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Pharmacological cognitive enhancement

The use of pharmacological cognitive stimulants in healthy adults has increased dramatically in the last decade.

The use of various substances by people hoping to boost their performance is not new and can be tranced to ancient times. The trend of adopting pharmaceutical treatment to enhance performance of healthy individual is also not a new concept, and is in fact quite popularised already. Sildenafil (commonly known under a trade name Viagra) is a good example illustrating this point.

The nonmedical use of substances with a potential to increase memory or concentration is known as pharmacological cognitive enhancement (PCE). PCE use has been on the rise in the last decade. Scientific American reported on a publication in the International Journal of Drug Policy showing that in a survey of almost 80,000 people, 14 percent admitted to using stimulants at least once in the preceding 12 months in 2017, up from 5 percent in 2015.

The practice appears to be relatively safe, as no significant issues are being reported worldwide, despite the percentage of people admitting to using PCE in surveys can be as high as 30% (!). Despite the lack of observed medical concerns, such practices raise significant ethical challenges.

In the United States, where ADHD diagnoses are high and medication is a common treatment, 22 percent of respondents said they had used amphetamine-combination drugs for PCE. Those drugs are not approved in the European Union, where methylphenidate is more commonly used.

The study suggests that the spread of US-style practices in ADHD treatment is driving the trend and making drugs more available: countries with higher rates of ADHD diagnoses, such as the United States, Canada and Australia, have higher rates of nonmedical prescription-drug use for cognitive enhancement.

Another challenge is the use of the PCE without proper medical supervision. Nearly half (48 percent) of people said they obtained the drugs through friends; 10 percent bought them from a dealer or over the Internet; 6 percent obtained them from a family member; and 4 percent said that they had their own prescriptions.

This begs another medical question: should doctors be able to prescribe pharmaceuticals for healthy individuals? How can the risk/benefit balance be established? Would such practice be superior than possible (or likely?) over diagnosis of certain cognitive conditions in health individuals for medico-legal reasons?

What is even more complicated, is that emerging data suggest that many healthy people benefit from certain drugs in specific situations—for example, surgeons using modafinil, pilots using amphetamines, or snipers taking beta-blockers. While pharmaceutical enhancement is more widely accepted in the military, it is not yet popular nor sanctioned in civilian professions.

Sources and further reading:
1. Poll results: look who’s doping
2. The ethics of brain boosting
3. The smart-pill oversell
4. Use of ‘smart drugs’ on the rise

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