inhibited by general shyness but are otherwise normal? Would that be a good thing? Or would it just increase the pressure on people to conform within an increasingly extroverted society?
Let’s consider the advent of drugs for “cognitive enhancement”. The inescapable “problem” with the development of drugs to improve memory and attention for the clinical treatment of conditions such as ADHD or Alzheimer’s, is that the drug development is informed (and informs) our understanding of the underlying brain processes involved in memory and attention across human and animal species.
To the same extent any new drug successfully alters or enhances these processes in a clinical population, they are also likely to lead to similar changes or improvements in the average person walking down the street.
That might strike you as a good thing if the person taking these drugs is a doctor about to perform open-heart surgery on you, but what if it is a colleague in your office that you are competing with for a promotion?
If you just want the best for your child and decide to hire a maths tutor, would it be abusive to give your child a drug that would help them learn and remember their lessons, or negligent not to?
Finally, consider sleep. Everyone needs it and most people don’t get enough of it. Drugs, such as modafinil, were originally developed for the treatment of narcolepsy – the severe and chronic sleep disorder that causes people to nod off repeatedly throughout the day.
But this drug seems to reduce the need for sleep for everyone and is now being used widely in the US by shift workers and others feeling the pressure of deadlines.
This might be great if you’re the only person taking the drug, but if everyone starts taking it, the expectations and demands placed on individuals will just increase accordingly: we could end up with what some people have referred to as a pharmacological arms war.
As should be clear from the examples above, we need to look beyond the tablet when we think about drugs. I have no doubt the future will bring new discoveries and developments leading to an increase in the range and availability of drugs that can enhance human mental capacities.
As I sit here today, my overall sense is that a considerable portion of the downstream consequence of drugs used for cognitive enhancement will be negative. But, as a scientist, it’s also important to have an open mind.
There is no rule of nature that mandates all drugs must be bad, and that every positive effect is balanced by a negative side effect.
I certainly don’t believe the world’s population has reached maximum levels (if there even is such a concept) of general happiness, productivity and mental ability. So I see no reason why a drug might not be developed that appears to cause greater good then harm.
But this brings its own dilemmas, such as fair and equal access to the drug across all racial and socio-economic boundaries.
Could we end up in a society where certain drugs are mandated for the good of all people in society, in the same way immunisations are given to most children and fluoride is added to our water?
With this future approachin,g we need to be prepared for the wider impact of drug use – good and bad – as the distinction between these two opposites is becoming increasingly blurred.