Bradley Partridge

Smart drugs "as common as coffee": media hype about neuroenhancement.

Background The use of prescription drugs to improve cognitive functioning in normal persons –“neuroenhancement” – has gained recent attention from bioethicists and neuroscientists. Enthusiasts claim that the practice is widespread and increasing, and has many potential benefits; however recent evidence provides weak support for these claims. In this study we explored how the newsprint media portrays neuroenhancement. Aims We conducted an empirical study of media reporting of neuroenhancement to explore: media portrayals of the prevalence of neuroenhancement; the types of evidence used by the media to support claims about its prevalence; and, the possible benefits and risks of neuroenhancement mentioned in these media articles. Methods Using the Factiva database, we found 142 newspaper articles about the non-medical use prescription drugs for neuroenhancement for the period 2008-2010. We conducted a thematic content analysis of how articles portrayed the prevalence of neuroenhancement; what type of evidence they used in support; and, the potential benefits and risks/side-effects of neuroenhancement that were mentioned. Results 87% of media articles mentioned the prevalence of neuroenhancement, and 94% portrayed it as common, increasing or both. 66% referred to the academic literature to support these claims and 44% either named an author or a journal. 95% of articles mentioned at least one possible benefit of using prescription drugs for neuroenhancement, but only 58% mentioned any risks/side effects. 15% questioned the evidence for efficacy of prescription drugs to produce benefits to users. Conclusions News media articles mentioned the possible benefits of using drugs for neuroenhancement more than the potential risks/side effects, and the main source for media claims that neuroenhancement is common and increasingly widespread has been reports from the academic literature that provide weak support for this claim. We urge journalists and researchers to be cautious in their portrayal of the non-medical use of drugs for neuroenhancement.

Why Don't Smokers Want Help to Quit? A Qualitative Study of Smokers' Attitudes towards Assisted vs. Unassisted Quitting.

The development of prescription medication for smoking cessation and the introduction of evidence-based guidelines for health professionals has increasingly medicalised smoking cessation. There are debates about whether medicalisation is a positive development, or whether it has devalued unassisted quitting. In this debate the views of smokers have been neglected. This study explored the attitudes of smokers towards a range of quitting methods, and their considerations when judging their value. We conducted semi-structured interviews with 29 smokers and analysed data using thematic analysis. The results show that the perceived nature of an individual smoker’s addiction was central to judgments about the value of pharmacological cessation aids, as was personal experience with a method, and how well it was judged to align with an individual’s situation and personality. Unassisted quitting was often described as the best method. Negative views of pharmacological cessation aids were frequently expressed, particularly concerns about side effects from prescription medications. Smokers’ views about the value of different methods were not independent: attitudes about cessation aids were shaped by positive attitudes towards unassisted quitting. Examining smokers’ attitudes towards either assisted or unassisted quitting in isolation provides incomplete information on quitting preferences.

Academic doping or Viagra for the brain?: The history of recreational drug use and pharmacological enhancement can provide insight into these uses of neuropharmaceuticals

Recent developments in neuroscience have raised the possibility that neuropharmaceuticals and other interventions could be used to enhance brain processes in ‘normal’ people who are not impaired by mental illness or disorder. The terms ‘cognitive enhancement’ and ‘neuroenhancement’ are often used interchangeably to describe this type of drug use—which is similar to doping in sports—that is not for treating impairments of clinical significance or for recreation.

Researchers' perspectives on scientific and ethical issues with transcranial direct current stimulation: an international survey

In the last decade, an increasing number of studies have suggested that transcranial direct current stimulation (tDCS) may enhance brain function in healthy individuals, and ameliorate cognitive and other symptoms in patients suffering from various medical conditions. This, along with its presumed safety, simplicity, and affordability, has generated great enthusiasm amongst researchers, clinicians, patient populations, and the public (including a growing “do-it-yourself” community). However, discussion about the effectiveness and ethics of tDCS thus far has been confined to small groups of tDCS researchers and bioethicists. We conducted an international online survey targeting the opinions of researchers using tDCS who were asked to rate the technique’s efficacy in different contexts. We also surveyed opinions about ethical concerns, self-enhancement and public availability. 265 complete responses were received and analyzed statistically and thematically. Our results emphasize the potential uses of tDCS in clinical and research contexts, but also highlight a number of emerging methodological and safety concerns, ethical challenges and the need for improved communication between researchers and bioethicists with regard to regulation of the device. Neither the media reputation of tDCS as a “miracle device” nor concerns expressed in recent neuroethical publications were entirely borne out in expert opinion.

Verbal abuse and physical assault in the emergency department: Rates of violence, perceptions of safety, and attitudes towards security

INTRODUCTION Emergency Department (ED) workers are prone to occupational violence, however the extent and impact of this may not be evenly felt across all roles in the ED. AIMS Explore: 1) the rate of verbal abuse and physical assaults experienced by ED staff, 2) perceptions of safety, 3) attitudes towards security officers, and 4) formal reporting of incidents. METHODS 330 ED workers were surveyed at four public hospitals in one metropolitan health service district in Queensland, Australia, including 179 nurses, 83 medical staff, 44 administration staff, 14 allied health, and 9 operational. RESULTS Nurses were more likely to have been physically assaulted in the last six months and were less likely to feel safe. Most ED staff across all roles experienced verbal abuse. Nurses were better than medical staff at reporting instances of occupational violence although overall reporting across all roles was low. Staff who thought that security officers respond to incidents quickly and are a visible presence in the ED were more likely to feel safe in the ED. CONCLUSIONS Workers in the ED, particularly nurses, experience high rates of verbal abuse and physical aggression and there may be a case for having designated security guards in the ED.

Anticipating the anti-ageing pill: Lessons from the history of the oral contraceptive pill and hormone replacement therapy

Throughout history, the prospect of extending the human lifespan—with the ultimate aim of living forever—has been an attractive fantasy. Now, some researchers argue that it will soon be possible to increase our average life expectancy to at least 100 years, if not more, by slowing down the processes of ageing (Guarente & Kenyon, 2000). There are several potential methods for life extension interventions (Lucke & Hall, 2006), but perhaps the most likely is an anti‐ageing pill, possibly one that mimics the well‐described, life‐extending effects of caloric restriction (Everitt & Le Couteur, 2007; Michalow, 2008). Let us assume, for the purpose of argument, that a pill could be developed in the next couple of decades that extended the average human lifespan to around 150 years. > Cultural values have an important influence on the acceptability of innovations… The development and distribution of an effective anti‐ageing pill would have significant societal impacts that could easily catch many parties unawares, including governments, medical practitioners and legislators. A useful way to anticipate what these impacts might be is to look at the history of two other innovations that profoundly changed society: the oral contraceptive pill (OCP; Asbell, 1995; Marks, 2001; Tone, 2001; Watkins, 1998) and hormone replacement therapy (HRT; Watkins, 2007). Such analogies are a useful tool for the bioethical analysis of new technologies (Hofmann et al , 2006) and therefore we propose to address the issue of human life extension by applying this approach. Since its creation more than 50 years ago, the OCP has been heralded as one of the “greatest miracle drugs” (Goldin & Katz, 2002), a “medical milestone” (Djerassi, 2007) and the first “lifestyle and designer drug” (Junod & Marks, 2002). It was the first virtually fail‐safe contraceptive method that women could use independently, and was controversial as …

Concussion Ethics and Sports Medicine.

Despite considerable scientific dispute the science of concussion, there has been a proliferation of position statements and professional guidelines published on sports concussion management over the last 15 years. A number of ethical and clinical problems associated with concussion management protocols remain concerning, (i) diagnosis and management; (ii) conflicts of interest and coercion; (iii) same day return to play; and (iv) reporting, auditing and confidentiality. These issues are critically discussed in the light of recent Consensus Statements. It is argued that the use of independent match day doctors may ameliorate some of these concerns.

A preliminary video review of in-game head injury incidents (hii) and use of the head injury assessment (hia) from the 2015 super rugby season

Objective To complete a video evaluation of the management of players suspected of sustaining concussion in professional Rugby Union during the 2015 season. Design Retrospective, observational study. Setting Super Rugby match play. Participants Players representing Australian Super Rugby franchises who were evaluated by their team doctor (TD) and an independent match day doctor (MDD) for concussion during the 2015 season. Outcome measures In-game ‘head injury incidents’ (HII) and use of the World Rugby (WR) Head Injury Assessment (HIA) process were recorded. TD and MDD had access to video during games which allowed review of HIIs as part of their decision making process. A retrospective review of the video of each incident by three experienced clinicians was conducted to assess the decision-making process (i.e., permanent removal, remain-in-play, or return-to-play). Main results There were 47 ‘head injury incidents’ (HII) evaluated by TD and MDD. Using WR HIA criteria, 18 incidents resulted in a player’s permanent removal, of which 16 were subsequently diagnosed with concussion. On retrospective video review, the in-game decision to permanently remove a player was agreed upon in 78% (14/18) of cases. Using WR HIA criteria, there were 28 decisions to temporarily remove a player and conduct a HIA. On retrospective review, the in-game decision to complete a HIA was agreed upon in 68% (19/28) of cases. Conclusions Reviewing match video footage can be a useful addition to the TDs’ and MDDs’ in-game clinical assessment of concussion. The clinical relevance of some brief signs on video review warrants further investigation. Competing interests Ryan Kohler, Bradley Partridge – None. Michael Makdissi (see declaration form for full disclosures) Warren McDonald is the Chief Medical Officer of the Australian Rugby Union (ARU). He also operates his own private sports and exercise medicine practice in Canberra, Australia. Andrew Gardner has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion (including current and former athletes). He serves, in a voluntary capacity, as a member of the Australian Rugby Union (ARU) concussion advisory group. He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation and the Hunter Medical Research Institute (HMRI), supported by Jennie Thomas. He is currently receiving research funding through the HMRI, supported by Anne Greaves.

A Bubble of Enthusiasm: How Prevalent Is the Use of Prescription Stimulants for Cognitive Enhancement?

This chapter focuses on the evidence for the prevalence of non-medical stimulant use by students for cognitive enhancement. Some of what is cited as apparent evidence for widespread cognitive enhancement (also known as neuroenhancement) has a number of weaknesses that we should be aware of. Here, I expand upon several examples whereby the prevalence of cognitive enhancement has been uncritically presented. Caution needs to be exercised to avoid whipping up hype about neuroenhancement by overextending what the currently available data on prevalence really says.