On the Moral Use of “Smart Drugs”

Cognitive enhancement drugs (CEDs), such as Ritalin, Adderall, and Provigil, are most commonly known for their use in treating patients with Attention Deficit Hyperactivity Disorder (ADHD). But these drugs, often called “smart drugs,” can profoundly enhance a perfectly healthy person’s ability to sustain concentration and thus improve the effectiveness of his mind for a period of time. When working on a difficult mental task—engaging in research, taking a test, performing an operation, or the like—sustained concentration can be the difference between success and failure. Although research on CEDs is still in its infancy, a handful of compounds on the market are showing remarkable results—and, of course, generating much controversy.

Various ethicists and policy advisers object to the use of “smart drugs” by healthy people. They allege, among other things, that such usage is dangerous because it can make criminals more effective at doing harm, or that it is “unfair” to those who don’t use the drugs, or that it is akin to the dishonest use of steroids by professional athletes.¹ But do such objections make sense in light of the relevant facts? Are these legitimate grounds for morally condemning or even legally prohibiting the use of CEDs by healthy people? Are there circumstances in which the use of such drugs by healthy people can be moral?

Toward answering these questions, let us begin with a brief indication of the basic nature of these drugs and how they work.

Prominent CEDs include methylphenidate (Ritalin is a brand name), modafinil (Provigil is a brand name), and that great staple in life, caffeine. Each of these drugs stimulates the nervous system and regulates the cellular release and uptake of neurotransmitters, which are chemical compounds that transmit signals from one nerve cell to another. Consider first the most common of these, caffeine.

Research has shown that caffeine improves cognitive performance mainly by inhibiting a brain-activity inhibitor known as adenosine. Adenosine is a neurotransmitter that suppresses brain excitation and is involved in regulating the sleep cycle. Caffeine blocks adenosine receptors in the central nervous system, preventing adenosine from binding to nerve cells.² This, in turn, reduces the inhibitory effect of adenosine on the brain and enables greater neural activity.³ Caffeine is used by many millions of people every day to increase alertness and mental efficacy. It is by far the most widely used CED.

Ritalin, originally intended to help ADHD patients concentrate, works by preventing the neurotransmitters dopamine and norepinephrine from being stored within nerve cells. When these neurotransmitters are stored within nerve cells, they are inactive. But when they are free-floating outside of nerve cells, they are available to attach to the outside of neighboring neurons, producing a stimulant effect. In test subjects with normal levels of dopamine, Ritalin has increased the capacity to sustain concentration.⁴ Ritalin is used by college students for studying and test taking, by pilots in the U.S. Air Force (and elsewhere) during extended operations, and by many other people who seek the alertness and sustained concentration it affords.⁵

Provigil, originally intended for treating patients with narcolepsy, has remarkable effects on the cognitive potential of healthy people, but the exact mechanism of action is unknown.⁶ In addition to enhancing the user’s ability to sustain concentration, Provigil promotes wakefulness even in users who have experienced prolonged sleep deprivation.⁷ In studies in which sleep-deprived test subjects were given either Provigil or a placebo, the subjects who received Provigil reportedly had better short-term memory and were able to suppress distractions significantly more so than those who received the placebo.⁸ Like Ritalin and caffeine, Provigil is used by students, pilots, and others who seek to benefit from such effects.⁹

According to research by Jakov Gather, although Ritalin and Provigil have some side effects, using them in moderation is not significantly more risky than regularly consuming caffeine in caramel lattes.¹⁰ Nor, according to clinical trials of Provigil, does it appear to have a profound effect on a person’s personality, mood, or ability to make rational judgments.¹¹

If CEDs provide increased concentration or alertness with few and relatively insignificant side effects, what is the moral status of the use of these drugs? From college students studying for exams to professors and scientists conducting research to doctors performing surgeries to pilots flying long distances, the ability to sustain concentration or alertness is profoundly life-serving. If a substantial increase in this ability is just a pill away, then, by the standard of the requirements of life, the use of these drugs by healthy people can be profoundly moral.

In addition to being directly beneficial to those who take them, these drugs can be indirectly beneficial to many, many more besides. As Harvard philosopher Elizabeth Fenton writes, “People who struggle with disease, disability, . . . crop failure or dramatic climatic shifts are just some of those who stand to gain a sufficiently large increase in their or their children’s quality of life . . . by accelerated scientific progress [due to CED use].”¹²

Given the foregoing, what is not to like about these drugs? Let’s consider some of the main objections to them.

One fear of CEDs is that, by their very nature, they hold the potential to cause great public harm. Oxford philosophers Julian Savulescu and Ingmar Persson, for instance, argue that CED use by evil people will make it easier for them to cause large-scale harm, such as by creating and deploying a doomsday machine. Savulescu and Persson point out that because CEDs improve mental function across the board, both evil people and good people will be able to better achieve their agendas, and they argue that this fact is grounds for regulating or even banning the drugs.¹³ But this argument, if taken seriously and to its logical conclusion, would mean that we should regulate or ban everything that can be used by bad people to do bad things. It would mean that we should regulate or ban not only hammers, knives, plastic bags, and bricks—all of which can be used to do great harm—but also education and human thought processes as such. As University of Manchester philosopher John Harris notes, Savulescu’s and Persson’s “extreme risk aversion would justify not only retarding scientific progress but retarding the cognitive powers of people as well.”¹⁴

Some people claim that the use of CEDs by healthy people amounts to cheating because it gives the users an advantage over those not using the drugs. The example frequently given is that of a curved exam, where a higher grade for one student causes lower grades for other students.¹⁵ Yet if using a CED while studying or taking an exam is unfair to those who do not use a CED, then not only is it unfair for one student to drink coffee before an exam when others do not; but it is also unfair for one student to take detailed notes if others do not, or to get a good sleep if others do not, or to hire a tutor if others do not, or to think longer and harder than others do, and so on.

The premise behind this “CED-use is cheating” objection is that anything that gives a student an advantage over other students is wrong. But that premise is false. Advantages and disadvantages among students—and among people in general—abound. Some are innate (e.g., natural intelligence), some are environmental (e.g., economic situation), some are chosen (e.g., the choice to exert effort or not), and some are combinations of these. But having an advantage over others is not immoral—unless one gains it by dishonest means. And there are no moral grounds for forbidding people to use things or engage in practices that enhance their abilities or provide them with advantages over others—unless they violate others’ rights in the process.

Of course, under certain circumstances the use of a CED to gain an advantage over others can be dishonest and violate rights. For instance, if an employer or a university specifies in its contract that the consumption of CEDs (or certain CEDs) is forbidden, then an employee or student who signs the contract has a moral and legal obligation to refrain from using the drugs. To violate such a contract is to violate the rights of the other parties to the contract. Such contracts are common in professional sports organizations, and when athletes violate these contracts, they obviously are morally and legally in the wrong for doing so. But in the absence of such a contract or the equivalent, for a person to use a CED in no way violates anyone’s rights.

Then there is the egalitarian approach to the issue. Some people argue that the use of CEDs by healthy people is not morally acceptable unless the drugs are universally accessible. (On this premise, Stanford professor Henry Greely suggests a policy of distributing school-wide CEDs during exam week.)¹⁶ Here, again, the example of coffee is illuminating. In one sense, coffee is universally accessible—everyone is free to buy it if he chooses. In another sense, it is accessible only to those who are able to pay for it. If someone cannot afford a coffee on exam day, does that mean students who can afford it should not drink it? It depends on whether the students have entered into a contract to that effect. In the absence of such a contract, nothing is wrong with a student drinking a cup of coffee or tea before an exam. Likewise, nothing is wrong with a student taking another kind of CED.

Setting aside the dishonest acquisition of money (i.e., via theft, fraud, government pull, or the like), differences in purchasing ability are a normal aspect of human existence. Although some but not all people can afford CEDs—whether coffee or Provigil or Ritalin—this does not mean that those who can afford them are being unfair by enjoying them when others cannot. It is worth noting that even if CEDs were used uniformly within the population, outcomes would vary tremendously among different people because of differences in biology and choice.¹⁷ The equality that morally matters is equal protection of rights and equality before the law.

Another common concern about the use of CEDs by healthy people is that, allegedly, the drugs are “unnatural.” As University of Münster philosopher Kurt Bayertz points out, in the minds of many, “naturalness is intuitively regarded as a value.”¹⁸ But the idea that natural products are better than artificial ones is senseless. To begin with, everything is made of material from nature; there is nowhere else to get material. Further, almost every food and medicine we consume is processed in some way, whether treated with heat or chemicals, or mixed with other ingredients, or converted to an extract, or countless other possible ways or combinations of ways. This is true even of many allegedly “all-natural” products. Yet observe that there are no moral condemnations of people who use vitamin B3, Ginkgo biloba, St. John’s wort, or fish oil. (Observe also that these compounds cause or allegedly cause advantageous chemical changes in the body, just as CEDs do.) This preference for “naturalness” is based not on fact but on misunderstanding.

Another objection to CED use by healthy people is that some of these drugs can be addictive (i.e., when routine drug use stops, withdrawal symptoms can follow). The possibility of addiction when using potentially addictive CEDs is, of course, a legitimate concern, just as it is with respect to the many other potentially addictive drugs used by people for many reasons every day. Alcohol, oxycodone, caffeine, and countless other drugs used by people on a daily basis can be addictive to some extent. But this is no reason to morally condemn those who use them or to forbid their use; rather, it is a reason for those who choose to use them to be cognizant of their addictive potential and to proceed accordingly.

The foregoing are common objections to the use of CEDs by healthy people, and none of them nor all of them amount to a sound argument that such use is immoral.

The fact is that CEDs can help people more effectively pursue and achieve their life-serving goals—and, as with the use of virtually all drugs, the use of these drugs entails some risks. Accordingly, the moral status of consuming such drugs is the same as the moral status of consuming any other drug: It depends on whether the person taking the drug does due diligence so that he is aware of the available and relevant facts about the drug, and on whether he uses the drug rationally and responsibly—which means, with respect to the full context of his knowledge and the hierarchy of his life-serving values.

The purpose of this inquiry is not to encourage people to take CEDs. Rather the purpose is to point out that taking such drugs can, under certain circumstances, be life-enhancing and thus moral, and to dispel the notion that consuming them is somehow inherently wrong. As always, caveat emptor.

About Mitchell Feinberg

Mitchell Feinberg holds a bachelor of science in biomedical engineering, with a focus in cell and tissue engineering, from Columbia University. He resides in Cambridge, Massachusetts and is currently pursuing a JD at Harvard Law School.

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