Today’s edition of Nature has some commentary from scientists responding to their recent feature on ‘optimising’ the healthy brain with pharmaceutical drugs.
I suspect the letters have been edited a little though, as the first, from developmental psychologist James M. Swanson and neurobiologist Nora Volkow (who is also director of the National Institute on Drug Abuse) seems to suggest that enhancement drugs risk being addictive because:
…cognitive enhancers such as the stimulants methylphenidate (Ritalin) and amphetamine amplify the activity of dopamine, a neurotransmitter that increases saliency, making cognitive tasks and everyday activities seem more interesting and rewarding. This learned experience can lead to abuse of the drug and to compulsive use and addiction in vulnerable people.
These drugs are widely used for cognitive enhancement, but the issue is hardly new as these are relatively old drugs that almost solely target the dopamine system, whereas the newer ‘cognitive enhancement’ drugs (most notably modafinil) work in a quite different way (modafinil alters dopamine, among other effects, but it’s hardly comparable).
Hence, they do not have the same pharmacological potential for abuse and simply aren’t found to be as addictive as the amphetamines in the ‘real world’.
In fact, when the Nature article asked the hypothetical question whether you would take an enhancing drug if it had no side effects, it was almost certainly inspired by modafinil.
While the drug isn’t side-effect free (several are common) it tends to be significantly less risky than your typical high-charge dopamine agonist such as amphetamine, which can cause cardiovascular problems and psychosis to name but a few of its dangerous effects.
That issue aside, one of the most interesting points is made in a letter from philosopher Nick Bostrom who argues that drug companies should be allowed to develop enhancement drugs without having to specify an illness to treat.
He argues this is because the current system demands that drugs are licensed for a specific disorder, which means new disorders get invented (‘disease mongering‘) as a way of legitimising the sale of drugs which are helpful but for less serious problems of living, such as low-level anxiety, persistent tiredness or normal memory decline, but are not significant medical treatments.
So maybe the solution to the drug companies warping medicine is to allow them to sell drugs as ‘tonics’, rather than medications. Certainly food for thought.
There’s several other responses on the ethics and experiences of cognitive enhancement from some of the leaders in the field, so well worth a look through.
Link to ‘brain doping’ correspondence in Nature
Mind Hacks 
I don’t agree with the idea of selling “tonics.” Without a specific purpose for a drug, people may take unneeded substances. If these mind-enhancing drugs are sold over the counter, people may run into problems with allergic reactions and drug abuse that would otherwise be dealt with or prevented through prescriptions/recommendation from a doctor.
Enhancer drugs would have specific purposes rather than being good for everything. Most enhancements would likely involve trade-offs: something that improves attentional focus is likely to reduce peripheral awareness, making them great for academic work but very bad for driving. Using the right enhancer for the right task is going to require not only medical studies, but also the development of an “enhancer culture” of popular experience with what works and what doesn’t. A bit like how people today use caffeine.
Prescription enhancers might be a good idea for some drugs (Nick’s point is that today it is not possible to prescribe drugs for enhancement). One can also borrow the idea from the current trials in the UK with over the counter Viagra: customers are screened for the big contraindications, and if they want to use the drug for a longer while they are given medical check-ups. This both keeps them safe and provides medical data.