Abstract
Cognitive enhancement, a rather broad-ranging principle, can be achieved in various ways: healthy eating and consistent physical exercise can lead to long-term improvements in many cognitive domains; commonplace stimulants such as caffeine, on the other hand, temporarily raise levels of alertness, attentiveness, and concentration; sedative substances are also used as an indirect form of enhancement to relax before an exam or an important meeting. Such approaches raise no ethical issue. Nonetheless, clinical research has led to the off-label use of drugs called nootropics or “smart drugs”, which can, under certain conditions, elicit some degree of cognition-improving effects: methylphenidate and modafinil can enhance working memory and concentration in healthy individuals, although the significance and effectiveness of such applications are dubious. Such “cognitive enhancement” methods, however, do raise multiple ethical issues, and their contentious nature has caused bioethical authorities to lay out opinions and recommendations meant to regulate their use. Most notably, the Italian Committee on Bioethics has extensively dealt with the spread of nootropics, which resulted in the Italian Code of Medical Ethics including “cognitive enhancement” drugs and their prescription by doctors as critical points, along with cosmetic surgery (the latest version of the Code, updated in December 2017, deals with the two separately, in Article 76 and 76 BIS). The United States Presidential Commission for the Study of Bioethical Issues broadened the scope of cognitive enhancement techniques so as to include neural modifiers, i.e. mechanisms of brain and nervous system change: a much wider array of interventions, technologies, behaviors, and environmental conditions that may potentially affect several aspects of the human brain and nervous system. The potential of neuroscience to profoundly reshape society is nothing short of mind-blowing.
Highlights
The ever-growing use of nootropics— known as “smart drugs”—such as modafinil, piracetam, and methylphenidate by healthy users seeking to enhance their cognitive capabilities has led to widespread social alarm
In 2016 in Germany, Dietz et al reported a prevalence of 19% prescription and illicit drug users for cognitive enhancement among 1,021 people working in the field of economics; methylphenidate, amphetamine, and modafinil were the most commonly used prescription drugs [7]
As we argued before, cognitive enhancement is not the end of the line, far from it: unremitting scientific progress and advancements make it essential to move beyond it and toward a broader array of interventions, technologies, behaviors and environmental conditions that can affect many aspects of the human brain and nervous system
Summary
Section of Forensic Medicine, School of Law, University of Camerino, Camerino, Italy. Clinical research has led to the off-label use of drugs called nootropics or “smart drugs”, which can, under certain conditions, elicit some degree of cognition-improving effects: methylphenidate and modafinil can enhance working memory and concentration in healthy individuals, the significance and effectiveness of such applications are dubious. Such “cognitive enhancement” methods, do raise multiple ethical issues, and their contentious nature has caused bioethical authorities to lay out opinions and recommendations meant to regulate their use.
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