[L5] - Health and Enhancement Flashcards
Enhancement vs. Medical Treatment
“‘Enhancement,’ by contrast, is the directed
use of biotechnical power to alter not disease processes but the ‘NORMAL’
workings of the human body and psyche, to augment or IMPROVE their native capacities and
performances” (President’s Council on Bioethics, 2003, p. 13)
What is Health?
- WHO (1948) - Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
- Nietzsche - Health is the amount of illness that still allows me to engage
in my essential activities. - Katz - Being healthy doesn’t mean: I am not ill right now. It means: I feel great. I have energy, I can do that which I want to do.
Why are we updating our definition of health?
The WHO’s old definition is only appropriate for acute, not chronic
disorders!
It helped in the medicalization of problems/marketing of drugs.
It “minimizes the role of the human capacity to cope with life’s challenges and to function with fulfillment
and wellbeing even in the face of a chronic disease or disability.” (Huber in the BMJ) → In other words, it perpetuates the idea that you are just a passive patient
The new definition (Huber et al.), focuses on one’s ability to ADAPT and to SELF MANAGE.
Huber’s Six Pillars of Positive Health
D, B, M - SS,Q,SE
Daily Functioning
Bodily Functions
Mental Functions and Perception
Social and Societal Participation
Quality of Life
Spiritual-Existential Dimension
The more educated a healthcare provider was - the greater their stance on these pillars/the definition of health differed with those of the patients.
Who are we providing healthcare for? Patients, or Experts?
A Wrap-Up on Enhancement
Enhancement is often distinguished from medical treatment. However, this distinction is of limited use, as the definition of ‘health’ itself is vague.
Different definitions of ‘health’ can have different implications on what to understand as a medical problem – and how to deal with it.
New research has found differences between experts and patients/citizens in how to define ‘health’.
Note that the experts’ strong focus on ‘bodily functioning’ is neither consistent with the WHO (1948) nor with the Positive Health (2011) concept!
The Contrast between Cognitive Enhancement and Drug Use as reported in the media - and reality
Media:
● “On some campuses more than 25 percent of students had used the pills.”
● “For 25% of the American students, substances like Ritalin are part of their exam
preparations.”
● “20% of scientists already use psychopharmacological drugs to improve their cognition.”
● Studie drugs (Groninger Studentenkrant June 2012)
● Everyone does Ritalin (UKrant, December 5, 2017)
● What student doesn’t love Ritalin? (UKrant, March 15, 2021)
Scientific Articles:
- Of those who support/are ambivalent towards Cognitive Enhancement…
- 94% of articles present brain doping as common, increasing, or both.
- 66% refer to academic literature to support these claims.
- 95% mention benefits; 58% mention risks/side effects.
Reality:
- In contrast to media reports, the larger and more representative studies
generally report a prevalence of <10% for non-medical stimulant drug use, often including
‘recreative’ and ‘lifestyle use’ and referring to lifetime.
- In NL: Last-month use is reported by 2% of the students
- (Smith and Farah) The strongest predictors of past-year nonmedical stimulant use by
college students were admissions criteria (competitive and most competitive more likely than
less competitive), fraternity/sorority membership (members more likely than nonmembers), and
gender (males more likely than females).
In other words, the prevalence of brain doping has been exaggerated.
What cognitive effects can Brain Doping/Ritalin use have in healthy adults?
- (Agay) Small short-term memory improvements.
- Moderate IMPAIRMENT in future planning.
- (Franke) Players who were enhanced scored more points, but not statistically significantly so.
- Minor differences only between drug benefits and caffeine benefits.
- Slower with drugs and often ran out of time - may have performed better without these constraints - even minor differences can have an impact in competitive environments though, but this won’t make a master out of a novice.
- (Vrecko) Students’ Experiences with the emotional impact of study drugs
- Feeling Up - stimulants used to overcome negative feelings associated with academic work.
- Drivenness–“I’ll just sit down and do whatever it is I have to do and won’t feel okay until I finish it.”
- Interestedness–users did work on stimulants better work when they did not find the topic very interesting in the first place
- Enjoyment–users enjoyed doing the academic work more
Perhaps these drugs have more emotional than cognitive effects?
The prevalence puzzle
- ADHD medication use is rising. WHO warned the public of this trend of increasing prescriptions for children and adolescents, and it got increasingly worse.
- Note that we diagnose
ADHD better now (detecting the undetected - and diagnosing milder cases), people are more informed and seek help, more problems are being framed as medical problems (MEDICALIZATION), people are suffering more, but also have started to acknowledged ADHD as a problem for adults,
which could in turn lead to more diagnoses, and therefore medication. - However, why is it that low prevalence of these disorders are being reported, but the consumption of many psychopharmacological drugs is increasing dramatically. How can we understand this difference?
- Germany decided that stimulants were no
longer a first line treatment for ADHD, which could account for the stabilization around 2011. However, this is recently changed again that if a patient (or their parents) think that it would
really benefit them. There is an
increase in many countries though, although the UK is in general a lot more hesitant to prescribe. - Schleim mentioned how the strong increase is in large part due to medical use since 1990. An important distinction is that enhancement is not medical use though! These are different
things. In research, we have not found an increase specifically for non-medical use.
How can we make sense of the increase in stimulant use?
The increase of stimulant use can be understood as medical use…while
the non-medical use actually seems to be declining since the 1980s (Schleim, f. 2023).
Instead of
‘cognitive enhancement’, quantitative correlations and qualitative studies indicate emotional
use/coping.
Cognitive-behavioral differences in healthy people seem negligible, perhaps except
in highly competitive environments.
The History of Stimulant Development
Initially Used in the Treatment of Social Problems:
→ 1950s Kramer refers to the notion of ‘mother’s little helpers’ for Prozac (SSRIs) and other substances
this term can also be seen in Rolling Stones’ and Eminem’s music
- Pharmacological treatment of a social problem (tranquilizers)
- Friedan: Women were ashamed of their dissatisfaction (as a result of the way society treated women) and they blotted this feeling they couldn’t explain out with tranquilizers.
→ 1953: Women’s gold (lecture 1) was a combination of herbs and alcohol meant to ‘stabilize’ women’s emotions
⇒ internalization, individualization and decontextualization of blame and responsibility, emotion regulation, possibly enhancement
→ When people started fighting for their rights, they got a diagnosis of schizophrenia
- it became a ‘black disease’; was used as a tool against them in society.
→ We can try to make sense of the substance use phenomenon in society by understanding that these trends reflect some trends in society (gender roles, etc.) - now becoming student’s little helpers in response to higher stress and increasing drives for perfection (as opposed to mother’s little helpers)
- Contraceptive Pill initially associated with emancipation, control of body - then oppression, sexual availability - now enhancement, beautiful hair & skin, bigger breasts(?), working better (skipping side effects of menstruation)
→ Christian Muller’s take on instrumental drug use:
- most people use drugs instrumentally and rationally
- only a minority becomes addicted in the clinical sense
- is it then justified to prohibit drugs at all?
(he believed instrumental drug use could contribute positively to some life aspects - sex, social, stress, attractiveness)
Brain doping and the power of definitions
Depending on where we draw the
line between disorders, health, and enhancement, substance use appears differently (i.e., as
treatment, coping, or brain doping).
There is ample social-historical evidence that substances
were used to treat social problems.
