A fu­ture filled with pill pop­pers . . .

The Washington Times Weekly - - Commentary -

The year is 2018. You wake in the morn­ing and take Sun­rise, a mild stim­u­lant pill that erases the foggy feel­ing of slum­ber. Be­fore go­ing off to work or school, you take your mem­ory-boost­ing pill and your at­ten­tion-en­hanc­ing pill, and, if it is the first day, a cal­ma­tive to keep your sweaty palms dry.

Right be­fore com­ing home af­ter your hec­tic day, you take Sub­lime, the pill that calms you and puts you in a serene mood so you will be cen­tered and peace­ful when you walk back in the door to greet your fam­ily. Fi­nally, as night falls, you take Sleepex, a new drug that keeps you awake and re­freshed with only four hours of sleep a night.

If my ex­pe­ri­ence as a so­cial sci­en­tist and ethi­cist are any mea­sure, some peo­ple will read the above para­graphs with de­light. How won­der­ful it will be to lose less time to sleep, to be able to mem­o­rize son­nets or box scores, to put the wor­ries of a high-pres­sure job com­pletely be­hind you when you get home!

Oth­ers will read it with a kind of dread, see­ing phar­ma­ceu­ti­cally en­hanced work­ers la­bor­ing un­der a new kind of hu­man servi­tude, de­pen­dent on drugs that in­crease com­pet­i­tive­ness, re­move in­cen­tives to im­prove our­selves through hard work and turn us into en­hance­ment junkies.

Hu­man be­ings have al­ways looked for nat­u­ral sub­stances to al­ter their men­tal func­tion­ing. We may even have a nat­u­ral, in­nate de­sire to vary our states of con­scious­ness.

Take stim­u­lants, for ex­am­ple. Al­most ev­ery cul­ture has dis­cov­ered one or two that were com­monly in­gested; in the Amer­i­cas, na­tive cul­tures used chocolate, mate and guarana to get their doses of caf­feine, coca leaves to en­hance at­ten­tion and en­durance for trav­el­ing or hunt­ing, to­bacco for the stim­u­lat­ing ef­fects of nico­tine.

Of course, na­tive cul­tures did it the right way; coca leaves are nour­ish­ing, non­ad­dict­ing and only give a mild stim­u­la­tion. Co­caine, on the other hand, is a highly stim­u­lat­ing, highly ad­dict­ing and danger­ous sub­sti­tute. The same with to­bacco; na­tive cul­tures would chew it or take a puff or two, not smoke two packs a day.

Now, we have a new class of phar­ma­ceu­ti­cals in de­vel­op­ment. On the mar­ket al­ready are stim­u­lants, such as modafinil (mar­keted as Provigil) that en­hances at­ten­tion but which, un­like am­phet­a­mines, does not in­crease heart rate and blood pres­sure and is non­ad­dic­tive.

Mil­lions of Amer­i­can chil­dren are on Ri­talin or other psy­chotropic drugs, and one study showed that up to 20 per­cent of col­lege stu­dents used pre­scrip­tion stim­u­lants to help them study for ex­ams. Beta block­ers are pre­scribed to stage per­form­ers and ner­vous brides and grooms to set­tle them be­fore the big day. Com­ing down the pike are mem­ory-en­hance­ment pills (al­ready in clin­i­cal tri­als), mem­ory-sup­pres­sion pills (pro­pra­nolol is al­ready be­ing tested for that pur­pose), pills that en­hance the brain’s ex­ec­u­tive func­tion­ing (de­ci­sion-mak­ing, judg­ment), and pills like Donepezil, an Alzheimer’s treat­ment, which has a wide range of ef­fects, in­clud­ing in­creas­ing con­cen­tra­tion, mem­ory and the abil­ity to learn.

Dan­gers lurk in the ca­sual use of such sub­stances, how­ever. First, very few drugs are as ef­fec­tive or safe as they first ap­pear; there seems to be a bub­ble ef­fect, where peo­ple re­port that newly re­leased drugs are highly ef­fec­tive, but as the nov­elty wears off, so does con­sumer sat­is­fac­tion (Vi­a­gra is a case in point).

The long-term safety of phar­ma­ceu­ti­cally en­hanc­ing our brains in th­ese ways is un­known. Also, things we value can be lost in the rush for phar­ma­ceu­ti­cal so­lu­tions. If I try to cen­ter and calm my­self us­ing yoga and ther­apy, I learn a dis­ci­pline, I learn things about my­self, I might have col­lat­eral ben­e­fits such as lower blood pres­sure and a more flex­i­ble body. If I take Sub­lime, I may be calmer, but I lose all those other pos­i­tive ef­fects.

More im­por­tant, the temp­ta­tions to use en­hancers in the work­place will be great. Right now, Amer­i­cans work longer hours and take fewer va­ca­tions than peo­ple in most other West­ern so­ci­eties. How much more can we work? If pills al­low us to sleep four hours a night, do we use stim­u­lants to turn our 40hour weeks into 60-hour weeks, and our 60 into 80? Will there be work­place pres­sure to use phar­ma­ceu­ti­cals to en­hance per­for­mance?

Will cog­ni­tive and mem­ory en­hancers start a phar­ma­ceu­ti­cal arms race, with busi­nesses and coun­tries try­ing to outdo each other with stronger and longer last­ing brain pills? And if some par­ents are al­ready push­ing Ri­tal­i­non on lit­tle Johnny, what will hap­pen when mem­ory pills hit the mar­ket?

The dilemma is al­ready upon us. A se­ri­ous con­ver­sa­tion must be­gin in our so­ci­ety, ex­am­in­ing our val­ues around en­hance­ments and con­sid­er­ing ap­pro­pri­ate lev­els of reg­u­la­tion. We may all be pop­ping pills in 2018, but if we do, it should be through a con­sid­ered ex­am­i­na­tion of what kinds of peo­ple we want to be, not sim­ply be­cause the pills are there and every­one else is tak­ing them.

Paul Root Wolpe is the Asa Griggs Can­dler pro­fes­sor of bioethics and the di­rec­tor of the Cen­ter for Ethics at Emory Uni­ver­sity.

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