"We're on the verge of profound changes in our ability to manipulate the brain," says Paul Root Wolpe, a bioethicist at the University of Pennsylvania. He isn't kidding. The dawning age of neuroscience promises not just new treatments for Alzheimer's and other brain diseases but enhancements to improve memory, boost intellectual acumen, and fine-tune our emotional responses. "The next two decades will be the golden age of neuroscience," declares Jonathan Moreno, a bioethicist at the University of Virginia. "We're on the threshold of the kind of rapid growth of information in neuroscience that was true of genetics 15 years ago."
One man's golden age is another man's dystopia. One of the more vociferous critics of such research is Francis Fukuyama, who warns in his book Our Posthuman Future that "we are already in the midst of this revolution" and "we should use the power of the state to regulate it" (emphasis his). In May a cover story in the usually pro-technology Economist worried that "neuroscientists may soon be able to screen people's brains to assess their mental health, to distribute that information, possibly accidentally, to employers or insurers, and to 'fix' faulty personality traits with drugs or implants on demand."
There are good reasons to consider the ethics of tinkering directly with the organ from which all ethical reflection arises. Most of those reasons boil down to the need to respect the rights of the people who would use the new technologies. Some of the field's moral issues are common to all biomedical research: how to design clinical trials ethically, how to ensure subjects' privacy, and so on. Others are peculiar to neurology. It's not clear, for example, whether people suffering from neurodegenerative disease can give informed consent to be experimented on.
Last May the Dana Foundation sponsored an entire conference at Stanford on "neuroethics." Conferees deliberated over issues like the moral questions raised by new brain scanning techniques, which some believe will lead to the creation of truly effective lie detectors. Participants noted that scanners might also be able to pinpoint brain abnormalities in those accused of breaking the law, thus changing our perceptions of guilt and innocence. Most nightmarishly, some worried that governments could one day use brain implants to monitor and perhaps even control citizens' behavior.
But most of the debate over neuroethics has not centered around patients' or citizens' autonomy, perhaps because so many of the field's critics themselves hope to restrict that autonomy in various ways. The issue that most vexes them is the possibility that neuroscience might enhance previously "normal" human brains.
The tidiest summation of their complaint comes from the conservative columnist William Safire. "Just as we have anti-depressants today to elevate mood," he wrote after the Dana conference, "tomorrow we can expect a kind of Botox for the brain to smooth out wrinkled temperaments, to turn shy people into extroverts, or to bestow a sense of humor on a born grouch. But what price will human nature pay for these nonhuman artifices?"
Truly effective neuropharmaceuticals that improve moods and sharpen mental focus are already widely available and taken by millions. While there is some controversy about the effectiveness of Prozac, Paxil, and Zoloft, nearly 30 million Americans have taken them, with mostly positive results. In his famous 1993 book Listening to Prozac, the psychiatrist Peter Kramer describes patients taking the drug as feeling "better than well." One Prozac user, called Tess, told him that when she isn't taking the medication, "I am not myself."
One Pill Makes You Smarter...
That's exactly what worries Fukuyama, who thinks Prozac looks a lot like Brave New World's soma. The pharmaceutical industry, he declares, is producing drugs that "provide self-esteem in the bottle by elevating serotonin in the brain." If you need a drug to be your "self," these critics ask, do you really have a self at all?
Another popular neuropharmaceutical is Ritalin, a drug widely prescribed to remedy attention deficit hyperactivity disorder (ADHD), which is characterized by agitated behavior and an inability to focus on tasks. Around 1.5 million schoolchildren take Ritalin, which recent research suggests boosts the activity of the neurotransmitter dopamine in the brain. Like all psychoactive drugs, it is not without controversy. Perennial psychiatric critic Peter Breggin argues that millions of children are being "drugged into more compliant or submissive state[s]" to satisfy the needs of harried parents and school officials. For Fukuyama, Ritalin is prescribed to control rambunctious children because "parents and teachers...do not want to spend the time and energy necessary to discipline, divert, entertain, or train difficult children the old-fashioned way."
Unlike the more radical Breggin, Fukuyama acknowledges that drugs such as Prozac and Ritalin have helped millions when other treatments have failed. Still, he worries about their larger social consequences. "There is a disconcerting symmetry between Prozac and Ritalin," he writes. "The former is prescribed heavily for depressed women lacking in self-esteem; it gives them more the alpha-male feeling that comes with high serotonin levels. Ritalin, on the other hand, is prescribed largely for young boys who do not want to sit still in class because nature never designed them to behave that way. Together, the two sexes are gently nudged toward that androgynous median personality, self-satisfied and socially compliant, that is the current politically correct outcome in American society."
Although there are legitimate questions here, they're related not to the chemicals themselves but to who makes the decision to use them. Even if Prozac and Ritalin can help millions of people, that doesn't mean schools should be able to force them on any student who is unruly or bored. But by the same token, even if you accept the most radical critique of the drug -- that ADHD is not a real disorder to begin with -- that doesn't mean Americans who exhibit the symptoms that add up to an ADHD diagnosis should not be allowed to alter their mental state chemically, if that's an outcome they want and a path to it they're willing to take.
Consider Nick Megibow, a senior majoring in philosophy at Gettysburg College. "Ritalin made my life a lot better," he reports. "Before I started taking Ritalin as a high school freshman, I was doing really badly in my classes. I had really bad grades, Cs and Ds mostly. By sophomore year, I started taking Ritalin, and it really worked amazingly. My grades improved dramatically to mostly As and Bs. It allows me to focus and get things done rather than take three times the amount of time that it should take to finish something." If people like Megibow don't share Fukuyama's concerns about the wider social consequences of their medication, it's because they're more interested, quite reasonably, in feeling better and living a successful life.
What really worries critics like Safire and Fukuyama is that Prozac and Ritalin may be the neuropharmacological equivalent of bearskins and stone axes compared to the new drugs that are coming. Probably the most critical mental function to be enhanced is memory. And this, it turns out, is where the most promising work is being done. At Princeton, biologist Joe Tsien's laboratory famously created smart mice by genetically modifying them to produce more NMDA brain receptors, which are critical for the formation and maintenance of memories. Tsien's mice were much faster learners than their unmodified counterparts. "By enhancing learning, that is, memory acquisition, animals seem to be able to solve problems faster," notes Tsien. He believes his work has identified an important target that will lead other researchers to develop drugs that enhance memory.
A number of companies are already hard at work developing memory drugs. Cortex Pharmaceuticals has developed a class of compounds called AMPA receptor modulators, which enhance the glutamate-based transmission between brain cells. Preliminary results indicate that the compounds do enhance memory and cognition in human beings. Memory Pharmaceuticals, co-founded by Nobel laureate Eric Kandel, is developing a calcium channel receptor modulator that increases the sensitivity of neurons and allows them to transmit information more speedily and a nicotine receptor modulator that plays a role in synaptic plasticity. Both modulators apparently improve memory. Another company, Targacept, is working on the nicotinic receptors as well.