Brad Partridge

Deflating the Neuroenhancement Bubble

This article questions the evidence base for some commonly accepted assumptions among bioethicists about the prevalence of neuroenhancement among college students and the degree to which putative neuroenhancers in fact enhance cognitive functioning. We argue that the evidence on the prevalence of stimulant drug use does not support bioethicists’ claims that neuroenhancement use of these drugs is widespread; that the evidence that putatively enhancing pharmaceuticals are truly neuroenhancing is much weaker than often supposed; that bioethicists have underestimated the challenges in assessing the safety and efficacy of putative neuroenhancers; and that the assumption that neuroenhancement is a novel development has deflected attention from historical experiences with other putatively enhancing pharmaceutical drugs such as cocaine and the amphetamines.

Addiction: Current Criticism of the Brain Disease Paradigm

To deepen understanding of efforts to consider addiction a “brain disease,” we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease.

Ethical Concerns in the Community About Technologies to Extend Human Life Span

Debates about the ethical and social implications of research that aims to extend human longevity by intervening in the ageing process have paid little attention to the attitudes of members of the general public. In the absence of empirical evidence, conflicting assumptions have been made about likely public attitudes towards life-extension. In light of recent calls for greater public involvement in such discussions, this target article presents findings from focus groups and individual interviews which investigated whether members of the general public identify ethical issues surrounding life-extension, and if so, what these ethical issues are? In this study, while some participants were concerned primarily with the likely personal consequences of life-extension, for others the question of whether or not to pursue interventions to extend longevity, and how they should be implemented, clearly raised important ethical issues, many of which have been prominent in debates among bioethicists.

Ethical, Social, and Personal Implications of Extended Human Lifespan Identified by Members of the Public

There are a number of ethical, social, and personal implications generated by the potential development and use of technologies that may extend human longevity by intervening in aging. Despite speculations about likely public attitudes toward life extension, to date there have been few attempts to empirically examine the publics perspective of these issues. Using open-ended survey questions via telephone interviews, this study explored the attitudes of 605 members of the Australian public toward the implications of life extension. Participants were asked to briefly describe in their own words what they believed would be the beneficial, as well as negative, implications arising from life extension (if there were any), both for themselves personally and for society as a whole. Participants were also asked to describe any ethical concerns they had about life extension, if they had any at all. All open-ended responses were collated and then underwent a thematic analysis to uncover commonly cited issues regarding personal benefits/negatives, societal benefits/negatives, and ethical concerns. A considerable number of participants envisioned at least some beneficial as well as negative implications for themselves and for society, and many claimed to have at least some ethical concerns. Some novel issues were raised as well as a number of those discussed within the bioethical literature. The results should encourage researchers, bioethicists, and policy makers to engage with members of the public about the goals of research surrounding life extension, the expected outcomes of such research, and the likely implications for individuals and society.

A Comparison of Attitudes Toward Cognitive Enhancement and Legalized Doping in Sport in a Community Sample of Australian Adults

Background: This article compares public attitudes toward the use of prescription drugs for cognitive enhancement with the use of performance enhancing drugs in sport. We explore attitudes toward the acceptability of both practices; the extent to which familiarity with cognitive enhancement is related to its perceived acceptability; and relationships between the acceptability of cognitive enhancement and legalized doping in sport. Methods: A survey was administered through a computer-assisted telephone interviewing system to members of the Australian general public aged 18–101 years in the state of Queensland. Results: Of 1,265 participants, 7% agreed that cognitive enhancement is acceptable; 2.4% of the total sample said they had taken prescription drugs to enhance their concentration or alertness in the absence of a diagnosed disorder, and a further 8% said they knew someone who had done so. These participants were twice as likely to think cognitive enhancement was acceptable. Only 3.6% of participants agreed that people who play professional sport should be allowed to use performance-enhancing drugs if they wanted to. Participants who found cognitive enhancement acceptable were 9.5 times more likely to agree with legalized doping. Conclusions: Policies that facilitated the use of prescription drugs by healthy people for cognitive enhancement or permitted performance-enhancing drugs in sport would be at odds with the attitudes of the vast majority of our participants. Furthermore, our findings do not support media claims that the use of prescription drugs for cognitive enhancement is widespread in all sectors of society.

Dazed and Confused: Sports Medicine, Conflicts of Interest, and Concussion Management

Professional sports with high rates of concussion have become increasingly concerned about the long-term effects of multiple head injuries. In this context, return-to-play decisions about concussion generate considerable ethical tensions for sports physicians. Team doctors clearly have an obligation to the welfare of their patient (the injured athlete) but they also have an obligation to their employer (the team), whose primary interest is typically success through winning. At times, a team’s interest in winning may not accord with the welfare of an injured player, particularly when it comes to decisions about returning to play after injury. Australia’s two most popular professional football codes—rugby league and Australian Rules football—have adopted guidelines that prohibit concussed players from continuing to play on the same day. I suggest that conflicts of interest between doctors, patients, and teams may present a substantial obstacle to the proper adherence of concussion guidelines. Concussion management guidelines implemented by a sport’s governing body do not necessarily remove or resolve conflicts of interest in the doctor–patient–team triad. The instigation of a concussion exclusion rule appears to add a fourth party to this triad (the National Rugby League or the Australian Football League). In some instances, when conflicts of interest among stakeholders are ignored or insufficiently managed, they may facilitate attempts at circumventing concussion management guidelines to the detriment of player welfare.

The search for Methuselah. Should we endeavour to increase the maximum human lifespan

One of the oldest dreams of humankind has been to find a way to evade death for as long as possible—or even entirely. Molecular biologists, geneticists and biogerontologists are actively exploring ways to extend the maximum human lifespan by slowing or stopping the ageing process. This so‐called ‘strong’ form of life extension differs from ‘weak’ forms, which focus only on the better prevention and treatment of common diseases, without seeking to alter the upper lifespan limit of about 120 years (Lucke & Hall, 2006). There is no consensus at present on whether anti‐ageing interventions will prove possible or, if such methods are developed, when they will be available and to whom. Nevertheless, the idea of expanding the maximum human lifespan has fascinated philosophers, scientists and writers for millennia—from the biblical Methuselah to the medieval Fountain of Life, and from the Philosophers Stone to contemporary debates about increasing longevity using scientific methods. Also, given the unwavering media interest in research into slowing or preventing ageing, it is not surprising that ethicists have begun to debate whether we should attempt to increase human longevity—and whether society should finance research focused on this goal. In this article, we briefly summarize the ethical arguments raised in this debate, with a focus on the issues surrounding the more controversial form of life‐extension research that would extend the human life span beyond the current maximum of 120 years. The most fundamental opponents of increasing the maximum human lifespan in this way are conservative critics of biotechnology, who argue that this would be contrary to the ‘natural’ order of things or that it would be against ‘divine’ law. These conservatives have taken ‘pro‐life’ stances in abortion and stem‐cell debates, and are generally wary of human intervention in natural processes, such as reproduction and ageing (Horrobin, 2006 …

Public attitudes towards the acceptability of using drugs to treat depression and ADHD.

Objective: This paper examines public attitudes towards the acceptability of using prescription drugs to treat depression and attention deficit hyperactivity disorder (ADHD), and whether attitudes are influenced by familiarity with the use of pharmacological treatments for these disorders. Method: Participants were 1265 members of the general public aged 18–101 years (50% female) participating in the Queensland Social Survey (QSS), an omnibus state-wide survey of households in the state of Queensland. The survey was administered through a CATI (computer-assisted telephone interviewing) system. Results: Most members of the public thought that the drug treatment of depression was acceptable (55%) but attitudes were much less positive towards the use of drugs to treat ADHD (35.6% acceptable). Regression analyses showed that respondents who knew someone who had received pharmacological treatment for depression were more likely to find it acceptable. However, participants were divided about the acceptability of drug treatment for ADHD regardless of whether they knew someone who had received drug treatment for ADHD or not. Participants with a higher level of education were more likely to find drug treatment for depression and ADHD acceptable. Participants who did not know anyone who had received drug treatment were less likely to have a definite opinion on whether it was acceptable or unacceptable. Conclusions: Attitudes towards the acceptability of the use of prescription drugs are more positive for depression than for ADHD. This may broadly reflect ongoing controversies in the public sphere about the potential over-diagnosis of ADHD or overmedication of children with ADHD. Members of the public who do not know anyone with depression or ADHD may need particular information from prescribers in the event that they (or their child) are diagnosed.

Letter to the Editor: Better evidence for safety and efficacy is needed before neurologists prescribe drugs for neuroenhancement to healthy people

In this paper we question the guidance offered to neurologists by the Ethics, Law and Humanities Committee of the American Academy of Neurology (Larriviere, Williams, Rizzo & Bonnie, 2009) on how to respond to requests for “neuroenhancement”: the use of pharmaceuticals to enhance cognitive function in cognitively normal people. The guidance assumes that the benefits of using neuroenhancers will prove to outweigh the risks in the absence of any evidence that this is the case. However, the principle of nonmaleficence dictates that the use of these drugs by healthy people should not be condoned before reliable evidence for their short and long term safety and efficacy is at hand. The proposed ethical framework for neuroenhancement prescribing also neglects the broader social implications of condoning such practices. The adoption of these guidelines by neurologists could have adverse social and medical effects that need to be more carefully considered.

Community perceptions on the significant extension of life: an exploratory study among urban adults in Brisbane, Australia.

Some researchers in the field of ageing claim that significant extension of the human lifespan will be possible in the near future. While many of these researchers have assumed that the community will welcome this technology, there has been very little research on community attitudes to life extension. This paper presents the results of an in-depth qualitative study of community attitudes to life extension across age groups and religious boundaries. There were 57 individual interviews, and 8 focus groups (totalling 72 focus group participants) conducted with community members in Brisbane, Australia. Community attitudes to life extension were more varied and complex than have been assumed by some biogerontologists and bioethicists. While some participants would welcome the opportunity to extend their lives others would not even entertain the possibility. This paper details these differences of opinion and reveals contrasting positions that reflect individualism or social concern among community members. The findings also highlight the relationship between Christianity, in particular belief in an afterlife, and attitudes to life extension technology. Overall, the study raises questions about the relationship between interest in life extension, the medicalisation of ageing and the increasing acceptability of enhancement technologies that need to be addressed in more representative samples of the community.