1. Pharmacological Manipulation of the Nervous System Treatment vs. Enhancement By: David Hall 9/27/2007

2. Outline Examples of Affected Pathways Examples of Affected Pathways The science of the drugs The science of the drugs The ethics of the drugs The ethics of the drugs Case study? Case study?

3. Examples Depression Depression Erectile Dysfunction Erectile Dysfunction Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder For the purpose of today, we will focus on ADHD Medications and the ethics of their abuse For the purpose of today, we will focus on ADHD Medications and the ethics of their abuse

4. ADHD According to the NIMH, from 3-5% of children (about 2 million) have ADHD According to the NIMH, from 3-5% of children (about 2 million) have ADHD Principle symptoms: inattention, hyperactivity, and impulsivity Principle symptoms: inattention, hyperactivity, and impulsivity Must appear before age 7 and last 6 months Must appear before age 7 and last 6 months May be caused by environmental agents, brain injury, or genetics May be caused by environmental agents, brain injury, or genetics

5. Methylphenidate (MPH) Ritalin or Concerta (extended release) Ritalin or Concerta (extended release) Originally used for depression/fatigue Originally used for depression/fatigue CNS Stimulant, dopamine reuptake inhibitor (increases dopamine), and may affect serotonin levels CNS Stimulant, dopamine reuptake inhibitor (increases dopamine), and may affect serotonin levels Side effects: difficulty sleeping, headaches, lack of hunger, dry mouth Side effects: difficulty sleeping, headaches, lack of hunger, dry mouth May cause cardiac arrest, addiction, and is a suspected carcinogen? Chemical structure is similar to cocaine May cause cardiac arrest, addiction, and is a suspected carcinogen? Chemical structure is similar to cocaine

6. Adderall Psychostimulant containing mixed amphetamine (speed) salts Psychostimulant containing mixed amphetamine (speed) salts Originally introduced as Obetrol, a weight-loss drug Originally introduced as Obetrol, a weight-loss drug Increases levels of dopamine, norepinephrine, and serotonin Increases levels of dopamine, norepinephrine, and serotonin Usually founded in XR (extended release form) Usually founded in XR (extended release form) Side effects: aggression, new abnormal thoughts/behaviors, mania, weight loss Side effects: aggression, new abnormal thoughts/behaviors, mania, weight loss

7. NIDA Study Dr. Sean Esteban McCabe, University of Michigan and Harvard University, 2001 Dr. Sean Esteban McCabe, University of Michigan and Harvard University, 2001 10,904 randomly selected students enrolled at 119 colleges across the United States. 10,904 randomly selected students enrolled at 119 colleges across the United States. 4% Reported having used a stimulant 4% Reported having used a stimulant Men were twice as likely as women (5.8 percent versus 2.9 percent) White (4.9 percent), African-American (1.6 percent) Asian (1.3 percent) Men were twice as likely as women (5.8 percent versus 2.9 percent) White (4.9 percent), African-American (1.6 percent) Asian (1.3 percent) Members of fraternities or sororities (8.6 percent versus 3.5 percent for nonmembers) Members of fraternities or sororities (8.6 percent versus 3.5 percent for nonmembers) Students who abused prescription stimulants reported higher levels of cigarette smoking; heavy drinking; risky driving; and abuse of marijuana, MDMA (Ecstasy), and cocaine Students who abused prescription stimulants reported higher levels of cigarette smoking; heavy drinking; risky driving; and abuse of marijuana, MDMA (Ecstasy), and cocaine More competitive colleges = More abuse More competitive colleges = More abuse

8. Statistics of Abuse on College Campuses As many as 20% of students have used Ritalin or Adderall to study As many as 20% of students have used Ritalin or Adderall to study National Center on Addiction and Substance Abuse at Columbia found that the number of teenagers who admit to abusing prescription medications tripled from 1992 to 2003, while in the general population such abuse had doubled. National Center on Addiction and Substance Abuse at Columbia found that the number of teenagers who admit to abusing prescription medications tripled from 1992 to 2003, while in the general population such abuse had doubled.

9. Neuroethics Book Gratitude Framework vs Creativity Framework Gratitude Framework vs Creativity Framework Genuine vs. Fake enhancement Genuine vs. Fake enhancement Just because A and B both work to achieve C doesn’t mean that B is a good replacement for A Just because A and B both work to achieve C doesn’t mean that B is a good replacement for A

10. Treatment vs. Enhancement How many of you have a problem with the following? How many of you have a problem with the following? –Cosmetic surgery to improve body image –Exercising to improve body image –Wearing makeup?

11. What about… Eyeglasses Eyeglasses Hearing Aids Hearing Aids Running Shoes Running Shoes Prosthetic Limbs Prosthetic Limbs Caffeine Caffeine

12. My opinion Cousins with ADHD Cousins with ADHD Performance enhancing drug Performance enhancing drug Cheating Cheating Line between treatment and enhancement is fuzzy at best Line between treatment and enhancement is fuzzy at best