Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Psychostimulant Medication. Show all posts
Showing posts with label Psychostimulant Medication. Show all posts

Tuesday, May 28, 2019

Should Students Take Smart Drugs?

Darian Meacham
www.philosophersmag.com
Originally posted December 8, 2017

If this were a straightforward question, you would not be reading about it in a philosophy magazine. But you are, so it makes sense that we try to clarify the terms of the discussion before wading in too far. Unfortunately (or fortunately depending on how you look at it), when philosophers set out to de-obfuscate what look to be relatively forthright questions, things usually get more complicated rather than less: each of the operative terms at stake in the question, ‘should students take smart drugs?’ opens us up onto larger debates about the nature of medicine, health, education, learning, and creativity as well as economic, political and social structures and norms. So, in a sense, a seemingly rather narrow question about a relatively peripheral issue in the education sector morphs into a much larger question about how we think about and value learning; what constitutes psychiatric illness and in what ways should we deal with it; and what sort of productivity should educational institutions like universities, but also secondary and even primary schools value and be oriented towards?

The first question that needs to be addressed is what is a ‘smart drug’? I have in mind two things when I use the term here:

(1) On the one hand, existing psychostimulants normally prescribed for children and adults with a variety of conditions, most prominently ADHD (Attention Deficit Hyperactivity Disorder), but also various others like narcolepsy, sleep-work disorder and schizophrenia. Commonly known by brand and generic names like Adderall, Ritalin, and Modafinil, these drugs are often sold off-label or on the grey market for what could be called non-medical or ‘enhancement’ purposes. The off-label use of psychostimulants for cognitive enhancement purposes is reported to be quite widespread in the USA. So the debate over the use of smart drugs is very much tied up with debates about how the behavioural and cognitive disorders for which these drugs are prescribed are diagnosed and what the causes of such conditions are.

(2) On the other hand, the philosophical-ethical debate around smart drugs need not be restricted to currently existing technologies. Broader issues at stake in the debate allow us to reflect on questions surrounding possible future cognitive enhancement technologies, and even much older ones. In this sense, the question about the use of smart drugs situates itself in a broader discussion about cognitive enhancement and enhancement in general.

The info is here.

Monday, February 27, 2017

Enhancing responsibility: Nicole Vincent at TEDxSydney 2014



Published on Jun 2, 2014

Performance enhancing has dominated debate in sport the world over. But what about in the rest of our lives? In this thought-provoking talk, Nicole Vincent discusses the fact that, whether we are aware of it or not, people have been actively pursuing ways and means to enhance their performance for years, even decades.

At work, while studying, or on stage, pressure to perform better is also increasing. This is being driven by many factors: competition, consumer demand, societal and even employer expectations. Dr Nicole Vincent proposes that with enhanced abilities comes greater responsibility. And, she says in this fascinating talk, unless we recognise and even regulate this new reality, our ability to choose may be lost.

Thursday, August 18, 2016

Why ‘smart drugs’ can make you less clever

Nadira Faber
The Conversation
Originally posted July 26, 2016

It is an open secret: while athletes dope their bodies, regular office workers dope their brains. They buy prescription drugs such as Ritalin or Provigil on the internet’s flourishing black market to boost their cognitive performance.

It is hard to get reliable data on how many people take such “smart drugs” or “pharmacological cognitive enhancement substances”, as scientists call them. Prevalence studies and surveys suggest, though, that people from different walks of life use them, such as researchers, surgeons, and students. In an informal poll among readers of the journal Nature, 20% reported that they had taken smart drugs. And it seems that their use is on the rise.

So, if you are in a demanding and competitive job, some of your colleagues probably take smart drugs. Does this thought worry you? If so, you are not alone. Studies consistently find that people see brain doping negatively.

The article is here.

Friday, July 3, 2015

The rise of cognitive enhancers is a mass social experiment

By Emma A. Jane and Nicole A. Vincent
The Conversation
Originally posted June 15, 2015

Want to sign up for a massive human experiment? Too late. You’re already a lab rat. There was no ethics approval or informed consent. You weren’t asked, you never signed up, and now there’s no easy way to opt out.

We don’t want to be alarmist. We’re not suggesting you’re about to sprout wings, grow coarse hairs in surprising places and become a gruesome half-insect like the Brundlefly (the side effects of real life scientific experiments rarely impress like the special effects in David Cronenberg’s film The Fly).

But we do know not everyone wants to be a human lab rat. And yet we are all currently enrolled in a massive experiment involving cognitive enhancers.

(cut)

But what drugs, what devices? Well, take this guy, for instance, pumping electricity through his brain with a homegrown transcranial direct current stimulation (tDCS) device that emits a current so small it can run off a nine-volt battery. Or Elizabeth, the 20-something founder of a start-up who takes Adderall – a medication prescribed to treat attention deficit and hyperactivity disorder (ADHD) – except she doesn’t have ADHD.

The entire article is here.

Monday, June 15, 2015

The increasing lifestyle use of modafinil by healthy people: safety and ethical issues

By Sebastian Porsdam-Mann & Barbara J Sahakian
Current Opinion in Behavioral Sciences
Volume 4, August 2015, Pages 136–141

Pharmacological cognitive enhancers (PCEs) are used in the treatment of a variety of disorders, including targeting cognitive impairment and sleep abnormalities. Evidence suggests that PCEs also enhance cognition in healthy individuals. PCEs have attracted considerable interest recently, particularly from students, academics and the military. Proponents of PCE use in healthy people argue that these substances may be used to reduce fatigue-related and work-related accidents and improve learning outcomes.

In this article, safety concerns as well as ethical issues of fairness and coercion are considered. Discussion amongst experts in the field, government officials and members of society on the topic of the increasing lifestyle use of PCEs in healthy people is urgently needed.

The entire article is here.

Tuesday, June 2, 2015

Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worries

By Alan Schwarz
The New York Times
Originally published May 16, 2014

More than 10,000 American toddlers 2 or 3 years old are being medicated for attention deficit hyperactivity disorder outside established pediatric guidelines, according to data presented on Friday by an official at the Centers for Disease Control and Prevention.

The report, which found that toddlers covered by Medicaid are particularly prone to be put on medication such as Ritalin and Adderall, is among the first efforts to gauge the diagnosis of A.D.H.D. in children below age 4. Doctors at the Georgia Mental Health Forum at the Carter Center in Atlanta, where the data was presented, as well as several outside experts strongly criticized the use of medication in so many children that young.

The entire article is here.

Saturday, August 9, 2014

The New Normal: How the definition of disease impacts enhancement

By Ray Purcell
The Neuroethics Blog
Originally posted July 24, 2014

Here is an excerpt:

Why does the definition of disease matter? Enhancement is typically defined relative to normal abilities. Anjan Chatterjee of the University of Pennsylvania suggested that “Therapy is treating disease, whereas enhancement is improving “normal” abilities. Most people would probably agree that therapy is desirable. By contrast, enhancing normal abilities gives pause to many.” However, many neuroethicists have wrestled with clearly defining enhancement. The director of Emory’s Center for Ethics, Paul Root Wolpe argued (2002) that the enhancement debate centers on the ability of substances or therapeutics to directly affect the brain in ways that are not necessary to restore health and, certainly, to date the cognitive enhancement debate has focused primarily on pharmaceuticals, many of which are approved to treat disorders but can have effects on healthy individuals as well. Perhaps the best examples of this are methylphenidate (Ritalin) and modafinil (Provigil) which are prescribed for attention deficit hyperactivity disorder (ADHD) and narcolepsy respectively, but are increasingly being used by students and professionals to boost cognitive performance at school and in the workplace. 

Saturday, June 7, 2014

The ethics of personal enhancement, from beta blockers to ADHD drugs

By Joe Gelonesi
The Philosopher's Zone
Originally posted May 16, 2014

Here is an excerpt:

It’s a question for the times, as the cognitive enhancement revolution rolls on. The use of substances to help with performance—from sitting exams to playing recitals—has well and truly gone beyond novelty status.

Drugs previously reserved for ADHD are now being imbibed by students to sharpen performance. There is no shortage of first-person testimony mixed with consumer advice on YouTube. Vincent cites studies in Australia which suggest that our appetite for such drugs is greater than in the USA. She also uses the example of Simon Tedeschi, who in January published an article about his extensive use of beta blockers to subdue stage fright. Tedeschi, an esteemed local musician, has no qualms about coming out over his use of what is primarily intended as blood pressure medication. He’s not alone in the performing arts community.

The entire story is here.

Sunday, May 18, 2014

Many Ivy League students don't view ADHD medication misuse as cheating: 18 percent use stimulants to help them study

By Science Daily
Source: American Academy of Pediatrics
Originally published May 1, 2014

Summary

Nearly one in five students at an Ivy League college reported misusing a prescription stimulant while studying, and one-third of students did not view such misuse as cheating, according to a new study. Stimulants are used to treat attention-deficit/hyperactivity disorder (ADHD). Recent studies have shown that students without ADHD are misusing these medications in hopes of gaining an academic edge.

The entire article is here.

Saturday, April 5, 2014

Are We Obligated to Make Ourselves More Moral and Intelligent? (Part One)

By J. Hughes
Ethical Technology
Originally posted March 13, 2014

Most of the ethical discussion of the use of stimulant drugs without a prescription in education has been negative, associating their use with performance enhancement in sports and with drug abuse. But the use of stimulants as study drugs actually has few side effects, and is almost entirely applied to the student’s primary obligation, academic performance. In this I consider some objections to off-label stimulant use, and to stimulant therapy for ADD, and argue that there are ethical arguments for the use of stimulants, and for future cognitively and morally enhancing therapies, in education, the work place, and daily life.

In recent years, as the diagnosis of ADD has become more common, and increasing numbers of adults have begun taking stimulant medications as a treatment for ADD, or without a prescription as a study aid, there have been calls for stricter regulation of the diagnosis and the drugs. People have suggested that the treatment of ADD with stimulants is a conspiracy of pharmaceutical capitalists in league with dubious pediatricians, when the real cause of inattentiveness is allegedly a dysfunctional industrial era educational system obsessed with standardized testing. The alleged risks of the use by adults without prescriptions have been hyped, and the "users vilified as "cheaters" contributing to a pharmaceutical arms race.

The entire article is here.

Monday, December 30, 2013

The Selling of ADHD

By Alan Schwarz
The New York Times
Originally posted December 14, 2013


Here is an excerpt:

“The numbers make it look like an epidemic. Well, it’s not. It’s preposterous,” Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”

The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.

Few dispute that classic A.D.H.D., historically estimated to affect 5 percent of children, is a legitimate disability that impedes success at school, work and personal life. Medication often assuages the severe impulsiveness and inability to concentrate, allowing a person’s underlying drive and intelligence to emerge.

The entire story is here.

Monday, October 14, 2013

National Trends in Psychotropic Medication Use in Young Children: 1994–2009

By Vilawan Chirdkiatgumchai, and others
Pediatrics
doi: 10.1542/peds.2013-1546

OBJECTIVE: To examine recent national trends in psychotropic use for very young children at US outpatient medical visits.

METHODS: Data for 2- to 5-year-old children (N = 43 598) from the 1994–2009 National Ambulatory and National Hospital Ambulatory Medical Care Surveys were used to estimate the weighted percentage of visits with psychotropic prescriptions. Multivariable logistic regression was used to identify factors associated with psychotropic use. Time effects were examined in 4-year blocks (1994–1997, 1998–2001, 2002–2005, and 2006–2009).

RESULTS: Psychotropic prescription rates were 0.98% from 1994–1997, 0.83% from 1998–2001, 1.45% from 2002–2005, and 1.00% from 2006–2009. The likelihood of preschool psychotropic use was highest in 2002–2005 (1994–1997 adjusted odds ratio [AOR] versus 2002–2005: 0.67; 1998–2001 AOR versus 2002–2005: 0.63; 2006–2009 AOR versus 2002–2005: 0.64), then diminished such that the 2006–2009 probability of use did not differ from 1994–1997 or from 1998–2001. Boys (AOR versus girls: 1.64), white children (AOR versus other race: 1.42), older children (AOR for 4 to 5 vs 2 to 3 year olds: 3.87), and those lacking private insurance (AOR versus privately insured: 2.38) were more likely than children from other groups to receive psychotropic prescriptions.

CONCLUSIONS: Psychotropic prescription was notable for peak usage in 2002–2005 and sociodemographic disparities in use. Further study is needed to discern why psychotropic use in very young children stabilized in 2006–2009, as well as reasons for increased use in boys, white children, and those lacking private health insurance.

Friday, May 31, 2013

Not robots: children's perspectives on authenticity, moral agency and stimulant drug treatments

By Ilina Singh
J Med Ethics 2013;39:359-366 doi:10.1136/medethics-2011-100224

Abstract

In this article, I examine children's reported experiences with stimulant drug treatments for attention deficit hyperactivity disorder in light of bioethical arguments about the potential threats of psychotropic drugs to authenticity and moral agency. Drawing on a study that involved over 150 families in the USA and the UK, I show that children are able to report threats to authenticity, but that the majority of children are not concerned with such threats. On balance, children report that stimulants improve their capacity for moral agency, and they associate this capacity with an ability to meet normative expectations. I argue that although under certain conditions stimulant drug treatment may increase the risk of a threat to authenticity, there are ways to minimise this risk and to maximise the benefits of stimulant drug treatment. Medical professionals in particular should help children to flourish with stimulant drug treatments, in good and in bad conditions.

The entire article is here.

Saturday, April 6, 2013

A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise

By ALAN SCHWARZ and SARAH COHEN
The New York Times
Published: March 31, 2013

Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.

These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.

The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade. About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with A.D.H.D. but can also lead to addiction, anxiety and occasionally psychosis.

“Those are astronomical numbers. I’m floored,” said Dr. William Graf, a pediatric neurologist in New Haven and a professor at the Yale School of Medicine. He added, “Mild symptoms are being diagnosed so readily, which goes well beyond the disorder and beyond the zone of ambiguity to pure enhancement of children who are otherwise healthy.”

The entire story is here.

Wednesday, February 13, 2013

Easing ADHD without meds

Psychologists are using research-backed behavioral interventions that effectively treat children with ADHD.

By Rebecca A. Clay
February 2013, Vol 44, No. 2
Print version: page 44

Because of his attention-deficit/hyperactivity disorder (ADHD), the 10-year-old boy rarely even tried to answer the questions on the math and language arts worksheets his fourth-grade teacher asked students to complete during class. Not only that, he often bothered the students who did.

Then the teacher made an important change to the boy's worksheets: She wrote the correct answers on them with invisible markers so that the boy could reveal the correct answer by coloring over the space as soon as he finished a question. The teacher also randomly inserted stars he could uncover by coloring and told him he would earn a reward for collecting four stars. The strategy paid off: The boy was soon answering every question and getting 84 percent of them correct.

Giving immediate feedback is just one of many simple and effective behavioral approaches to improving children's attention, says psychologist Nancy A. Neef, PhD, who described the invisible marker experiment in a chapter on treating ADHD she co-authored in the 2012 "APA Handbook of Behavior Analysis." With ADHD affecting an estimated 7 percent of American children ages 3 to 17, psychologists are developing behavioral interventions that parents, teachers and others can use to help kids focus and control their impulses. Others are conducting research that demonstrates that more exercise and longer sleep can help.

That's good news for kids, says Neef, who believes that parents, teachers and pediatricians are sometimes too quick to jump to prescribing medication for ADHD.

"Particularly in the case of stimulant medications, which are the most common treatment for ADHD, we don't know an awful lot about the long-term side effects," says Neef, a professor of special education at The Ohio State University.

And medication doesn't address problems related to children's academic performance and relationships with family members, peers and others. "Even though medication can be effective and very helpful, it's not a panacea," Neef says.

Behavioral interventions

Surprisingly, nonpharmacological approaches are also controversial, especially among the medical community.

"If you read the professional guidelines for psychiatrists or sometimes pediatricians, the treatment that is emphasized for kids with ADHD is a pharmacological one," says Gregory A. Fabiano, PhD, an associate professor of counseling, school and educational psychology at the State University of New York at Buffalo.

The entire story is here.

Tuesday, February 12, 2013

Drowned in a Stream of Prescriptions

By ALAN SCHWARZ
The New York Times
Published: February 2, 2013

Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

The entire story is here.

Wednesday, October 17, 2012

Attention Disorder or Not, Pills to Help in School

By ALAN SCHWARZ
The New York Times
Originally published October 9, 2012

Here is an excerpt:

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”

Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: “We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.”

Dr. Anderson’s instinct, he said, is that of a “social justice thinker” who is “evening the scales a little bit.” He said that the children he sees with academic problems are essentially “mismatched with their environment” — square pegs chafing the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.