Tuesday, May 9, 2017

Reading into the Science: The Neuroscience and Ethics of Enhancement

By Shweta Sahu

Image courtesy of Pexels.
I was always an average student: I was good, just not good enough. I often wondered what my life and grades would be like if I’d had a better memory or learned faster. I remember several exams throughout my high school career where I just could not recall what certain rote memorization facts or specific details were, and now in college, I realize that if I could somehow learn faster, how much time would I save and be able to study even more? Would a better memory have led me to do better on my exams in high school, and would my faster ability to learn new information have increased my GPA?

Such has been the question for years now in the ongoing debates of memory enhancement and cognitive enhancement, respectively. I’m not the only student to have ever felt this way and I’m sure I won’t be the last. Technology and medicine seem to be on the brink of exciting new findings, ones that may help us in ways we’ve never before thought imaginable.

Though neuroscientists are still attempting to understand the intricacies of how memory functions, it has been known since the early 1900’s that memory works in three modes: working memory, short-term memory, and long term memory, each of which are regionalized to different parts of the brain. Working memory, which lasts from seconds to minutes, contains information that can be acted on and processed, not merely maintained by rehearsal. Short term memory on the other hand, is slightly longer in duration and occurs in the prefrontal cortex (think George Miller’s Magic number 7). It is here in short term memory that if an item is rehearsed, it can be “moved” into long term memory, and this long term memory is of particular interest to physicians and clinicians. Long term memory lasts over days, months, or years and is divided into declarative (explicit) memory and nondeclarative (implicit) memory. Declarative memory itself can be further subdivided into episodic memories, which are memories of personal experiences and autobiographical memories, and semantic memory, which is objective knowledge that is factual in nature, deemed “world knowledge.” The brain’s ability to acquire the aforementioned declarative memories depends on the medial temporal lobe regions, which include the amygdala, hippocampus, and the surrounding parahippocampal, perirhinal and entorhinal cortical areas. It is within these structures that memory and learning occur, specifically communication via neurotransmitters and the repeated activation of certain synapses.

Image courtesy of Novalens.
It is also here that enhancement is used, whether it's enhancement via chemical means (notably the neurotransmitters: acetylcholine, dopamine, and serotonin) or enhancement via technological means (TMS, DBS, tDCS, etc.). From studies in humans and animals, it is well known that the hippocampus is crucial for the formation of new long term memories, but since the hippocampus is deep within the brain, electrically stimulating it becomes tricky. This is where stimulation of the entorhinal cortex becomes key, as it is heavily connected to the hippocampus. Both transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) are techniques which target specific regions of the brain, as opposed to the chemical equivalent (i.e. drugs) that are not localizable. A revolutionary study done in 2012 by Suthana et al., aimed to test whether DBS of the hippocampus or entorhinal cortex altered memory performance on spatial memory tasks. They found that “entorhinal stimulation applied while the subjects learned locations of landmarks enhanced their subsequent memory of these locations,” though direct hippocampal stimulation did not yield similar results. Moreover, in past studies, TMS has been shown to improve performance on different tasks, but a 2014 study found that repeated TMS over the span of one week could be used to improve memory for events at least 24 hours after the stimulation is given, specifically when tested with “memory tests consisting of a set of arbitrary associations between faces and words that they were asked to learn and remember.” This study is particularly noteworthy because it was done on healthy volunteers with “normal” memory, and essentially those in whom you wouldn’t expect to see marked improvement since their brains are already ‘functioning at their normal capacities.’

Enhancement via chemical means is also rising in popularity among adults and college students. For example, Ritalin and Adderall, two commonly prescribed stimulants for ADHD, increase the extracellular concentration of dopamine in the brain by blocking the dopamine transporter. Patients with hyperactivity-impulsive ADHD have changes to their dopamine transport gene, which is why prescribing these stimulants can alleviate those symptoms. However, Ritalin and Adderall are now being used off-label and are being abused by nonmedical users (those who are not being prescribed it) in order to try to enhance their performance. One intriguing qualitative study found that “stimulants’ effects on users’ emotions and feelings are an important contributor to users’ perceptions of improved academic performance” and thus, felt cognitively enhanced. Of the college students interviewed, many reported a feeling “up”, and one stated, “your energy level is higher… it’s just easier to function at a highly productive level.” Further, students reported increased drive and motivation, saying that Adderall produced surplus energy that was discharged through an “internal push, pressure.” Moreover, they claimed these stimulant medications allowed them to be “interested” in the material which thereby increased their feeling of enjoyment. All this is to say that these students did feel cognitively enhanced and saw nothing wrong with it. In contrast, some students think that the unauthorized use of prescription medications is cheating, whether it be to enhance motivation, information, or recall. In fact, some school administrators see it the same way, with Duke being the most notable example of a university that has explicitly stated in its Student Conduct code that such unintended usage is deemed “cheating.”

That brings us to the questionable ethics of cognitive and memory enhancement, both chemical and electrical. The current state of affairs is divided and there is no distinguishable line in the sand. One view in medicine is “first, do no harm.” Maurice Bernstein, MD, says that transforming physicians from healers to enhancers has the potential to “degrade” this standard of doing no harm. Richard M. Restak, MD, is a clinical professor of neurology, and provides another, more technical answer when asked if he would prescribe enhancement. He says, “I don’t prescribe them… Such use is definitely off-label and puts the physician at a disadvantage should something go wrong." However, Dr. Chatterjee, a prominent neuroethicist and inventor of the term “cosmetic neurology” offers up a realistic view that “medical economics will drive some physicians to embrace the enhancement role with open arms, especially if it means regaining some of the autonomy lost to managed care plans.” So much of medicine is now dictated by protocols and standard operating procedures, but Dr. Chatterjee suggests this may change if physicians are given this new option to reclaim some of their authority, putting the decision making-power back in their hands.

Image courtesy of Wikipedia.
Nevertheless, physicians are not the only ones divided on this issue; the general public seems to be even more so. A proponent of enhancement and author of Liberation Biology: The Scientific and Moral Case for the Biotech Revolution, Ronald Bailey, argues that disease is a state of dis-ease. He further states, “if patients are unsatisfied with some aspect of their lives and doctors can help them with very few risks, then why shouldn't they do so?" However, Deane Alban, researcher, writer, and manager of BeBrainFit.com offers a contrasting opinion. She writes,
“Smart drugs have side effects, are almost always obtained quasi-legally, and may not even work. You have only one brain. You can artificially stimulate it now for perceived short-term benefits. Or you can nourish and protect it so that it stays sharp for a lifetime. The decision is a no-brainer.”
But is it? By not taking advantage of such enhancing technologies will we get left behind? Now the issue turns to that of implicit coercion, where one feels like he/she has to do something or take something in order to keep up even if he himself/ she herself doesn’t want to. This further raises the question of whether employers will begin contemplating enhancement for their employees, even preferring those who are functioning at a higher level than others. Speaking in terms of efficiency, why not take the more productive team member? Already, air force pilots are required (and some medical residents are encouraged) to take Modafinil, a stimulant originally intended to treat narcolepsy and sleep disorders. If the work force continuously demands excellence of its employees, why not expand that and take a cognitive enhancer, since they make employees less prone to error, able to work and concentrate for longer hours, and operate more efficiently? If surgeons and restaurant employees are “coerced” to wash their hands and follow other protocol, this step may not be all that far away for the rest of us if these enhancement drugs are proved safe and efficacious.

That said, if there is a way for me to enhance my memory, learn faster, motivate myself to learn more, and enjoy what I do learn, I think I would take it *if it is not considered cheating and *if they are deemed effective. Lots of literature exists out on the internet as to how patients with ADHD feel that they are brought to a comparable level as others when they take this medication. However, there are several conflicting results as to whether these Smart Drugs can help enhance those beyond the “normal capacity.” Yet, if we can’t make people who use it illegally stop (and we cannot completely and irrevocably accomplish this), is there a time in the near future when we will legalize it for everyone, and those who choose to take Smart Drugs can take them according their own volition? At that point, I might just take it. I don’t want to get left behind. Do you?

Want to cite this post?

Sahu, S. (2017). Reading into the Science: The Neuroscience and Ethics of Enhancement. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2017/05/reading-into-science-neuroscience-and.html

No comments: