  In
1932's Brave New World, Aldous Huxley describes
soma, the wonder drug everyone in the future is popping,
as having "all the advantages of Christianity and alcohol;
none of their defects." Three articles in the September
28 issue of Neurology explore how close we've inched
toward a Huxleyesque future � it remains to be seen if
it will be a utopia or a dystopia. In the section, several
eminent neurologists discuss the future of so-called 'cosmetic
neurology' � the use of neurological treatments to improve
the mood, cognition, attention, memory or motor skills
of people who are not ill.
FITTER,
HAPPIER, SMARTER
Humans have been on a never-ending quest for wonder
drugs � without "defects" � to help us when we're ill,
or for some brave souls, medicate our cares away and
make us fitter, happier or smarter. For the moment,
though, the fact is most of the treatments available
to us have undesirable side effects, so we tend to avoid
them unless we're sick. Moreover, existing drugs only
have the potential to restore us to normal health, not
to improve us beyond that point.
But what if that situation were
to change? What would be the doctor's moral prerogative
if risk-free drugs that could make healthy people fitter,
happier or smarter than ever before were developed?
If the Neurology authors are anything to go by,
it's high time we started exploring these questions.
ENHANCED
PERFORMANCE
Enhancement medicine is already a reality, and it goes
far beyond breast implants. Growth hormones are now
regularly given to children within the normal height
range and athletes take human erythropoietin, among
other things. Military pilots already take amphetamines;
Alzheimer's drug donepezil has been shown to improve
their performance in emergency simulations.
All those drugs carry side effects,
and so we disapprove of their use in healthy people.
But remove the side effects and what happens to our
objections? Botox injections, a clear case of cosmetic
neurology, became universally available as soon as they
were proven safe.
The Neurology authors make
the claim that future interventions are likely to be
more than skin deep. One of them, Dr Anjan Chatterjee
of the University of Pennsylvania, argues in his "Cosmetic
neurology: the controversy over enhancing movement,
mentation, and mood" that recent developments in the
treatment of dementia and other neurological disorders
are likely to produce therapies capable of enhancing
the performance of healthy people.
MEMORIES
ARE MADE OF THIS
Dr Chatterjee mentions two new classes of drugs on the
horizon, both designed to improve memory. Ampakines
are thought to facilitate the acquisition and consolidation
of new memories, a potential that has been confirmed
in rat and human studies. They work on the brain NMDA
receptors, but Dr Chatterjee points out that these receptors
could also become the direct target of genetic modification.
The other new class of drug, CREB
modulators, work on cyclic AMP response element binding
protein. Evidence suggests that these drugs may help
fix normal memories while selectively clipping emotionally
charged or negative memories. Studies have shown that
an existing drug, propanolol, can also potentially enable
people to remember traumatic events without emotion.
Few would argue against using such a drug to prevent
debilitating post-traumatic stress, but what about less
disturbing memories?
MORAL
SNOWBALL EFFECT
In an accompanying editorial in the same issue of Neurology,
Professor Richard Dees of the University of Rochester,
NY, asks whether, if we are the sum of our experiences,
we diminish ourselves by suppressing some of those experiences.
In particular, if we have medicated suffering out of
our own lives, how can we empathise with those who do
feel pain?
Dr Stephen Hauser, a neurologist
at the University of California, San Francisco, who
also contributed an editorial to the Neurology
debate, worries that a free-for-all in neurologic enhancements
would extend to the unborn fetus. "If one could predict
that an embryo has a 30% chance of developing multiple
sclerosis, is termination ethical?" he asks. "Even more
difficult, what about embryos in which the inherited
component of intelligence falls at the low end of the
parents' gene pool?"
CAREFUL
WHAT YOU WISH FOR
Dr Chatterjee calls on his colleagues to start thinking
about these issues before someone else decides for them.
But he believes any objections neurologists raise will
be swept aside by a combination of capitalism, military
expediency, and the personal vanity and competitiveness
of the average human. Then there's the socio-economic
ethics issue: since cosmetic neurological drugs are
unlikely to be paid for by the state, the prospect opens
before us that rich people might become smarter and
stronger than everybody else. Are we really ready for
a race of super Oprahs and Bill Gates?
"Such questions are not simply
thought experiments," argues Dr Chatterjee. "Patients
and advocacy groups encouraged by direct advertising
to consumers will raise them. How will you respond to
these 'patients' when they turn to you as the gatekeeper
in their pursuit of happiness?"
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