From the Department of Bioethics (S.H., C.G., S.Y.K.), Clinical Center, National Institutes of Health; and Biostatistics and Clinical Epidemiology (X.L.), NIH Clinical Center, Bethesda, MD.
Neurology. 2024 Aug 27;103(4):e209681. doi: 10.1212/WNL.0000000000209681. Epub 2024 Jul 23.
Some individuals are using drugs to try to enhance cognitive and social-affective functioning and asking physicians for off-label prescriptions for neuroenhancement (e.g., stimulants). Several medical societies released guidance on prescribing neuroenhancers, some of which refer to potential societal effects of neuroenhancement (e.g., distributive justice), besides risks and benefits to users. Which institutions (e.g., medical societies, government, universities) should make decisions on allowing neuroenhancement and whether they should consider potential societal effects are unclear. We examined whether and how much support for allowing pharmaceutical neuroenhancers was influenced by the institution and potential individual and societal effects of neuroenhancers.
We conducted a discrete-choice experiment using a constructed representative sample of the US adult public. Multinomial logit models were used to analyze the data.
Participants (n = 927) demographically resembled the US population. Risks of serious side effects (OR 0.20, CI 0.18-0.22) and a lack of benefits for users (OR 0.31, CI 0.26-0.38) had the largest negative effect on participants' support for allowing neuroenhancers. A risk of mild side effects had a moderate negative effect on participants' support for allowing neuroenhancers (OR 0.67, CI 0.62-0.74) and the prospect of more meaningful, long-lasting benefits for users a moderate positive effect (OR 1.74, CI 1.61-1.87). Positive or negative effects of neuroenhancers on the average well-being of people in society and on equality had moderate effects on participants' support for allowing neuroenhancers. For example, the odds of participants' support for allowing enhancers with a negative effect on societal well-being were around half (OR 0.45, CI 0.40-0.50) and the odds of allowing enhancers that worsen inequality were approximately 40% lower compared with enhancers without such effects (OR 0.62, CI 0.55-0.71). The odds of participants allowing neuroenhancers were slightly (10%) lower if enhancers reduced users' authenticity (OR 0.90, CI 0.84-0.97). The institution regulating neuroenhancers and neuroenhancers providing users with an unfair advantage did not affect participants' decisions.
When presented with both individual and societal considerations, the public seems to support medical societies and other institutions making policy decisions about neuroenhancers based on risks and benefits for users, as well as, but to a lesser extent, effects on equality and societal well-being.
有些人正在使用药物来试图提高认知和社会情感功能，并向医生寻求非标签处方的神经增强药物（例如兴奋剂）。一些医学协会发布了关于神经增强药物处方的指南，其中一些指南除了考虑使用者的风险和益处外，还提到了神经增强的潜在社会影响（例如分配公正）。允许神经增强以及是否应考虑潜在的社会影响的决策应该由哪些机构（例如医学协会、政府、大学）做出尚不清楚。我们研究了允许药物神经增强的支持程度是否取决于机构以及神经增强对个人和社会的潜在影响。
我们使用美国成年公众的构建代表性样本进行了离散选择实验。使用多项逻辑回归模型对数据进行分析。
参与者（n=927）在人口统计学上与美国人口相似。严重副作用的风险（OR 0.20，CI 0.18-0.22）和对使用者没有益处（OR 0.31，CI 0.26-0.38）对参与者允许神经增强的支持产生了最大的负面影响。轻度副作用的风险对参与者允许神经增强的支持产生了适度的负面影响（OR 0.67，CI 0.62-0.74），而使用者获得更有意义、更持久的益处的前景则产生了适度的积极影响（OR 1.74，CI 1.61-1.87）。神经增强对社会中人们的平均幸福感和公平性的积极或消极影响对参与者允许神经增强的支持产生了适度的影响。例如，参与者支持具有负面社会影响的增强剂的可能性大约是一半（OR 0.45，CI 0.40-0.50），而允许加剧不平等的增强剂的可能性比没有这种影响的增强剂低约 40%（OR 0.62，CI 0.55-0.71）。如果增强剂降低了使用者的真实性（OR 0.90，CI 0.84-0.97），则参与者允许神经增强的可能性略低（10%）。管理神经增强的机构和为使用者提供不公平优势的神经增强药物并不会影响参与者的决策。
当考虑到个人和社会因素时，公众似乎支持医学协会和其他机构根据使用者的风险和益处以及对平等和社会福祉的影响来制定关于神经增强的政策决策，尽管影响程度较小。
