Should physicians prescribe cognitive enhancers to healthy individuals?

scription stimulants (e.g., methyl phenidate, dextroamphetamine mixed salts) and other neuropharmaceuticals (e.g., modafinil) are used by some healthy individuals without diagnosed attention deficit disorder to enhance concentration, memory, alertness and mood, a phenomenon often described as “cognitive enhancement” or “neuroenhancement.” Recently the term cognitive enhancement has captured the effort to deliberately augment the performance of healthy individuals and has, therefore, been criticized for the implicit assumption that these agents will be beneficial for healthy people. In contrast, the terms “nonmedical use” and “prescription drug abuse” are used in public health literature. The prevalence of cognitive enhancer use by students on university campuses ranges from 1% to 11%. This practice raises important ethical and so cietal questions concerning the freedom of people to engage in cognitive enhancement and whether this is fair practice in academic and professional environments. Box 1 presents landmarks in the debate surrounding the ethics of cognitive enhancement. Physicians are important stakeholders in this debate, given the risks and regulations of prescription drugs and the potential for requests from patients for cognitive enhancers. The underlying question for physicians is not solely whether cognitive enhancement should be legitimized, but what role physicians should play, and under what circumstances they should prescribe these agents to individuals with no medical need, if at all. Physician obligation to grant, decline or redirect requests for cognitive enhancement has not been discussed extensively. Box 2 contains additional medical context. Here we argue that uncertain measures of benefits and harms, limited health care resources and professional integrity of physicians are 3 reasons why physicians should not prescribe cognitive enhancers to healthy individuals. Why “can” is not enough