Regulation of Pharmacological

Substances Enhancing

Cognition: Policy Proposal

Alma LINKEVICIUTE

PhD stude t i Fou datio s of Life Sciences and their Ethical

Co se ue ces P og a e

OUTLINE

Usage and attitudes to pharmacological

cognitive enhancement (PCE) among

Lithuanians (food supplements).

PCE usage and attitudes in other countries.

Reasons for and against the use of PCE.

Values to be protected.

Policy proposal.

PCE usage among Lithuanians

2008 2011

N=531

Paper questionnaire

Students of 7 universities

3 non-university higher

education colleges

40,9% used food

supplements

Only 2 respondents used

prescriptions drugs

N=61

23 students

Online questionnaire

30 academics

8 physical work/unemployed

34,4 % used food supplements to

enhance cognition

Substance 2008 (%)

Food supplements, vitamins

Medicinal drugs under prescription

Energy drinks

Coffee, tea

Recreational drugs

Over the counter drugs

Alcohol, nicotine

Other

61

54,4

36,3

29,8

26,2

18,6

13,2

1,9

What respondents considered to be pharmacological cognitive

enhancement (N=531). Respondents could choose few answers.

Food supplements, vitamins

Medicinal drugs under prescription

61

54,4

Effect 2008 (%) 2011 (%)

My concentration became better

I felt more awake

I could memorize new information faster

I had energy boost

I did not notice any effect

I experienced some side effects

I could finish my tasks faster

39,7

35,8

30,9

29,1

26,5

14,8

14,7

33,3

42,9

33,3

28,6

28,6

9,2

28,6

Effects respondents experienced while taking food supplements which were described

as enhancing cognition by distributor (N=217 in 2008; N=21 in 2011). Respondents

could choose few answers.

My concentration became better

I felt more awake

I could memorize new information faster

I did not notice any effect

Both surveys at glance

2008

NEUROZAN, GERIMAX,

MEMOREX, BILOBIL

Using or used in the past:

40,9%

Main source of information:

TV adverts – 80,4%

PCE is cheating – 5,6%

2011

NEUROZAN, GERIMAX,

MEMOREX, BILOBIL

Using or used in the past:

34,4%

Main source of information:

Scientific articles 66,6%

TV adverts – 60,7%

Consultation with doctor/pharmacist

49,1%

PCE is cheating – 14,7%

Situation 2008 (%) 2011 (%)

Degenerative illness affecting cognition

During the exams

During intensive work

Being in a job requiring attentiveness

Going for an important interview

Serving at the military

60,6

57,1

54,6

28,4

3,4

2,6

67,2

39,3

50,8

19,7

3,3

4,9

Situations in which respondents would justify the usage of pharmacological

cognitive enhancement (N=531 in 2008; N=61 in 2011).Respondents could

choose few answers.

Degenerative illness affecting cognition

During the exams

During intensive work

Expectation 2008 (%) 2011 (%)

Effectiveness in short time

Limited side effects

Safety

Self-confidence

70

37,4

27,1

17,2

85,7

33,3

49,9

28,6

Expectations influencing the decision to use cognition enhancing food

supplements (N=217 in 2008; N=21 in 2011). Respondents could choose few

answers.

Effectiveness in short time

Key points:

• Confusion in distinguishing medicinal drugs

and food supplements (advertising violations)

• Liberal attitude to usage (especially among

individuals doing intellectual work)

• Scepticism about the effectiveness (emphasis

on effort)

• Only small numbers agreed that the usage of

PCE is cheating or promotes social inequalities

PCE usage in other countries:

• US estimates of PCE usage differ between

1.5% and 31% which makes research

techniques questionable (Hall et Lucke, 2010).

• Ragan et al., 2013; provides an international

PCE prevalence overview for prescription

drugs: Germany <2%, Belgium – 4%, Denmark

– 7%, the UK – up to 10%, Iran – 7,7%

Attitudes towards PCE in other

countries: Australia and Canada (student surveys): could lead to

unfair advantage, coercion to take enhancement if

majority is doing that and limit individual freedom to

choose how to study (Bell et al., 2012; Forlini et

Racine, 2009).

Sweden: general public finds it acceptable to enhance

human capacities by using natural remedies but only

small minorities of general public and medical

practitioners agree to allow the use of

pharmaceuticals (Bergstrom et Lynoe, 2008).

What are broader attitudes?

Not clear what public opinion on PCE is

(individual trends, societal tendencies,

institutional promotions)

No unity in the regulations across EU

(enhancement tourism)

No solid scientific evidence that PCE really works

Laissez-fair approach in Europe

What are recommendations?

2004: enhancement projects suggested to be

blocked politically (HLEG)

2007: healthcare concerns must be met first

(EGE, Opinion 21)

2008: research aiming for non-therapeutic

enhancement should not be undertaken (EC

Recommendation)

2009: STOA study; 2012: Discussion in EP (CSC)

Institutional policies:

Universities and business are reportedly

ignoring the ethical challenges posed by the

use of cognitive enhancement. The use of

cognitive enhancement drugs is not discussed.

Majority of university codes speak of drugs in

a light of compromised work performance

(Goodman, 2014).

Arguments for PCE:

• Usage would reduce personal losses: lost keys,

forgotten passwords, flooded bathrooms, etc.

• Make work more effective, learning process

faster.

• Help to create welfare and avoid poverty.

• Contribute to individual and society wide

benefits.

Arguments against PCE:

SAFETY: side-effects, addiction, too risky

COERTION: pressure to perform better

FAIRNESS: advantage in the competition

INEQUALITY: not everybody can assess

ALTERED PERSONALITY: boosted self-confidence

HUMAN NATURE: changed radically

PURPOSE OF MEDICINE: treat, prevent, enhance?

ACCOMPLISHMENT ARGUMENT: pride of own work

What do European societies value?

HUMAN RIGHTS and HUMAN DIGNITY

Autonomy, justice, equality, bodily integrity,

health, solidarity, freedoms, beauty...

European values is political and ethical but not

geographical concept.

When and if values clash, they can be ranked

(Hermeren, 2008).

Are we putting ban on PCE?

REASONED PRO-ENHANCEMENT APPROACH

REASONED RESTRICTIVE APPROACH

CASE-BY-CASE APPROACH

Economic Disincentives Model (Dubljevic, 2012)

Temporary committee/working group (Coenen

et al, 2012)

Reasoned pro-enhancement

approach

Meets demands and desires for individual life

choices but not at public expense.

Reflects on changing socioeconomic framework.

Does not necessarily promote the use of PCE but

encourage open public debate.

Shifts from tacit PCE use to a culture of open

use.

Allowing research sets foundations for safety

and quality standards.

Individual Institutions Society

Research Safety

Efficacy

Quality

Knowledge

Clarified

expectations

Transparency

Communication

Public discussion Limits coercion

Helps to establish

fairness in usage

and access

Openness about

usage

Institutional PCE

usage culture

Addresses

inequality issues

Deliberation

about the costs

The points to address when

drafting a policy on PCE:

Why clearer stand is beneficial?

Ensures equal access for all Europeans

Avoids enhancement tourism

Sets up unified safety standards

Safeguards safety and quality of technology

Protects vulnerable (children, students, elderly)

Helps to make informed choice

Defines misuse and abuse

Acknowledgements:

• P of. D . Osvaldas Rukšė as, D . G ita “kujie ė and Dr.Saulius Noreika at Vilnius University,

Lithuania

• Law, Philosophy and History Department at

Mykolas Romeris University, Lithuania

• Erasmus Mundus Master of Bioethics

Programme at K.U.Leuven, Belgium

• FOLSATEC team at European Institute of

Oncology in Milan, Italy

Thank you for your enhanced

attention!