The American Journal of Bioethics

ISSN: 1526-5161 (Print) 1536-0075 (Online) Journal homepage: https://www.tandfonline.com/loi/uajb20

Enhancement Policy and the Value of Information

Anders Sandberg

To cite this article: Anders Sandberg (2013) Enhancement Policy and the Value of Information,
The American Journal of Bioethics, 13:7, 34-35, DOI: 10.1080/15265161.2013.795826

To link to this article: https://doi.org/10.1080/15265161.2013.795826

Published online: 14 Jun 2013.

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The American Journal of Bioethics, 13(7): 34–55, 2013
Copyright c Taylor & Francis Group, LLC
ISSN: 1526-5161 print / 1536-0075 online
DOI: 10.1080/15265161.2013.795826
Open Peer Commentaries
Enhancement Policy and the Value
of Information
Anders Sandberg, University of Oxford
Veljko Dubljević (2013) makes a welcome addition to the
discussion of public policies for handling psychopharma-
cological cognitive enhancement by doing a case analysis of
Adderall and Ritalin.
While the article is a focused analysis of two of the most
popular cognitive enhancer drugs, it is important to con-
sider that there are more enhancers than just psychostimu-
lants. There exists a diverse set of drugs that have effects
on learning, attention, and neural function that are also
used or could be used as enhancers (Jones, Morris, and
Nutt 2006; Lynch, Palmer, and Gall 2011; Malykh and Sadaie
2010). Many drugs in this set have usage and risk profiles
very different from the psychostimulants: They are used
in a chronic rather than acute manner, and many (most?)
are likely to lack autonomy-impairing addiction properties.
From a harm profile perspective they are likely safer than
the extended-release methylphenidate, are legally mostly
outside the UN Convention, and should hence presumably
be regulated even more permissively under any regulatory
approach.
A conservative assumption that appears to run through
the Dubljević article is that enhancers are on the whole
something that should be discouraged: They act either as
positional goods leading to wasteful competition for minor
gains, or as medications with potential risks to autonomy
or health that outweigh their benefits. But this presupposes
that we already have a fairly complete understanding of
their risks and benefits; this appears unduly optimistic
(Ragan, Bard, and Singh 2013). It can also be seen as a
precautionary approach, in which case the rational ac-
tion is to acquire more information while implementing
a temporary and flexible decision, rather than to decide
on a fixed preventative measure (Gollier and Treich
2003).
One of the key problems in the enhancement debate is
the lack of ecologically valid testing: Do the enhancers ac-
tually benefit real-world tasks in real-world settings, and
conversely, what are the harms and downsides when used
in everyday life? Laboratory testing, focused on practical,
Address correspondence to Anders Sandberg, The Future of Humanity Institute, University of Oxford, Suite 8, Littlegate House, 16/17
St. Ebbe’s St, Oxford OX11PT, United Kingdom. E-mail: anders.sandberg@philosophy.ox.ac.uk
34 ajob
publishable, hypothesis-driven research, tends to reveal ef-
fects on single cognitive systems. Since healthy volunteers
are typically not put on long-term regimens, only acute ef-
fects of single doses are studied. Studies of the effects of
chronic therapeutic use are likewise biased toward the ef-
fects or problems caused in the context of the treated condi-
tion, rather than overall functioning.
As noted by Lynch and colleagues (2011), there are rea-
sons to think that learning enhancers can change how ac-
quired information is organized, possibly even creating cog-
nitive structures of a type that does not occur within the
range of normal human experience. This might have im-
portant benefits and drawbacks, but cannot be predicted a
priori or based on current cognitive neuroscience; only long-
term tests on monitored subjects can give the information
needed for proper risk/benefit analysis.
The actual benefit of an enhancer might be highly de-
pendent on the user, the tasks encountered in daily life, and
how the user values them. Whether enhancers are merely
positional goods also depends on for what activities they
are used in practice. The current enhancer debate tends to
suffer from an implicit “workism” assumption that the pri-
mary use of enhancers will be competitive work and study.
It might be that “lifestyle” cognitive enhancement for per-
sonal noncompetitive purposes and enhancing well-being
across the life span is going to be a larger market.
The degree to which the public will desire the use of en-
hancers also partially depends on having valid information
about their usefulness; lack of information may well cre-
ate irrational demand and employer coercion when hype
dominates. Given the strong placebo effects that are likely,
objective measurements are important for calibrating ex-
pectations.
The complexity of real-world safety and effectiveness
does not mean they cannot be studied. There are quan-
titative and qualitative methods available, and even rela-
tively crude estimates such as drug harm scales can provide
policy-relevant information, as the Dubljević article shows.
But given the costs of creating and updating policies (and
 Regulation of Stimulants for Enhancement Use

maintaining obsolete counterproductive policies), it is ratio- REFERENCES

nal to aim for policies that can both gather data and adapt
to it.
The method used to regulate enhancers will affect what
information will become available for fine-tuning policy.
Most obviously, bans will make users unlikely to be forth-
coming and total laissez faire will not provide much infor-
mation. Adding taxes and fees as suggested in Dubljević
(2012a) does not give much feedback except usage (assum-
ing no black or gray markets). Having licensed users un-
dergo regular medical tests as in Dubljević (2012b) would
provide more relevant information, but an economic disin-
centives model would risk creating principal-agent prob-
lems between the interests of users, companies, testing
bodies, and society in general. Society would benefit from
extensive and careful testing, while users would not be in-
terested in paying too much money and privacy for it. If
some enhancers are found to be more beneficial or safe than
previously thought, there would then exist vested interests
in maintaining the regulatory status quo (consider past ex-
perience with sin taxes or where advances in technology
undermines policy rationales; Foldvary and Klein 2002).
These problems are, like ecological validity, not insur-
mountable, and even imperfect solutions can be enough to
achieve overlapping consensus, harm reduction, and indi-
vidual benefits. It seems that the way forward that would
minimize integrated future harms (whether medical or ethi-
cal) would be the one that accumulates relevant information
as early and accurately as possible. That supports the use of
a liberal permissible regulation of safer enhancers. 
Dubljević, V. 2012a. Principles of justice as the basis for public policy
on psychopharmacological cognitive enhancement. Law, Innovation
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Constraints on Regulatory Options for

Putatively Cognitive Enhancing Drugs
Wayne Hall, University of Queensland Centre for Clinical Research
Brad Partridge, University of Queensland Centre for Clinical Research
Jayne Lucke, University of Queensland Centre for Clinical Research

We welcome Velko Dubljević’s article (2013) as a useful step
in moving neuroethical discussions about the regulation of
putative cognitively enhancing drugs (CED) beyond arm-
chair analyses from a priori ethical principles into the real
world of drug regulation.
The adjective “putatively” CED should be understood
as qualifying CED in the remainder of our commentary. As
we have argued elsewhere, many ethical analyses of CEDs
assume that there is evidence that stimulant drugs enhance
cognition in individuals without a diagnosed cognitive im-
pairment, when the evidence on their efficacy is equivocal
(Lucke et al. 2011; Repantis et al. 2010).
Many analyses of the ethics of using CED start from a
presumptively libertarian position that gives priority to the
ethical principle of autonomy. Given this, it is unsurpris-
ing that these authors conclude that CEDs should be made

Since May 2012 Wayne Hall has served as a World Health Organization-nominated member on the International Narcotics Control Board,
an independent quasi-judicial body that is appointed by the UN to monitor compliance by member states with the provisions of the 1961,
1971, and 1988 international drug control treaties. Wayne Hall and Jayne Lucke’s contribution was funded by Wayne Hall’s NHMRC
Australia Fellowship and Brad Partridge’s work was funded by an NHMRC Post-Doctoral Fellowship.
Address correspondence to Wayne Hall, The University of Queensland, UQ Centre for Clinical Research, Herston, Queensland, 4029,
Australia. E-mail: w.hall@uq.edu.au

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