No doubt many readers are familiar with debates about the role of neuroscience in seeking to enhance (or augment) cognition, and possible policy implications, recently featured in Nature. Diverse contributions to science policy discussion help highlight important considerations for policy makers, including potential “tripping hazards” along the path to feasible policy, as illustrated in the recent commentary from Greely et al (2008). By “tripping hazards,” we mean papered-over or simply overlooked value fault-lines in policy formation that are likely to erupt in problems of feasibility or public acceptance. The authors’ recommendations about the use of cognitive enhancing drugs in healthy persons include concerns about safety, coercion, and fairness (meanwhile dismissing others as lacking substance). Their discussion of safety relies upon selectively stretching the idea of effectiveness and purpose for medication, while calling for safety standards to be held the same as for medicines treating illnesses. The “evidence-based evaluation” for which they call would thus be stretched over the values they’ve selected for inclusion and exclusion, and would be more likely to set up a “stretched line tripping hazard” for policy making than it would be to resolve controversy. The “thin ice tripping hazard,” on the other hand, emerges from their discussions of coercion and fairness, where the recommendations cannot support the weight of the problem. One sign of thin ice ahead is contradiction among recommendations, partially acknowledged but not here addressed, that we protect freedom by discouraging even indirect coercion to take enhancement drugs such as in schools, and protect fairness by providing them to all test-takers in a competitive examination. We commend the authors for contributing to the ongoing public debate but note that much remains to be done.

Jim Olds and Lee L. Zwanziger

Lee works at the FDA and therefore notes that the findings and conclusions in this letter have not been formally disseminated by the Food and Drug Administration and should not be construed to represent any Agency determination or policy.)

Greely H, Sahakian B, Harris J, Kessler RC, Gazzaniga M, Campbell P, Farah MJ.”Towards responsible use of cognitive-enhancing drugs by the healthy.” Nature. 2008 Dec 11;456(7223):702-5.