Smart thinking

If you were taking an important exam and knew that one small pill could sharpen your thinking, would you be tempted to take it?  A new book raises awareness of the ethical dilemmas we face as the result of advances in technologies for understanding the functioning of the brain and medications developed to treat mental disorders. In particular, the book addresses questions that arise when technologies and treatments developed for a closely-regulated clinical setting are more widely adopted and used for a whole range of non-medical purposes.

The publication this month of The Oxford Handbook of Neuroethics, edited by Barbara Sahakian, Professor of Clinical Neuroscience at Cambridge University, and Judy Illes, Professor of Neurology at the University of British Columbia, coincides with the release of the film Limitless, which tells the story of a struggling writer who takes a pill to boost his brain. He finishes the novel he has barely started in just four days and embarks on a dizzying upwards trajectory, only to find his grip on reality unravelling.  The storyline vividly illustrates the human temptation to enhance performance in a competitive world, with any qualms about long-term side effects swept aside in the quest for short-term gain.

The Oxford Handbook of Neuroethics, which is divided into themed chapters contributed by leaders in their fields, is the first ever book to comprehensively address the intersection between specific neuroscientific advances and society. Professor Sahakian says: “There is a real need both to discuss these big questions raised by developments in neuroscience with the public, as they begin to filter into the non-medical world, and to give young neuroscientists a foundation for thinking about, and communicating, some of  issues which they may confront in their own research.”

The brain was largely undiscovered territory until the advent of neuro-imaging, which revolutionised our ability to look inside the brain of living people and see it in action. The expanding field of neuroscience, which brings together a wide range of research strands from the study of cells to the study of entire nervous systems, has led to huge strides in our understanding of the brain and mind. Neuroimaging showed that distressing conditions such as early stage Alzheimer’s disease and schizophrenia were associated with changes in the brain.

A generation of treatments were developed for these disorders – for example antipsychotic medication to prevent psychosis. When it was realised that people experiencing disorders such as schizophrenia and attention deficit hyperactivity disorder (ADHD) often had significant cognitive problems, which affected their ability to concentrate, exert cognitive control and remember things, neuroscientists began developing drugs to combat cognitive disability resulting from these neuropsychiatric disorders. Treatments for the symptoms of neuropsychiatric disorders such as Alzheimer’s disease and ADHD are currently available and include Aricept and Ritalin. For many people these drugs are a lifeline, allowing them to live fuller and more rewarding lives compared with the past.

But what happens when healthy people begin to make use of these same drugs? Limitless is set in today’s trendy loft-living New York – and the plotline has a disquieting ring of authenticity. Ordinary people, like the lackadaisical character played by Bradley Cooper, are already using some of the smart drugs developed to treat disorders. The drug modafinil, developed to treat narcolepsy, is easily obtained over the internet from overseas sources. Shift workers use it to cope with sleep disruption, students take it to sharpen their intellect, party goers use it to enable them to work hard and play hard. Yet no-one knows what effects long-term use of modafinil has on the brain.

Recent research in the US shows that Ritalin, first introduced to treat children with attention deficit hyper-activity disorder (ADHD), is taken by as many as 16 per cent of college students in order to improve their concentration and to allow them to work longer and later. You could argue that people have always used drugs as a pick-me-up or to relax: coffee, tea, alcohol, nicotine all fall into this category. So should we be wary of entering new territory with widespread use of smart drugs?

Professor Sahakian was instrumental in conducting proof of concept studies for the cholinesterase inhibitors, drugs such as Aricept, as a treatment for Alzheimer’s disease. She is concerned about healthy people accessing these smart drugs, such as Ritalin and modafinil, over the internet. She says: “By obtaining drugs over the internet you are taking a huge risk. Not only do you not know exactly what you are purchasing but you also do not know how the drug will affect any other condition you might have, such as high blood pressure, or how it will react with any other medication you might be taking.”

Advanced neuro-imaging technology can now tell us a lot about an individual’s brain. In research carried out in The Wellcome Department of Imaging Neuroscience in London, scientists were even able to detect intention in the brain even before the individual concerned was aware of having made a choice. In a medical setting, this level of understanding may eventually help clinicians look at the brain function of people in a vegetative state – and thus help families make difficult decisions about their life support.

Transfer this technology into other environments and the waters become muddier. Take the legal system: in the context of a court case, neuroimaging technology might be used to show if an individual is likely to be lying or not, or whether he or she has abnormal brain function that might explain their criminal behaviour. Information obtained by a brain scan could be used by the defence to argue that someone is not responsible for their actions. Equally it could be used by the prosecution as evidence of guilt.

Already a company based in the US is offering brain scan technology that promises to detect whether an individual is telling the truth or lying. In India, the use of brain mapping and truth-serum, which were being used by courts in some states, was banned by the Supreme Court in 2010.

Subliminal marketing techniques are well-established: the aroma of fresh coffee in the supermarket, the clever placing of products in movies. Now the savviest advertising agencies are employing neuro-marketing to give them access to our innermost responses to the products they want us to buy. Neuro-marketing harnesses brain imaging to show the workings of the subconscious mind. In this context, brain-imaging is a powerful commercial tool, giving an edge over the competition. But is it ethical for companies to tap into our gut feelings and exploit our vulnerability to subliminal messages?

We’ve always known roughly how advertising and branding works – and the public are pretty wise to marketing ploys. But when it comes to marketing that relies on brain scans, we are talking about something that’s a lot more personal. “In this context, brain-imaging may in the future become a powerful commercial tool, giving an edge over the competition. But is it ethical for companies to tap into our gut feelings about our preferences and to access our views without our explicit stating of them?” asks Professor Sahakian.

Neuroscience undoubtedly brings us huge benefits in terms of health and wellbeing. Whether we like it or not, developments in understanding the brain will be exploited by those working in non-medical fields. An informed debate about the ethical issues that surround the use of technologies and treatments developed as a result of research into neuroscience is vital to increasing public awareness of both the benefits of these advances and how they can be used as tools to analyse or manipulate human behaviour.

Professor Sahakian concludes: “Neuroscience is of growing importance in the 21^st century given the rapid technological advances in this area and their impact on society. For example, neuroscience is critical in the understanding of the brain in health and disease and in developing more accurate diagnosis and new treatments across the lifespan. However, we need to ensure that these new advances in neuroscience are used for maximal benefit with minimal harm and hopefully produce improvements for humanity in the future.”

The Oxford Handbook of Neuroethics, edited by Judy Illes and Barbara Sahakian, is published by Oxford University Press, 7 April 2011.