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За разрешение использования Риталина выступают известные британские учёные

via Medportal (1, 2).

Через 20 лет применение психотропных препаратов для восстановления работоспособности и стимуляции работы мозга станет повсеместно распространенным явлением.

Об этом на заседании кабинета министров Великобритании заявил главный научный советник правительства Дэвид Кинг (David King). По мнению Кинга, восстановительные психотропные препараты способны существенно повысить качество жизни, поэтому свободный доступ к ним должны получить и граждане, не испытывающие проблем с психическим здоровьем. Кроме того, стимуляторы нового поколения способны совершить переворот в лечении психических расстройств и наркотической зависимости, полагает советник британского правительства.

Доклад Дэвида Кинга вносит весомый вклад в общественную кампанию за отмену ограничений на использование ноотропных препаратов для повышения работоспособности и стрессоустойчивости. В последнее время эта практика получила название «косметической неврологии».

По данным опроса, проведенного в 2005 году, 20% американских студентов принимают перед экзаменами Риталин – препарат для лечения синдрома дефицита внимания с гиперактивностью у детей.

Немедицинское использование лекарств, первоначально предназначавшихся для лечения психических расстройств и депрессии, широко распространено в США и Европе. В качестве стимуляторов умственных способностей широко используются также Модафинил, предназначенный для лечения нарколепсии, и Донепезил, первоначально разработанный как лекарство от болезни Альцгеймера.

Известный британский учёный, специалист в области биоэтики, профессор Университета Манчестера (University of Manchester) Джон Харрис (John Harris) предлагает отменить законодательные ограничения на использование некоторых стимуляторов. Статья профессора была опубликована в научном журнале BMJ (полный текст статьи приводится в конце записи). BMJ (British Medical Journal), выходящий с 1840 года, опирается на принципы доказательной медицины и входит в четвёрку ведущих мировых научных изданий по медицине.

В своей статье профессор Харрис предлагает разрешить свободное использование стимулирующего препарата метилфенидат, так как считает его безопасным для здоровья. Метилфенидат продается в Великобритании и США под торговым названием "Риталин". Его хранение и отпуск без рецепта является уголовным преступлением. В России этот препарат без всяких на то оснований отнесён к наркотическим, соседствуя в списке с героином.

Харрис заявил, что в пользу отмены ограничений на использование этого лекарства свидетельствует его длительное безопасное применение для лечения синдрома расстройства внимания и гиперактивности у детей. Данное заболевание не является угрожающим жизни пациентов.

По мнению ученого, запрет на использование "Риталина" для стимуляции деятельности мозга аналогичен запрету искусственного освещения.

Использование здоровыми людьми психотропных средств, которые предназначены для лечения психических расстройств и депрессии, широко распространено в США и Европе. Развитие технологий усиления интеллекта с помощью фармакологии продвигают трансгуманистические организации, такие как основанная Дэвидом Пирсом BLTC (Better Living Through Chemistry) или Российское Трансгуманистическое Движение, продвигающее (статья "Киборги в раю") использование ноотропных препаратов и ведущее исследовательские проекты в данной области.


Is it acceptable for people to take methylphenidate to enhance performance? Yes

British Medical Journal, 2009

John Harris, Lord Alliance professor of bioethics and director

1 Institute for Science, Ethics and Innovation, University of Manchester, Manchester M13 9PL

john.harris@manchester.ac.uk

A drug that can improve your exam results may sound tempting, and John Harris believes that we should embrace its possibilities. Anjan Chatterjee (doi:10.1136/bmj.b1956), however, argues that the dangers have been underplayed

Many healthy students are thought to use methylphenidate (Ritalin) and other chemical cognitive enhancers to improve academic performance.1 The arguments against their being permitted so to do have not been persuasive.2 The crucial ethical question is whether this is a matter for regret or celebration.

Ethical dimension

Suppose a university were to set out deliberately to improve the mental capacities of its students; suppose its stated aims were to ensure that students left the university more intelligent and learned than when they arrived. Suppose they further claimed that not only could they achieve this but that their students would be more intelligent and mentally alert than any students in history. What should our reaction be?

We might be sceptical, but if the claims could be sustained, should we be pleased? Would we welcome such a breakthrough and want our children to go to such a university? We ought to want this. It is, after all, part of what education is supposed to be for. And if the gains in cognitive functioning were significant and the costs commensurate we would probably want them for our children and want to see them more widely adopted in education.

Now suppose, as indeed has already happened, several drugs had been shown to improve cognitive performance and had been proved to be safe for use in children. What should our reaction be? Would it be unethical to use these drugs in healthy people to enhance performance? Would it be ethical not to do so?2

Risks and benefits

Methylphenidate and several other so called chemical cognitive enhancers have been shown to significantly improve cognitive functioning and have proved safe in clinical contexts.3 Safe always means safe enough, and since no drugs are free of side effects, that always means that the consumer has judged the risks of adverse effects worth taking, given the probable benefits. Methylphenidate has been judged safe enough to be widely used in children and young people with attention deficit hyperactivity disorder (ADHD) over a long period. Since the disorder is not usually life threatening and the beneficial therapeutic effects largely depend on the same properties that make the drug an enhancing intervention, those same benefits will also justify its use from the safety perspective in healthy adults, who (presumably) value those effects as much as do those with ADHD. Moreover, methylphenidate has proved safe enough to be ethical to use in research with healthy subjects to test cognitive effects, where the use is clearly elective rather than therapeutic.

The drug’s significant advantages include enhanced executive functioning, enhanced study skills, and improvement in the focusing of attention and in the manipulation of information.2 As Farah and colleagues have noted: "Our regulatory agencies determine what constitutes a sufficiently careful search for side effects and what side effects are acceptable in view of a drug’s benefits . . . we see no reason why the same approach cannot be applied [in the case of neurocognitive enhancement]".4 This would be one reasonable approach to safety. However, here I am interested in the question of whether there are any principled ethical objections to the use of chemical cognitive enhancers in healthy individuals, not with the definition of safety.

Human nature

Clear thinking on the issue of human enhancement has been bedevilled by the issue of doping in sport. Sport, however, is not a matter of life and death, even though some might agree with the football manager Bill Shankly that it is "far more important than that." The wrong of performance enhancers in sport, if there is one, is that such substances are almost universally banned by the rules of competition; using them is therefore cheating. But absent the ban, absent the cheating.

It is not rational to be against human enhancement; humans are creatures that result from an enhancement process called evolution (mixed as its benefits are) and moreover are inveterate self improvers in every conceivable way.

Synthetic sunshine (firelight, lamplight, and electric light) is just one accepted example of a valuable enhancement technology which, like such others as written language, education, physical exercise, and diet, creates problems of justice as well as the side effects of use and overuse. And beneficial neural changes have been reported for reading,5 education,6 physical exercise,7 and diet.8 How then are drugs ethically distinct? Before synthetic sunshine people slept when it was dark and worked in the light of day. With the advent of synthetic sunshine work and social life could continue into and through the night, creating competitive pressures and incentives for those able or willing to use it to their advantage. The solution, however, was not to outlaw synthetic sunshine but to regulate working hours and improve access. The same is, or will be, true of chemical cognitive enhancers.

Cite this as: BMJ 2009;338:b1955


Competing interests: None declared.

References

  1. Greely H, Sahakian B, Harris J, Kessler R, Gazzaniga M, Campbell P, Farah M. Towards responsible use of cognitive enhancing drugs by the healthy. Nature 2008;456:18-25.[ISI][Medline]
  2. Harris J. Enhancing evolution. Princeton: Princeton University Press, 2007.
  3. Sahakian B, Morein-Zamir S. Professor’s little helper. Nature 2007;450:1157-9.[CrossRef][ISI][Medline]
  4. Farah MJ, Illes J, Cook-Deegan R, Gardner H, Kandel E, King P, Parens E, et al. Neurocognitive enhancement: what can we do and what should we do? Nature Rev Neurosci 2004;5:421-5.[CrossRef][ISI][Medline]
  5. Schlagger BL, McCandiss BD. Development of neural systems for reading. Annu Rev Neurosci 2007;30:475-503.[CrossRef][ISI][Medline]
  6. Draganski B, Gaser C, Busch V, Schuierer G, Bogdahn U, May A. Neuroplasticity: changes in grey matter induced by training. Nature 2004;427:311-2.[CrossRef][Medline]
  7. Hillman CH, Erikson KI, Kramer AF. Be smart, exercise your heart: exercise effects on brain and cognition. Nature Rev Neurosci 2008;9:58-65.[CrossRef][ISI][Medline]
  8. Almeida SS, Duntas LH, Dye L, Nunes ML, Prasad C, Rocha JB, et al. Nutrition and brain function: a multidisciplinary virtual symposium. Nutr Neurosci 2002;5:311-20.[CrossRef][ISI][Medline]
Tags: риталин, усиление интеллекта
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