As we approach the 60th Anniversary of the Universal Declaration on Human Rights, many have argued that the time is ripe for public engagement on the increasing use of the drugs described as ‘cognitive enhancers’, and the implications of these pharmaceuticals for the ‘dignity and justice of us all’. This paper argues that at present, the models which drive the public engagement initiatives of institutional science are of little use to solve the particular societal challenges posed by these neurotechnologies. Drawing from diverse literatures, this paper identifies the two issues that make current models of public engagement redundant in this context; and proposes a systemic approach to public engagement that could be useful in these, and other areas.

1. Beyond ‘cognitive enhancement’ and ‘cosmetic neurology’: do the
new (old?) nootropics highlight inadequacies in our models of public
engagement?
Jenny Gristock

2. Models of public engagement
■ Deficit model – ‘public
understanding of
science’ (education, awareness)
■ Dialogue/upstream engagement
(‘two-way’ – often not in practice)
■ User-led / citizen-framed topic/
activity chosen by citizen

6. EEG ‘enhanced’ groupware
..it might tell the
team leader, ‘Take
Bill out of loop, we
don’t want him
monitoring the space
shuttle today. He’s
had too much coffee
and too little sleep.
Sally, though, is
giving off the right
signals to do a great
job.’”

9. Engineering confusion
What is being enhanced??
=

10. Multiple systems
‘..cognitive
functions
contributing to
mental
performance are
distinct but
heavily
intermingled.’
Lanni et al
(2008)

11. Multiple systems
‘different
cerebral circuits
and molecular
events
regulating
memory,
attention and
creativity’

12. De Jongh et al (2008)
■ Long-term memory
versus working memory
■ Stability versus flexibility
of long-term memory
■ Stability versus flexibility
of working memory
■ Cognition versus mood
Trade-offs?

13. and…
■ Baseline dependencies cognitive
enhancer and leash for different people
■ dose conflicts appropriate dose for one
system improvement worsens another
■ well patient incertitudes effect on other
systems unknown when induced change
is not restorative (different to side-effects)
■ Mood / cognition interactions?

14. Enhancement?
■ Racine and Forlini (in press) say that
describing the phenomenon as
enhancement does not resonate with the
unknown risks of long-term, non-medical
use of prescription drugs
■ However, if Lanni and de Jongh are
correct, we are not only ignoring long-
term risks, we are also denying any
possibility of baseline dependencies,
dose conflicts, trade-offs and well-patient
incertitudes as well

15. Cognitive enhancers?
Boosting brain power??
■ nootropics?
■ modulators?
■ modifyers?
■ psychopharmeceuticals?

16. More confusion!
■ Time for analysis
■ Case study?
■ Product that is called a ‘cognitive
enhancer’

17. A ‘smart drink’ ??

18. Neuro Fuel

19. Neuro Fuel
■ 750 mg Piracetam, an old nootropic
■ Graduate entrepreneurs – sports
enthusiast and an MBA
■ Facebook group – ‘fans of Neuro
Fuel’
■ Many health claims

20. ‘Serotonin in the brain’
■ Neuro Fuel is a complex
beverage that increases
dopamine and serotonin in the
brain through a mix of
proponents, cofactors, and
precursors. Through this
combination Neuro Fuel
increases energy, alertness,
motivation, concentration, drive,
intelligence, memory, euphoria,
and sexual drive and
performance”.

21. a whopping 750mg!
■ The active ingredients in Neuro
Fuel … has been shown to be
beneficial for everything from
Alzheimer's, Parkinson's
disease, and Autism to ADD,
depression, and anxiety. And
Neuro Fuel has more than just a
little sprinkling of this compound,
it has a whopping 750mg!

22. ■ “I've just started a new
corporation called Utopian
Enterprises, LLC.
In about a month Utopian
Enterprises is coming out with
a revolutionary new energy
drink called Neuro Fuel.

27. ■

28. Neuro Fuel is now
sold in more than
1,000 stores from
Grand Rapids,
Mich., to Key
West, Fla.
Knoxville News, 5
June 2008

29. Piracetam
• a cyclic derivative of the
neurotransmitter ã-aminobutyric
acid (GABA), originally marketed
in 1971 by UCB Pharma.
• ‘Remarkably well tolerated’
•‘Many thanks to Sarah Meredith
and Yannick Lambé (UCB South
Africa., Belgium) for their excellent
support during the preparation of
this article’

30. Piracetam
■ use of piracetam in pregnant or
lactating women should be avoided
■ enhances the anticonvulsant effects
of carbamazepine
■ Dosage: For cognitive disorders
and vertigo it is 2.4–4.8 g daily p.o.,

31. What do users think?
■ “I suffer from Depression and Anxiety and
this product is suppost [sic] to help with
these problems. I would love for this to
work for me so I don't have to rely on
meds and doctors” M.H. NeuroFuel on
Facebook, 28 September 2008
■ great! i was thinking in the past they
should make energy drinks with a lot of
nootropics Medievel, ImmInst Forums,
18 June 2008

32. What do users think?
“Yikes! what are they thinking? They are in
way over their head…I think this will ruffle
the feathers of the feds and they will take
this down and potentially all other
piracetam on the market.”
Ortcloud, ImmInst Forums 18 June 2008
firs
"im
Alz
dem

33. What do users think?
“If we feel strongly enough about the
negative impact of their marketing,
perhaps we should alert them to this
thread, or have a "sit down" with them.
I would tell them to cut down the sugar
and vitamin content as well as to not
make outlandish claims.
‘Mind’, ImmInst Forums, 18 June 2008

34. Which model?
■ All, and yet none of them

35. Deficit?
■ The popularity of the term ‘enhancement’,
not only in popular science, but also in
the neuroscience and neuroethics
literatures, confirms that awareness or
acknowledgement of the potential
baseline dependencies, dose conflicts,
trade-offs and well-patient incertitudes
may be low on the part of specialists and
the public alike.

36. Upstream engagement?
■ we do not have to assume that the drugs
will work as they are marketed for their
influence to be felt in society
■ whether or not the drugs work in intended
or unintended ways, their benefits (or
their perceived benefits) will not be strictly
delineated to the communities of
‘institutional science’ and ‘the public’

37. User led engagement?
■ Yes, and no.
■ Users – yes
■ But completely outside academic or
big pharma ‘Neuroscience’

39. My d’oh moment..
■ An analysis of governmentalities
then, is one that seeks to identify
these different styles of thought,
their conditions of formation, the
principles and knowledges that
they borrow from and generate,
the practices that they consist of,
how they are carried out, their
contestations and alliances with
other arts of governing... (Rose,
O’Malley, and Valverde 2006)

40. My d’oh moment (ctd)
■ Further, instead of seeing any
single body—such as the state—as
responsible for managing the
conduct of citizens, this perspective
recognizes that a whole variety of
authorities govern in different sites,
in relation to different objectives.
(Rose, O’Malley, and Valverde
2006)

41. Time to start again!
■ How do I revaluate neurobiological
claims without falling into the same
traps as everyone else?
■ How does one approach
engagement from a
governmentality point of view?

42. See tables

43. • ‘cognitive
enhancement’
• ‘Prescription
drug abuse’
• ‘Lifestyle drug
choice’
Racine and Forlini
‘distinct paradigms
for approaching the
non-medical use of
pharmaceuticals’

44. Other issues:
■ Social control
■ Chronic illness
■ Employers
■ Marketing outside packaging and
traditional media
■ Online supply
■ Inequitable access to sources that could
contextualise information available
through non-traditional marketing
■ … and many others

45. Thank you!

46. Piracetam
■ ‘mechanisms of action of piracetam have
yet to be fully elucidated..‘
■ Yet ‘it influences neuronal and vascular
functions’
■ now indicated for use in vertigo, dyslexia,
cortical myoclonus and sickle cell
■ anemia in addition to age-related
cognitive disorders.
■ ‘Action appears to be unrelated to the
properties of this neurotransmitter.’

47. …the apparent
epidemic of
depression
reflects a
changing
attitude towards
behaviours that
we consider to be
problematic or
undesirable—and
therefore worthy
of medical
attention and
intervention

48. ■

49. Racine and Forlini
■ “To better understand the ethics of
performance-enhancement drugs at
a social level, further research will
be needed to determine which
paradigm or which combination of
paradigms reflects the views of
stakeholders such as students, lay
citizens, healthcare professionals,
and public health authorities.”

52. add a breakdown in activities per year
and per group, and the othet aspects
that need to be quantified.

53. ■ Hence a major part of the impact of
developments in neuroscience can be
traced to the means through which we
come to evaluate and experience their
knowledge products: the values
embedded in the EEG system
architecture; the definition of
enhancement used not only in labelling,
but in advertising and marketing (Dees
2004), the regulations on the use of
nootropics in food products, web
advertising, for example.

54. ■ Under this scenario, what is needed
is not upstream engagement on the
technologies themselves, but
rather, engagement on the nature
of the systems of mediation
(Gristock 2000, 2001) in innovation
systems.

58. Nature survey - Public
engagement?
one in five had used
methylphenidate
(Ritalin), modafinil
(Provigil) or
betablockers in an
effort to ‘stimulate their
focus, concentration or
memory’
the time has come to ‘take the question out to the public’
(Illes, quoted in Morris 2008),

60. … a fundamental shift in the
distinctions and relations
between mental and
psychological health and illness,
perhaps even conceptions of
personhood itself.

61. the shape and incidence of the
pathology of depression in Western
developed nations can only be
understood in relation to
contemporary conceptions of the self
involving the obligation of freedom:
responsibility, choice and active self-
fulfilment.

62. To be a "somatic" individual, in
this sense, is to code one's
hopes and fears in terms of
this biomedical body, and to
try to reform, cure or improve
oneself by acting on that body

63. links and relays between
classification of disorders,
marketing, testing, licensing and
promoting psychopharmaceuticals

64. A way of thinking has taken shape,
and a growing proportion of
psychiatrists find it difficult to think
otherwise. In this way of thinking,
all explanations of mental pathology
must "pass through" the brain and
its neurochemistry - neurones,
synapses, membranes, receptors,
ion channels, neurotransmitters,
enzymes, etc.

65. commercial decisions are actually
shaping the patterns of psychiatric
thought at a very fundamental level.

66. From another perspective the developments in
psychiatric drug use are merely one dimension of a new
set of relations between ideas of health and illness,
practices of treatment and prevention of bodily
malfunctions, and commercially driven innovation,
marketing and competition for profits and shareholder
value. Where Foucault analyzed biopolitics, we now
must analyze bioeconomics and bioethics, for human
capital is now to be understood in a rather literal sense-
in terms of the new linkages between the politics,
economics and ethics of life itself.

67. The significance of the emergence
of these new pharmacological
treatments for mental ill health lies
not only in their specific effects, but
also in the way in which they
reshape how both experts and lay
people see, interpret, speak about
and understand their world.

68. are becoming central to the ways in
which our conduct is determined to
be problematic and governed, by
others, and by ourselves to the
continuous work of modulation of
our capacities that is the life's work
of the contemporary biological
citizen.

71. ‘pharmacological Calvinism’ (Conrad
2007, Healy 1997, Klerman 1972):
the Puritan, disciplined, ascetic
belief, that is to say, that we need to
work hard in order to achieve a
valued goal or objective rather than
take drugs or medications as a
short-cut to success.

72. Thank you!

73. http://www.youtube.com/watch?v=8gMrG5lkYeg

74. Neuro fuel 1857