Should physicians prescribe cognitive enhancers to healthy individuals?

December 17, 2012

Physicians should not prescribe cognitive enhancers to healthy individuals, states a report being published today in the Canadian Medical Association Journal (CMAJ). Dr. Eric Racine and his research team at the IRCM, the study's authors, provide their recommendation based on the professional integrity of physicians, the drugs' uncertain benefits and harms, and limited health care resources.

Prescription stimulants and other neuropharmaceuticals, generally prescribed to treat attention deficit disorder (ADD), are often used by healthy people to enhance concentration, memory, alertness and mood, a phenomenon described as cognitive enhancement.

"Individuals take prescription stimulants to perform better in school or at work," says Dr. Racine, a Montréal neuroethics specialist and Director of the Neuroethics research unit at the IRCM. "However, because these drugs are available in Canada by prescription only, people must request them from their doctors. Physicians are thus important stakeholders in this debate, given the risks and regulations of prescription drugs and the potential for requests from patients for such cognitive enhancers."

The prevalence of cognitive enhancers used by students on university campuses ranges from 1 per cent to 11 per cent. Taking such stimulants is associated with risks of dependence, cardiovascular problems, and psychosis.

"Current evidence has not shown that the desired benefits of enhanced mental performance are achieved with these substances," explains Cynthia Forlini, first author of the study and doctoral student in Dr. Racine's research unit. "With uncertain benefits and clear harms, it is difficult to support the notion that physicians should prescribe a medication to a healthy individual for enhancement purposes."

"Physicians in Canada provide prescriptions through a publicly-funded health care system with expanding demands for care," adds Ms. Forlini. "Prescribing cognitive enhancers may therefore not be an appropriate use of resources. The concern is that those who need the medication for health reasons but cannot afford it will be at a disadvantage."

"An international bioethics discussion has surfaced on the ethics of cognitive enhancement and the role of physicians in prescribing stimulants to healthy people," concludes Dr. Racine. "We hope that our analysis prompts reflection in the Canadian medical community about these cognitive enhancers."
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About the study

Éric Racine's research is funded through a New Investigator Award from the Canadian Institutes for Health Research (CIHR). The report's co-author is Dr. Serge Gauthier from the McGill Centre for Studies in Aging.

About Dr. Eric Racine

Eric Racine obtained his PhD in applied human sciences and bioethics from the Université de Montréal. He is an Associate IRCM Research Professor and Director of the Neuroethics research unit. Dr. Racine is an associate professor-researcher in the Department of Medicine (accreditation in social and preventive medicine) at the Université de Montréal. He is also adjunct professor in the Department of Medicine (Division of Experimental Medicine) and the Department of Neurology and Neurosurgery at McGill University. In addition, he is an affiliate member of the Biomedical Ethics Unit at McGill University. For more information, visit www.ircm.qc.ca/racine.

About the Institut de recherches cliniques de Montréal (IRCM)

Founded in 1967, the IRCM is currently comprised of 37 research units in various fields, namely immunity and viral infections, cardiovascular and metabolic diseases, cancer, neurobiology and development, systems biology and medicinal chemistry. It also houses three specialized research clinics, eight core facilities and three research platforms with state-of-the-art equipment. The IRCM employs 425 people and is an independent institution affiliated with the Université de Montréal. The IRCM clinic is associated to the Centre hospitalier de l'Université de Montréal (CHUM). The IRCM also maintains a long-standing association with McGill University.

About the Canadian Institutes of Health Research (CIHR)

CIHR is the Government of Canada's health research investment agency. CIHR's mission is to create new scientific knowledge and enable its translation into better health, more effective health services and products, and a stronger Canadian health care system. Composed of 13 Institutes, CIHR provides leadership and support to more than 14,100 health researchers and trainees across Canada.

Institut de recherches cliniques de Montreal

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