Slippery slopes, wonder drugs, and cosmetic neurology

Drug therapies that are already available can help patients improve their muscle mass and endurance, attention and memory, ability to learn, and moods. Future research, Anjan Chatterjee argues in this issue of Neurology, will almost certainly produce relatively safe wonder drugs that will allow us to manipulate our strength, our memory, our ability to concentrate, and our capacity to learn.1 Once these drugs are available, he contends, the pressures of the marketplace and of potential military uses will compel us to embrace them to remain competitive. To some extent, this discussion has an air of unreality: for the foreseeable future, any drug powerful enough to enhance brain functions significantly is likely to have serious side effects, especially with prolonged use. But if we accept the premise that safe neurologic enhancement technologies will eventually become available, then we face two important moral questions: 1) What kind of doctors should neurologists be? 2) What kind of society should we become? The answer to the first obviously depends on the second. So the question of whether neurologists should become, as Chatterjee suggests, “lifestyle consultants” who dispense fixes for the mind the way plastic surgeons offer fixes for the body does not even arise unless the mere availability of these treatments implies that neurologists must prescribe them to whoever seeks them. Putting the …