Navigating the enhancement landscape

An increasing number of opinions and commentaries are being written about the possible benefits and risks of so-called ‘cognitive enhancers’ [1], a term that usually refers to technologies that purportedly augment cognitive performance or modulate mood and behaviour [2]. These discussions have focused on both existing pharmaceuticals, such as prescription medications, and new drugs and technologies that could be developed with the explicit purpose of enhancing cognitive function in healthy individuals [3]. Nearly all of these articles have discussed the ethical, legal and societal implications of using cognitive enhancers and whether the risks in relation to potential benefits would require regulation , oversight or even bans. Interestingly, some discussions indicate that existing cognitive-enhancement drugs have an effect on healthy individuals and provide clear benefits [1,4,5]. In fact, however, other reviews of the topic [6–11] have found insufficient evidence for both the efficacy and safety of most cognitiveenhancing medications in healthy populations. At the same time, calls for further research have been made [12,13], but in a context that is shaped more by a ‘melioristic misconception’, rather than a genuine scientific confirmation of benefit [14,15]. Thus, before discussing bans or regulations, society must address two crucial questions: are these drugs safe and do they work? To answer these in a satisfactory manner would require either drug trial-like studies to ascertain safety and efficacy, or health surveys to monitor for adverse side-effects from taking cognitive enhancers. Inevitably, both would require considerable financial resources for studies of something that is not a health issue per se, but a recreational use at best or an ethically questionable activity at worst. Not surprisingly, the critics of cognitive enhancement have already argued against the further funding and promotion of research into cognitive enhancers, owing to ethical concerns [16]. However, ethical concerns are only one facet; such research also has possible wide-ranging social and public health consequences. If future studies found cognitive enhancers to be safe and efficient, any bans or regulations would create a black market for these drugs. Given these factors, funding agencies or policymakers might therefore choose to promote active research on the efficacy of cognitive enhancers, to restrict it or to not address the issue at all.