Abstract
The ethical dimensions of pharmacological cognitive enhancement have been widely discussed in academic circles and the popular media, but missing from the conversation have been the perspectives of physicians - key decision makers in the adoption of new technologies into medical practice. We queried primary care physicians in major urban centers in Canada and the United States with the aim of understanding their attitudes towards cognitive enhancement. Our primary hypothesis was that physicians would be more comfortable prescribing cognitive enhancers to older patients than to young adults. Physicians were presented with a hypothetical pharmaceutical cognitive enhancer that had been approved by the regulatory authorities for use in healthy adults, and was characterized as being safe, effective, and without significant adverse side effects. Respondents overwhelmingly reported increasing comfort with prescribing cognitive enhancers as the patient age increased from 25 to 65. When asked about their comfort with prescribing extant drugs that might be considered enhancements (sildenafil, modafinil, and methylphenidate) or our hypothetical cognitive enhancer to a normal, healthy 40 year old, physicians were more comfortable prescribing sildenafil than any of the other three agents. When queried as to the reasons they answered as they did, the most prominent concerns physicians expressed were issues of safety that were not offset by the benefit afforded the individual, even in the face of explicit safety claims. Moreover, many physicians indicated that they viewed safety claims with considerable skepticism. It has become routine for safety to be raised and summarily dismissed as an issue in the debate over pharmacological cognitive enhancement; the observation that physicians were so skeptical in the face of explicit safety claims suggests that such a conclusion may be premature. Thus, physician attitudes suggest that greater weight be placed upon the balance between safety and benefit in consideration of pharmacological cognitive enhancement.
Highlights
Public acceptance of new technology ranges from wholehearted embrace to outright rejection of radical technological change [1,2,3]
As with prescribing cognitive enhancers to patients of differing ages, we found that male physicians rated themselves as being significantly more comfortable than the females with prescribing sildenafil, modafinil, and the hypothetical cognitive enhancer to the 40-year-old patient (Figure S4)
Our primary hypothesis was that physicians would feel more comfortable prescribing cognitive enhancers to older patients than to young adults, notwithstanding the fact that all of the patients presented to them were normal, healthy adults
Summary
Public acceptance of new technology ranges from wholehearted embrace to outright rejection of radical technological change [1,2,3] Few advances bring this divergence of opinion into such stark relief as the subject of cognitive enhancement in healthy persons, in part because of the value society places upon cognitive ability [4,5]. The views of physicians on this subject have received scant attention [28] This is not to say that the subject of the challenges that cognitive enhancement brings to the clinic has gone unconsidered, but rather that the issue has been largely restricted to thought leaders in academic medicine [10,18,29,30,31]. Given their roles as key decision makers in the adoption of new technologies into medical practice, and as individuals likely to be called upon as the gatekeepers in dispensing pharmaceutical cognitive enhancers, an examination of physician attitudes on this topic struck us as overdue
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