Should medical knowledge be extended to enhance the lives of those who are already healthy?

While one purpose of medicine is to improve the quality of life of individuals who are sick, should medical knowledge be extended to enhance the lives of those who are already healthy? This question and others are addressed in three articles about cosmetic neurology in the September 28 issue of Neurology, the scientific journal of the American Academy of Neurology.

Cosmetic neurology goes beyond the use of botulinum toxin for smoothing wrinkles and includes applying medical therapies to enhance normal abilities. In the journal’s “Views & Reviews” section, Anjan Chatterjee, MD, a neurologist at the University of Pennsylvania, Philadelphia, describes movement and endurance, attention and memory, and moods as three areas of cosmetic neurology. For example, amphetamines that help stroke patients could possibly benefit healthy individuals during a time of skilled motor learning, like playing the piano or swimming. Transcranial magnetic stimulation used to treat clinical depression could be applied to people who simply have “off” days.

Cosmetic neurology has ethical implications for both individuals and society, Chatterjee said. For the individual, concerns include safety and the notion that the self is challenged by chemically altering the brain. For society, concerns include the potential inequality of access to cosmetic neurology, as well as the coercion to use enhancements to compete at the highest level in a winner-take-all environment.

“For instance, if pilots perform better in emergencies when they take donepezil (a drug typically used to treat dementia), should they be expected or required by their employer to take this medication?” Chatterjee said. “We need an explicit notion of what it means to be human and a clear sense of the evolving role of physicians.”

Despite these concerns, Chatterjee sees the development of cosmetic neurology moving forward due to the growth of direct-to-consumer marketing and the military’s research efforts.

Two editorials published in the same issue of Neurology offer comments on Chatterjee’s claims.

In one editorial, Stephen L. Hauser, MD, a neurologist at the University of California, San Francisco, agrees that the future of neurology will be impacted by biomedical advances, including cosmetic pharmacology, stem cell research, and genetic engineering.

“Neurologists must assume a central role in shaping the debate about how society might define the boundary between interventions used to promote or restore optimal health and those used for enhancement,” Hauser said. “To participate in this debate, we must be fluent in the language of science.”

In another editorial, Richard H. Dees, PhD, a professor of philosophy at the University of Rochester, N.Y., does not accept the assumption that neurological enhancements will inevitably become routine. He contends that Chatterjee’s argument falls prey to “the allure of the slippery slope.”

“If we accept this argument, we have simply surrendered ethics to power,” Dees said. “There is nothing inevitable about the course of our society or of neurology as a profession. Because we can choose, we face deep moral questions that we must simply answer one by one.”

The American Academy of Neurology, an association of more than 18,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, autism and multiple sclerosis.