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Non therapeutic Neuro-Enhancement

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“Neuro-enhancement” (or NE) is a research field that focuses on the research for treatments and applications to improve human capacities by acting mainly in the brain. The main purpose of NE, both for healthy individuals and patients, is an increase of cognitive abilities that leads to an improvement (for example, of memory, concentration, ability to calculate, etc.). In general, when the application has a therapeutic purpose, it is referred to as “neuro-rescue”; when the user is focused on healthy people, on the other hand, it is referred to as “neuro-enhancement”.

Author / translator Gema Revuelta

“Neuro-enhancement” (or NE) is a research field that focuses on the research for treatments and applications to improve human capacities by acting mainly in the brain. The main purpose of NE, both for healthy individuals and patients, is an increase of cognitive abilities that leads to an improvement (for example, of memory, concentration, ability to calculate, etc.). In general, when the application has a therapeutic purpose, it is referred to as “neuro-rescue”; when the user is focused on healthy people, on the other hand, it is referred to as “neuro-enhancement”.

Technologies included in the concept of NE are diverse: drugs and chemicals, brain implants with surgery, external devices, etc. Moreover, NE technologies found themselves nowadays in different stages of research and development: some already exist but are only applied to treat diseases and their use in healthy individuals is limited to the experimental field (considered is illegal in some cases or lacking a specific legal framework), while other applications are still in a preliminary stage. Any activity that increases the cognitive abilities of the individual –such as reading, calculus, healthy eating, etc. – could theoretically be described as NE. However, the ethical debate around these “ordinary” activities is practically nonexistent. The complexity of the debate changes for the case of therapeutic NE (in treated patients) and nontherapeutic NE (healthy subjects). This kit of DECIDE focuses on the non-therapeutic NE, excluding the therapeutic NE as well as the “ordinary” methods of NE.

The NE on healthy people may have a great potential, but it can also be linked with a legal, ethic and social debate. Some of the reasons suggested for the regulation of this research and innovation field are described below. We would like to know if you agree or disagree with them and hear you share your opinions with your group. We encourage you to propose your own position in case it is not gathered among the four proposals (as proposal 5 in the blank space).

Created 5 August 2014
Last edited 10 July 2018
Topics Ethics, Health, Science
Original Spanish

Policy positions

Policy position 1

Non-therapeutic neuro-enhancement technologies should be regulated according to the actual legislation and the ethical values. Therefore, they do not need specific legislation.

Policy position 2

Considering that non-therapeutic NE combines different technologies (such as drugs, invasive and non-invasive neuro-modulation, etc.), specific regulatory agencies should be created in order to control and regulate the use of each case.

Policy position 3

A regulation system should be applied for non-therapeutic neuro-enhancement focused on the precautionary principle. Such position should be based on a risk assessment that took into account scientific evidence, recommendations from experts and international organizations (from different fields) and the whole society’s opinion.

Policy position 4

A strict control of non-therapeutic NE should be guaranteed by analyzing and authorizing case by case. This position seeks a generalized restriction controlled by a governmental agency, which would be responsible of authorizing and recording the research projects of these techniques as well as their application.

Story cards

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When the conventional treatment for Parkinson does not work, the “Deep Brain Stimulation” (DBS) is recommended. The DBS consists on the implantation of an electrode into the brain and a neuro-stimulator under the skin near the collarbone.
Although treating this disease with DBS usually has successful results, Ana’s doubts are understandable: DBS requires invasive surgery and it has the potential risk of changes in personality.

[Names and pictures are fictitious]

The case of Ana
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A researcher from the University of Washington told one of his companions when to perform an action using only his mind. This was possible because both were connected through a Brain Interface (BCI, Brain Computer Interface) in order to undertake this basic example of mind control.
The BCI analyzes brain activity using EEG, detecting electrical signals from the brain and transforming them into operational orders that also go to a computer. This technique could be considered as neuro-enhancement because it somehow improves cerebral capacities. This system does not allow to “read minds" nor controlling someone else’s actions against their own will.

[Names and pictures are fictitious]

The case of Rajesh and Andrea
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This 43-year-old housewife and mother of 3 children has been taking Prozac ® (trade name for fluoxetine) for 2 years. Susana belongs to the 5% of the population who uses antidepressants without medical prescription and with the sole purpose of feeling better.
Some experts state that happier individuals can significantly increase their productivity and competitiveness, and the same would apply to a community or group level. However, self-medication is associated to several problems – usually severe ones.

[Names and pictures are fictitious]

The case of Susan
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I declared as a witness in the trial of Lee (27 years old), for attacking a young man (25 years old). This kind of aggression was not the first one on Lee’s record. As an expert in such disorders, I stated that Lee has no control over his own violent behavior and that the most likely cause is growing up in an unstructured environment. Drugs can be prescribed to control and modulate Lee’s aggressiveness. However, in this case, the jury is not sure whether this measure would interfere with certain fundamental rights of the individual, such as his identity, autonomy or freedom - in case Lee does not accept the treatment voluntarily.

[Names and pictures are fictitious]

The case of Dr Marti
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In Spain, Alzheimer's disease is ranked as the sixth most common cause of death. This neurodegenerative disease involves the loss of short-term memory and other mental abilities.
Rosa has a mild cognitive impairment, which is a pre-condition of dementia that increases the chances of suffering Alzheimer’s disease in the following years. Some drugs help to slow down this process, although they don’t stop it completely. The cost of these preventive drugs is high and Rosa does not know for how long she will be able to afford them.

[Names and pictures are fictitious]

The case of Rose
Thumbnail

Among my high school students, one of every 20 takes Concerta ® (brand name for methylphenidate) or other drugs for treating Attention deficit hyperactivity disorder (ADHD). Besides those who take the drug with medical prescription, we know that more students use these drugs in order to improve their academic performance. Their side effects include weight and appetite loss, sleep disorders and headaches.

[Names and pictures are fictitious]

The case of Claire
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Several surveys indicate that illegal consumption of amphetamines in colleges is considerable.
The Presidential Bioethics Commission of the U.S concludes that they are specially consumed in medical school (18%). Like Mary, 95% of the students use these drugs to improve their academic performance. She states that not consuming amphetamines would mean being at a disadvantage compared to their classmates – who would still consume them.

[Names and pictures are fictitious]

The case of Mary
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In recent years, Trans-cranial Direct Current Stimulation (tDCS) has begun to be applied in disorders such as Parkinson’s disease or Fibromyalgia. However, professional athletes as Javier use it to improve their muscular strength or fatigue tolerance. tDCS is a noninvasive method that conducts a weak current through the brain, using small electrodes placed on the head. Effects can be seen immediately after the session. No adverse effects have been reported, although they still cannot be disregarded.

[Names and pictures are fictitious]

The case of Javier

INFO CARDSISSUE CARDS

Internal tools

Since early days, humans have developed external tools that allow them to carry out activities that they could not do naturally, and hence overcoming their limitations. Why not get over these barriers to improve ourselves?

Electrodes and drugs

Is there any difference between wearing an electrode in the brain and taking drugs?

Freedom and human dignity

Is a medical treatment approved by a judge to correct sexually violent criminal behavior a violation of individual freedom and human dignity? What if the treatment involves the implantation of electrodes? What if the individual freely accepts the treatment?

Improving oneself

Which of these aspects would you improve in yourself by using artificial methods (such as drugs, electrodes, EMT, etc.) if it was possible?

• Memory?
• Intelligence?
• Concentration?
• Mood?

Are some methods more acceptable than others?

Drugs and society

Will the improvement of brain functioning have large-scale social effects?
Would there be some social groups that would be at an advantage over others?

Affecting the evolution

Will the course of human evolution change if we artificially modify the human brain?

Drugs for the powerful

Since presidents and prime ministers take decisions that affect the entire world, Should we ask them to take drugs in order to improve their brain performance and thus make better decisions?

Assess the risks

How can we know the long-term risks of psychoactive drugs, especially when people start taking them in early ages and for a long time?

Controlling the use of drugs

It is commonly said that "Once a drug is approved and accepted, people will use it for other purposes." Do you agree with this statement?

Will people be forced to improve their brains?

Is there any risk that companies and schools -who want their workers and students to perform better- pressure them to improve their brain function?

Drugs effects

Will I be the same person after taking a drug that works on my brain?

Matter of regulation

Does neuro-enhancement have too many implications to be left to the individual’s will?
Should society intervene and set the guidelines for its regulation?
Who should decide whether it is morally or ethically acceptable?

Risk management

Currently, invasive medical procedures are carefully regulated in order to avoid unnecessary damage. Are we going to be able to manage the risks of neuro-enhancement technologies in the same way?

Setting boundaries

In the field of mood disorders, is the boundary between health and disease clear?

What type of disorder is depression?

Is depression a disorder of the person or of the society?

Hiding the problem

Could brain performance enhancement be hiding a social problem?

The attitudes of society

Up to what extent are variations in human behavior socially accepted?

Concern over drugs

Probably everyone would like to live a happy life, be slender and gracious, be able to quickly focus on work and enjoy nights of unbridled sex. However, we are concerned about the idea of getting this life through the consumption of drugs. Why?

Who has the control?

Who defines the behavior and its disorders? Who should be in charge of assessing its treatment?

Take advantage

Is it ethical to use drugs to be at an advantage over others?

Justice and improvement of brain function

Education boosts cognition and is spread unequally. However, society is not against education. Contrarily, neurocognitive enhancers could be easily and equally distributed to the entire population.

Drugs to pass exams and competitions

If one day we can develop drugs to enhance cognition, what will be the implications for those who would use them to pass exams?

Coffee and other stimulants

Is taking a stimulant different from having a coffee before an exam?

Parental choice

We decide all sorts of things ahead for our children.
Will they blame us if we choose not to use methods of neuro-enhancement on them? Or would they blame us for doing it?

Prevention of neurogeneration

Drugs such as Aricept ®, Exelon ®, Exelon ® or Reminil ® (cholinesterase inhibitors) are used to treat Alzheimer's disease. They also seem to improve the cognitive abilities of healthy old people and could be used in the future to prevent these degenerative disorders. However, at high doses they can decrease the cognitive performance.

Increasing memory

Drugs that increase vascularity, oxygen transport and the consumption of glucose, are candidates to improve cognitive abilities such as memory. Many pharmaceutical companies are working on the development of these products for their economic and business potential. The efficacy of these drugs depends on dose, genetics and personality traits.

Deep brain stimulation

Any disease related to a particular alteration of the brain activity (like depression, Alzheimer’s disease or obsessive-compulsive disorders) are potential candidates to Deep Brain Stimulation. In addition, research is been made to see whether DBS may improve certain memory functions.
However, it requires open brain surgery which carry serious health risks and may cause changes in personality.

Transcranial Direct Current Stimulation.

With Transcranial Direct Current Stimulation (tDCS), the activity of different brain areas can be modulated using a number of electrodes placed on the scalp. In pilot studies, it has been proved that this method can improve several capacities, such as sensorimotor skills, memory, attention and problem solving. No side effect resulting from its use is known yet.

Transcranial magnetic stimulation

Transcranial magnetic stimulation is a non-invasive method based on the use of weak electromagnetic fields to stimulate neurons. This influences the activity of specific brain region with a minimal discomfort and can improve memory and reasoning, erase severe fatigue symptoms and help learn new skills. Side effects that could result from its application are still unknown.

Neuroplasticity

Neuroplasticity is the ability to modify the structure and function of neuronal circuits. This remodeling is the result of process such as learning. It occurs in response to several physiological situations (like pregnancy or thirst) and after a suffering from an injury. Plasticity is maintained throughout life but is especially important during the early years. It can be induced by brain stimulation, although its effects are unknown.

Information overload

Aún no se conocen los efectos secundarios psicológicos que tendría aumentar la memoria de manera crónica.
The psychological side effects that the chronic increase of memory would have remain unknown.
Will we overload the brain with too much information that won’t be possible to forget?

Pharmacological enhancement

Some available drugs for attention deficit hyperactivity disorder (ADHD) have structural similarities to amphetamines. However, they are considered safe enough to be daily taken by children older than 6. Besides this, although it is thought that its consumption can improve cognitive abilities in healthy people, there is still no scientific evidence to support this.

“Feel better than good”

In neuro-enchancemente, “Cosmetic Pharmacology” is referred to the use of drugs to improve the mood of individuals who do not suffer from any pathology. The most commonly used are antidepressants and their byproducts.

Dementia and age

Dementia is a syndrome that supposes the deterioration of memory, intellect, behavior and the ability to perform daily life activities.
Data provided by the U.S Presidential Commission of Bioethics indicate that dementia increases with age, affecting 5% of people aged between 71-79, 24% of those aged around 80-89 and 37% of individuals over 90. More than 35 million people worldwide suffer from dementia.

Stem cells

Neural stem cells could be used to regenerate affected cells in order to treat brain or nervous system damage. The method itself has a great potential for treating degenerative diseases and acute attacks such as a stroke.

Neuroprosthetics

Sensory prostheses are being developed, such as retinas (sight) or cochlea (hearing).
Currently there is only one type of retinal prosthesis approved in the U.S. and Europe, which partially restores vision of people with degenerative eye diseases (Retinitis Pigmentosa). Although these prostheses have a clear therapeutic purpose, their use in the field of nontherapeutic neuro-enchancemente is being considered.

Economic and social impact of dementia

Dementia has an important impact regarding its medical and social costs, as well as the attention provided outside of the institutional environment. The World Health Organization (WHO) has pointed out that in 2010 the total social cost of dementia worldwide was estimated at 446.448 million euro, an amount that equals 1% of global gross domestic product (GDP).

Military experiments

Drugs intended to treat sleep disorders can prolong wakefulness for days. The U.S. army is investigating its use in healthy people, so it can be used to prevent fatigue in soldiers, who could then stay awake and alert for several days without side effects. The U.S. has already spent $20 million in researching how to make soldiers smarter and stronger than "normal" people ("superhuman").

DBS and Parkinson

For the first time in 2002, the Federal Food and Drug Administration of the U.S (FDA) approved the use of Deep Brain Stimulation (DBS) as a treatment for Parkinson's disease. DBS’s success to control several motor symptoms of the disease suggests that it may have a promising future in other fields.

Alzheimer’s and age

Age is the main risk factor for Alzheimer's disease, in addition to genetic risk.
The majority of patients with Alzheimer’s disease are over 65 and the probability to develop the illness increases after this age. Moreover, the World Health Organization (WHO) indicates that between 25% and 30% of those over 85 suffer from some kind of cognitive

Do It Yourself (DIY)

Brain stimulation devices can be bought online. They promise to increase the capacity, efficiency and creativity of the brain. These devices are based on electric currents or electromagnetic fields that penetrate the scalp and skull to stimulate neurons, but there are no clinical studies proving its effectiveness nor its safety. Some of them are not labeled as medical technologies, so proper regulation and control are not guaranteed.

BCI technologies support

One of the main applications of the Brain Computer Interface (BCI) or Neurofeedback is as supporting technology. With it, patients with disabilities could use their brain activity to control multiple devices, including computers and wheelchairs. Most likely, they will be able to easily manage their prosthesis through BCI one day.

Pharmacological legislation

In case drugs for nontherapeutic neuro-enhancement should be included into the current law, they should be classified in one of the following categories:
- Prescription Drugs
- Advertising drugs or ordinarily called OTC (Over The Counter). They are non-prescription medicines.
- Homeopathic Medicines, cosmetics.
- ADUMES or dietary foods for special medical purposes, to be used under close medical supervision.

Neurofeedback or BCI

Brain Computer Interfaces (BCI) measures brainwave patterns in real time, and use them as a "language" to interact with computer systems. It can be used as a tool for Neurofeedback, so we can learn to produce certain desired brain states with visual and auditory feedback.
This has been used in healthy people such as elite musicians that wanted to increase their creativity - although its effectiveness is still discussed.

OTC drugs

The Spanish Medicine Agency decides whether a drug is safe enough to be dispensed without medical prescription (advertising drugs or OTC’s).
In all member states of the European Union, these drugs are sold in pharmacies - except from in the United Kingdom and the Netherlands, where they are freely distributed. In Spain, a royal decree has been approved allowing the sale of these drugs through pharmacies’ websites.

Cognitive enhancement devices

These devices affect the functioning of a healthy brain by improving its performance at least in one cognitive domain, for example, the memory. They are called Cognitive Enhancement Devices (CED). These include the Transcranial Direct Current Stimulation, Transcranial Magnetic Stimulation, etc.

tDCS curiosities

The position of the electrodes in the Transcranial Direct Current Stimulation is crucial to obtain reliable effects. As an example, one have to bear in mind that the proper placement of the electrons varies between right- and left-handed subjects, for left-handed people’s brains may be organized differently.

Current situation of amphetamines

Amphetamines are considered dual substances: they can be medicines and "drugs", legal and illegal, past and present. They have a very complex mechanism of action due to their structural similarity with neurotransmitters and their ability to act on different areas of the brain. The pharmacology of amphetamines is therefore complex and it is being constantly updated.

CED regulation

Cognitive Enhancement Devices (CED) could be covered by the Directive 93/42/EEC of Medical Devices of the EU by defining Medical Device as "any instrument, apparatus, appliance, software, material or other product, used alone or in combination, intended by the manufacturer to be used in human beings to investigate, replace or modify the anatomy or a physiological process”.

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