[W5] - Readings Flashcards
Limitations of the old WHO definition of health
- It unintentionally contributes to the medicalization of society (complete health is not achievable for most people)
→ Disease patterns have changed since 1948: chronic disease is increasing (so complete physical well-being is not possible for many)
→ The operationalization of this definition is impracticable, because ‘complete’ is neither operational NOR MEASURABLE.
- We need operational definitions for research - and such measurement instruments should relate to health as defined below.
- Huber and colleagues propose changing the emphasis towards the ability to adapt and self manage in the face of social, physical, and mental challenges - but to use this we need to define health in these three domains
Physical, Mental and Social health
Physical Health:
→ a healthy organism maintains stability (allostasis) by adapting to changing conditions
→ when faced with stress, it responds to protect itself and restore balance
→ if these adaptive responses fail, the resulting strain (allostatic load) can lead to illness
Mental Health:
→ in the mental domain, Antonovsky describes the “sense of COHERENCE” (the ability to comprehend the whole situation at hand and use all resources available) as a factor that contributes to a successful capacity to cope, recover from strong psychological stress, and prevent PTSD
Social Health:
→ by successfully adapting to an illness, people are able to work or to participate in social activities and feel healthy despite limitations.
Responses to Huber’s Desire for Change
Proposal for New Definition:
→ some suggested that while adaptation and self-management are important, a contemporary definition should also include health as a human right
→ they feel as though Hubert’s definition does not do much for disadvantaged populations
→ they propose an alternative: “health is created when individuals, families, and communities are afforded the income, education, and power to control their lives”
WHO Definition is Still Valid:
→ others consider that the WHO definition is still very much valid
→ they consider that Hubert’s proposal diminishes the suffering that is associated with chronic conditions if the patient is doing well on surface level
→ they believe that there is nothing shameful about being ill and that people should learn to face the truth
Health is a State of Well-Being:
→ others consider that Huber defines SURVIVAL, not health
→ they believe it is TOO MUCH OF A REDUCTIONIST approach
→ well-being is a concept shared across all human boundaries and is the final common pathway
The relationship between performance enhancement and social pressure
Performance enhancement might be tightly related to social pressure
Even if such enhancement was mandatory and safe to achieve, the demand for further improvement would always rise again due to competition!
Cognitive vs. Moral Enhancement
Enhancement refers to improvement beyond healthy or normal functioning.
Moral Enhancement:
→ Douglas argued that there is a clear scope for people to morally enhance themselves, since we often have bad/suboptimal motives
→ he hoped that there would be a way to neurologically optimize people on a moral level
→ Delgado further believed that such enhancement should be mandatory to prevent humankind from destroying itself
→ There is still no clarity about how moral enhancement should be applied practically and ethically - and if people have such bad motives, why should they be making that choice? Would changing emotions without consent not be a violation of autonomy?
Cognitive/ Neuroenhancement:
→ Agay et. al. (2010) investigated the effects of methylphenidate (Ritalin) on cognitive ability and decision-making in ADHD and healthy populations on
three different tasks:
→ digit-span task (increasingly longer sequences of numbers were shown and had to be reproduced forwards or backwards)
Enhanced healthy scored slightly higher than placebo.
→ ‘Iowa Gambling Task’ (decision-making to maximize financial rewards and minimize losses in which subjects draw cards from four decks with different reward/loss structures)
→’Foregone Payoff Gambling Task’ (same as the previous one but in addition the participants saw what the results would have been for the other decks)
Placebo Better at planning.
→ three conclusions can be drawn from this study:
it is unclear whether these tasks (e.g., remembering digits or drawing cards) are relevant for people’s everyday lives
→ this might lead to a TRANSLATIONAL FALLACY, which is the premature translation of clinical tests into real life
- we should not expect much of these substances (effects are usually modest)
- results are often inconsistent (they suggest an improvement in some domains and no improvement in others)
Researcher perspectives on Cognitive Enhancement (although some studies suggest it may be more emotional enhancement - Vrecko)
→ a review co authored by E. Kandel and B. Sahakian claimed that people’s growing ability to alter brain function can be used to enhance the mental processes of normal individuals
they believe that pharmacological enhancement has already begun
→ a Nature article with H. Greely as first author was also in favor of this practice
it starts out with the claim that “society must respond to the growing demand for cognitive enhancement”
→ E. Nutt takes a positive stance on the practice and describes it as a logical follow-up to biological evolution
→ Hyman took a moderately positive stance but also highlighted the problems of fairness and coercion, particularly in competitive settings
→ Volkow pointed out that, in the US, 8% of 12th graders had used amphetamine non medically in the previous year and that the stimulant is known for its addictive potential
→ Farah raised the problem of dependence and the fact that many studies are inconclusive
→ others believed that cognitive enhancement is a multidimensional endeavor, which calls for a more differentiated approach
Is neuroenhancement a mass phenomenon.
Unclear, but unlikely.
- Current reviews indicate a variability as high as 2.1% to 58.7%, which indicates highly inconclusive evidence
→ The honest answer is that we cannot really say with any certainty how many people engage in neuroenhancement
→ The clearest indication of an increase in use at all is provided by a repeated survey between 2003 and 2013 - which revealed an increase from 5.4% to 9.3% - but no indication of frequency of use.
→ These along many other findings suggest that neuroenhancement has never been a mass phenomenon.
→ Some studies even suggest that the use of cognitive enhancers was likely more prevalent in the past (!) compared to 2010 data
Nonpharmacological alternatives for enhancement
- Research highlights the significant benefits of physical exercise on brain function, particularly through increasing neuroplasticity
- Combining cognitive training with cardiovascular fitness can maximize these benefits
→ The appeal of neurotechnology or substances for enhancement lies in their convenience, requiring less personal effort compared to lifestyle changes
- Yet, despite decades of research, NO neuroenhancement method has proven to be a significant breakthrough - which suggests that our bodies have already evolved to a highly efficient level.
Is neuroenhancement overhyped or real?
- Ethicists stress the importance of evaluating the safety and COERCION related to neuroenhancement
→ Evidence shows that competition and performance pressure increase students’ use of prescription stimulants to boost motivation and cope with stress
- this highlights a need to scrutinize the environments that drive such behavior
→ Given the Blurred Lines between Disorder, Health, and Enhancement, it is proposed to move away from the concepts of cognitive and neuroenhancement and to reassess substance use - without these labels
