Ethics and Expectations CE drugs as technologies of neo – liberal self governance Expectations of high demand, increased availability, better drugs coming soon contribute to construction of particular futures by ethicists ‘the enhancement of normal neurocognitive function by pharmacological means is already a fact of life for many people in our society, from elementary school children to aging baby boomers….Pharmacological enhancement has already begun’ (Farah et al; 2004: 42). ‘what’s coming is the wide availability of powerful, specific cognitive enhancements…we will enthusiastically embrace these technologies, even as we agonise over whether or not we should do so’ (Paul Root Wolpe quoted in The Lancet, 2003:132)
Literature Maher (2008) – UK survey data to suggest that prescription stimulants (e.g. modafinil, Methylphenidate) are being accessed and used by students and academics to overcome sleep/enhance alertness, concentration and focus. Partridge et al (2012) – Telephone survey in Australia, of 1,265 adults 7% thought that CE was acceptable, 2.4% had used prescription drugs to enhance concentration or alertness in the absence of a diagnosed disorder Coveney (2011) – UK study, CE tempting but acceptability of use outside of medical authority questionable Vreko (2013) – US students, didn’t think drugs would make them smarter, but instead would change their attitude towards academic work making working at their optimum easier
Our aims: Using modafinil as a case study – to map out current perceptions of and attitudes towards pharmaceutical cognitive enhancement that exist in the UK today.
Overview of findings 16/99 had heard of modafinil (1 student, 1 paramedic, 12 narcolepsy patients, 2 academics) 13/99 (12 narcolepsy, 1 Sleep Apnoea patient) said that they had used one or more of these drugs Spaces for drug use easily imagined across different social contexts Range of attitudes towards pharmaceutical cognitive enhancement – indifference, liberal/ pro-choice, temptation, sceptical, cautious, enhancement as unnecessary, discomfort, anger More contentious in competitive situations – cheating, gaining an unfair advantage over others, abusing medication
1. MEDICAL USES Narcolepsy vs. Sleep Apnoea patients Today there are several drugs on the market that improve memory, concentration, planning and reduce impulsive behaviour and risky decision-making, and many more are being developed. Doctors already prescribe these drugs to treat cognitive disabilities and improve quality of life for patients with neuropsychriatric disorders and brain injury. The prescription of use of such drugs is being extended to other conditions including shift workers (Sahakian & Morein- Zamir, 2007, 1157)
N2F1 : I was on a Facebook group for applicants to one of the Universities and someone said ‘who needs revision? Look at this article about modafinil and how much it improves your studying’ and I was like ‘ha, suckers, I’m on this drug already’. N2F2: Yeah, yeah. I heard that. N2M1 : I feel as though I annoy people because I’m this sort of laid back sleepy character because of the narcolepsy but then when I am on the ball I’m on the ball! And things interest me! And when I’m taking to people I think they think ‘oh he’s a smartarse ain’t he? I wish he’d shut up sort of thing’ and I back off and sort of sit back and think ‘no I’m annoying people’. N2F1 : Uh-huh, yeah. I get over-competitive I’m much more bothered than anybody else is, even people on my team. Everyone gets annoyed. LM – So in terms of its benefits for studying, does it give you an advantage over others? N2F1: I don’t know. I’ve been taking it for such a long time I couldn’t possibly say. It’s not like you can do a clinical trial. N2M1: How can you compare normality? You don’t know what normality is do you? N2F2: I think it makes people function at what normal people would say is a normal rate. That’s the thing, it is kind of like, with these sort of drugs they don’t make us high or really, you know, they just give us some sort of measure of normality, you know, things that if you gave to someone who didn’t have narcolepsy yeah they would probably be climbing the walls and jumping around and all that sort of thing. But for us actually is just means that we might be able to go down and do the shopping or maybe go and do a bit of work, something like that. It just makes us more of a normal balance.
SA3F1: [I am] definitely more alert, definitely more alert and can function on a much higher level. It was very woolly prior to the mask and really couldn’t function properly. And it’s not so now, I’m alive and alert and want to do stuff. It’s very different. LM- What if you had a tablet that kept you awake and alert during the day time? SA3F2: No. Can’t you buy that on street corners? (Laughter). SA3M1:Are we talking about purple hearts here? Amphetamines, for that. No. SA3F3:No, I don’t think that’s the answer by keeping you awake during the day. SA3M1:Back in the 60’s people were on speed and things like that because they wanted to do so much, the pop music culture. And then because they’d been taking these they’re so high, they have to take something to come back down again so... SA3M2:The idea of taking a tablet to address symptoms is anathema to me, it really is, I mean you’ve got to tackle the disease or the condition and, well if it’s not dealing with why you are not sleeping then I would say no, I think that that’s quite a, you know, an appalling approach to take. A drug to keep you awake is slightly outside my sphere of expectation.
NON- MEDICAL USES: Cognitive enhancement in the workplace ‘From assembly line workers to surgeons, many different kinds of employee may benefit from enhancement and want access to it, yet they may also need protection from the pressure to enhance […] in a world in which human workspans and lifespans are increasing, cognitive enhancement tools- including the pharmacological- will be increasingly useful for improved quality of life and extended work productivity, as well as to stave off normal and pathological age-related cognitive declines. Safe and effective cognitive enhancers will benefit both the individual and society’. (Greely et al 2008: 704)
SW3M2: I think all paramedics should be able to do the job to a certain level. That’s what you’re trained to do […] SW3M1: Yeah, I agree. With the job that we do, really, you don’t have to concentrate for 12 hours, you have to concentrate, maybe, for 15 – 20 minutes at a time, once or twice a shift. SW3M2: In relating to our job that’s about it, the adrenalin gets you through those moments. LM - So, there’s not really that need there for an extra boost? SW3M2: I don't think so. SW3M1: You don't need to be concentrating for the whole 12 hours, do you? SW3M2: No, hopefully I’m going to get my 20 minute kip before I’m taking Modafinil! SW3M1:If the alternatives have already been tried and it’s a last resort, I wouldn’t want it to be a first line thing but […] I suppose I wouldn’t rule [modafinil] out. It would be maybe something useful to have available if I was really struggling but I wouldn’t... SW3M2:Being honest, I would say it would be like a Pro Plus, it would be there and on a day when I was having a nightmare […] It isn’t a drug I would want to take on anything like a regular basis. I’d consider it on a one off if things were going pear shaped. LM- So, you think it might be useful to have as a one off option for people who work in professions like yours? SW3M2: If you’re on a shift and you’ve still got three or four hours to go and you know you’re not going to get that kip and you’re absolutely exhausted, and if Pro Plus doesn’t do it for you then it’s a time when you might need it. SW3M1:But we shouldn’t have to do that. SW3M2:No.
LM- Do you think it’s OK for students to take a drug like modafinil? SFG4F1 No SFG4F3 Not really. I mean, I can totally understand it and empathise; perhaps when I was doing my first degree, if someone had offered me it then I would have given it a try, but it wasn’t really the done thing then and not really accessible. It wasn’t something that my friends were doing, but had it been, I think I would have been tempted to at least try it. It’s just not something I would do now. SFG4F1Not necessarily to like to do an all-nighter but … SFG4F2To concentrate. SFG4F1Yes, to concentrate, yes. SFG4F3That’s exactly it, not necessarily to… SFG4F1Not to force myself to stay awake because I know that sleep’s important, but I would have done it if I was sort of lagging in the middle of the day. SFG4F3Or even if I felt completely normal and not sleepy but I just thought I could take a drug that would increase my revising potential, I would take it. SFG3F1 Yeah, yeah. SFG4F2I think the problem is, there’s a kind of slippery slope. Just start off just doing it for one exam and then before you know it, you’re doing it all the time to get more work done. SFG4F3And if you’re not having any adverse effects to it, then what’s the harm in doing it just because you’ve got a big party or something. I would feel really uncomfortable about that or other non-medical…
Summary + Reflections on the data Sleep as an effective non- pharma method of cognitive enhancement Drug use as a last resort when other non-pharma strategies do not work In general, motivations and justifications for drug use were not to boost performance or cognitive functioning beyond a normal level – instead for normalisation/repair or as technological fix to maintain performance or to achieve ones best under conditions of illness or stress Strong critical/ cautious theme in the data Empirical research grounds ethical debates in social context – can begin to perturb some of the assumptions embedded in these debates re: desirability, demand, motivations for use etc.