I read a very interesting article in Nature recently that got my brain going (which, ironically, is kind of a joke once you hear what this article was about). Essentially, the authors -- a team of 7 scientists in the The commentary opens with a discussion of growing trends on college campuses for students to buy and sell drugs like Adderall and Ritalin (you know, the stimulants typically prescribed to folks with ADHD), not to get high, but to get better grades -- to enhance their brain functioning in a way that gives them a leg-up in the academic rat-race. (On a side note, I also often hear stories of upper/middle-class soccer moms (and many others) becoming Ritalin junkies as they try to keep up with the pressures of day-to-day life, but the authors don't talk about these folks.)
Overall, the scientists say that "We should welcome new methods of improving our brain function" and that doing so with pills is the moral equivalent of undertaking a healthy diet, regular exercise, or ample sleep. They say:
"The drugs just reviewed [Ritalin, Adderall, Provigil], along with the newer technologies such as brain stimulation and prosthetic brain chips, should be viewed in the same general category as education, good health habits, and information technology -- ways that our uniquely innovative species tries to improve itself."
Brain scientist Martha Farah, one of the article's authors, said that once such brain-boosting pills are developed and marketed, "Almost everybody is going to want to use it."
Okay. Uh. I have to stop here. 'Almost everybody'?! Are you kidding me?! If that's true, you're talking to one sad girl who is losing faith in humanity by the second. For argument's sake, let me try to explain myself. First, my gut is saying that we as a culture are looking at all of this from the totally wrong perspective. If so many people are in situations in which they feel such an extreme pressure to perform -- whether the context be grades, jobs, or day-to-day duties and responsibilities -- and they are turning to brain-altering drugs to 'keep up,' why is our cultural response to 'fix' normal, human (and apparently 'slow') brain functioning rather than to 'fix' a culture that demands greater than human abilities of us? Do you see what I'm saying?! These scientists seem to go along with the assumption that the 'problem' to be solved is human inefficiency, rather than unrealistic cultural expectations. So rather than change the system, we try to change the individual, with mind and body-altering medical intervention. That does not sit well with me. At all.
Anticipating my potential disdain for their pro-cognitive-enhancing banter, the authors try to derail three common arguments against brain pills (my word, not theirs):
1) They're cheating.
2) They're unnatural.
3) They entail drug abuse.
My thoughts and responses:
1) Brain pills are cheating. I care little about this argument. I'm not a fan of cheating. I think it sucks. But in my personal interests, I care less about HOW folks are cheating than WHY they feel they have to do so and addressing those issues first, working to eliminate the desire to cheat rather than punishing those who do. Even so, these scientists argue that brain pills aren't a form of cheating at all. Rather, they suggest, that all forms of intervention modify brain function -- be it getting a good night's sleep, finding a good strategy for relieving stress, getting a private tutor, or drinking a double shot of espresso. And I agree. Yes, all the actions of my life have the potential to affect my brain function, some for the better and some not so much. My concern comes with the manipulative, 'unnatural' way in which brain pills screw with my body. Moving on to argument 2...
2) Brain pills are unnatural. The scientists confront this one directly saying that:
"the lives of almost all living humans are deeply unnatural; our homes, our clothes and our food -- to say nothing of the medical care we enjoy -- bear little relation to our species' 'natural' state."
So, if I understand correctly, humanity is no longer 'natural' so why be concerned about what is natural or unnatural behavior or what is a natural or unnatural product to put into my body? Uh, what?! Is humanity so far removed from Nature that none of the warnings of living in the natural world still apply? Because I don't live in a home built by my own hands, because I don't wear clothes I made myself (from growing the cotton to sewing the garment), because I have a guilty love of Doritos, which surely are no where close to 'natural' -- I have no right to be concerned about the way that naturalness is defined within humanity and within my own life?! Um, yeah, I don't accept that. And even if scientists tried to appease me with a brain pill full of 'natural' stuff (aka - non-synthetic, unaltered, unengineered) that doesn't mean I would accept such a product without concern either. For example, I get freaked out by those advertisements for fancy, 'all natural' vitamin packs or 'health shakes' that promise to make me a super woman. (Maybe it's the 'natural' combined with corporate marketing that I find unsettling and untrustworthy...) Similarly, gasoline is 'natural' but that doesn't make is safe for me to huff. You know what I'm saying? I guess my concern on this whole 'naturalness' conversation is a sense of arrogance I perceive on behalf of these scientists (actually Science, in general) that we (humans) are somehow superior to Nature in knowing what is 'best' for us. How many times do we have to be proven wrong before we gain a little humility? (Uh, global warming comes to mind...) Call me stupid, but I feel pretty confident in the idea that if my brain was meant to function faster than it is, then I would have been born that way or have a natural disposition for it naturally, without the intervention of drugs. Just because my brain CAN work faster or function differently does not mean it's a GOOD IDEA. Ya dig? Just because you can does not mean you should, and in this case doesn't mean it's good for you. We don't know the consequences of altering brain function long-term, and like I said, if my brain was meant to work that way, I think it would. So the "'humans aren't natural' plus 'brain pills aren't natural' equals 'humans shouldn't worry about taking brain pills'" argument doesn't work for me.
3) Using brain pills is drug abuse. The scientists argue that society already addresses drugs along a wide spectrum of social acceptability: caffeine, nicotine, alcohol, marijuana, and heroin all have their place of acceptance/outlaw along a social continuum, and the scientists argue that there is no reason to place brain pills immediately alongside drugs that have been outlawed. I can understand this argument, but I am really hung up on the idea of medicating otherwise healthy persons. When one of my personal goals is to be as careful as possible about what I put into my body and its effects, really aiming to allow my body to function as 'naturally' as possible, this flies in the face of the expectations I have set for myself. I do not believe in holding others to expectations I set for myself, so the best I can offer is a series of questions: What are the connections between brain pills and addiction? What are the long-term effects of brain pills on the body? Are the pills addressing a concern that could be dealt in a different, less brain-altering way? What motivations are leading people to the use of brain pills to begin with? At the end of the day, I'm not interested in telling anyone what to do with their bodies, so from that perspective, I wouldn't suggest outlawing brain pills or criminalizing those who use them, but I certainly have concerns about persons' health and well-being and apprehensions that pills are not the best means by which to meet those needs.
In fairness, the authors are not flippant about the use of cognition-enhancing drugs, but I am unsatisfied with their suggestions for dealing with probably ethical concerns. First, they site concerns over issues of human safety, which they say can be addressed with study. I agree; study is needed. Lots of study. Though, I would suggest that some of that study include a questioning of the larger cultural contexts surrounding brain pills, rather than just an examination of brain pills themselves.
Second, the authors site a concern for supporting individual freedom from coercion to use brain-enhancing drugs. They recognize both structural and individual sites of coercion and suggest that 'policy' (for which they provide little concrete suggestion) could prevent these problems. I think they're wrong. If we look at their own examples of the percentages of college students already taking brain-enhancing drugs, which is currently an illegal act, you can't tell me that making the drugs legal and then enacting 'policy' -- against what?! peer pressure? -- will provide individuals with truly free choice about taking the drugs. I think the 'freedom' they are talking about is a cultural fluke; that level of true freedom is not possible in the context of our culture. Even if policy says folks are free to make their own choices, cultural pressures will always take their toll. Such is life.
Additionally, the scientists suggest that not all people should be offered the choice to drug up or to refrain. They highlight professions such as those in the military and some in the field of emergency medicine as contexts in which exemptions from policies supporting freedom to refrain are valid. So, even if some people might be protected from forced pill-popping, what does it mean when people holding important, valued positions within society are required to take these drugs? How would this influence the common citizen's attitudes towards the drugs? It seems to me that such acts would support wide-spread drugging up. Is that who we as a culture want to be?
Similarly, the authors support the continued, non-consensual drugging of children -- which is a common practice today anyway, particularly among children diagnosed with ADHD and raises continued questions of children's rights and autonomy (which I'm not going to address further here and now).
And third (and I find this most interesting), the authors highlight their concern for fairness when it comes to use of the drugs. Essentially, they are discussing questions of socioeconomic access and distribution, suggesting (accurately, I believe) that these drugs have the potential to deepen social inequalities, particularly between class groups, if action isn't taken to prevent such gaps. Such inequality already exists. We see it everyday. Who is likely to get the best education? (Answer, in case you need it: white, middle/upper class folks with a history of education and sustained funds to pay for education and all its auxiliary costs.) Obviously, issues of availability and issues of cost will affect how brain pills shift social dynamics in our culture. The authors suggest that 'policy' (again, pretty vaguely addressed) could help address these concerns. For example:
“If cognitive enhancements are costly, they may become the province of the rich, adding to the educational advantages they already enjoy. One could mitigate this inequity by giving every exam-taker free access to cognitive enhancements, as some schools provide computers during exam week to all students. This would help level the playing field.”
So, to solve the problem of unequal access, institutions can give away brain pills to anyone who wants them... Awesome. I found it pleasantly surprising that these scientists considered the social contexts of introducing such drugs into society (perhaps I owe them more credit), but I'm unsatisfied with their solutions for addressing potential social concerns.
When it comes down it, I think the authors suggest -- quite accurately -- that a pivotal key to cognition-enhancing drugs' acceptance is an ongoing questioning of the definition of 'medicine.' On one hand, medicine can be viewed as a field devoted to healing -- a defensive, responsive approach to health. On the other hand, medicine can be viewed as committed to helping people live better lives (though I think the definition of 'better' is up for debate). While I am a happy proponent of preventative health care, I wouldn't place brain pills into the category 'preventative' because I am uncertain what it is preventing. It seems that I trust my own body to function in healthy, live-supporting, and enhancing ways more than these scientists do. And I think that is very scary.
I can't help but think of those "This is your brain on drugs" PSAs from the '80s. (Yes, you can laugh at the thought. I did too.) Apparently their warnings no longer apply.
What are your thoughts? If you’re interested in joining the debate, hit me up here or visit Nature’s public forum on the topic.
1 comment:
Hey Kelly, I just found your blog and I'm glad I did--thanks for the thought-provoking piece.
This has me wondering what Nature would have been writing about Steroids back in the '30s and '40s... there was a time when steroids must have seemed (at least to some) like a great way to improve our physical performance, but it turns out that it's not as simple as it seems. That [perhaps dubious] analogy alone is at least enough to keep me out of the ranks of early adopters. Plus, let's face it, it just wouldn't be fair to anyone else to make me even smarter. ;)
One other point I'd like to make here is by analogy to the drugs we're already taking, as a society, from the Adderall and Ritalin you already mentioned to our abundance of antidepressants. As someone teaching the ADHD generation, I can see both the benefits and at least some of the negatives of such medication. Yes, little Billy does focus a bit better when he's on his meds... but it's certainly not a cure-all, and when it comes down to it the habits of mind that he hasn't developed (which I suspect derive at least partially from too much TV and internet and not enough old-fashioned reading) still aren't there. He doesn't suddenly become a great student because he's medicated, and too often we don't address those very real issues because we as a culture expect the pill to do the trick. As a culture, we're famously averse to delayed gratification, and so we gravitate toward pills or surgeries to give us "instant" fixes to our problems, and typically just mask the symptoms by doing so.
But let me back up for a moment: the positive that these drugs can do, it seems, is help balance the levels of certain chemicals in the brain that aren't at "normal" levels and that consequently interfere with the ability to, for instance, sit still and focus. It's unclear to what extent these chemical levels are the result of genes and to what extent we can blame the environment and habits of the individual, but in either case initial conditions or a feedback loop are set up that the drugs can help remedy: but we shouldn't see that as the be-all and end-all.
The same applies to anti-depressants. Do they address the chemical levels of the brain? Obviously. But to what extent were those chemical levels set by "nature" and to what extent are they a reaction to life circumstances? When it comes down to it, I suppose I don't actually have a problem with messing with nature in such cases (I mean theoretically--practically speaking we're still open to problems of unintended consequences when we start poking around) so much as a I have a problem with not facing squarely the personal and environmental aspects of the problem, whatever it is.
The same principles, I think, apply to the case you're raising.
Oh, and another thing: what kind of model of intelligence (or "brain power") are they using here? It seems like the model here (okay, I didn't read the article but just relied on your summary and my own presuppositions) is to equate "brain power" with what in computer terminology (and, as a side note, how dangerous is that to take as our model for understanding our minds the computer?) as processing speed. If we speed it up, won't it just mean that people can think dumb thoughts really quickly? Or they can remember more "facts," but how will a pill help someone put those facts together in a coherent, intelligent way? I doubt it can, but the mere fact of having a pill is going to seem like the be-all and end-all for some people, and that transformation of our understanding of intelligence could be dangerous to us.
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