Beyond ‘cognitive enhancement’ and ‘cosmetic neurology’: do the new (old?) nootropics highlight inadequacies in our models of public

engagement?

Jenny Gristock

Models of public engagement■ Deficit model – ‘public

understanding of science’ (education, awareness)

■ Dialogue/upstream engagement (‘two-way’ – often not in practice)

■ User-led / citizen-framed topic/activity chosen by citizen

EEG ‘enhanced’ groupware

..it might tell the team leader, ‘Take Bill out of loop, we don’t want him monitoring the space shuttle today. He’s had too much coffee and too little sleep. Sally, though, is giving off the right signals to do a great job.’”

Engineering confusionWhat is being enhanced??

=

Multiple systems

‘..cognitive functions contributing to mental performance are distinct but heavily intermingled.’ Lanni et al (2008)

Multiple systems‘different cerebral circuits and molecular events regulating memory, attention and creativity’

De Jongh et al (2008)

■ Long-term memory versus working memory

■ Stability versus flexibility of long-term memory

■ Stability versus flexibility of working memory

■ Cognition versus mood

Trade-offs?

and…■ Baseline dependencies cognitive

enhancer and leash for different people ■ dose conflicts appropriate dose for one

system improvement worsens another ■ well patient incertitudes effect on other

systems unknown when induced change is not restorative (different to side-effects)

■ Mood / cognition interactions?

Enhancement?■ Racine and Forlini (in press) say that

describing the phenomenon as enhancement does not resonate with the unknown risks of long-term, non-medical use of prescription drugs

■ However, if Lanni and de Jongh are correct, we are not only ignoring long-term risks, we are also denying any possibility of baseline dependencies, dose conflicts, trade-offs and well-patient incertitudes as well

Cognitive enhancers? Boosting brain power??

■ nootropics? ■ modulators? ■ modifyers? ■ psychopharmeceuticals?

More confusion!■ Time for analysis

■ Case study?

■ Product that is called a ‘cognitive enhancer’

A ‘smart drink’ ??

Neuro Fuel

Neuro Fuel■ 750 mg Piracetam, an old nootropic ■ Graduate entrepreneurs – sports

enthusiast and an MBA ■ Facebook group – ‘fans of Neuro

Fuel’ ■ Many health claims

‘Serotonin in the brain’■ Neuro Fuel is a complex

beverage that increases dopamine and serotonin in the brain through a mix of proponents, cofactors, and precursors. Through this combination Neuro Fuel increases energy, alertness, motivation, concentration, drive, intelligence, memory, euphoria, and sexual drive and performance”.

a whopping 750mg!■ The active ingredients in Neuro

Fuel … has been shown to be beneficial for everything from Alzheimer's, Parkinson's disease, and Autism to ADD, depression, and anxiety. And Neuro Fuel has more than just a little sprinkling of this compound, it has a whopping 750mg!

■ “I've just started a new corporation called Utopian Enterprises, LLC. In about a month Utopian Enterprises is coming out with a revolutionary new energy drink called Neuro Fuel.

■

Neuro Fuel is now sold in more than 1,000 stores from Grand Rapids, Mich., to Key West, Fla.

Knoxville News, 5 June 2008

Piracetam• a cyclic derivative of the neurotransmitter ã-aminobutyric acid (GABA), originally marketed in 1971 by UCB Pharma.

• ‘Remarkably well tolerated’

•‘Many thanks to Sarah Meredith and Yannick Lambé (UCB South Africa., Belgium) for their excellent support during the preparation of this article’

Piracetam■ use of piracetam in pregnant or

lactating women should be avoided ■ enhances the anticonvulsant effects

of carbamazepine

■ Dosage: For cognitive disorders and vertigo it is 2.4–4.8 g daily p.o.,

What do users think?■ “I suffer from Depression and Anxiety and

this product is suppost [sic] to help with these problems. I would love for this to work for me so I don't have to rely on meds and doctors” M.H. NeuroFuel on Facebook, 28 September 2008

■ great! i was thinking in the past they should make energy drinks with a lot of nootropics Medievel, ImmInst Forums, 18 June 2008

What do users think? “Yikes! what are they thinking? They are in

way over their head…I think this will ruffle the feathers of the feds and they will take this down and potentially all other piracetam on the market.”

Ortcloud, ImmInst Forums 18 June 2008

first quotes website which says "improve other disorders such as Alzheimer's, Parkinson's disease, dementia, dyslexia and autism."

What do users think? “If we feel strongly enough about the

negative impact of their marketing, perhaps we should alert them to this thread, or have a "sit down" with them.I would tell them to cut down the sugar and vitamin content as well as to not make outlandish claims.

‘Mind’, ImmInst Forums, 18 June 2008

Which model?■ All, and yet none of them

Deficit?■ The popularity of the term ‘enhancement’,

not only in popular science, but also in the neuroscience and neuroethics literatures, confirms that awareness or acknowledgement of the potential baseline dependencies, dose conflicts, trade-offs and well-patient incertitudes may be low on the part of specialists and the public alike.

Upstream engagement?■ we do not have to assume that the drugs

will work as they are marketed for their influence to be felt in society

■ whether or not the drugs work in intended or unintended ways, their benefits (or their perceived benefits) will not be strictly delineated to the communities of ‘institutional science’ and ‘the public’

User led engagement?■ Yes, and no. ■ Users – yes ■ But completely outside academic or

big pharma ‘Neuroscience’

My d’oh moment..■ An analysis of governmentalities

then, is one that seeks to identify these different styles of thought, their conditions of formation, the principles and knowledges that they borrow from and generate, the practices that they consist of, how they are carried out, their contestations and alliances with other arts of governing... (Rose, O’Malley, and Valverde 2006)

My d’oh moment (ctd)■ Further, instead of seeing any

single body—such as the state—as responsible for managing the conduct of citizens, this perspective recognizes that a whole variety of authorities govern in different sites, in relation to different objectives. (Rose, O’Malley, and Valverde 2006)

Time to start again!■ How do I revaluate neurobiological

claims without falling into the same traps as everyone else?

■ How does one approach engagement from a governmentality point of view?

See tables

• ‘cognitive enhancement’

• ‘Prescription drug abuse’

• ‘Lifestyle drug choice’

Racine and Forlini ‘distinct paradigms for approaching the non-medical use of pharmaceuticals’

Other issues:■ Social control ■ Chronic illness ■ Employers ■ Marketing outside packaging and

traditional media ■ Online supply ■ Inequitable access to sources that could

contextualise information available through non-traditional marketing

■ … and many others

Thank you!

Piracetam■ ‘mechanisms of action of piracetam have

yet to be fully elucidated..‘ ■ Yet ‘it influences neuronal and vascular

functions’ ■ now indicated for use in vertigo, dyslexia,

cortical myoclonus and sickle cell ■ anemia in addition to age-related

cognitive disorders. ■ ‘Action appears to be unrelated to the

properties of this neurotransmitter.’

…the apparent epidemic of depression reflects a changing attitude towards behaviours that we consider to be problematic or undesirable—and therefore worthy of medical attention and intervention

■

Racine and Forlini ■ “To better understand the ethics of

performance-enhancement drugs at a social level, further research will be needed to determine which paradigm or which combination of paradigms reflects the views of stakeholders such as students, lay citizens, healthcare professionals, and public health authorities.”

add a breakdown in activities per year and per group, and the othet aspects that need to be quantified.

■ Hence a major part of the impact of developments in neuroscience can be traced to the means through which we come to evaluate and experience their knowledge products: the values embedded in the EEG system architecture; the definition of enhancement used not only in labelling, but in advertising and marketing (Dees 2004), the regulations on the use of nootropics in food products, web advertising, for example.

■ Under this scenario, what is needed is not upstream engagement on the technologies themselves, but rather, engagement on the nature of the systems of mediation (Gristock 2000, 2001) in innovation systems.

Nature survey - Public engagement?

one in five had used methylphenidate (Ritalin), modafinil (Provigil) or betablockers in an effort to ‘stimulate their focus, concentration or memory’

the time has come to ‘take the question out to the public’ (Illes, quoted in Morris 2008),

… a fundamental shift in the distinctions and relations between mental and psychological health and illness, perhaps even conceptions of personhood itself.

the shape and incidence of the pathology of depression in Western developed nations can only be understood in relation to contemporary conceptions of the self involving the obligation of freedom: responsibility, choice and active self-fulfilment.

To be a "somatic" individual, in this sense, is to code one's hopes and fears in terms of this biomedical body, and to try to reform, cure or improve oneself by acting on that body

links and relays between classification of disorders, marketing, testing, licensing and promoting psychopharmaceuticals

A way of thinking has taken shape, and a growing proportion of psychiatrists find it difficult to think otherwise. In this way of thinking, all explanations of mental pathology must "pass through" the brain and its neurochemistry - neurones, synapses, membranes, receptors, ion channels, neurotransmitters, enzymes, etc.

commercial decisions are actually shaping the patterns of psychiatric thought at a very fundamental level.

From another perspective the developments in psychiatric drug use are merely one dimension of a new set of relations between ideas of health and illness, practices of treatment and prevention of bodily malfunctions, and commercially driven innovation, marketing and competition for profits and shareholder value. Where Foucault analyzed biopolitics, we now must analyze bioeconomics and bioethics, for human capital is now to be understood in a rather literal sense-in terms of the new linkages between the politics, economics and ethics of life itself.

The significance of the emergence of these new pharmacological treatments for mental ill health lies not only in their specific effects, but also in the way in which they reshape how both experts and lay people see, interpret, speak about and understand their world.

are becoming central to the ways in which our conduct is determined to be problematic and governed, by others, and by ourselves to the continuous work of modulation of our capacities that is the life's work of the contemporary biological citizen.

‘pharmacological Calvinism’ (Conrad 2007, Healy 1997, Klerman 1972): the Puritan, disciplined, ascetic belief, that is to say, that we need to work hard in order to achieve a valued goal or objective rather than take drugs or medications as a short-cut to success.

Thank you!

http://www.youtube.com/watch?v=8gMrG5lkYeg

Neuro fuel 1857