Is Non-Prescription ADHD Medication Use Ever Ethical? 487
derekmead writes "College students' voracious appetite for study drugs like Adderall is widespread enough that it was one of the main topics of a marquee lecture on neuroethics at Society for Neuroscience's 2012 conference called 'The Impact of Neuroscience on Society: The Neuroethics of "Smart Drugs."' It was excellent stuff by Barbara Sahakian, faculty at Department of Psychicatry at the University of Cambridge. Her focus is on prescription drugs for diseases and conditions like Alzheimer's, attention deficit hyperactivity disorder, and depression, with the fundamental goal of understanding the neural basis of dysfunction to develop better drugs. Specifically, she wants to create drugs with no risk for substance abuse which means drugs that have no effect on dopamine. The true goal then of her research, fundamentally and briefly, is to repair the impaired. But doing so brings us to the discussion of how much repair is ethical when the repair can be disseminated to people who don't actually need it. Divisions abound on what is to be done. Some experts say that if people can boost their abilities to make up for what mother nature didn't give them, what's wrong with that? Others say that people shouldn't be using these drugs because they're designed for people with serious problems who really need help. So another question for the ethicists is whether cognitive enhancers will ultimately level the playing field or juice the opposing team."
Is this different from sport? (Score:4, Insightful)
Just like steroids in sports right?
Need to seperate off-label from non-prescribed use (Score:2, Insightful)
Re:Is this different from sport? (Score:5, Insightful)
No, it's not nearly the same thing as steroids in sports today. Steroids are used to gain an advantage in an playing field kept as level as possible through external rules and a large suite of referees watching every move, in order to maximize the entertainment value. But this is about life, where the playing field is never level, the rules are far more vague, and enforcement all but non-existent.
In school, the idea is that these drugs improve your grades. But that might mean you remember "more", or somehow end up "smarter" than you would have otherwise. You might go be a more productive member of society. What if these drugs make the difference, enhancing someone enough to recognize a novel cure for some horrible disease, or design a new class of CPUs, or a new energy source?
Many of us spend our livelihoods trying to enhance human knowledge and experience and abilities through improved software. Hell, half of us would sign up today for an internet implant chip. What's wrong with improving the wetware directly?
I've been taking Adderall for almost 13 years (Score:5, Insightful)
Studies show that nothing is more effective at treating ADHD than stimulants and cognitive therapy does virtually nothing without drugs. Furthermore, people who control their ADHD with medication are FAR more likely to avoid substance abuse than if they leave their condition untreated. I'm sure everyone knows a really smart kid in high school who smoked their life away on weed and never made anything of themselves. I know that I personally would have probably gone this route, as I was already heading in that direction. Finally, stimulants like Adderall haven't been shown to have any real long term health consequences and (contrary to popular belief) are not particularly addictive if taken as directed.
Anyone who has been to college in the past decade can tell you that Adderall can certainly help you cram for tests. Does that mean it gives them an advantage? I really don't think so. I've crammed for a lot of tests, and unless you're a business or mass communication major, you are not going to get an A by cramming. Try cramming a month's worth of organic chemistry in one night with some Adderall. You'll probably pass, but you definitely aren't getting an A. People get A's on tests by keeping up with the work. Not to mention the horrific day you have after cramming all night on speed. The biggest advantage I saw with Adderall was playing Quake 3, and even then there were people a lot better than me that used nothing but Mountain Dew.
I guess what I'm saying is that I think that people are overestimating the power of stimulants. Their biggest advantage is that you can stay up later, but if you don't take the drug regularly, you will also not be able to get to sleep. You'll also not eat enough and will probably have issues with sexual dysfunction. If that sounds like an unfair advantage to you, I don't know what to tell you.
Re:or, (Score:5, Insightful)
Now in the "real" world, I realise how handicapping this affliction is, where I'll take an hour to write a 2-sentence e-mail, and where I can't read through a research paper without taking a break every 2 minutes. Unfourtunately I now live in a country where Adderall is illegal, and the country I lived in before doesn't recognize ADD/ADHD in adults. There are people with worse problems, but it's still extremely frustrating to have the attention span of a goldfish.
As an aside, the best way I've found to deal with the problem is to say things out loud as I do them, I think that somehow the speech centers of the brain help with concentration (though I still tune out quite frequently in conversations). I'm less than comfortable about doing that with my coworkers though.
What's the definition of "impaired"? (Score:4, Insightful)
What's the definition of "impaired"? I have always had a terrible memory. In college, I would study the material when it was taught. When the tests came around, I had to basically re-learn the material from scratch. And re-learn it again for the final exam. While I was a top student, I looked on with amazement when other students could retain stuff after learning it the first time. Is a lousy memory an impairment? I don't know, but I would certainly have been ecstatic to be able to swallow a safe, non-addictive pill and get a decent memory.
Let's set any PC idiocy aside. If one can avoid addiction and side-effects, there is absolutely nothing wrong with enhancing people's cognitive abilities. Why should there be?
Show me a Smart Drug... (Score:4, Insightful)
... and I'll show you a misleading marketing campaign worthy of a Presidential election.
Ain't no such thing yet. Possibly never will be. Prescribing neuroactive drugs now is like playing darts blindfolded.
Re:I know a simple solution: (Score:5, Insightful)
"We employ people for industry. Welders, electricians, mechanics, etc. to build or repair mining machinery, among other things. Some work sites do mandatory drug testing."
I can understand it if you are operating heavy or otherwise dangerous machinery, or you're a bus driver or something. But other jobs? I mean, you have companies out there insisting on pre-employment testing for grocery store boxboys and people who wash and stock produce, or do laundry! And in the computer business? Forget it.
I vowed long ago that I would never take again take a pre-employment drug screening, or agree to random testing. I am sick and tired of this "guilty until proven innocent" bullshit. If I worked for a company and they had GOOD REASON to suspect that I was taking illegal drugs on the job, that would be one thing. But treat me like I'm guilty without any reason or evidence? Hell, no!
And yes, I have passed up several jobs because of this.
I have made one exception since then, but only because the employer convinced me that the parent corporation left them no choice in the matter. Even then I was reluctant.
There is one other exception I am willing to consider. In an office setting, if ANYBODY is going to screw things up by making a drug-addled decision, it's far more likely to be a manager or corporate officer than some clerk or programmer. So my policy is: if the managers will piss in a cup and show me the results (or show me recent past results), I will do the same.
I think that's very fair.
Re:Is this different from sport? (Score:3, Insightful)
You're implying that school is somehow a competition. It is not. School is about learning.
Re:Highly unethical. (Score:5, Insightful)
I can't imagine a world where perfectly healthy people feel the need to take addictive stimulants just to help them focus throughout the day.
You joke, but it's a serious problem. We have the fewest number of vacation days of any industrialized country, poor health care, and many of our poorer citizens work north of 50 hour work-weeks, some with two jobs, others balancing college and a full-time job (and still wind up hundreds of thousands in debt from student loans). We are literally working ourselves to death -- obesity rates are skyrocketing, and the average person consumes 2.25 cans of soda per day. Frankly, it's worse for you than smoking -- each of those cans is 130 calories, and then it amps your metabolism and simultaniously acts as a dieretic so your appetite increases. I read something about how the average American consumes something like 2,800 calories per day. My weight and build puts my daily consumption at around 1,500 calories a day... which means the average person consumes 86% more food than I do. And we pack in the stimulants, along with the pounds. Then to top it off, we don't get enough sleep because of our LCD screens, 26 hours of TV a week... our lifestyles are killing us.
Now, I have severe ADHD. I've been tested repeatedly by neuropsychologists, and there is no question I have it. I have to take it just to keep pace with this "Type A with rabies" culture I live in, and it isn't easy. The side effects aren't terribly pleasant either -- shaking, insomnia, anxiety... I can't understand why someone would want to deal with these effects unless they had to. People, strong stimulants aren't fun. They will give you energy, but at a cost -- the candle that burns twice as fast burns half as long. I have to take it, and it's expensive. And I don't take it on the weekends, or vacation, etc. I take as little as I can functionally get away with.
Please guys, I'm telling this to you as someone with the attention span of -- oh look, a kitty -- life is too short. Don't take medication you don't need. Please. It isn't worth it. You're young, and stupid, and your body can tolerate it now... but you're wearing it out faster, and it's for stupid silly shit that twenty years from now, you won't care about. Stop being obedient slaves and putting in 60 hour work weeks. Stop working yourself into an early grave. Go out, see friends, see family. Leave work in the office... don't take it home.
Drugs without side effects are like unicorns -- they don't exist. They all have risks. I have a cousin right now who's a pain pill junkie. They were prescribed by her doctor. She was told they were safe, and the addiction crept up on her slowly. Now, she's on parole for five years after getting so doped up she didn't know her head from her ass -- all on legally prescribed drugs at the doses prescribed by competent physicians -- and she did something stupid. And the thing is, she got out and went right back to doing it. Stimulants do the same thing to some people -- everyone has their drug of choice. Everyone. Not everyone has found it yet.
Now I'm not against recreational drugs; It's your choice. And if tomorrow they decided to hand out bottles of Adderall and Ritalin next to the aspirin, I wouldn't complain. It's your life, it's your body, it's your choice. But please people, think. Think long and hard about whether finishing that TPS report is really worth the extra minutes off your life, the high blood pressure, the sleepless nights, and the cold sweat when you're so amped you feel like there's a strange presence in the room with you, watching. Just ask yourself that. Choose well.
Re:Is this different from sport? (Score:5, Insightful)
What's wrong with improving the wetware directly?
Your brain isn't a computer. You can't just upgrade the processor and it works 20% faster from that point on, but otherwise does the exact same stuff. Anytime you tweak something in a brain, any brain, you're making a tradeoff. You're getting one thing by giving up another. Millions of years of evolution have figured out the most efficient way to balance survival, intelligence, and metabolic conservation. You start tweaking that on your own, and while you might get something you want, and may not notice a downside right away -- eventually, one will become apparent. And it could be irreversible.
There was a drug used to treat anxiety a number of years ago... and it's still on the market... and some patients who were taking it had their symptoms re-appear (shaking, nervous facial tics, etc.)... so the doctors thought the underlying pathology had worsened and increased the dose. And this went on for several years -- the dose levels creeping slowly upwards to combat the apparently chronic and worsening underlying disease. And then one day, someone noticed a correlation: For this subset of patients, the drug was simultaniously the cause of, and the cure for, muscle twitching. And when the patients were taken off the drug, the symptoms were unbearable to watch... they'd flop about like a fish out of water. As it turns out, the drug turned what had been a mild problem into a permanent and severe neurological condition.
So the next time you get the notion in your head that tweaking your brain with chemicals, wires, magnets, or whatever else you happen to read about: Remember the law of unintended consequences. In biology, there is always a price to pay. Every evolutionary step is a tradeoff. Every. Single. One.
Re:Is this different from sport? (Score:1, Insightful)
Fully actualized humans alter their brain and body chemistry all the time. Astronauts do it. Fighter pilots do it. Doctors do it. Athletes do it.
The problem comes when people who aren't fully actualized do it. They are't able to discriminate between productive and unproductive use. They become dependent, and atavistic.
How do we protect them from themselves without giving up the powerful benefits chemistry gives the rest of us? Should there be some sort of test? And who to administer it? Doctors are proven unworthy of this responsibility. Lawyers and their judge kin were never even suspected of being capable for so important a role.
The answer is obvious. Actualized people know that rules are for others. Fully actualized people can handle the responsibility themselves. For the semi-actualized there are Darwin and the criminal justice systems. Life can be cruel that way. It is in our nature to o'erreach our grasp.
Re:Is this different from sport? (Score:5, Insightful)
Millions of years of evolution have figured out the most efficient way to balance survival, intelligence, and metabolic conservation.
True but the environment that they have optimised us for is the one that we were in during the Stone Age. Evolution is great at optimising but very slow to adapt to changes which is why we are so successful as a species: our intelligence lets us adapt far faster than evolution.
That being said, while I have no objection in principle to intelligence enhancing medication, in reality the problem is that while the short term effects can be easily determined the long term effects are far harder to figure out. So, just like sport, you do not want to end up with people being forced to take drugs to compete which may have deleterious long term effects.
Re:Is this different from sport? (Score:4, Insightful)
It should be, in practice it's becoming a place where smart private companies auction off magic pieces of paper called "diploma" that demonstrate your membership of some fancy/shmansy semi private club.
Re:Is this different from sport? (Score:5, Insightful)
The drawback is, like steroids, side effects. Do we really know what happens, in the long term, to our brains, the more we ingest these drugs? Personally, fuck it - I don't care. I already know that I have only so many days here in this existence. However, while I'm here, I want to perform as best I can, even if it means I cut short my existence by 10 to 20 percent. I'm willing to pay that price. More better drugs, please...
Re:Is this different from sport? (Score:4, Insightful)
What's wrong with improving the wetware directly?
Your brain isn't a computer. You can't just upgrade the processor and it works 20% faster from that point on, but otherwise does the exact same stuff.
Why not stick with that analogy... Your brain is the CPU that's soldered into the iPhone of your body. if it's damaged, you wasted your body and live. You may be able to overclock it by 20% with drugs - but did you remember to improve the cooling by... well.. how many percent is save? You only have one try.
Re:Is this different from sport? (Score:3, Insightful)
Many of us spend our livelihoods trying to enhance human knowledge and experience and abilities through improved software. Hell, half of us would sign up today for an internet implant chip. What's wrong with improving the wetware directly?
The rules are different, but the problems are the same as in sports with steroids. They start to arise when us others, who for various reasons don't want sign up for "improving the wetware directly", don't have any possibility of leaving normal lives anymore. You want super-powers. That's fine. But first move our society away from competitive living to just living. Take away the "winner takes it all" mentality, so you can have your drugs while I won't have mine.
Why? Because "winning" defined as who's better at "enhance human knowledge and expirience and abilities", "being smarter", "be productive", recognize a novel cure for disease" is just as random as "being a better entertainer at sports" -- life, as we live it, is still a game with a relatively level playing field imposed by society. The ruleset may be a lot more complex than sports, but still it has it's own rules and enforcements. Otherwise, in the absence of rules and enforcement, what would stop me from killing your drug-pumped, better-graded child, in order for my clean, very smart, but slightly less-performant kid to have a chance for University later on, too?
Now, we can argue whether society is such a good concept to have or not, but this is a different debate. At any rate, as long as we have one, we need to make sure that every member of society has a decent chance, not only those who would readily put their long-term health at risk for being more productive. (How much "productive" do you actually need, really, that cannot be archived otherwise? And for what, exactly?)
Re:Is this different from sport? (Score:5, Insightful)
Sorry but what?
As far as I know brain workings are still experimental, but you are saying that there always has to be a negative along with a positive. That somehow doesn't sound correct, in fact it sounds more like intelligent design than evolution. Evolution isn't smart, it just randomly affects things, some things work, some don't it doesn't have a mind to "balance" anything. Saying that there has to be a trade off for getting the mind to operate better, is the same as saying, we shouldn't cure cancer because people will just die of something else. Or even, we shouldn't educate people because we will suppress their own natural intelligence.
As to the main article, personally I couldn't care less if others are able to make themselves smarter, having more people smarter than me would be a boon. I assume the article is trying to say that norms shouldn't be taking drugs because it gives them an unfair advantage, but I would think the only people that would care about that are those that want to compete with others and probably unfairly. I don't care if John is smarter than me, if he is more productive, doesn't that help me in the long run?
Insecure is more like it. (Score:4, Insightful)
I don't see any reason to believe those people are "fully actualized." Why would someone who is "fully actualized" see the need to alter their body chemistry in order to enhance their "performance," in the face of potential harmful side-effects. A fighter pilot, maybe, in order to stay awake, but those others don't really need them. This whole conversation reeks of insecurity. Most of these uses are really no better than the "male enhances" they sell at conveince stores. Only someone who's insecure has that much trouble accepting their limitations.
Re:Insecure is more like it. (Score:2, Insightful)
Nonsense. (Score:5, Insightful)
Of course its not unethical. Its your body, you have the right to do what you want to it.
Steroids in sports aren't unethical either. Lying about using them in order to game the system is what makes steroids an ethical issue, not their consumption. People need to stop telling other people what to do with their own bodies and mind their own fucking business.
Re:Insecure is more like it. (Score:4, Insightful)
That's a tool and the risks and advantages of it are well understood. What's not well understood are the consequences of screwing around with brain chemistry. It's tolerable when it comes to treating ADHD because there aren't many options and the dosage is generally low. Along with that people are generally monitored to make sure that nothing is obviously going wrong.
Plus, the people that get treated usually aren't responding to other forms of treatment and the alternatives tend to be much less desirable than possible damage due to taking low doses of stimulants over long periods of time.
With a step ladder there are things not to do like not standing on the top rung and making sure to have it well braced. If it's a tall one then you'll want to have somebody bracing it and such.
Re:Is this different from sport? (Score:5, Insightful)
-1 Smug (actually -2 for using "o'erreach" previously)
Maybe I'm just so actualized that I don't need to bother with ill-defined psychobabble to enable my life script and keep myself from declining into a shame spiral.
Actualized people know that rules are for others.
Ah! Psychopaths.
Re:Is this different from sport? (Score:4, Insightful)
Re:For a view from the other side... (Score:4, Insightful)
Philip K. Dick has an interesting note on drug use at the end of A Scanner Darkly. Basically he says that he and all his friends did drugs left and right because it was fun. He then goes on to explain the consequences of their actions. While he may have writtena number of brillient and insightful books, his life was not one I would want to have.
Phillip K. Dick's actuall thoughts on drug use [american-buddha.com]
Re:Is this different from sport? (Score:4, Insightful)
"Fuck "fair." "
Exactly! First comes the feeding, then the ethics.
Unfair doesn't have to be unethical. There are several different colleges, some better than others. These also vary by cost. My parents may have helped with the cost of the college where another student's parents did not. This is clearly unfair, but not unethical.
If everything had to be "fair", then wouldn't a countries resources have to be be equally distributed to all people that live there? I couldn't even say citizens of the country, as that would be unfair to the non-citizens that live there. Now, for the rhetorical part of this, doesn't this make it unfair to take more money from one person than another to insure that it's fair for everyone? E.g. professional skills/labor pay more/contribute more than unskilled labor.