Some medications that were originally designed to treat diseases like narcolepsy, clinical depression and Alzheimer’s, are now being used by healthy people to enhance themselves.
These medicines, known as nootropics, are used to increase their cognition, improve their mood, and to reduce the number of hours they require for sleep.
This is called an off-label use of medicine, the drug is perfectly legal, however, it hasn’t been tested for this type of use. So what are the concerns for safety when a drug developed for say Alzheimer’s is used as a cognitive enhancer?
The data recorded may not carry over between the two, and the difference between taking a drug at age 20 versus age 80. Do the side effects warranted for treating a debilitating condition transverse into being acceptable when boosting a normal functionality.
How Could Human Enhancement Concern Us?
Does enhancement concern us because of the goals being pursued or the ways we pursue these goals?
The goals of enhancement: Some questions about enhancement concern the goals we pursue when we seek to improve something. We want to assess the value of the goal being pursued by technology. These questions ask us to consider what is truly of value?
The way we pursue enhancement: Sometimes we have agreed that the goal is valuable, but we may still have questions about the way that we pursue the goal. These questions ask us to consider what are the acceptable means of making ourselves better.
We live in a time where the dangers no longer come from predators. The natural biological arms race has changed for humans and as we utilise science and technology to live longer, new diseases have become to appear.
If we can cure cancer, will another deadlier disease cause us trouble? Viruses mutate to become resistant to antibiotics. What competitive advantage do we gain from selective alteration?
Evolution doesn’t stop to consider if there is a better way, it has no foresight.
Natural selection is a compromise between a beneficial component and the cost of everything else. What happens if we intervene, will we enhance one thing at the expense of another. We see it in dog breeds that have been overbred with some suffering from breathing difficulties.
So what are the costs of the intervention? Can there be an optimised trade-off between the balance of limited body energy cost versus the ability to enhance a new function?
Pioneering Through Medicine
It can be deeply troubling, but pioneering has always been a way to move forward. It helps us to think more profoundly about enhancement and the purpose of medicine in our society.
Nevertheless, how far does this concern go with many of these medicines being thoroughly studied? Robust data on safety, low side effects and some of them could be safer than over-the-counter enhancements like taking large doses of caffeine.
So at the end of the day, the central concern isn’t to object to the uses of these medicines, as they are already commonly in use. The interest lies in the ability to conduct quality clinical trials on them, which are already in place.
Another issue which is not about safety concerns, but about the purpose of medicine. What is the end game for the use of a certain medicine, should it be about treatment or enhancement.
Some methods in medicine work by enhancing a function, remember the body’s ability to fight infection or absorb nutrients. Should medicine’s effort be aimed at battling illness and dysfunction, not at making healthy people better than well?
Though this isn’t as straightforward as it seems, when we think back to what counts as a disease or disorder. When we look at what’s dysfunctional is somewhat a matter of context.
It’s absolutely natural to be exhausted after being up for 30 hours straight. Someone who experiences this isn’t ill, but normal or not, it can be extremely dangerous for people whose jobs require this of them.
Emergency room doctors, pilots, soldiers on duty, they all need to keep their wits about them. So if we can keep them alert while being sleep deprived, from drugs developed for narcolepsy, lives will be saved.
Establishing the Issue at Hand
Matters can get complicated when we look at what we establish as medical disorders. These are distinct from diseases like diabetes, where a regular role in the body breaks down, here the pancreas creating insulin.
A disorder is when someone is operating at the low end of the distribution curve, well under a typical healthy human average. So when this interferes with a persons well-being it becomes a candidate for treatment.
Now for a function like focus, which is distributed at a bell curve in humans, it stands to reason that we extend help to those at the lower end of the scale first. But this doesn’t mean that the people in the middle of the curve, or those at the higher end won’t benefit as well.
And if the middle of the bell-curve is normal for humans, would that also make people at both ends dysfunctional. The ones at the lower end get medicine to improve their ability while the higher end get drugs to lower it.
How about decision making under stress, I bet you’ve had the experience feeling incapable of deciding after an extremely hard day. This is called decisional fatigued and it is a real thing.
Certain neurotransmitters support our ability to reach decisions, with some people naturally produce more than others. A drug that heightened decisional stamina would help everyone out. It would lessen the chances of making bad business or relationship decision, or to avoid tough but important choices.
Can we say that a 5% increase in our respected levels of decisional stamina is more beneficial than compared with a treatment for a mild but official disease? Say taking antibiotics for a slightly irritating skin infection that will clear up on its own anyway.
Does the conventional perception of disease and disorder become a somewhat feeble agent for ascertaining what actually improves our well-being?
Social Aspects of Our Goals
Perhaps a more intriguing concern is not about the outcomes of medicine, but about the potential social downsides of medical enhancements.
An extremely powerful topic of who gets access to them, especially highly socially valued capacities like cognition? This is an ongoing issue prevalent throughout history. It threatens to increase the gap between the ones that have and those that don’t.
Plus once we have the ability to treat something normal to make it better, it can be a short step into categorising it as a new dysfunction. So what was once completely adequate levels of focus or decisional stamina, now becomes a pathology, something we need to fix.
What some in the medical humanities call disease creep, and do such enhancements unintentionally increase exploitation. Now we have workers using bootlegged alertness medicines just trying not to get fired from unreasonable long hours.
Or do medicinal enhancements reinforce a pressure to be perfect, if there can be the case for that now? As the more we improve, the greater expectations and standards increase, a never-ending mountain to climb.
These concerns aren’t always resolved by increasing access to something, as extending access can sometimes make circumstances worse. This is not an argument unique to medical enhancements, any enhancement whether medical, cultural or technological can compromise these issues.
Though are they still worth pursuing, take the action of education, this is one of the most influential cognitive enhancements we have today.
Instead, we need to be thoughtful in our approach to any given enhancement. To think about the context it brings about within a cultural and economic setting.
What it opens up in possibilities versus what it threatens to foreclose. To the practical advantages it delivers to an individual or group, like better decision making or fewer injuries, against the constraining welfare of others.
Questions About Enhancement
Safety: Is there sufficient data and understanding of the benefits and risks of a given enhancement? This is an epistemic concern about enhancement.
Goal of Medicine: Should the purpose of medicine be to treat disease instead of providing enhancement? This question asks us to assess what goals are valuable for medicine to pursue. It also connects with questions about human nature and identity.
Social Consequences: Will inequality increase with the widespread adoption of enhancement? Will people be stigmatised and pressured to change traits that were previously deemed acceptable? This is ultimately a question about social justice.
When there is a specific enhancement in mind we need to consider the goals of what we are trying to achieve versus the effects it has on an individual and society as a whole.
Do the intentions justify the risks involved? Are there risks for not pursuing an enhancement? We could look at each argument and come to opposite conclusions.