A new survey of family doctors in North America has found that they are more comfortable prescribing viagra than modafinil or ritalin. The new study in PLoS ONE was conducted by Opeyemi Banjo, Roland Nadler and Peter Reiner, three neuroethicists at the University of British Columbia in Vancouver. They were interested in doctor’s attitudes to pharmacological cognitive enhancers (or smart drugs as we stupid people call them). They found a strong reluctance to prescribe the cognitive drugs seemingly motivated by safety concerns.
They asked 212 general practicioners across Canada and the United States how comfortable they would be prescribing Sildenafil (aka Viagra), Modafinil (an alertness drug), Methylphenidate (Ritalin) or a hypothetical drug specificially marketed as a cognitive enhancer.
The graph on the right shows the main result, which was that doctors were much happier handing out viagra than any of the other drugs. In each case the imagined patient was 40 year old man exhibiting symptoms consistent with the drug’s labelled effects. The authors were surprised to find that the hypothetical smart drug was treated equivalently to the two well known cognitive enhancers and that all of these were much less likely to be prescribed than the sexual enhancer. Despite the emphasis given in the questions that all drugs were fully FDA approved.
When queried as to the reasons they answered as they did, the most prominent concerns physicians expressed were issues of safety that were not offset by the benefit afforded the individual, even in the face of explicit safety claims. Moreover, many physicians indicated that they viewed safety claims with considerable skepticism. It has become routine for safety to be raised and summarily dismissed as an issue in the debate over pharmacological cognitive enhancement; the observation that physicians were so skeptical in the face of explicit safety claims suggests that such a conclusion may be premature.
A secondary finding supported the authors’ expectations that doctors would be more willing to prescribe any of these drugs to older compared to younger patients, comparing three ages (65, 45 & 25yrs).
The authors of the study were neuroethicists, researchers who concern themselves with the ethics of the brain sciences and psychiatric medicine. They were motivated to conduct their survey by the fact that doctors opinions had been overlooked in the popular and academic discussion of smart drugs. Yet doctors, especially those on the ‘front-line’ like general practicioners will be “key decision makers in the adoption of new technologies into medical practice”.
The surveys findings are in line with the commonly acknowledged observation that the medical profession is highly conservative. (Although as Ben Goldacre observes in Bad Science, it is very difficult for GP’s to keep up to date with their field.) A natural question this study raises is whether GP’s safety concerns are genuine or if their skepticism of smart drugs is another example of the Semmelweis effect. (In the 1840’s Ignaz Semmelweis tried and failed to get doctor and surgeons to wash their hands.) The report concludes
The issue of safety is often raised and summarily dismissed in the debate over pharmacological cognitive enhancement by deferring to the authority of regulatory approval  The observation that physicians remained skeptical in the face of explicit safety claims suggests that such a conclusion may be premature. These data lend empirical force to the notion that regulatory authorities would be well advised to maintain the highest standards possible with respect to safety claims when evaluating pharmaceutical agents that may be construed as being enhancements.
Banjo, O., Nadler, R., & Reiner, P. (2010). Physician Attitudes towards Pharmacological Cognitive Enhancement: Safety Concerns Are Paramount PLoS ONE, 5 (12) DOI: 10.1371/journal.pone.0014322
- Popping Smart Pills: The Case for Cognitive Enhancement (time.com)
- My dalliance with smart drugs – and the lesson I learned (johannhari.com)
- Cognitive enhancers increasingly being used by athletes (sentientdevelopments.com)
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