Monday, October 26, 2009

Neuroenhancement American Academy of Neurology

I have not been posting for awhile. I did go on vacation for a week which was quite nice and then surprisingly (for me) I had very little to say for awhile but my mind is back and I will resume posting.

It is amazing how much we forget and distort the past. I indicated in my last post that we had no student loan debt to pay off after medical school. My wife reminded me that we did have some debt (she had to work hard to pay it off!) but it was a small amount compared to what graduating medical students face today.

I want to talk a little bit about the topic of "neuroenhancement". Neuroenhancement refers to the use of psychotropic drugs in mentally healthy individuals to improve cognition to enhance performance. The three main medications that are considered are the stimulants used to treat Attention Deficit Hyperactivity Disorder, modafanil which is a wakefulness agent used to treat narcoplepsy and the cholinesterase inhibitors which are used to slow down the progression of Alzheimer's disease. Stimulants are already widely used on college campuses by students to improve their ability to stay up and study for long hours without losing focus. They work. Modafanil is now starting to be used for the same purpose. It has been clearly shown that these agents enhance cognitive performance. Caffeine has been known for a long time to do this. It is not yet clear whether the cholinesterase inhibitors will improve memory in healthy people but patients are asking their doctors for them. The question is, what are the ethical issues involved in prescribing psychotropic medications to healthy people?

I haven't seen a lot of discussion of this issue but the American Academy of Neurology has recently issued a guidance document for physicians. This is the only organized medical group that has tried to tackle this one. They acknowledge that there is no professional or societal consensus on this issue. Their statement though indicates that they believe the prescription of cognitive performance enhancing medications is ethical for physicians "provided that they adhere to the well known bioethical principles of respect for autonomy, beneficence, and nonmalficience".

I will talk some tomorrow on their reasoning regarding this issue and provide my own ideas.

Thought for the day

We are definitely in the era of better living through modern chemistry.

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