Research Report on Whether the Public Should Be Allowed to Use Drug Enhancers

Introduction

In recent years, some individuals have started using drugs to enhance cognitive and socio-emotional functions and have requested off-label prescriptions from doctors for neuroenhancement (e.g., stimulants). However, discussions about whether such uses should be allowed and their potential social impacts (e.g., distributive justice) have sparked widespread controversy. With the increasing availability of neuroenhancement drugs on the market, there is considerable uncertainty about which institutions (such as medical associations, governments, universities, etc.) should make related decisions and whether the potential social effects of these drugs should be considered.

Purpose and Background of the Study

This paper, written by Saskia Hendriks, Xiaobai Li, Christine Grady, and Scott Y. Kim, was published in “Neurology” on August 27, 2024, volume e209681. The main purpose of the study is to investigate the impact of individual and social effects of drug neuroenhancers on public support for policies, including which institutions should decide whether to allow the use of neuroenhancers.

In the United States, the use and regulation of drug neuroenhancers have attracted widespread attention. For example, the American Neurological Association believes that prescribing neuroenhancers to healthy individuals is ethically permissible, while the American Medical Association and several neurological associations oppose this practice. The controversy in this context makes it particularly important to investigate public attitudes towards drug neuroenhancers.

Methods

The study adopted a Discrete-Choice Experiment (DCE) method, surveying a representative sample of American adults. Data were analyzed using multinomial logit models. The survey questionnaire designed six neuroenhancement scenarios with different levels of characteristics, and participants were repeatedly asked to choose which of the two hypothetical neuroenhancement drugs they believed should be allowed.

The study’s subjects were 927 American adults, with the sample being representative of the entire U.S. population in terms of age, gender, race, etc. Data collection was conducted through CloudResearch, a subsidiary of Baidu, from January to June 2022. Besides background information, the survey questionnaire also included understanding and attention checks to ensure data quality.

Main Results

The main results of the survey indicate that the risk of severe side effects for neuroenhancer users and the lack of user benefits are the biggest negative factors affecting participants’ support for allowing neuroenhancers. The impact of neuroenhancers on social welfare and justice also significantly influenced participants’ choices. Additionally, the authenticity of the users and the type of institutions had some influence on participants’ decisions, but relatively minor.

Individual Impact on Users

The survey results show that for neuroenhancers with a risk of severe side effects, public support dropped about fivefold (OR 0.20, CI 0.18–0.22, p < 0.0001), while for neuroenhancers with no benefits, support decreased by one-third (OR 0.31, CI 0.26–0.38, p < 0.0001). Conversely, support was higher for neuroenhancers with significant, lasting benefits (OR 1.74, CI 1.61–1.87, p < 0.0001).

Impact on Society

The study found that the impact of neuroenhancers on social welfare and justice moderately influenced public support. If neuroenhancers negatively impacted social welfare, support decreased by about half (OR 0.45, CI 0.40–0.50, p < 0.0001). Moreover, if neuroenhancers could improve social equality or have a positive impact on social welfare, support significantly increased (OR 1.50, CI 1.41–1.80, p < 0.0001 and OR 1.60, CI 1.35–1.65, p < 0.0001, respectively).

Influence of Different Institutions

The study also found that although the public had no significant preference for which institution should regulate neuroenhancers, different institutions had different weights on risks, social welfare, and justice. For instance, when neuroenhancers posed severe risks to users, the government and employers had a greater impact on public support (OR 0.55, p = 0.001 and OR 0.70, p = 0.02, respectively).

Differences in Opinions Among Small Groups

Latent class analysis showed that participants could be divided into two major subgroups. One group (62%) was highly opposed to neuroenhancers with severe side effects and no benefits, while the other group (38%) was relatively insensitive to these risks and might be more supportive of individuals making informed choices about whether to use neuroenhancers.

Conclusion

This study shows that when supporting whether to allow drug neuroenhancers, the public considers both the risks and benefits to individual users and the impact on social welfare and fairness. The public has a highly negative attitude towards neuroenhancers with severe side effects while holding a highly positive attitude towards neuroenhancers that can bring significant, lasting benefits. Although the type of regulatory institution has little impact on public opinion, the public adjusts their preferences for different institutions based on the specific risks and social effects in the scenario.

The results of this study support policymakers in considering not only individual risks and benefits but also the overall impact on social welfare and fairness when making decisions about drug neuroenhancers. This differs somewhat from the current approach of most drug regulations, which primarily focus on user safety and effectiveness, particularly in the context of neuroenhancers potentially having broader social impacts. Future research can further explore the roles and responsibilities of different institutions in regulating neuroenhancers.