Category: HNRS 20 – Difficult Dialogues in Genetics and Medicine

An Ethical Look At Cognitive Stimulants, Part 1

adderallIS“Every era has its own defining drug.” – Margaret Talbot

With the high availability of so-called “cognitive enhancing drugs” like Ritalin, Adderall, and Provigil on college campuses, students everywhere are facing the choice of whether or not to take non-prescribed medications to help them “perform better” in school. Studies show that anywhere between 20-35% of college students have used one of these medications without a prescription in their college career, but an informal survey would likely reveal an even higher percentage, as the use of these medications is on the rise.  Many claim these drugs help them concentrate, study longer, and juggle more tasks by creating more productive hours in the day.  Others rely on them in a crunch, during midterms, finals, or the night before a big test, when the clock is ticking and assignments are due, and there doesn’t seem to be enough time –or brain power–to get everything that needs to get done, done.

The question of whether to use these “cognitive enhancing drugs” poses many ethical concerns– some rooted in the very immediate and direct impact of these drugs on the developing brains of young people, and some rooted more in what these drugs say philosophically about the direction our society is headed in.  And with the rate of use tripling within the past ten years, along with the fact that dozens of new cognitive stimulants are currently in the pharmaceutical pipeline, it seems an important issue to examine.  Should we embrace the use of these drugs, in hopes of them making us smarter, more efficient, and more productive?  Or should we be wary of using them, concerned with the risks that they pose not only to our brains, but to our own personal and societal values?

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Food For Thought: Cognitive Stimulants

question mark“If we have a tradition it is this: Everything can always be done faster and better.” – Henry Ford

An Ethical Look At Cognitive Stimulants, Part 2, Guest Post by Dr. Sean Hatt

Prescription PillsWho decides what’s right, what is socially appropriate, and what is societally acceptable when it comes to the use of things that alter your brain function?

It’s interesting to consider how we decide what the rules are about which drugs are deemed socially acceptable and which ones are not.  We condone (not only condone, but actively rely on) certain substances like caffeine, guzzling down cups of coffee and cans of Red Bull without a second thought about their “ethical implications.”  We condemn marijuana as illegal but allow a much more dangerous drug – alcohol – to be consumed at will after the age of 21.  We think it’s permissible to use coffee and chain-smoking cigarettes to pull an all nighter to complete work but would gape at someone snorting a line of cocaine for the same reason.  How are these lines we draw–the ones that call a certain brain-altering substance taboo and another one completely embraceable– determined?  Do they involve a careful assessment of their effects on the brain?   A standardized measure of risks?  Do they come from some subjective evaluation grandfathered in by socially determined forces?

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Genetics, Privacy, and The Web

genomeDid you know that with $399 and a tube of your saliva, you can find out your genetic predispositions for disease, personality traits, and what medications might work best for you?  Or with $149, you can check out your genetic family heritage?  How about that for less than $1,000, you will soon be able to get your entire genome mapped?

And what does this mean to you? It seems fair to say that currently, most people don’t concern themselves with their genetic profiles in their day-to-day lives.  Surely we read about genetics in the media: what genes are linked with what traits, what advancements are being made in the field of medicine with the growing knowledge of genetic information.  But our society certainly doesn’t conduct itself like the science-fiction movie Gattaca, where each person is branded with his or her genetic likelihoods from birth and assigned societal roles accordingly. We are generally oblivious to our own genetic profiles, and pay selective attention to findings about genes mostly when faced with a pressing health problem.  For the most part, we carry on our lives with little knowledge about our own genetic makeup and what that information might tell us about ourselves.

This, however, is changing.

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Food For Thought: Direct-To-Consumer Genetics

question mark“With the genome no less than with the Internet, information wants to be free, and I doubt that paternalistic measures can stifle the industry for long (but then, I have a libertarian temperament). For better or for worse, people will want to know about their genomes. The human mind is prone to essentialism — the intuition that living things house some hidden substance that gives them their form and determines their powers. Over the past century, this essence has become increasingly concrete. Growing out of the early, vague idea that traits are “in the blood,” the essence became identified with the abstractions discovered by Gregor Mendel called genes, and then with the iconic double helix of DNA. But DNA has long been an invisible molecule accessible only to a white-coated priesthood. Today, for the price of a flat-screen TV, people can read their essence as a printout detailing their very own A’s, C’s, T’s and G’s.

A firsthand familiarity with the code of life is bound to confront us with the emotional, moral and political baggage associated with the idea of our essential nature. People have long been familiar with tests for heritable diseases, and the use of genetics to trace ancestry — the new “Roots” — is becoming familiar as well. But we are only beginning to recognize that our genome also contains information about our temperaments and abilities. Affordable genotyping may offer new kinds of answers to the question “Who am I?” — to ruminations about our ancestry, our vulnerabilities, our character and our choices in life.”

-Dr. Steven Pinker, My Genome, My Self.  Read more here.  His genome is available for viewing as part of the Personal Genome Project here.

Ethical Issues With Prenatal and Preimplantation Genetic Diagnosis by Professor Lawrence Nelson

iStock_000000396261XSmallIt’s not science fiction. Nowadays prospective parents cannot only know the sex of their unborn child but also learn whether it can supply tissue-matched bone marrow to a dying sibling and whether it is predisposed to develop breast cancer or Huntington’s disease — all before the embryo gets implanted into the mother’s womb.” -Esthur Landhuis

Have you heard of “designer babies”?  Or perhaps you saw or read My Sister’s Keeper, a story about a young girl who was conceived through In Vitro Fertilization to be a genetically matched donor for her older sister with leukemia? The concept of selecting  traits for one’s child comes from a technology called preimplantation genetic diagnosis (PGD), a technique used on embryos acquired during In Vitro Fertilization to screen for genetic diseases.  PGD tests embryos for genetic abnormalities, and based on the information gleaned, provides potential parents with the opportunity to select to implant only the “healthy”, non-genetically diseased embryos into the mother.  But this genetic testing of the embryo also opens the door for other uses as well, including selecting whether you have a male or female child, or even the possibility of selecting specific features for the child, like eye color.  Thus, many ethicists wonder about the future of the technology, and whether it will lead to babies that are “designed” by their parents.

Today’s post is an exploration of the ethical issues raised by prenatal and preimplantation genetic diagnosis, written by Santa Clara Professor Dr. Lawrence Nelson, who has been writing about and teaching bioethics for over 30 years.  Read on to examine the many ethical issues raised by this technology.

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Food For Thought: Preimplantation Genetics

question mark“I was born for a very specific purpose.  I wasn’t the result of a cheap bottle of wine or a full moon or the heat of the moment.  I was born because a scientist managed to hook up my mother’s eggs and my father’s sperm to create a specific combination of precious genetic material.  In fact, when (my brother) Jesse told me how babies get made and I, the great disbeliever, decided to ask my parents the truth, I got more than I bargained for.  They sat me down and told me all the usual stuff, of course – but they also explained that they chose little embryonic me, specifically, because I could save my sister, Kate.  ‘We loved you even more,’ my mother made sure to say, ‘because we knew what exactly we were getting.”

-A passage from My Sister’s Keeper by Jodi Picoult, written from the perspective of Anna, a child conceived using PGD to save the life of her cancer-stricken sister. Read more here.

What Ethical Issues Are Raised By Advertisements for Egg Donors?

donor“Help loving couples conceive a child! Seeking egg donors with a clear health history, GPA 3.6+ and above 1350 on SAT.  Must play a musical instrument.  $10,00 Compensation.”

Have you seen an ad like this in your local college newspaper?  Chances are if you leaf through the classified sections of any elite university, you’ll find one just like it.  The advertisements, placed by couples or agencies looking for women to donate their eggs to be used to help couples conceive through In Vitro Fertilization, appear in college classifieds across the country.  They are notoriously featured at Ivy League schools, often targeting high achieving women with superior grades and test scores, offering anywhere from $5,000 to $50,000 for highly qualified donors.  Many call for specific qualities in their donors:  “Donor ideally has artistic skills, as intended mother is a talented oil painter and piano player,” reads one.

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Food For Thought: Egg Donation

question mark“Now in market terms, this potential transaction makes perfect sense—matching a willing seller and a willing buyer. Both parties get what they need—tuition money, the seeds of a new child—and no one is coerced into anything. But what is the human meaning of what is happening?”

-Eric Cohen, Biotechnology and The Spirit of Capitalism.  Read more here.

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