At a Dana Foundation conference on neuroethics last week at the Library of Congress, University of Pennsylvania neurologist Anjan Chatterjee declared that we are already well advanced in the enhancement era of neuropharmacology.
As evidence, Chatterjee offered a scenario in which a high level executive who works 80 to 100 hours a week comes to clinical neurologist for help. His wife has just divorced him because he was never home, and he's feeling down, which is affecting his work. The executive asks for something to brighten his mood so he can function effectively at work once again. The neurologist prescribes one of the anti-depressant selective serotonin reuptake inhibitors like Prozac or Paxil. A few weeks later, his colleagues find him more pleasant and cooperative than he's ever been and he soon gets another promotion.
Meanwhile, the executive's daughter, stressed out by the divorce, is suffering from anxiety and her grades are falling. Here the obliging neurologist can offer Adderal to help her control her social anxiety and get her back on track. The executive's son seems to be handling the divorce all right and has thrown himself into high school sports. He is a talented middle distance runner who can compete at the county level, but isn't quite good enough to compete at the state level. However, the executive's physician can offer his son Viagra, which not only corrects erectile dysfunction (presumably not a problem in an adolescent male) but also is known to boost the lungs' capacity to absorb oxygen, which might augment his running performance just enough for him to get a college athletic scholarship.
In Chatterjee's scenario, the executive's new position has involved him with negotiating a contract with a company in Saudi Arabia. A lot of his competitors are vying for the contract, so the executive figures that if he knew some Arabic it might improve his chances of making the deal. Wondering if there is some way to enhance his ability to learn Arabic, he turns again to his neurologist for help. The neurologist knows that recent research shows that downing 10 milligrams of dextra-amphetamine half an hour before his Arabic lessons will improve his attention and retention. Fueled by dextra-amphetamine, the executive learns a good bit of polite Arabic.
Six weeks later, the executive flies off to Saudi Arabia. He wants to arrive fresh and alert, so the neurologist has prescribed Ambien for him to take on the flight over so he can get some sleep. When the executive arrives in Riyadh, he swallows modafinil to keep himself awake and alert without jitteriness through the grueling negotiations. In the end, the Saudis, flattered by his efforts to speak Arabic, award him the contract. He goes home in triumph.
When he finished outlining his scenario, Chatterjee asked, "Is this a kind of dystopia or not?" Whether or not this is a dystopia, Chatterjee's point is that we already live on the threshold of a world in which widely available pharmaceuticals can and do enhance human performance. "This is coming regardless of your view of whether or not this is a good world, a bad world or somewhere in between," he declared.
Chatterjee described two other cases in which drugs are already known to enhance the capacities of human beings to perform critical functions. Beta-blockers which are generally prescribed for heart disease also still the normal tremor of our limbs and hands. In fact concert musicians and golfers already often use beta-blockers for this purpose. All things being equal, which would you prefer—a neurosurgeon with normal tremor or one whose hands are made steadier with beta-blockers? Researchers have also found that pilots taking cholinesterase inhibitors perform better on complex maneuvers. Again which airline would you rather fly—one whose pilots rely on their native abilities or one whose pilots' abilities to cope with emergencies are enhanced with cholinesterase inhibitors?
Nevertheless, some people do object to using enhancement drugs. For instance, opponents often argue that they pose a kind of tragedy of the commons in which people who would otherwise not take enhancement drugs will feel forced to do so just to keep up with their competitors. But those kinds of pressures have always existed. Today, people get graduate degrees, buy new computers, and so forth to keep up. It's hard to see how using safe drugs to enhance performance is much different. I suspect that pharmacological enhancement will be more popular than, say, graduate school, since most of what will be involved is taking a pill with one's morning coffee. However, even in the era of pharmacologic enhancement, there will be some people—even as there are today—who choose to drop out of what they regard as the rat race and live less competitively and ambitiously.
Chatterjee cited an interesting poll in which people were asked whether they would give a safe drug to a child that would enhance his or her ability to learn to play the piano if they had the opportunity. Half of the respondents said absolutely not. They regarded learning the piano through persistent practice as character building and using pills as a cheat. However, the other half had no problem at all with giving kids a piano pill. What sets the stage for social and political conflict over enhancement technologies is that people on both sides in the poll were completely convinced that their view would be shared by everybody.
Chatterjee ended by joking that if his next NIH grant got turned down, he might "stop what I'm doing and open up a brain spa." Whether or not he decides to hang out a shingle, he predicted, "There will be a brain spa opening close to you in the near future."