- The Washington Times - Sunday, August 24, 2008

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 40-hour 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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