National Core for Neuroethics, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2010 Dec 14;5(12):e14322. doi: 10.1371/journal.pone.0014322.
The ethical dimensions of pharmacological cognitive enhancement have been widely discussed in academic circles and the popular media, but missing from the conversation have been the perspectives of physicians - key decision makers in the adoption of new technologies into medical practice. We queried primary care physicians in major urban centers in Canada and the United States with the aim of understanding their attitudes towards cognitive enhancement. Our primary hypothesis was that physicians would be more comfortable prescribing cognitive enhancers to older patients than to young adults. Physicians were presented with a hypothetical pharmaceutical cognitive enhancer that had been approved by the regulatory authorities for use in healthy adults, and was characterized as being safe, effective, and without significant adverse side effects. Respondents overwhelmingly reported increasing comfort with prescribing cognitive enhancers as the patient age increased from 25 to 65. When asked about their comfort with prescribing extant drugs that might be considered enhancements (sildenafil, modafinil, and methylphenidate) or our hypothetical cognitive enhancer to a normal, healthy 40 year old, physicians were more comfortable prescribing sildenafil than any of the other three agents. When queried as to the reasons they answered as they did, the most prominent concerns physicians expressed were issues of safety that were not offset by the benefit afforded the individual, even in the face of explicit safety claims. Moreover, many physicians indicated that they viewed safety claims with considerable skepticism. It has become routine for safety to be raised and summarily dismissed as an issue in the debate over pharmacological cognitive enhancement; the observation that physicians were so skeptical in the face of explicit safety claims suggests that such a conclusion may be premature. Thus, physician attitudes suggest that greater weight be placed upon the balance between safety and benefit in consideration of pharmacological cognitive enhancement.
药理学认知增强的伦理维度在学术界和大众媒体中已经得到了广泛的讨论，但在这个讨论中却缺少了医生的观点——他们是将新技术应用于医学实践的关键决策者。我们在加拿大和美国的主要城市中心调查了初级保健医生，旨在了解他们对认知增强的态度。我们的主要假设是，医生会更愿意为老年患者开认知增强药物，而不是年轻患者。医生们被提供了一种假设的药物认知增强剂，这种药物已经获得监管机构的批准，可用于健康成年人，并且被认为是安全、有效且没有明显不良反应的。受访者压倒性地报告说，随着患者年龄从 25 岁增加到 65 岁，他们开认知增强药物的意愿越来越强。当被问及他们对开处方现有药物（西地那非、莫达非尼和哌甲酯）或我们假设的认知增强剂给一个正常、健康的 40 岁成年人的舒适度时，医生们更愿意开西地那非，而不是其他三种药物。当被问及他们为何这样回答时，医生们最关心的是安全问题，这些问题没有被个人受益所抵消，即使是在明确的安全声明面前。此外，许多医生表示，他们对安全声明持相当怀疑的态度。在关于药理学认知增强的争论中，安全问题已经成为一个常见的话题，但被简单地忽视了；医生们在面对明确的安全声明时表现出如此怀疑，这表明这样的结论可能还为时过早。因此，医生的态度表明，在考虑药理学认知增强时，应该更加重视安全和受益之间的平衡。
