Published 18 June 2009
BMJ 2009;338:b1955
Head to Head
Is it acceptable for people to take methylphenidate to enhance performance? Yes
John Harris, Lord Alliance professor of bioethics and director
Institute for Science, Ethics and Innovation, University of Manchester, Manchester M13 9PL
A drug that can improve your exam results may sound tempting, and John Harris believes that we should embrace its possibilities. Anjan Chatterjee (doi:10.1136/bmj.b1956), however, argues that the dangers have been underplayed
Many healthy students are thought to use methylphenidate (Ritalin) and other chemical cognitive enhancers to improve academic performance.1 The arguments against their being permitted so to do have not been persuasive.2 The crucial ethical question is whether this is a matter for regret or celebration.
Ethical dimension
Suppose a university were to set out deliberately to improve the mental capacities of its students; suppose its stated aims were to ensure that students left the university more intelligent and learned than when they arrived. Suppose they further claimed that not only could they achieve this but that their students would be more intelligent and mentally alert than any students in history. What should our reaction be?
We might be sceptical, but if the claims could be sustained, should we be pleased? Would we welcome such a breakthrough and want our children to go to such a university? We ought to want this. It is, after all, part of what education is supposed to be for. And if the gains in cognitive functioning were significant and the costs commensurate we would probably want them for our children and want to see them more widely adopted in education.
Now suppose, as indeed has already happened, several drugs had been shown to improve cognitive performance and had been proved to be safe for use in children. What should our reaction be? Would it be unethical to use these drugs in healthy people to enhance performance? Would it be ethical not to do so?2
Risks and benefits
Methylphenidate and several other so called chemical cognitive enhancers have been shown to significantly improve cognitive functioning and have proved safe in clinical contexts.3 Safe always means safe enough, and since no drugs are free of side effects, that always means that the consumer has judged the risks of adverse effects worth taking, given the probable benefits. Methylphenidate has been judged safe enough to be widely used in children and young people with attention deficit hyperactivity disorder (ADHD) over a long period. Since the disorder is not usually life threatening and the beneficial therapeutic effects largely depend on the same properties that make the drug an enhancing intervention, those same benefits will also justify its use from the safety perspective in healthy adults, who (presumably) value those effects as much as do those with ADHD. Moreover, methylphenidate has proved safe enough to be ethical to use in research with healthy subjects to test cognitive effects, where the use is clearly elective rather than therapeutic.
The drug's significant advantages include enhanced executive functioning, enhanced study skills, and improvement in the focusing of attention and in the manipulation of information.2 As Farah and colleagues have noted: "Our regulatory agencies determine what constitutes a sufficiently careful search for side effects and what side effects are acceptable in view of a drug's benefits . . . we see no reason why the same approach cannot be applied [in the case of neurocognitive enhancement]".4 This would be one reasonable approach to safety. However, here I am interested in the question of whether there are any principled ethical objections to the use of chemical cognitive enhancers in healthy individuals, not with the definition of safety.
Human nature
Clear thinking on the issue of human enhancement has been bedevilled by the issue of doping in sport. Sport, however, is not a matter of life and death, even though some might agree with the football manager Bill Shankly that it is "far more important than that." The wrong of performance enhancers in sport, if there is one, is that such substances are almost universally banned by the rules of competition; using them is therefore cheating. But absent the ban, absent the cheating.
It is not rational to be against human enhancement; humans are creatures that result from an enhancement process called evolution (mixed as its benefits are) and moreover are inveterate self improvers in every conceivable way.
Synthetic sunshine (firelight, lamplight, and electric light) is just one accepted example of a valuable enhancement technology which, like such others as written language, education, physical exercise, and diet, creates problems of justice as well as the side effects of use and overuse. And beneficial neural changes have been reported for reading,5 education,6 physical exercise,7 and diet.8 How then are drugs ethically distinct? Before synthetic sunshine people slept when it was dark and worked in the light of day. With the advent of synthetic sunshine work and social life could continue into and through the night, creating competitive pressures and incentives for those able or willing to use it to their advantage. The solution, however, was not to outlaw synthetic sunshine but to regulate working hours and improve access. The same is, or will be, true of chemical cognitive enhancers.
Cite this as: BMJ 2009;338:b1955
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Competing interests: None declared.
References
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Hillman CH, Erikson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nature Rev Neurosci 2008;9:58-65.[CrossRef][ISI][
Almeida SS, Duntas LH, Dye L, Nunes ML, Prasad C, Rocha JB, et al. Nutrition and brain function: a multidisciplinary virtual symposium. Nutr Neurosci 2002;5:311-20.[CrossRef][ISI][
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