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Cognitive Enhancement: Methods, Ethics, Regulatory Challenges

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Abstract

Cognitive enhancement takes many and diverse forms. Various methods of cognitive enhancement have implications for the near future. At the same time, these technologies raise a range of ethical issues. For example, they interact with notions of authenticity, the good life, and the role of medicine in our lives. Present and anticipated methods for cognitive enhancement also create challenges for public policy and regulation.
CognitiveEnhancement:Methods,Ethics,
RegulatoryChallenges
(2006)
Nick Bostrom
Anders Sandberg
Future of Humanity Institute
Faculty of Philosophy & James Martin 21st Century School
Oxford University
[Science and Engineering Ethics, 2007, forthcoming]
[www.nickbostrom.com]
Abstract
Cognitive enhancement takes many and diverse forms. In this paper, we survey the
current state of the art in cognitive enhancement methods and consider their prospects for
the near-term future. We then review some of ethical issues arising from these
technologies. We conclude with a discussion of the challenges for public policy and
regulation created by present and anticipated methods for cognitive enhancement.
I.Introduction
Cognitive enhancement may be defined as the amplification or extension of core
capacities of the mind through improvement or augmentation of internal or external
information processing systems. As cognitive neuroscience has advanced, the list of
prospective internal, biological enhancements has steadily expanded.1 Yet to date, it is
progress in computing and information technology that has produced the most dramatic
advances in our ability to process information.2 External hardware and software supports
now routinely give humans beings effective cognitive abilities that in many respects far
outstrip those of our biological brains.
Cognition can be defined as the processes an organism uses to organize information. This
includes acquiring information (perception), selecting (attention), representing
(understanding) and retaining (memory) information, and using it to guide behavior
1 (Farah, Illes et al. 2004)
2 Advances in social organization have also enabled individual minds – through interactions with other
people’s minds – to become vastly more effective. Improvements in social organization that are not directly
mediated by technology lie outside the scope of this review.
1
(reasoning and coordination of motor outputs). Interventions to improve cognitive
function may be directed at any one of these core faculties.
An intervention that is aimed at correcting a specific pathology or defect of a cognitive
subsystem may be characterized as therapeutic. An enhancement is an intervention that
improves a subsystem in some way other than repairing something that is broken or
remedying a specific dysfunction. In practice, the distinction between therapy and
enhancement is often difficult to make out, and it could be argued that it lacks practical
significance. For example, cognitive enhancement of somebody whose natural memory is
poor could leave that person with a memory that is still worse than that of another person
who has retained a fairly good memory despite suffering from an identifiable pathology,
such as early-stage Alzheimer’s disease. A cognitively enhanced person, therefore, is not
necessarily somebody with particularly high (let alone super-human) cognitive capacities.
A cognitively enhanced person, rather, is somebody who has benefited from an
intervention that improves the performance of some cognitive subsystem without
correcting some specific, identifiable pathology or dysfunction of that subsystem.
The spectrum of cognitive enhancements includes not only medical interventions, but
also, as we shall see, psychological interventions (such as learned “tricks” or mental
strategies), as well as improvements of external technological and institutional structures
that support cognition. A distinguishing feature of cognitive enhancements, however, is
that they improve core cognitive capacities rather than merely particular narrowly
defined skills or domain-specific knowledge.
Most efforts to enhance cognition are of a rather mundane nature, and some have been
practiced for thousands of years. The prime example is education and training, where the
goal is often not only to impart specific skills or information, but also to improve general
mental faculties such as concentration, memory, and critical thinking. Other forms of
mental training, such as yoga, martial arts, meditation, and creativity courses are also in
common use. Caffeine is widely used to improve alertness. Herbal extracts reputed to
improve memory are popular, with sales of Ginko biloba alone in the order of several
hundred million dollars annually in the U.S.3 In an ordinary supermarket we find a
staggering number of energy drinks on display, vying for consumers hoping to turbo-
charge their brains.
Education and training, as well as the use of external information processing devices,
may be labeled as “conventional” means of enhancing cognition. They are often well
established and culturally accepted. By contrast, methods of enhancing cognition through
“unconventional” means, such as ones involving deliberately created nootropic drugs,
gene therapy, or neural implants, are nearly all to be regarded as experimental at the
present time. Nevertheless, these unconventional forms of enhancements deserve serious
consideration for several reasons:
3 (van Beek 2002)
2
They are relatively new, and consequently there does not exist a large body of
“received wisdom” about their potential uses, safety, efficacy, or social
consequences;
They could potentially have enormous leverage (consider the cost-benefit ratio of
a cheap pill that safely enhances cognition compared to years of extra education);
They are sometimes controversial;
They currently face specific regulatory problems, which may impede advances;
and
They may eventually come to have important consequences for society and even,
in the longer run, for the future of humankind.
In examining the challenges for public policy with regard to cognitive enhancement, it is
important to consider the full range of different possibilities that are becoming available,
and their different individual characteristics. From such a comprehensive viewpoint, the
inadequacies of some aspects of the current regulatory and policy framework become
apparent, as it treats different modes of enhancement differently even though, arguably,
there is no good justification for doing so.
One general caveat must be placed in front of the survey that follows. Many of the
cognitive enhancement methods being studied today remain highly experimental or have
small effect sizes. This makes the present scientific literature a weak guide to their
eventual usefulness4. Findings need to be repeated in multiple studies and larger clinical
trials before they can be fully trusted. It is likely that many enhancement techniques will
in the long run prove less efficacious than their current promoters claim. At the same
time, the sheer range of enhancement methods suggests that it would be very unlikely
that all current methods are ineffective or that future advances will fail to produce an
increasingly potent toolbox for enhancing cognition.
II.MethodsofCognitiveEnhancement
Education,enrichedenvironmentsandgeneralhealth
Education has many benefits beyond higher job status and salary. Longer education
reduces the risks of substance abuse, crime and many illnesses while improving quality of
life, social connectedness, and political participation5. There is also positive feedback
between performance on cognitive tests such as IQ tests and scholastic achievement6.
Much of what we learn in school is “mental software” for managing various cognitive
domains: mathematics, categories of concepts, language, and problem solving in
particular subjects. This kind of mental software reduces our mental load through clever
encoding, organization, or processing. Instead of memorizing multiplication tables we
compress the pattern of arithmetic relationships into simpler rules of multiplication,
4 (Ioannidis 2005)
5 (Johnston 2004)
6 (Winship and Korenman 1997)
3
which in turn (among very ambitious students) can be organized into efficient mental
calculation methods like the Trachtenberg system7. Such specific methods have a
narrower range of applicability but can dramatically improve performance within a
particular domain. They represent a form of crystallized intelligence, distinct from the
fluid intelligence of general cognitive abilities and problem solving capacity8. The
relative ease and utility of improving crystallized intelligence and specific abilities have
made them popular targets of internal and external software development. Enhancement
of fluid intelligence is more difficult.
Pharmacological cognitive enhancements (nootropics) have physiological effects on the
brain. So too do education and other conventional interventions. In fact, conventional
interventions often produce more permanent neurological changes than do drugs.
Learning to read alters the way language is processed in the brain9. Enriched rearing
environments have been found to increase dendritic arborisation and to produce synaptic
changes, neurogenesis, and improved cognition in animals10. While analogous controlled
experiments cannot easily be done for human children, it is very likely that similar effects
would be observed. Stimulation-seeking children, who might be seeking out and creating
enriched environments for themselves, score higher on IQ tests and do better at school
than less stimulation-seeking children11. This also suggests that interventions, whether
environmental or pharmaceutical, that make exploring and learning more appealing to
children might improve cognition.
Enriched environments also make brains more resilient to stress and neurotoxins12.
Reducing neurotoxins and preventing bad prenatal environments are simple and widely
accepted methods of improving cognitive functioning. These kinds of intervention might
be classified as preventative or therapeutic rather than enhancing, but the distinction is
blurry. For instance, an optimized intrauterine environment will not only help avoid
specific pathology and deficits but is also likely to promote the growth of the developing
nervous system in ways that enhance its core capacities.
In brains that have already been damaged, e.g. by lead exposure, nootropics may alleviate
some of the cognitive deficits13. It is not always clear whether they do so by curing the
damage or by amplifying (enhancing) capacities that compensate for the loss, or whether
the distinction is even always meaningful. Comparing chronic exposure to cognition
enhancing drugs with an enriched rearing environment, one study in rats found that both
conditions improved memory performance and produced similar changes in the neural
matter. The improvements in the drug-treated group persisted even after cessation of
treatment. The combination of drugs and enriched environment did not improve the rats’
abilities beyond the improvement provided by one of the interventions alone. This
7 (Trachtenberg 2000)
8 (Cattell 1987)
9 (Petersson, Reis et al. 2000)
10 (Walsh, Budtz-Olsen et al. 1969; Greenoug.Wt and Volkmar 1973) (Diamond, Johnson et al. 1975)
(Nilsson, Perfilieva et al. 1999)
11 (Raine, Reynolds et al. 2002)
12 (Schneider, Lee et al. 2001)
13 (Zhou and Suszkiw 2004)
4
suggests that both interventions produced a more robust and plastic neural structure
capable of learning more efficiently.
Improving general health has cognition-enhancing effects. Many health problems act as
distractors or directly impair cognition14. Improving sleep, immune function, and general
conditioning promotes cognitive functioning. Bouts of exercise have been shown to
improve temporarily various cognitive capacities, the size of the effect depending on the
type and intensity of the exercise15. Long-term exercise also improves cognition, possibly
through a combination of increased blood supply to the brain and the release of nerve
growth factors16.
Mentaltraining
Mental training and visualization techniques are widely practiced in elite sport17 and
rehabilitation18, with apparently good effects. Users vividly imagine themselves
performing a task (running a race, going to a store), repeatedly imagining every
movement and how it would feel. A likely explanation for the efficacy of such exercises
is that they activate the neural networks involved in executing a skill at the same time as
the performance criteria for the task is held in close attention, optimizing neural plasticity
and appropriate neural reorganization.
General mental activity—“working the brain muscle”—can improve performance19 and
long-term health20, while relaxation techniques can help regulate the activation of the
brain21. It has been suggested that the Flynn-effect22, a secular increase in raw
intelligence test scores by 2.5 IQ points per decade in most western countries, is
attributable to increased demands of certain forms of abstract and visuospatial cognition
in modern society and schooling, although improved nutrition and health status may also
play a part23. On the whole, however, the Flynn effect seems to reflect a change in which
specific forms of intelligence are developed, rather than an increase in general fluid
intelligence.
The classic form of cognitive enhancement software is learned strategies to memorize
information. Such methods have been used since antiquity with much success24. One
such classic strategy is “the method of loci”. The user visualizes a building, either real or
imaginary, and in her imagination she walks from room to room, depositing imaginary
objects that evoke natural associations to the subject matter that she is memorizing.
14 (Schillerstrom, Horton et al. 2005)
15 (Tomporowski 2003)
16 (Vaynman and Gomez-Pinilla 2005)
17 (Feltz and Landers 1983)
18 (Jackson, Doyon et al. 2004)
19 (Nyberg, Sandblom et al. 2003)
20 (Barnes, Tager et al. 2004)
21 (Nava, Landau et al. 2004)
22 (Flynn 1987)
23 (Neisser 1997) (Blair, Gamson et al. 2005)
24 (Yates 1966) (Patten 1990)
5
During retrieval, the user retraces her imaginary steps, and the sequence of memorized
information is recalled when she “sees” the objects she placed along the route. This
technique harnesses the brain’s spatial navigation system to remember objects or
propositional contents. Other memory techniques makes use of rhyming or the fact that
we more easily recall dramatic, colorful, or emotional scenes, which can serve as proxies
for items that are more difficult to retain, such as numbers or letters. The early memory
arts were often used as a substitute for written text or to memorize speeches. Today,
memory techniques tend to be used in service of everyday needs such as remembering
door codes, passwords, shopping lists, and by students who need to memorize names,
dates, and terms when preparing for exams25.
One study which compared exceptional memorizers (participants in the World Memory
Championships) with normal subjects found no systematic differences in brain
anatomy26. However, it found differences in activity patterns during memorization, likely
reflecting the use of a deliberate encoding strategy. Areas of the brain involved in spatial
representation and navigation were disproportionately activated in the skilled
memorizers, regardless of whether the items to be memorized where numbers, faces, or
the shapes of snowflakes. Asked about their memory strategies, nearly all the memorizers
reported using the method of loci.
In general, it is possible to attain very high memory performance on specific types of
material using memory techniques. They provide the greatest performance enhancement
for meaningless or unrelated information, such as sequences of numbers, but they do not
appear to help in complex everyday activities27.
There exists a vast array of mental techniques alleged to boost various skills, such as
creativity training, speed reading methods28, and mind-maps29. It is unclear how
widespread the use of such techniques is, and in most cases there is a lack of good data
about their efficacy. Even if a technique improves performance on some task under
laboratory conditions, it does not follow that the technique is practically useful. In order
for a technique to significantly benefit a person, it would have to be effectively integrated
into her daily life.
Drugs
Stimulant drugs such as nicotine and caffeine have long been used to improve cognition.
In the case of nicotine a complex interaction with attention and memory occurs30, while
caffeine reduces tiredness31. In more recent years, a wide array of drugs have been
developed that affect cognition32.
25 (Minninger 1997) (Lorrayne 1996)
26 (Maguire, Valentine et al. 2003)
27 (Ericsson 2003 )
28 (Calef, Pieper et al. 1999 ).
29 (Buzan 1982) (Farrand, Hussain et al. 2002)
30 (Warburton 1992; Newhouse, Potter et al. 2004; Rusted, Trawley et al. 2005)
31 (Lieberman 2001; Smith, Brice et al. 2003; Tieges, Richard Ridderinkhof et al. 2004)
32 (Farah, Illes et al. 2004)
6
Lashley observed in 1917 that strychnine facilitates learning in rats33. Since then several
families of memory enhancing drugs affecting different aspects of long-term memory
have been discovered. They include stimulants34, nutrients35 and hormones36, cholinergic
agonists37, the piracetam family38, ampakines39, and consolidation enhancers40.
Diet, and dietary supplements, can affect cognition. In order to maintain optimal
functioning, the brain requires a continuous supply of glucose, its major energy source41.
Increases in glucose availability, from the ingestion of sugars or the release of the acute
stress hormone norepinephrine, improve memory42, with the effects being particularly
pronounced in demanding tasks43. Creatine, a nutrient that improves energy availability,
also appears to benefit overall cognitive performance44 and reduce mental fatigue45.
Besides being an energy source, food can contribute to cognition by providing amino
acids needed in the production of neurotransmitters, which is particularly important
during periods of stress or sustained concentration46. There is also evidence that
micronutrient supplementation increases nonverbal intelligence in some children. This
effect might be due to correction of occasional deficiencies rather than a general
enhancing action47.
Stimulants enhance memory by increasing neuronal activation or by releasing
neuromodulators, facilitating the synaptic changes that underlie learning. The earliest
enhancer drugs were mainly nonspecific stimulants and nutrients. In antiquity, for
example, honey water (hydromel) was used for doping purposes.
Advances in the scientific understanding of memory enabled the development of drugs
with more specific actions, such as drugs stimulating the cholinergic system, which
appears to gate attention and memory encoding. Current interest is focused on
intervening in the process of permanent encoding in the synapses, a process which has
been greatly elucidated in recent years and is a promising target for drug development.
The goal is to develop drugs that not only allow the brain to learn quickly, but which also
facilitate selective retention of the information that has been learned. Several
experimental substances have been shown to improve performance in particular memory
tests. It is not yet known whether these drugs also promote useful learning in real-life
33 (Lashley 1917)
34 (Lee and Ma 1995) (Soetens, Dhooge et al. 1993; Soetens, Casaer et al. 1995)
35 (Korol and Gold 1998) (Foster, Lidder et al. 1998) (Meikle, Riby et al. 2005) (Winder and Borrill 1998)
36 (Gulpinar and Yegen 2004)
37 (Iversen 1998) (Power, Vazdarjanova et al. 2003) (Freo, Ricciardi et al. 2005)
38 (Mondadori 1996)
39 (Lynch 1998) (Ingvar, AmbrosIngerson et al. 1997)
40 (Lynch 2002)
41 (Fox, Raichle et al. 1988)
42 (Wenk 1989; Foster, Lidder et al. 1998)
43 (Sunram-Lea, Foster et al. 2002)
44 (Rae, Digney et al. 2003)
45 (Watanabe, Kato et al. 2002; McMorris, Harris et al. 2006)
46 (Banderet and Lieberman 1989; Deijen, Wientjes et al. 1999; Lieberman 2003)
47 (Benton 2001)
7
situations, but beneficial enhancement of memory through pharmacological means is
likely to be possible.
Pharmacological agents might be useful not only for increasing memory retention but
also for unlearning phobias and addictions48. Potentially, the combination of different
drugs administered at different times could give users a more fine-grained control of their
learning processes, perhaps even the ability to deliberately select specific memories that
they want to retain or get rid of.
Even common, traditional and unregulated herbs and spices such as sage can improve
memory and mood through chemical effects49. While less powerful than those of
dedicated cholinesterase inhibitors, such effects illustrate that attempts to control access
to cognition enhancing substances would be problematic. Even chewing gum appears to
affect memory, possibly by heightening arousal or blood sugar50.
Working memory can be modulated by a variety of drugs. Drugs that stimulate the
dopamine system have demonstrated effects, as do cholinergic drugs (possibly through
improved encoding)51. Modafinil has been shown to enhance working memory in healthy
test subjects, especially at harder task difficulties and for lower-performing subjects52.
(Similar findings of greater improvements among low performers were also seen among
the dopaminergic drugs, and this might be a general pattern for many cognitive
enhancers.) Modafinil has been found to increase forward and backward digit span, visual
pattern recognition memory, spatial planning, and reaction time/latency on different
working memory tasks53. The mode of action of this drug is not yet understood, but part
of what seems to happen is that modafinil enhances adaptive response inhibition, making
the subjects evaluate a problem more thoroughly before responding, thereby improving
performance accuracy. The working memory effects might thus be part of a more general
enhancement of executive function.
Modafinil was originally developed as a treatment for narcolepsy, and can be used to
reduce performance decrements due to sleep loss with apparently small side effects and
little risk of dependency54. The drug improved attention and working memory in sleep-
deprived physicians55 and aviators56. Naps are more effective in maintaining
performance than modafinil and amphetamine during long (48h) periods of sleep
deprivation, while the reverse holds for short (24h) periods of sleep deprivation. Naps
followed by a modafinil dose may be more effective than either one on its own57. These
results, together with studies on hormones like melatonin which can control sleep
48 (Pitman, Sanders et al. 2002) (Hofmann, Meuret et al. 2006) (Ressler, Rothbaum et al. 2004)
49 (Kennedy, Pace et al. 2006)
50 (Wilkinson, Scholey et al. 2002)
51 (Barch 2004)
52 (Muller, Steffenhagen et al. 2004)
53 (Turner, Robbins et al. 2003)
54 (Teitelman 2001) (Myrick, Malcolm et al. 2004 )
55 (Gill, Haerich et al. 2006)
56 (Caldwell, Caldwell et al. 2000)
57 (Batejat and Lagarde 1999)
8
rhythms58, suggest that drugs can enable fine-tuning of alertness patterns to improve task
performance under demanding circumstances or disturbed sleep cycles.
There also exist drugs that influence how the cerebral cortex reorganizes in response to
damage or training. Noradrenergic agonists such as amphetamine have been shown to
promote faster recovery of function after a brain lesion when combined with training59,
and to improve learning of an artificial language60. A likely explanation is that higher
excitability increases cortical plasticity, in turn leading to synaptic sprouting and
remodeling61. An alternative to pharmacologic increase of neuromodulation is to
electrically stimulate the neuromodulatory centers that normally control plasticity
through attention or reward. In monkey experiments this produced faster cortical
reorganization62.
Transcranialmagneticstimulation
Transcranial magnetic stimulation (TMS) can increase or decrease the excitability of the
cortex, thereby changing its level of plasticity63. TMS of the motor cortex that increased
its excitability improved performance in a procedural learning task64. TMS in suitable
areas has also been found beneficial in a motor task65, motor learning66, visuo-motor
coordination tasks67, working memory68, finger sequence tapping69, classification70 and
even declarative memory consolidation during sleep71. Snyder et al. claim to have
demonstrated how TMS inhibiting anterior brain areas could change the drawing style of
normal subjects into a more concrete style and improve spell-checking abilities,
presumably by reducing top-down semantic control72. While TMS appears to be quite
versatile and non-invasive, there are risks of triggering epileptic seizures, and the effects
of long-term use are not known. Moreover, individual brain differences may necessitate
much adjustment before it can be used to improve specific cognitive capacities. It is still
doubtful whether TMS will ever be a practically useful enhancement method.
Geneticmodifications
Genetic memory enhancement has been demonstrated in rats and mice. In normal
animals, during maturation, expression of the NR2B subunit of the NMDA receptor is
58 (Cardinali, Brusco et al. 2002)
59 (Gladstone and Black 2000)
60 (Breitenstein, Wailke et al. 2004)
61 (Stroemer, Kent et al. 1998) (Goldstein 1999)
62 (Bao, Chan et al. 2001) (Kilgard and Merzenich 1998)
63 (Hummel and Cohen 2005)
64 (Pascual-Leone, Tarazona et al. 1999)
65 (Butefisch, Khurana et al. 2004)
66 (Nitsche, Schauenburg et al. 2003)
67 (Antal, Nitsche et al. 2004) (Antal, Nitsche et al. 2004)
68 (Fregni, Boggio et al. 2005)
69 (Kobayashi, Hutchinson et al. 2004)
70 (Kincses, Antal et al. 2004)
71 (Marshall, Molle et al. 2004)
72 (Snyder, Mulcahy et al. 2003 ) (Snyder, T. et al. 2004 )
9
gradually replaced with expression of the NR2A subunit. This might be linked to the
lower brain plasticity of adult animals. Tsien et al.73 modified mice to overexpress the
NR2B subunit. The NR2B “Doogie” mice showed improved memory performance, in
terms of both acquisition and retention. This included unlearning of fear conditioning,
which is believed to be due to the learning of a secondary memory74. The modification
also made the mice more sensitive to certain forms of pain, suggesting a non-trivial trade-
off between two potential enhancement goals75. Pain sensitivity could be countered by
administration of an analgesic.
Increased amounts of brain growth factors76 and the signal transduction protein adenylyl
cyclase77 have also produced memory improvements. These modifications had different
enhancing effects. Unlearning took longer for these modified mice than for unmodified
mice, while the mice in the abovementioned Tsien study had faster than normal
unlearning. Different memory tasks were also differently affected: the cyclase mice had
enhanced recognition memory but not improved context or cue learning. Another study
found that mice with a deleted cbl-b gene had normal learning but enhanced long-term
retention, presumably indicating that the gene is a negative regulator of memory78. These
enhancements may be due to changes in neural plasticity during the learning task itself,
or to ontogenetic changes in brain development that promote subsequent learning or
retention.
The cellular machinery of memory appears to be highly conserved in evolution, making
interventions demonstrated to work in animal models likely to have close counterparts in
humans79.
Genetic studies have also found genes in humans whose variations account for up to 5%
of memory performance80. These include the genes for the NMDA receptor and adenylyl
cyclase that were mentioned above, as well as genes involved in other stages of the
synaptic signal cascade. These are obvious targets for enhancement.
Given these early results, it seems likely that there exist many potential genetic
interventions that would directly or indirectly improve aspects of memory. If it turns out
that the beneficial effects of the treatments are not due to changes in development, then
presumably some of the effects can be achieved by supplying the brain with the
substances produced by the memory genes without resorting to genetic modification. But
genetic modification would make the individual independent of an external drug supply
and would guarantee that the substances end up in the right place.
73 (Tang, Shimizu et al. 1999)
74 (Falls, Miserendino et al. 1992)
75 (Wei, Wang et al. 2001)
76 (Routtenberg, Cantallops et al. 2000)
77 (Wang, Ferguson et al. 2004)
78 (Tan, Liu et al. 2006)
79 (Bailey, Bartsch et al. 1996) (Edelhoff, Villacres et al. 1995)
80 (de Quervain and Papassotiropoulos 2006)
10
Studies of the genetics of intelligence suggest that there is a large number of genetic
variations affecting individual intelligence, but each accounting for only a very small
fraction (<1%) of the variance between individuals81. This would indicate that genetic
enhancement of intelligence through direct insertion of a few beneficial alleles is unlikely
to have a big enhancing effect. It is possible, however, that some alleles that are rare in
the human population could have larger effects on intelligence, both negative and
positive82.
Prenatalandperinatalenhancement
A notable form of chemical enhancement is pre- and perinatal enhancement.
Administering choline supplementation to pregnant rats improved the performance of
their pups, apparently as a result of changes in neural development83. Given the ready
availability of choline supplements, such prenatal enhancement may already
(inadvertently) be taking place in human populations. Supplementation of a mother’s diet
during late pregnancy and 3 months postpartum with long chained fatty acids has also
been shown to improve cognitive performance in human children84. Deliberate changes
of maternal diet might be regarded as part of the cognitive enhancement spectrum. At
present, recommendations to mothers are mostly aimed at promoting a diet that avoids
specific harms and deficits, but the growing emphasis on boosting “good fats” and the
use of enriched infant formulas point towards enhancement.
Externalhardwareandsoftwaresystems
Some approaches in human-computer interaction are explicitly aimed at cognitive
enhancement85. External hardware is of course already used to amplify cognitive
abilities, be it pen and paper, calculators, or personal computers. Many common pieces of
software act as cognition-enhancing environments, where the software helps display
information, keep multiple items in memory, and perform routine tasks. Data mining and
information visualization tools process and make graspable enormous amounts of data
that our perceptual systems cannot handle. Other tools such as expert systems, symbolic
math programs, decision support software, and search agents amplify specific skills and
capacities.
What is new is the growing interest in creating intimate links between the external
systems and the human user through better interaction. The software becomes less an
external tool and more of a mediating “exoself”. This can be achieved through mediation,
embedding the human within an augmenting “shell” such as wearable computers86 or
virtual reality, or through smart environments in which objects are given extended
capabilities. An example is the vision of “ubiquitous computing”, in which objects would
81 (Craig and Plomin 2006)
82 A possible example is suggested in (Cochran, Hardy et al. 2006), where it is predicted that
heterozygoticity for Tay-Sachs’ disease should increase IQ by about 5 points.
83 (Meck, Smith et al. 1988) (Mellott, Williams et al. 2004)
84 (Helland, Smith et al. 2003)
85 (Engelbart 1962)
86 (Mann 2001) (Mann and Niedzviecki 2001)
11
be equipped with unique identities and given ability to communicate with and actively
support the user87. A well-designed environment can enhance proactive memory88 by
deliberately bringing previous intentions to mind in the right context.
Another form of memory-enhancing exoself software is remembrance agents89, software
agents that act as a vastly extended associative memory. The agents have access to a
database of information such as a user’s files, email correspondence etc., which they use
to suggest relevant documents based on the current context. Other exoself applications
include additions to vision90, team coordination91, face recognition92, mechanical
prediction93, and the recording of emotionally significant events94.
Given the availability of external memory support, from writing to wearable computers, it
is likely that the crucial form of memory demand on humans in the future will
increasingly be the ability to link information into usable concepts, associations, and
skills rather than the ability to memorize large amounts of raw data. Storage and retrieval
functions can often be offloaded from the brain, while the knowledge, strategies, and
associations linking the data to skilled cognition cannot so far be outsourced to computers
to the same extent.
BrainComputerinterfaces
Wearable computers and PDAs are already intimate devices worn on the body, but there
have been proposals for even tighter interfaces. Direct control of external devices through
brain activity has been studied with some success for the last 40 years, although it
remains a very low bandwidth form of signalling95.
The most dramatic potential internal hardware enhancements are brain-computer
interfaces. Development is rapid, both on the hardware side, where multielectrode
recordings from more than 300 electrodes permanently implanted in the brain are
currently state-of-the art, and on the software side, with computers learning to interpret
the signals and commands96. Early experiments on humans have shown that it is possible
for profoundly paralyzed patients to control a computer cursor using just a single
electrode97 implanted in the brain, and experiments by Patil et al. have demonstrated that
the kind of multielectrode recording devices used in monkeys would most likely function
in humans too98. Experiments in localized chemical release from implanted chips also
87 (Weiser 1991)
88 (Sellen, Louie et al. 1996)
89 (Rhodes and Starner 1996)
90 (Mann 1997)
91 (Fan, Sun et al. 2005) (Fan, Sun et al. 2005)
92 (Singletary and Starner 2000)
93 (Jebara, Eyster et al. 1997)
94 (Healey and Picard 1998)
95 (Wolpaw, Birbaumer et al. 2000)
96 (Nicolelis, Dimitrov et al. 2003) (Shenoy, Meeker et al. 2003) (Carmena, Lebedev et al. 2003)
97 (Kennedy and Bakay 1998)
98 (Patil, Carmena et al. 2004)
12
suggest the possibility of using neural growth factors to promote patterned local growth
and interfacing99.
Cochlear implants are already widely used, and there is ongoing research in artificial
retinas100 and functional electric stimulation for paralysis treatment101. These implants
are intended to ameliorate functional deficits and are unlikely to be attractive for healthy
people in the foreseeable future. But the digital parts of the implant could in principle be
connected to any kind of external software and hardware. This could enable enhancing
uses such as access to software tools, the Internet, and virtual reality applications. In a
demonstration project, a healthy volunteer has been enabled to control a robotic arm
using tactile feedback, both in direct adjacency and remotely, and to perform simple
direct neural communication with another implant102. Non-disabled people, however,
could most likely achieve the essentially same functionality more cheaply, safely, and
effectively through eyes, finger, and voice control.
Collectiveintelligence
Much of human cognition is distributed across many minds. Such distributed cognition
can be enhanced through the development and use of more efficient tools and methods of
intellectual collaboration. The World Wide Web and e-mail are among the most powerful
kinds of cognitive enhancement software developed to date. Through the use of such
social software, the distributed intelligence of large groups can be shared and harnessed
for specific purposes103.
Connected systems allow many people to collaborate in the construction of shared
knowledge and solutions. Usually, the more individuals that connect, the more powerful
the system becomes104. The information in such systems is stored not just in individual
documents but also in their interrelations. When such interconnected information
resources exist, automated systems such as search engines105 can often radically improve
our ability to extract useful information from them.
Lowered coordination costs enable larger groups to work on common projects. Groups of
volunteers with shared interests, such as amateur journalist “bloggers” and open source
programmers, have demonstrated that they can successfully complete large and highly
complex projects, such as online political campaigns, the Wikipedia encyclopedia, and
the Linux operating system. Systems for online collaboration can incorporate efficient
error correction106, enabling incremental improvement of product quality over time.
99 (Peterman, Noolandi et al. 2004)
100 (Alteheld, Roessler et al. 2004)
101 (von Wild, Rabischong et al. 2002)
102 (Warwick, Gasson et al. 2003)
103 (Surowiecki 2004)
104 (Drexler 1991)
105 (Kleinberg 1999)
106 (Raymond 2001; Giles 2005)
13
One powerful technique of knowledge aggregation is prediction markets (also known as
“information markets” or “idea futures markets”). In such a market, participants trade in
predictions of future events. The prices of these bets tend to reflect the best information
available about the probability of whether the events will occur107. Such markets appear
to be self-correcting and resilient, and have been shown to outperform alternative
methods of generating probabilistic forecasts, such as opinion polls and expert panels108.
III.EthicalIssues
Safety
Safety concerns tend to focus on medical risks of internal biological enhancements. Yet
risks accompany any intervention, not just biomedical procedures. External software
enhancements raise safety issues such as privacy and data protection. Similar issues can
arise in some enhancements focusing on collaborative intelligence. The latter might also
create unique kinds of risks arising from emergent phenomena in large networks of
interacting agents – witness the “flame wars” into which some email lists are prone to
erupt, creating stress and unpleasantness for everyone involved. Psychological techniques
and training are generally regarded as safe, but to the extent that their long-term use have
significant effects on neural organization, they can pose subtle but substantial risks to the
user.
Even education is a risky enhancement method. Education can enhance cognitive skills
and capacities, but it can also create fanatics, dogmatists, sophistic arguers, skilled
rationalizers, cynical manipulators, and indoctrinated, prejudiced, confused, or selfishly
calculating minds. Even high-quality education that includes training in formal methods
and critical thinking can have problematic effects. For instance, several studies indicate
that the study of economics make students on average more selfish than they were
before.109 (Higher education may also increase the risk of becoming a professor or
university don – a profession characterized by E. Friedell as involving a slow
metabolism, a sluggish bowel, a penchant for gradualist doctrines, and pedantry110.)
One could argue that the risks from education are fundamentally different from certain
other categories of risk, such as medical risks. A student who becomes a fanatic or
selfishly calculating does so, one argument runs, through their own choice and their
deliberate acceptance of, or reaction to, the taught material. In contrast, a drug’s action on
the nervous system is more direct, unmediated by propositional beliefs or conscious
deliberation. This argument, however, is not entirely convincing. Educational
enhancements are widely applied to subjects who are too young to give informed consent
to the procedure, and who are unable critically to evaluate what they are being taught.
Even among more advanced students, it is implausible that all the effects of education are
107 (Hanson, Polk et al. 2003)
108 (Hanson, Opre et al. 2006)
109 (Frank, Gilovich et al. 1993; Rubinstein 2005)
110 Cited from (Kolnai 1976)
14
mediated by rational deliberation. Much is simply “absorbed” through subconscious
emulation and as a side-effect of how information is presented. Cognitive habits and
inclinations acquired from education often have life-long sequelae.
Nevertheless, it is in the area of medical enhancement that safety issues are likely to be
most salient. Since the current medical risk system is based on comparing treatment risk
with the expected benefit of reduced morbidity risk from successful treatment, it is
strongly risk averse in the case of enhancements that do not reduce morbidity risk and
whose utility to the patient may be entirely non-therapeutic, highly subjective, and
context dependent. Yet precedents for a different risk model can be found, for example in
use of cosmetic surgery. The consensus is that patient autonomy overrides at least minor
medical risks even when the procedure does not reduce or prevent morbidity. A similar
model could be used in the case of medical cognitive enhancements, with the user being
allowed to decide whether the benefits outweigh the potential risks, based on advice from
medical professionals and her own estimates of how the intervention might affect her
personal goals and her way of life. The risks of chronic use of a cognition enhancing drug
include the possibility of both medical side effects and effects more directly tied to the
drug’s intended function. For instance, a memory enhancer could, by exerting its
intended effect, increase the number of trivial “junk” memories retained, which might be
undesirable. It will often not be possible accurately to quantify these potential risks of
long-term use beforehand, so there is a limit to how much guidance a user can expect to
obtain from medical experts. Nor are medical experts necessarily in a position to judge
whether, for a particular user, the benefits are worth the risks.
The development of cognitive enhancers may also face problems in terms of acceptable
risk to test subjects. The reliability of research is another issue. Many of the cognition-
enhancing interventions show small effect sizes. This may necessitate very large
epidemiological studies, possibly exposing large groups to unforeseen risks.
Some enhancements may make us dependent on outside technology, infrastructure, or
drugs. If the supply is interrupted, users may suffer withdrawal symptoms or
impairments. Is this sufficient reason to discourage some enhancements? Is a life
dependent on external support structures less worth living, or less dignified, than an
independent, unassisted, or more “natural” life?
Thepurposeofmedicine
One common concern about enhancements in the biomedical sphere is that they go
beyond the purpose of medicine. The debate over whether it is possible to draw a line
between therapy and enhancement, and if so where, is extensive. Regardless of this, it is
clear that medicine does encompass many treatments not intended to cure, prevent, or
ameliorate illness, such as plastic surgery and contraceptive medication, which are
accepted. There are also many forms of enhancement that do not fit into the medical
framework, such as psychological techniques and diet, but which nevertheless produce
medical effects. Even if a boundary between therapy and enhancement could be agreed, it
is unclear that it would have any normative significance.
15
A related concern is that resort to medical or technological “fixes” will become a
displacement for efforts to confront deeper social of personal problems. Especially
Ritalin and other ADHD medications (many of which function as cognitive enhancers in
healthy subjects) have been fiercely debated in the past, some arguing that these
medications are often used to paper over the failings of the education system by making
rowdy boys calmer rather than developing teaching methods that can accommodate a
wider range of individual learning styles and needs. However, if modern society requires
much more study and intellectual concentration than was typical for our species in its
environment of evolutionary adaptation, then it is unsurprising that many people today
struggle to meet the demands of the school or the workplace. Technological self-
modification and the use of cognitive enhancement methods can be seen as an extension
of the human species’ ability to adapt to its environment.
Enhancementsforminorsandincompetentindividuals
Young children are not in a position to give informed consent for medical interventions.
The same holds true for individuals with severe mental disability, and for non-human
animals. Who should be making decisions about the use of enhancement on behalf of
incompetent subjects? On what grounds should these decisions be made? Is there a
special obligation to help some incompetent subjects become competent agents capable
of autonomous reasoning? One might also ask, supposing it became technologically
feasible, whether some animals (such as the great apes) ought to be given cognitive
enhancements (“uplifted”) to enable them to function at a level closer to that of normal
humans.
Procreativechoiceandeugenics
Some enhancements do not increase the capacity of any existing being but rather cause a
new person to come into existence with greater capacities than some other possible
person would have had who could have come into existence instead. This is what
happens in embryo selection111. At present, preimplantation genetic diagnosis is used
mainly to select out embryos with genetic disease, and occasionally for the purpose of
sex selection. In the future, however, it might become possible to test for a variety of
genes known to correlate with desirable attributes, including cognitive capacity. Genetic
engineering might also be used to remove or insert genes into a zygote or an early
embryo. In some cases, it might be unclear whether the outcome is a new individual or
the same individual with a genetic modification.
It has been argued that when parents are able to do so without significant cost or
inconvenience to themselves, they have an obligation to select – out of the possible
children they could have – the one that they judge would have the best prospects of
having a good life. This has been termed the Principle of Procreative Beneficence112.
111 (Glover 1984)
112 (Savulescu 2001)
16
Critics of genetic enhancements have asserted that the creation of “designer babies” will
corrupt parents, who will come to view their children as mere products, subject to being
evaluated according to standards of quality control rather than unconditionally accepted
and loved. Are we prepared to sacrifice on the altar of consumerism even those deep
values that are embodied in traditional relationships between child and parents? Is the
quest for perfection worth this cultural and moral cost?113 There is, however, currently no
clear evidence for the hypothesis that parents making use of enhancement options in
procreation would become incapable of accepting and loving their children. When in
vitro fertilization was first introduced, bioconservative critics predicted similar
psychological harms which, fortunately, did not materialize.
Some disability advocates have voiced concern that genetic enhancement could express a
negative attitude to people with disabilities, who might face increased discrimination as a
result. This objection appears to apply equally to the use of preimplantation genetic
diagnosis to screen embryos for genetic abnormalities, in that abnormal embryos are seen
as unworthy of being allowed to develop.
Some have argued that genetic selection and genetic enhancement would constitute a
kind of “tyranny of the living over the unborn”114. Others have responded that a child is
no freer if her genes are determined by chance than if they are determined by parental
choice. Furthermore, some enhancements would increase the offspring’s capacity for
autonomous agency115.
There are also questions about the relations of germ-line interventions to the now
discredited eugenics programs of the last century. Other interventions that may affect the
next generation, such as prenatal surgery, improvements in maternal nutrition, and
screening for genetic abnormalities, have not, however, evoked the same concerns. It is
important to determine the reason for this, and to examine whether there are ethically
relevant differences between what may appear to be simply various means to the same
end. Contemporary defenders of so-called “liberal eugenics” emphasize that they are not
supporting coercive state programs but rather that parents should be allowed to make
these choices themselves and that procreative freedom must be protected116. Several
issues still arise here, such as whether the state should subsidize enhancements for
parents who cannot afford them, and what protection against harmful interventions the
state could impose without unduly infringing on reproductive liberty.
Authenticity
The issue of authenticity has many sides. One is the idea that native or achieved
excellence has a higher worth than talent that is bought. If cognitive abilities are for sale,
in the form of a pill or some external aid, would that reduce their value and make them
less admirable? Would it in some sense make the abilities less genuinely ours? Related to
113 (Kass 2002)
114 (Jonas 1985)
115 (Fukuyama 2002)
116 (Agar 2004)
17
this, one might think that if excellence is achieved mostly through hard work, then
genetic differences and parental class play a smaller role in determining success. But if
there were shortcuts to excellence then access to such shortcuts would instead become the
determining factor of success and failure.
In many cases, however, shortcuts to excellence are tolerated. We do not denounce
athletes for wearing protective (and performance enhancing) shoes, since they enable the
athletes to concentrate on interesting talents rather than on developing thick soles. In
many elementary schools, calculators are disallowed in mathematics lessons, where the
goal is to understand basic arithmetic, but they are allowed and increasingly necessary in
the higher grades. The basics have by then been mastered, and the goal becomes to
understand more advanced topics. These examples illustrate that cognitive enhancement
aimed at extending and completing a person’s talents may promote authenticity by
offloading irrelevant, repetitive, or boring tasks and enabling a person to concentrate on
more complex challenges that relate in more interesting ways to her goals and interests.
Another side of the authenticity issue is the extent to which our “free choices” are
manipulated by advertisers or are slavishly bound to reigning fashions by our desire to
conform in order to gain social acceptance. If enhancements are added to the “must-
haves” of a modern consumer, does that mean that our bodies and minds would come
even more directly under the dominion of external and therefore “inauthentic” drivers
than is currently the case? Some critics see human enhancement in general as expressive
of a technocratic mindset, which threatens to “flatten our souls”, sap our moral fiber,
lower our aspirations, weaken our loves and attachments, lull our spiritual yearnings,
undermine our dignity, and as likely to lead to trite consumerism, homogenization, and a
Brave New World117. While these fears appear to triggered less by the prospect of
cognitive enhancement than by other possible forms of human enhancement or
modification (e.g. of mood and emotion), they do reflect a general unease about making
“the essence of human nature” a project of technological mastery118.
To some extent, these are cultural, social, and political issues rather than purely ethical
ones. A blinkered pursuit of shallow or misguided ends is not the only way in which
enhancement options could be used. If there were a widespread tendency to use the
options in that way, then the problem would probably lie in our culture. The criticism is a
criticism of mediocrity and bad culture rather than of enhancement tools. Many of the
negative consequences of enhancement may be avoided or changed in different social
contexts. Critics could argue that we have to look at the culture we have, not some ideal
alternative, or that there are particular attributes of the technologies which will inevitably
promote the erosion of human values.
Again, however, cognitive enhancements have the potential to play a positive role.
Insofar as cognitive enhancements amplify the capacities required for autonomous
agency and independent judgment, they can help a person lead a more authentic life by
117 (The President's Council on Bioethics 2003)
118 (Kass 2002)
18
enabling her to base her choices on more deeply considered beliefs about her unique
circumstances, her personal style, her ideals, and the options available to her.
Hyperagency,playingGod,andthestatusquo
The concern about “hyper-agency” is in a sense opposite to the concern about
authenticity. Here, the issue is that as human beings become more able to control their
lives and themselves, they also become more responsible for the results and less
constrained by traditional limits. The “playing God” objection asserts that human wisdom
is insufficient to manage this freedom. Whether hyper-agency is a problem or not
depends on both an analysis of the ethical implications of increased agency (such as the
burden of responsibility for previously uncontrollable events, and the potential for
increased autonomy) and the psychological and sociological question of how humans
would in fact react to their increased degrees of freedom, power, and responsibility119.
The policy challenge might be to ensure that there are adequate safeguards, regulations,
and transparency to support a society of increasingly cognitively resourceful individuals,
and also to moderate unrealistic expectations of infallibility.
Another version of the playing God argument asserts that it is sometimes better to respect
“the Given” than to try to better things using human abilities120. The claim that we should
stick with the status quo can be based on a religious sensibility, the idea that we literally
risk offending God if we overstep our mandate here on Earth. It can also be based on a
less theologically articulated feeling that the proper approach to the world is one of
humility and that enhancement would upset the moral or practical order of things; or,
alternatively, on an explicitly conservative vision according to which the existing state of
affairs has, due to its age, acquired some form of optimality. Since human agency is
already interfering with the natural order in many ways that are universally accepted (for
example, by curing the sick), and since society and technology have always been
changing and often for the better, the challenge for this version of the playing God
argument is to determine which particular kinds of interventions and changes would be
bad.
One recent paper has examined the extent to which opposition to cognitive enhancement
is the result of a status quo bias, defined as an irrational or inappropriate preference for
the status quo just because it is the status quo. When this bias is removed, through the
application of a method which the authors call “the Reversal Test”, many
consequentialist objections to cognitive enhancements are revealed to be highly
implausible121.
119 “In my view, the fear of hyper-agency is misplaced; society as a whole seems always to return to the
reasonable use of new knowledge. … Just as most people don't drink all the liquor in their liquor
cabinet…our society will absorb new memory drugs according to each individual’s underlying philosophy
and sense of self.”, (Gazzaniga 2005)
120 (Sandel 2002; Sandel 2004); but see also a critique in (Kamm 2006)
121 (Bostrom and Ord 2006)
19
Cheating,positionalgoods,andexternalities
On some campuses it is now not uncommon for students to take Ritalin when preparing
for exams (not to mention caffeine, glucose snacks, and energy drinks). Does this
constitute a form of cheating akin to illicit doping in the Olympics? Or should students be
positively encouraged to take performance enhancers (assuming they are sufficiently safe
and efficacious) for the same reasons that they are encouraged to take notes and to start
revising early?
Whether an action constitutes cheating depends on the agreed game rules for different
activities. To pick up the ball with one’s hands is cheating in golf and soccer, but not in
handball or American football. If school is to be regarded as a competition for grades,
then enhancers would arguably be cheating if not everyone had access to enhancements
or if they were against the official rules. If school is viewed as having primarily a social
function, then enhancement might be irrelevant. But if school is seen as being
significantly about the acquisition of information and learning, then cognitive
enhancements may have legitimate and useful role to play.
A positional good is one whose value is dependent on others not having it. If cognitive
enhancements were purely positional goods, then the pursuit of such enhancements
would be a waste of time, effort, and money. People might become embroiled in a
cognitive “arms race”, spending significant resources merely in order to keep up with the
Joneses. One person’s gain would produce an offsetting negative externality of equal
magnitude, resulting in no net gain in social utility to compensate for the costs of the
enhancement efforts.
Most cognitive functions, however, are not purely positional goods122. They are also
intrinsically desirable: their immediate value to the possessor does not completely depend
on other people lacking them. Having a good memory or a creative mind is normally
valuable in its own right, whether or not other people also possess similar excellences.
Furthermore, many cognitive capacities also have instrumental value, both for individuals
and for society. We face many pressing problems which we would be better able to solve
if we were smarter, wiser, or more creative. An enhancement that enables an individual to
solve some of society’s problems would produce a positive externality: in addition to
benefits for enhanced individual, there would be spillover benefits for other members of
society.
Nevertheless, competitive aspects of enhancements should be taken into account when
we assess the impact they might have on society. An enhancement may be entirely
voluntary and yet become difficult to avoid for those who do not desire it. It has been
suggested that many people would prefer to fly with airlines or go to hospitals where the
personnel take alertness-enhancing drugs. Such preferences could expand employment
opportunities for those willing to enhance themselves. Economic competition might
122 (Bostrom 2003)
20
eventually force people to use enhancements on pain of rendering themselves ineligible
for certain jobs123.
The case might be compared to that of literacy, which is also forced upon citizens in
modern societies. For literacy, the enforcement is both direct, in the form of mandatory
basic education, and indirect, in the form of severe social penalties for failure to acquire
reading and writing skills. The dominant cooperative framework124 of our society has
developed in such a way that an illiterate person is excluded from many opportunities and
unable to participate in many aspects of modern life. Despite these enormous and
partially coercive pressures, and despite the fact that literacy profoundly changes the way
the brain processes language,125 literacy is not regarded as particularly problematic. The
costs of illiteracy are placed on the individual who deliberately avoids education. As
social acceptance of other enhancements increases, and if these are available at a
reasonable price, it is possible that support for people who refuse to take advantage of
enhancements will diminish.
Inequality
Concern has been voiced that cognitive enhancements might exacerbate social inequality
by adding to the advantages of elites.
To assess this concern one would have to consider whether future cognitive
enhancements would be expensive (like good schools) or cheap (like caffeine). One
would also have to take into account that there is more than one dimension to inequality.
For example, in addition to the gap between the rich and the poor, there is also a gap
between the cognitively gifted and the cognitively deficient. One scenario might be that
the wealth gap increases at the same time as the talent gap decreases because it is
generally easier to enhance individuals at the low end of the performance spectrum than
those at the high end (whose brains are already functioning close to their biological
optimum). This could add a degree of complexity that is often overlooked in the ethical
literature on inequality. One should also have to consider under what conditions society
might have an obligation to ensure universal access to interventions that improve
cognitive performance. An analogy might be drawn to public libraries and basic
education126. Other relevant factors include the speed of technology diffusion, the need
for education to achieve full utilization of an enhancement, regulatory approach, and
accompanying public policies. Public policy and regulations can either contribute to
inequality by driving up prices, limiting access, and creating black markets; or reduce
inequality by supporting broad development, competition, public understanding, and
perhaps subsidized access for disadvantaged groups.
Different kinds of enhancements pose different social challenges. A pill that slightly
improves memory or alertness is a very different thing than some future radical form of
123 (Chatterjee 2004)
124 (Buchanan, Brock et al. 2001)
125 (Petersson, Reis et al. 2000)
126 (Hughes 2004)
21
genetic engineering that could lead to the creation of a new “posthuman” human
species127. It has been argued that even very powerful enhancements could be placed
within a regulatory framework for leveling the playing field if the objective is seen as
important enough128, but whether the political will to do so will be forthcoming remains
to be seen.
It is worth noting that inequality of access to enhancement is a pressing concern only if
we agree that enhancement confers genuine benefits. Otherwise, as Leon Kass observes,
complaining about unequal access to enhancement would be equivalent to objecting that
“the food is contaminated, but why are my portions so small?”129
IV.Discussion:challengesforregulationandpublicpolicy
“Conventional” means of cognitive enhancement, such as education, mental techniques,
neurological health, and external systems, are largely accepted, while “unconventional”
means – drugs, implants, direct brain-computer interfaces – tend to evoke moral and
social concerns. However, the demarcation between these two categories is blurry. It
might be the newness of the unconventional means, and the fact that they are currently
still mostly experimental, which is responsible for their problematic status rather than any
essential problem with the technologies themselves. As we gain more experience with
currently unconventional technologies, they may become absorbed into the ordinary
category of human tools.
At present, most biomedical enhancement techniques produce at most modest
improvements of performance (as a rule of thumb, about 10-20% improvement on typical
test tasks). More dramatic results can be achieved using training and human-machine
collaboration, techniques that are less controversial. Mental techniques can achieve
1000% or more improvement in narrow domains such as specific memorization tasks130.
While pharmacological cognitive enhancements do not produce dramatic improvements
on specific tasks, their effects are often quite general, enhancing performance across a
wide domain, such as all tasks making use of working memory or long term memory.
External tools and cognitive techniques such as mnemonics, in contrast, are usually task-
specific, producing potentially large improvements of relatively narrow abilities. A
combination of different methods can be expected to do better than any single method,
especially in everyday or workplace settings where a wide variety of tasks have to be
performed.
Even small improvements in general cognitive capacities can have important positive
effects. Individual cognitive capacity (imperfectly estimated by IQ scores) is positively
correlated with income. One study estimates the increase in income from one additional
127 (Silver 1998) (Fukuyama 2002)
128 (Mehlman 2000)
129 (Kass 2003), p. 15.
130 (Ericsson, Chase et al. 1980)
22
IQ point to 2.1% for men and 3.6% for women131. Higher intelligence appears to prevent
a wide array of social and economic misfortunes132 and to promote health133. Economic
models of the loss caused by small intelligence decrements due to lead in drinking water
predict significant effects of even a few points change134, and it is plausible that a small
increment would have positive effects of a similar magnitude. At a societal level, the
consequences of many small individual enhancements may be profound. A relatively
small upward shift of the distribution of intellectual abilities would substantially reduce
the incidence of retardation and learning problems. Such a shift would likely also have
important effects on technology, economy, and culture arising from improved
performance among high IQ groups.
Many extant regulations are intended to protect and improve cognitive function.
Regulation of lead in paint and tap water, requirements of boxing, bicycle, and
motorcycle helmets, bans on alcohol for minors, mandatory education, folic acid
fortification of cereals, and sanctions against mothers who abuse drugs during pregnancy
all serve to safeguard or promote cognition. To a large extent, these efforts are a subset of
general health protection measures, yet stronger efforts appear to be made when cognitive
function is at risk. One may also observe that mandated information duties, such as
labelling of food products, were introduced to give consumers access to more accurate
information in order to enable them to make better choices. Given that sound decision-
making requires both reliable information and the cognitive ability to retain, evaluate, and
apply this information, one would expect that enhancements of cognition would promote
rational consumer choice.
By contrast, we know of no public policy that is intended to limit or reduce cognitive
capacity. Insofar as patterns of regulation reflect social preferences, then, it seems that
society shows at least an implicit commitment to better cognition.
At the same time, however, there exist a number of obstacles to the development and use
of cognitive enhancements. One obstacle is the present system for licensing drugs and
medical treatments. This system was created to deal with traditional medicine which aims
to prevent, diagnose, cure, or alleviate disease. In this framework, there is no room for
enhancing medicine. For example, drug companies could find it difficult to get regulatory
approval for a pharmaceutical whose sole use was to improve cognitive functioning in the
healthy population. To date, every pharmaceutical on the market that offers some
potential cognitive enhancement effect was developed to treat some specific pathological
condition (such as ADHD, narcolepsy, and Alzheimer’s disease). The cognitive
enhancing effects of these drugs in healthy subjects is a serendipitous unintended effect.
Progress in this area might be accelerated if pharmaceutical companies could focus
directly on developing nootropics for use in non-diseased populations rather than having
131 (Salkever 1995)
132 (Gottfredson 1997; Gottfredson 2004). There is no link between higher intelligence and more happiness
(Sigelman 1981; Hartog and Oosterbeek 1998; Gow, Whiteman et al. 2005). However, see also (Newson
2000) for some more subtle ways intelligence might bring happiness.
133 (Whalley and Deary 2001)
134 (Salkever 1995) (Muir and Zegarac 2001)
23
to work indirectly by demonstrating that the drugs are also efficacious in treating some
recognized disease.
One of the perverse effects of the failure of the current medical framework to recognize
the legitimacy and potential of enhancement medicine is the trend towards medicalization
and “pathologization” of an increasing range of conditions that were previous regarded as
part of the normal human spectrum. If a significant fraction of the population could
obtain certain benefits from drugs that improve e.g. concentration, it is currently
necessary to categorize this segment of people as having some disease – in this case
attention-deficit hyperactivity disorder – in order to get the drug approved and prescribed
to those who could benefit from it. This disease-focused medical model is increasingly
inadequate for an era in which many people will be using medical treatments for
enhancement purposes.
The medicine-as-treatment-for-disease framework creates problems not only for
pharmaceutical companies but also for users (“patients”) whose access to enhancers is
often dependent on being able to find an open-minded physician who can prescribe the
drug. This creates inequities in access. People with high social capital and good
information get access while others are excluded.
The rise of personalized medicine which we are now beginning to see results both from
improved diagnostic methods that provide a better picture of the individual patient and
from the availability of a wider range of therapeutic options which make it necessary to
select the one that is most suitable for a particular patient. Many patients now approach
their physicians armed with detailed knowledge about their condition and possible
treatments. Information can be easily obtained from Medline and other Internet services.
These factors are leading to a shift in the physician-patient relationship, away from
paternalism to a relationship characterized by teamwork and a focus on the customer’s
situation. Preventative and enhancing medicine are often inseparable, and both will likely
be promoted by these changes and by an increasingly active and informed health care
consumer who insists on exercising choice in the medical context. These shifts suggest
the need for important and complex regulatory change.
Given that all medical interventions carry some risk, and that the benefits of
enhancements may often be more subjective and value-dependent than the benefits of
being cured of a disease, it is important to allow individuals to determine their own
preferences for tradeoffs between risks and benefits. It is highly unlikely that one size
will fit all. At the same time, many will feel the need for a limited degree of paternalism,
to protect individuals from at least the worst risks. One option would be to establish some
baseline level of acceptable risk in allowable interventions, perhaps by comparison to
other risks that society allows individuals to take, such as the risks from smoking,
mountain climbing, or horseback riding. Enhancements that could be shown to be no
more risky than these activities would be allowed (with appropriate information and
warning labels when necessary). Another possibility would be enhancement licenses.
People willing to undergo potentially risky but rewarding enhancements could be
required to demonstrate sufficient understanding of the risks and the ability to handle
24
them responsibly. This would both ensure informed consent and enable better
monitoring. A downside with enhancement licenses is that people with low cognitive
capacity, who may have the most to gain from enhancements, could find it hard to get
access if the license requirements were too demanding.
Public funding for research does not yet reflect the potential personal and social benefits
of many forms of cognitive enhancement. There is funding (albeit perhaps at inadequate
levels) for research into education methods and information technology, but not for
pharmacological cognitive enhancers. In view of the potentially enormous gains from
even moderately effective general cognitive enhancements, this area deserves large-scale
funding. It is clear that much research and development are needed to make cognitive
enhancement practical and efficient. As discussed above, this requires a change of the
view that medicine is only about restoring, not enhancing, capacities, and concomitant
changes in the regulatory regime for medical trials and drug approval.
The evidence on prenatal and perinatal nutrition suggests that infant formulas containing
suitable nutrients may have a significant positive life-long impact on cognition. Because
of the low cost and large potential impact of enriched infant formula if applied at a
population level, it should be a priority to conduct more research to establish the optimal
composition of infant formula. Regulation could then be used to ensure that
commercially available formula contains these nutrients. Public health information
campaigns could further promote the use of enriched formula that promote mental
development. This would a simple extension of current regulatory practice, but a
potentially important one.
There is a wider cultural challenge of destigmatizing the use of enhancers. At present, the
taking of medicine is regarded as a regrettable condition, and use of non-therapeutic
medication is seen as suspect, possibly misuse. Attempts to enhance cognition are often
construed as expression of a dangerous ambition. Yet the border between accepted
therapy and suspect enhancement is shifting. Pain relief is now seen as unproblematic.
Plastic surgery enjoys ever-wider acceptance. Millions of people ingest nutrient
supplements and herbal remedies for enhancing purposes. Self-help psychology is very
popular. Apparently, the cultural constructions surrounding the means of enhancement
are more important for their acceptance than the actual enhancement ability of these
means. To make the best use of our new opportunities, we need a culture of enhancement,
with norms, support structures, and a lay understanding of enhancement that takes it into
the mainstream cultural context. Consumers also need better information on risks and
benefits of enhancers, which suggests a need for reliable consumer information and for
more studies to determine safety and efficacy.
Testing of cognitive enhancers would ideally be done not only in the lab but also in field
studies that investigate how an intervention works in everyday life. The ultimate criterion
of efficacy would be various forms of life success rather than performance in a narrow
psychological lab tests. Such “ecological testing” would require new kinds of experiment,
including monitoring of large sample populations. Advances in wearable computers and
sensors may allow unobtrusive monitoring of behavior, diet, use of other drugs, etc. Data
25
mining of collected materials could help determine the effects of enhancers. Such studies,
however, would pose major challenges, including cost, new kinds of privacy concerns
(monitoring may accumulate information not only about the consenting test subjects but
also about their friends and family), and problems of unfair competition if enhancers
experience beneficial effects but others cannot get access to the enhancements due to
their experimental nature.
While access to medicine is currently regarded as a human right constrained by cost
concerns, it is less clear whether access to all enhancements should or would be regarded
as a positive right135. The case for at least a negative right to cognitive enhancement,
based on cognitive liberty, privacy interests, and the important interest of persons to
protect and develop their own minds and capacity for autonomy, seems very strong136.
Banning enhancements would create an incitement for black markets as well as limit
socially beneficial uses. Legal enhancement would promote development and use, in the
long run leading to cheaper and safer enhancements. Yet without public funding, some
useful enhancements may be out of reach for many of the people who would benefit the
most from them. Proponents of a positive right to enhancements could argue for their
position on grounds of fairness or equality, or on grounds of a public interest in the
promotion of the capacities required for autonomous agency. The societal benefits of
effective cognitive enhancement may even turn out to be so large and clear that it would
be Pareto optimal to subsidize enhancement for the poor just as the state now subsidizes
education.137
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... Cognition is a compilation of capabilities with regard to information, including acquiring (perception), selecting (attention), representing (understanding), processing, retaining (memory), and being creative with the information. (Dressler et al. 2019;Kostikov 2021;Bostrom and Sandberg 2009). Cognitively enhanced humans will have, compared to ordinary humans, advanced capabilities in some or all of these core faculties. ...
... Cognitively enhanced humans will likely benefit from artificial means to optimize learning and memory (Bostrom and Sandberg 2009). Research underway includes brain stimulation techniques, e.g., functional magnetic resonance imaging or fMRI neurofeedback (e.g., Dressler et al. 2019) and transcranial magnetic stimulation or TMS (e.g., Hummel and Cohen 2005). ...
... (Lavazza 2018) Significantly enhanced humans may require adjustments in our legal, political, educational, economic, and other systems. The ethical discussion is underway (e.g., Lavazza 2018; Al-Rodhan 2019; Bostrom and Sandberg 2009). No religion will be immune to such developments, which, if the faith traditions are to be relevant, will necessitate theological, ethical, institutional, and other responses (e.g., Donaldson and Cole-Turner 2018). ...
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... Recent studies have focused on developing measures to modulate attentional levels through cognitive and physical practices to overcome the expected limitations of human cognitive capacity [8], [9]. Broadly the following categories of cognitive-enhancement techniques have been introduced in the past: Physical, including aerobic exercise training [10]- [12] e.g., dance techniques [13] and brief strolls [14]; Neurological, including non-invasive braincomputer interface devices [15], invasive neural prosthetics [16] and transcranial stimulations, e.g., electrical, both direct and alternating [17] magnetic stimulations [18], focused ultrasound stimulations [19]; and Cognitive, including mindfulness meditation practices [20]- [23], multi-linguicism [24], [25], computerized cognitive training [26], [27]. ...
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Mindfulness is the practice of focusing attention in the present moment. Strategies for modulation of attention have been extensively studied recently. The present study has attempted to study the effect of brief mindfulness practices on executive control of the attention system using Stroop interference (incongruency) effect in twenty-six novice meditators. Behavioral responses indicate a positive effect on response time and accuracy after mindfulness intervention. Neurophysiological findings suggest more efficient allocation of attentional resources indicated by increase in positive component (P200, P300) and expected decrease in the inhibitory or negative component (N200) after intervention. The findings suggest a positive impact of mindfulness practices on brain functioning even for brief periods in non-meditating populations.
... 1 While filling this gap in the literature is itself important, there is additional reason why this question should be confronted sooner rather than later: as we gain greater insight into the neurological underpinnings of our mental life, new technologies to amend or enhance mental capabilities necessary for trial competence are likely to be developed. For example, so-called cognitive enhancements technologies (Bostrom and Sandberg 2009) may soon provide the state with new means to restore defendants currently deemed to be unrestorable due to cognitive deficits rather than mental pathologies-that is, defendants 'whose return to court is hindered by an inability to comprehend and to express basic legal concepts or their own legal situation' (Schwalbe and Medalia 2007, p. 522). For such defendants, emerging neuro-enhancement technologies, such as those that may enhance an agent's capacity to concentrate on or understand information (Sandberg 2011) and/or those speculated to be able to enhance capacities for memory recall and storage (Glannon 2019), may plausibly assist them in learning legal constructs central to their trial and in enabling them to aid in their legal defence. ...
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... Cognition encompasses a range of mental functions that enable us to perceive, process, and interact with our surroundings [11,30]. As a result, having healthy CF is critical for human existence. ...
... Makridis (2013) made a critical analysis of the cognitive enhancement phenomenon in the development of technology convergence. Bostrom and Sandberg (2009) believes that the impact of technology convergence on humans is not limited to changes in human life and technological levels in the macro world, but goes deep into cognitive changes such as genes, core intelligence, and memory. 2) Influence on organizations. ...
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... Cognitive enhancement may be described as "the improvement or augmentation of internal or external information processing systems to amplify or extend essential mental skills. " The general population seeks both non-pharmacological and pharmaceutical enhancers to boost performance when studying and at work by enhancing focus, motivation, and accuracy through physical, behavioral, and biochemical processes (Bostrom and Sandberg 2009;Dresler et al. 2019). ...
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Background The market for performance enhancement substances (PESs) is currently one of the fastest expanding sectors. Most studies have always concentrated on athletes in terms of PESs’ misuse, ignoring a critical segment of the community: the future health-care workers. Thus, the aim of the study was to probe the knowledge, perception, and attitude of medical students regarding the misuse of PESs in sports and medical academic study. A cross-sectional study was conducted among students of Alexandria Faculty of Medicine, Egypt. Data were collected via self-administered electronic survey from 208 students of both sexes (aged from 18 to 26 years old). Analysis of factors affecting the consumption of PESs like gender differences, and their prior knowledge and perception was performed using logistic regression models. Results More than half of the participants have no idea about law concerning the use of doping substances. There were no significant disparities in knowledge and perception between males and females. Female students, on the other hand, consistently reported having a better understanding of the negative impacts of PESs’ misuse. Surprisingly, females are more prone to consume PESs for cognitive enhancement rather than the physical performance. Conclusions The study is the first to explore the awareness of the medical students, their attitude, and perception towards different ethical scenarios confronted in the daily practice. This finding pinpoints that the common trend of striving for fitness and an ideal body shape and weight has produced a shift in the prevalence of the PESs use according to gender in Egypt. Moreover, females in medicine academics are more prone to use PESs to improve the cognitive functions albeit it is nonsignificant statistically. Therefore, efforts should be directed to raise the awareness of medical practitioners of diverse categories of these substances, health hazards, laws, and penalties. More importantly, policy measures for their production, marketing, and misuse among university students should be reconsidered by the government.
... Representative studies are rare in this context, e.g., [26,27] and several (often non-representative) studies focus on specific occupations, such as scientists [28], doctors, programmers, advertising specialists, and publicists [29]. The misuse of such drugs for enhancement purposes has been positively described as a means to increase productivity and wealth [30,31]. However, there is also concern given the possible negative health consequences arising from such drug misuse, which can include addiction. ...
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This study examines how work stress affects the misuse of prescription drugs to augment mental performance without medical necessity (i.e., cognitive enhancement). Based on the effort-reward imbalance model, it can be assumed that a misalignment of effort exerted and rewards received increases prescription drug misuse, especially if employees overcommit. To test these assumptions, we conducted a prospective study using a nationwide web-based sample of the working population in Germany (N = 11,197). Effort, reward, and overcommitment were measured at t1 and the 12 month frequency of prescription drug misuse for enhancing cognitive performance was measured at a one-year follow-up (t2). The results show that 2.6% of the respondents engaged in such drug misuse, of which 22.7% reported frequent misuse. While we found no overall association between misuse frequency and effort, reward, or their imbalance, overcommitment was significantly associated with a higher misuse frequency. Moreover, at low levels of overcommitment, more effort and an effort-reward imbalance discouraged future prescription drug misuse, while higher overcommitment, more effort, and an imbalance increased it. These findings suggest that a stressful work environment is a risk factor for health-endangering behavior, and thereby underlines the importance of identifying groups at risk of misusing drugs.
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Can education increase an individual’s IQ? This has been one of the most incendiary and controversial questions in the social sciences in the past few decades. The greatest firestorm occurred after the publication of Arthur Jensen’s 1969 article in The Harvard Education Review, “How Much Can We Boost IQ and Scholastic Achievement?”¹ The controversy was further fueled by Richard Herrnstein’s 1971 Atlantic Monthly article, “IQ.”² Then, after smoldering for two decades, the passion and acrimony reignited with publication in 1994 of The Bell Curve by Richard Herrnstein and Charles Murray.
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Our growing ability to alter brain function can be used to enhance the mental processes of normal individuals as well as to treat mental dysfunction in people who are ill. The prospect of neurocognitive enhancement raises many issues about what is safe, fair and otherwise morally acceptable. This article resulted from a meeting on neurocognitive enhancement that was held by the authors. Our goal is to review the state of the art in neurocognitive enhancement, its attendant social and ethical problems, and the ways in which society can address these problems.
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In this provocative book, philosopher Nicholas Agar defends the idea that parents should be allowed to enhance their children's characteristics. Gets away from fears of a Huxleyan 'Brave New World' or a return to the fascist eugenics of the past. Written from a philosophically and scientifically informed point of view. Considers real contemporary cases of parents choosing what kind of child to have. Uses 'moral images' as a way to get readers with no background in philosophy to think about moral dilemmas. Provides an authoritative account of the science involved, making the book suitable for readers with no knowledge of genetics. Creates a moral framework for assessing all new technologies.
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Personnel selection research provides much evidence that intelligence (g) is an important predictor of performance in training and on the job, especially in higher level work. This article provides evidence that g has pervasive utility in work settings because it is essentially the ability to deal with cognitive complexity, in particular, with complex information processing. The more complex a work task, the greater the advantages that higher g confers in performing it well. Everyday tasks, like job duties, also differ in their level of complexity. The importance of intelligence therefore differs systematically across different arenas of social life as well as economic endeavor. Data from the National Adult Literacy Survey are used to show how higher levels of cognitive ability systematically improve individual's odds of dealing successfully with the ordinary demands of modern life (such as banking, using maps and transportation schedules, reading and understanding forms, interpreting news articles). These and other data are summarized to illustrate how the advantages of higher g, even when they are small, cumulate to affect the overall life chances of individuals at different ranges of the IQ bell curve. The article concludes by suggesting ways to reduce the risks for low-IQ individuals of being left behind by an increasingly complex postindustrial economy.
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Translated and adapted by Ann Cutler and Rudolph Mcshane London: Souvenir Press Ltd. Pp. 270. Price 21s. What is described in this book is a new set of rules by which it is claimed the basic arithmetical operations can be performed with greater speed, facility and accuracy than by conventional methods. Jakow Trachtenberg, a Russian by birth, devised his system when he was a prisoner in a German concentration camp.