Weiss - our brave new pharmacological world.fm

OUR BRAVE NEW PHARMACOLOGICAL WORLD: A VIRTUE ETHICS CRITIQUE Steven D. WeissAugusta State University It’s not difficult to say what’s objectionable about soma in Aldous Huxley’s Brave New World: the majority of the blissed-out, mindless deni-zens of this socially and biologically engineered dystopia are obliviousnot only to their own manipulation but also to the fact that their liveshave become empty and hollow; they no longer care or strive for any-thing greater than the ecstasy of their next drug-induced vacation. Fran-cis Fukuyama argues in Our Posthuman Future that Huxley’s vision of thefuture was extremely prescient and that advances in biotechnology andneuropharmacology now threaten to alter human nature and thus under-mine the very basis of human dignity.1 One such threat stems from devel-opments he sees in neuropharmacology and the growing omnipresencein our lives of psychotropic drugs such as Prozac and Ritalin. The firstsection of this paper discusses advances in neuroscience and pharmacol-ogy that extend the aim of medicine beyond the treatment of disease andthe mitigation of pain and suffering to include “cosmetic neurology,” thatis, the enhancement of cognitive functioning in normal, healthy humanbeings. The second section challenges Fukuyama’s assertion that we canonly escape a “posthuman” future as nightmarish as Huxley’s Brave NewWorld if we anchor human dignity and values in an empirically defensibleconception of human nature. Given the theoretical difficulty of identify-ing a normatively relevant conception of human nature, I propose thatAlasdair Macintyre’s analysis of virtue, internal goods and practices inAfter Virtue offers the necessary conceptual apparatus and appropriatecontext of human activity–not human nature–that allows us to evaluate theethical significance of neurochemical enhancements. In the third andfinal section, I draw upon the myth of Theuth from Plato’s Phaedrus toargue that the use of performance-enhancement drugs within the arenaof Macintyre’s practices threatens the integrity of these special domains of human activity and the forms of excellence and achievement they fos-ter. As Fukuyama tells it, the advent of Prozac in the early 1990s repre- sented more than just a new drug therapy for treating depression: itopened our eyes to the possibility of what Peter Kramer in Listening toProzac dubbed “cosmetic pharmacology.”2 Not only did Prozac prove tobe effective in treating many clinically depressed patients, it also provideda psychic boost in self-esteem and confidence for healthy individuals andthe mildly depressed. While Fukuyama recognizes Prozac as a therapeuticboon for those trapped in the depths of depression, he worries that itmay become a kind of “happiness pill” for the mentally fit who want toelevate their serotonin levels to feel “better than good,” as he puts it.3Fukuyama doesn’t place Prozac in the same class with soma, but he statesthat with this antidepressant “the path is opened toward a drug that incertain ways looks uncomfortably like the soma of Aldous Huxley’s BraveNew World.”4 Stephen Braun in, The Science of Happiness: Unlocking the Mys-teries of Mood, rejects Fukuyama’s worry about Prozac and the potentialdangers of a pharmacological future not unlike Huxley’s, but nonethelessadmits that many of those using antidepressants today would never havebeen diagnosed as depressed in the past. Braun observes, “Today the linebetween mental illness and normalcy has become blurred to the pointthat a fully functioning, relatively happy person can walk into a doctor’soffice, complain vaguely of periodic low mood or low energy, and walkout with a prescription for Prozac, or Xanax, or Ritalin.”5 Huxley saw aconnection between the new psychotropics of his time and soma, a con-nection which he discussed in his 1958 work, Brave New World Revisited.
Soma, as Huxley remarked, packs a triple punch for the inhabitants of hisfuturistic society: it serves as a hallucinatory tranquillizer; a euphoricwhich stimulates both the mind and the body; and a blissful release fromtension and anxiety.6 Huxley observed a certain similarity between somaand the first antidepressant called Iproniazid that made its debut in theearly 1950s. First developed for the treatment of tuberculosis, Iproniazidwas moderately successful in combating this bacterial infection, but it hadthe unanticipated, though not unwelcomed, side effect of animating andenergizing TB patients. When Iproniazid was tried out on depressedpatients, some did remarkably well.7 Although Huxley didn’t suppose that Steven D. Weiss: Our Brave New Pharmacological World anything like soma would ever appear in our pharmacological future, hesaw enough on the horizon at the time to give him pause: the ideal stimulant—powerful but innocuous—stills awaits discovery. Amphetamine, as we have seen, was far from satis-factory; it exacted too high a price for what it gave. A morepromising candidate for the role of soma in its third aspect [asan anti-anxiety drug], is Iproniazid which is now being used tolift depressed patients out of their misery, to enliven the apa-thetic and in general to increase the amount of available psychicenergy. We see that, though soma does not yet exist (and willprobably never exist), fairly good substitutes for the variousaspects of soma have already been discovered. There are nowphysiologically cheap tranquillizers, physiologically cheapvision-producers and physiologically cheap stimulants.8 If Huxley could thumb through our Merck manual today, he woulddoubtless find enough antidepressants, anti-anxiety drugs, stimulants,cognitive enhancement drugs and psychoactive agents to mix-and-matchfor a perfect soma-induced mental holiday.
Fukuyama’s fears about the potential of a Prozac-like drug to serve as a “happiness pill” extend to drugs such as Ritalin and Adderal which,he says, have proven to be very effective in chemically controlling indi-viduals. Prescribed for the treatment of ADD and ADHD, Ritalin, ormethylphenidate, is a stimulant similar in structure to methamphetamineand cocaine;9 Adderal itself is an amphetamine. Ritalin has proven effec-tive in treating individuals suffering from ADD and ADHD: as aeuphoric and central nervous system stimulant, it improves performancein the “executive function” skills of organizing, planning, decision-mak-ing, judgment and goal setting.10 Children and students diagnosed withADHD have found that Ritalin and Adderal allow them to concentrateon their studies and better focus in the classroom. Fukuyama acknowl-edges all of this but suspects that healthy, rambunctious children–mainlyboys–are being labeled ADHD and chemically pacified in the classroom.
Researchers have yet to find an organic cause of ADD/ADHD and thediagnosis is made entirely on the basis of symptoms (the same is true ofdepression). Fukuyama sees a disturbing similarity between Prozac andRitalin: The former is prescribed heavily for depressed women lacking in self-esteem; it gives them more of the alpha-malefeeling that comes with high serotonin levels. Ritalin, on the other hand, is prescribed largely for younger boys who do notwant to sit still in class because nature never designed them tobehave that way. Together, the two sexes are gently nudgedtoward the androgynous median personality, self-satisfied andsocially compliant, that is the current politically correct out-come in American society.11 More than the issue of social control, however, what disturbs Fukuyamamost about psychotropic drugs is the threat they pose to our humanity byleveling the rich diversity and complexity of human ends and activities. As Fukuyama points out in his discussion of ADD and ADHD, with the medicalization of children and adults who trail off on the edgesof the standard distribution of normal behavior, the line between therapyand enhancement becomes blurred.12 Fukuyama is not alone in thisobservation. Anjan Chatterjee, a medical researcher and clinician, notesthat medicine is finding it increasingly more difficult to distinguish inpractice between therapy and enhancement. While clinicians may initiallyfocus on treating the biological causes of disease, in many instances, whatpatients complain about most regarding their illness are quality of lifeissues which may have little to do with the underlying organic pathologythat doctors seek to remedy. And so, in addition to treating the disease,physicians also include quality of life considerations alongside planning atherapeutic intervention for the patient. But if one of the goals of medi-cine is to improve the patient’s quality of life–where doing so does notdirectly relate to treating the underlying pathology—it is not implausibleto ask, as Chatterjee suggests, why medicine shouldn’t devote itself toimproving the lives of healthy individuals as well.13 Fukuyama’s objectionthat “the original purpose of medicine is to heal the sick, not to turnhealthy people into gods” can be met by simply removing enhancementsfor the healthy from the domain of medicine; as Erik Parens suggests, wemight envision a new group of professionals called “Schmocters” whowill practice enhancement “Schmedicine” for the healthy.14 And thefuture looks promising for “Schmedicine” as all kinds of enhancementdrugs now beckon for those who are of sound body and mind. Chatter-jee notes that with advances in neuroscience and neuropharmacologymany of the new drugs therapies being developed for cognitive disordersmay not only be effective in treating dementia, Alzheimer’s Disease,stroke, traumatic brain injury and the like, but may very well serve toimprove cognitive functioning in the healthy as well.15 Steven D. Weiss: Our Brave New Pharmacological World While professional athletes are vilified for using steroids, for many Americans performance-enhancement drugs have already become a wayof life.16 For example, Ritalin and Adderal have become wildly popularamong high school and college students who do not suffer from ADHDbut nonetheless seek to improve their academic performance with a littlehelp from these stimulants. Chattergie argues that it is all but impossibleto prevent healthy individuals from using cognitive enhancement drugsoriginally developed for treating the impaired,17 and Michael Gazzaniga,agrees: Drugs designed for psychotherapy can also be used to enhance certain regular mental functioning. Just as Ritalin canimprove the academic performance of hyperactive children, itcan do the same for normal children. It is commonly thoughtto boost SAT scores by more than 100 points, for both thehyperactive and the normal user. Many healthy young peoplenow use it that way for that purpose, and quite frankly, there isno stopping the abuse.18 Classical musicians have discovered that they can minimize the effects ofstage fright by taking small doses of propranolol, a prescription drug soldunder the trade name Inderal. Propranolol is a beta-blocker that was orig-inally prescribed for the treatment of angina and abnormal heartrhythms, but it works equally well as an anti-anxiety drug and can steadythe jittery hand of a nervous violinist.19 Paxil, a second-generation Pro-zac-type drug, is now used by shy people to help them overcome theirdiscomfort in social settings.20 Researchers have also found that donepe-zil (trade name Aricept), originally approved for slowing memory loss inAlzheimer patients, improves memory in normal populations as well.
Using a flight simulator, researchers trained pilots to respond to emer-gency scenarios; half of the subjects received donepezil and the other halfa placebo during simulator training. The research subjects were tested amonth later to determine how well they could recall and implement theirtraining; those who had received donepezil better remembered theirtraining as demonstrated though improved performance.21 The future ofcosmetic neurology is here as pharmaceutical companies scramble tosynthesize the next generation of “nootropes” or smart drugs that willboost memory and cognition in the young and old, the healthy and theinfirm.
Ethical concerns about the use of neuroenhancing drugs within the healthy population reflect a larger debate within bioethics over the quest for human perfection that includes technologies which promise betterbabies through genetic engineering, happier psyches through psychop-harmacology, and longer-lived bodies through muscle enhancement andregenerative medicine. The ethical questions raised by these issues arewide-ranging and provide fertile ground for debate and discussion withinany contemporary ethical issues class.22 Discussion is especially animatedamong students when it comes to considering the ethical issues sur-rounding the use of cognitive and performance enhancement drugs. Stu-dents are already familiar with the topic given the ongoing publicityabout the abuse of steroids and doping agents within professional sports;and many students who do not suffer from any kind of disability areextremely forthright in admitting (as studies confirm) to taking Addrealand Ritalin to stay up all night to study or write a term paper. The ethicalissues raised by neuroenhancing drugs for over-achievers can be groupedinto three categories. First, considerations of harm dictate that the safetyof these drugs for individuals seeking to boost their intellectual produc-tivity should be established before we can even begin to consider endors-ing this nonmedical drug use. The reality, however, is that there isvirtually no research on the side effects of cognitive enhancement drugsfor such a population; in fact, there is sparse evidence of the long termeffects of Adderal and Ritalin for children and adults who have been pre-scribed these drugs. Second, questions of justice, fairness and equityspring to mind: are normal, healthy students cheating when they usestimulants to improve their test-taking performance? Suppose Addrealare Ritalin are safe and confer a benefit on non-ADHD students: shouldwe be concerned about a possible “performance gap” between thosewho can and cannot afford such drugs? Would justice dictate that every-one have access to these drugs, in order to satisfy the demands of equityand distributive justice? Further, would individuals feel coerced to takethese drugs, just to keep up with the competition? Third, even if wecould resolve these issues of fairness, justice and equity, we would wantto know what a world in which neuroenhancing drugs made everyonesmarter, more mentally alert and higher-performing would mean for oursense of humanity, dignity and agency.23 Could we still take pride in ouraccomplishments? Or would these drugs diminish our sense of dignityand humanity to the extent that what we now admire is a certain pharma-cologically-enhanced achievement, rather than the outcome of genuinehuman effort and striving? Drawing from the third category of ethicalconcerns, this paper offers a virtue-ethics critique of cognitive enhance- Steven D. Weiss: Our Brave New Pharmacological World ment drugs in a way that avoids the pitfalls of attempting to articulate aconception of human nature. MACINTYRE’S PRACTICES, VIRTUES AND INTERNAL GOODS Fukuyama’s worry that biotechnology threatens to erode the com- plex diversity of human ends and activities deserves to be taken seriouslyeven if we think that anything approximating Huxley’s nightmarish futureis only remotely possible, for there are surely many ways in which ourhumanity may be diminished short of Huxley’s worst case scenario. Butin looking back to Brave New World and fearing a posthuman future of ourown, Fukuyama insists that “our final judgment on ‘what’s wrong’ withHuxley’s brave new world stands or falls with our view on how importanthuman nature is as a source of values.”24 Fukuyama’s project, therefore, isto identify our “human essence, the most basic meaning of what it is tobe a human being”25 and thus create a normative bulwark against theencroachments of biotechnology. In attempting to sort out the ethicaldifferences between traditional v. newer technological means of achievingour ends, Ronald Cole Turner agrees with Fukuyma’s enterprise butdespairs at the prospect of ever identifying an adequate theory of humannature: [I]t is distressing that precisely at the moment in human history when we are poised on the threshold of the possibilityof the technological manipulation of human nature, we havevery little consensus on what we mean by human nature. Infact, we have very few candidate theories of human nature,philosophical or theological, and so it is quite likely we will pro-ceed to alter what we do not even pretend to understand. Itmay turn out that through our self-alteration, through a kind ofscientific experiment on ourselves, we will come at last tounderstand ourselves more clearly.26 What Turner doesn’t say is that we may only come to an understandingof our humanity after we have irrevocably altered or damaged it—bychanging our germ line, for example. Turner’s pessimistic outlook aboutthe likelihood of settling on a theory of human nature that can do theethical heavy lifting Fukuyama demands of it is not unwarranted. Con-trary to Turner, however, the problem may not be the paucity of theoriesbut the sheer multitude of competing accounts of human nature, not justphilosophical or theological, but psychological, sociological, and biologi- cal as well.27 To further complicate matters, postmodernists reject thevery notion of an essential human nature that can function as value-determining or goal-directing. Finally, Fukuyama’s own definition ofhuman nature as “the sum of the behavior and characteristics that aretypical of the human species, arising from genetic rather than environ-mental factors”28 seems to rest on a kind of quixotic scientism that claimsan empirical account of species-typical behavior can provide us with an eth-ical vision of human flourishing and well-being. But the movement from“what is the case” to “what ought to be the case” is fraught with philo-sophical and ethical problems and can only be traversed—if at all—withgreat theoretical difficulty. The situation is not as grim as Turner suggests, however, since an ethical evaluation of advances in genetics and psychopharmacology neednot be theoretically grounded in a definition of human nature. An alter-native account of human ends and activities which doesn’t risk founder-ing on the concept of human nature and yet provides a rich context forevaluating the ethical implications of enhancement technologies can befound in Alasdair Macintyre’s notion of a “practice” as he defines it inAfter Virtue: By a ‘practice’ I am going to mean any coherent and com- plex form of socially established cooperative human activitythrough which goods internal to that form of activity are real-ized in the course of trying to achieve those standards of excel-lence which are appropriate to, and partially definitive of, thatform of activity, with the result that human powers to achieveexcellence, and human conceptions of the ends and goodsinvolved are systematically extended.29 Macintyre’s concept of a practice is wide-ranging and includes activitiessuch as chess, but not tic-tac-toe; football, but not the simple act ofthrowing a football; architecture, but not bricklaying. Physics, chemistryand biology are all practices, as well as historical inquiry, painting andmusic; in general, all the arts and sciences are included.30 Macintyre’snotion of a practice encompasses all those human endeavors, activitiesand modes of inquiry which allow us to distinguish ourselves and achieveour best; each activity, endeavor or inquiry captures a unique form ofhuman accomplishment and excellence; and each activity, endeavor orinquiry is sustained by a historical-cultural tradition of rules, standards ofexcellence and institutions creating a social arena within which we work Steven D. Weiss: Our Brave New Pharmacological World together to realize the goods internal to that practice as we strive toachieve our best as defined by that practice. Macintyre goes on to distinguish between the “internal” and “exter- nal” goods which attach to a practice. Awards, prizes, prestige, money,power and status are all external goods contingently related to a practicethrough accidental social circumstances and, as such, are not essential toor definitive of the practice itself. There are many different ways of pur-suing money, power and status, so that acquiring these things is never amatter of engaging in just one kind of practice.31 Moreover, says Macin-tyre, when I acquire these external goods they always become my prop-erty, my possession.32 External goods are therefore the object ofcompetition where there are always winners and losers: my gain is yourloss.33 Internal goods differ from external goods, according to Macintyre, in the following two ways. First, the internal goods of a practice can onlybe acquired by way of that particular practice; that is, they can only berealized within the confines of a specific practice and its focal activity.
Macintyre’s idea seems to be that since each practice nurtures and culti-vates a special form of human endeavor, activity or mode of inquiry, theintrinsic value that attaches to these undertakings and the unique form ofhuman excellence they embody can only be realized within that particularpractice. Secondly, it is only through the experience of participating in thepractice that one can come to identify and recognize the internal goodsof the practice. Unless I have had the relevant experiences peculiar to agiven practice and have actually submitted to and attempted to achievethe standards of excellence of that practice, I am not a competent judgeof the goods internal to that practice.34 One internal good of a practicemay even include an object created by the activity associated with thatpractice and its standards of excellence. For example, Macintyre explainsthat the practice of portrait painting from the late middle ages to theeighteenth century gave rise to two very different kinds of internal goods:first, the excellence of the painting itself as aesthetic object, as well as theartist’s excellence in the execution of the painting; and, second, the goodof living a certain kind of life as a portrait painter–a good that is experi-enced by artists as they strive to achieve the standards of excellence pecu-liar to their practice.35 Unlike portrait painting, however, some practicesdo not culminate in an entity or aesthetic object that exists apart from theactivity that produced it; in such cases the excellence of the event, e.g., aballet or theatrical performance, may be said to be either identical to orsupervene on the excellence of the activity of the performers. But even in those practices where the excellence of the “product” (e.g., the portrait asphysical object), as Macintyre refers to it, can be distinguished from theexcellence of the activity that produced it, the activity and its product donot occupy separate universes: it is the excellence of the activity that givesrise to the excellence of its product. While the internal goods of a practice can be realized as a result of the competition to excel, Macintyre is quick to point out that these goodsare never the sole property or possession of any one individual or selectgroup of individuals; rather, the achievement of these goods, even undercompetitive circumstances, represents a good for the whole communityparticipating in the practice.36 The end of chess, for example, is not win-ning per se, but the experience of a certain form of human excellence andachievement as defined by the standards of the practice. To furtherexplain the difference between internal and external goods, Macintyregives the example of a child who is first “persuaded” to play chess bybeing offered candy whenever she wins. Macintyre notes, however, that ifthis is the only reason she has for playing chess, she has no reason not tocheat and every reason to cheat if she can get away with it. But if sheeventually comes to enjoy playing chess for its own sake and begins tovalue the goods internal to the practice she will have acquired a wholenew set of reasons to win, not by whatever means possible, but in a waythat allows her to excel according to the rules and standards of the game.
For her to cheat now would be to lose out on the goods internal tochess—goods which can only be experienced by committing oneself tothe practice of chess and embracing its standards of excellence. Some ofthe internal goods of chess Macintyre mentions are “a highly particularkind of analytic skill, strategic imagination and competitive intensity.”37While these goods refer to the various powers, capacities and skills put touse by the outstanding chess player, they should not be thought of asmere instrumental means external to the activity of chess. Part of what itmeans to play chess and to play it well involves the utilization of thesepowers, capacities and skills which, following Macintyre’s definition,function as “internal means” to the end of chess: “I call a means internalto a given end when the end cannot be adequately characterized indepen-dently of a characterization of the means.”38 The fact that some of theinternal goods of chess include these internal means which are partiallyconstitutive of the activity of playing and excelling at this game will berelevant in critiquing the use of performance-enhancement drugs withinpractices. Steven D. Weiss: Our Brave New Pharmacological World The pursuit of the internal goods embedded in a practice, according to Macintyre, is always the result of the cooperative activity between theparticipants of the practice, and if practices are to sustain and perpetuatethemselves participants must embody certain character traits or virtues.
Macintyre defines a virtue as “an acquired human quality the possessionand exercise of which tends to enable us to achieve those goods whichare internal to practices and the lack of which effectively prevents usfrom achieving any such goods.”39 The virtues sustain the relationshipbetween participants and create the conditions of cooperation amongthose who share the same purposes and conform to the same standardsof excellence. Courage, honesty and justice are therefore necessary vir-tues of any practice, Macintyre argues, for without them participants arecut off from the internal goods of the practice. By embodying these vir-tues, the participants become members of a community and a traditionthat value the internal goods of the practice for their own sake and seekto preserve and sustain the practice and its standards of excellence.
Although practices depend on institutions to perpetuate themselves his-torically, Macintyre notes that institutions are notoriously driven by con-siderations of money, status and power; and so the virtues of honesty,truthfulness, fairness, justice and courage insulate practitioners from thepotentially corrupting influence of external goods.40 Without these vir-tues the practice becomes simply another competitive arena for acquiringexternal goods. The very integrity of a practice, its internal goods andstandards of excellence, depends upon those who embody the virtueswithin the practice.
A VIRTUE ETHICS CRITIQUE OF ENHANCEMENT DRUGS Immersing oneself in a particular practice always involves the devel- opment of a set of technical skills peculiar to that practice; but Macintyrecautions that a practice is never just a set of technical skills, even when directed towards some unified purpose and even if the exercise of thoseskills can on occasion be valued or enjoyed for their own sake.
What is distinctive in a practice is in part the way in which con-ceptions of the relevant goods and ends which the technicalskills serve—and every practice does require the exercise oftechnical skills—are transformed and enriched by these exten-sions of human powers and by that regard for its own internalgoods which are partially definitive of each particular practice or type of practice. Practices never have a goal or goals fixedfor all time—painting has no such goal nor has physics—butthe goals themselves are transmuted by the history of the activ-ity. It therefore turns out not to be accidental that every prac-tice has its own history and a history which is more and otherthan that of the improvement of the relevant technical skills.41 It is here where we can locate the first distorting influence of perfor-mance-enhancement drugs on human ends and activities within prac-tices. When string musicians use beta-blockers to dampen stage frightand improve their coordination and musicianship, they risk thinkingabout their practice more as a set of technical skills than a shared tradi-tion embodying internal goods which can only be experienced withinthat practice. This shift in focus and attitude may be subtle. In Technopoly:The Surrender of Culture to Technology, Neil Postman argues that every toolhas an ideological bias which operates as “a predisposition to constructthe world as one thing rather than another, to value one thing overanother, to amplify one sense or skill or attitude more loudly thananother.”42 The temptation to use enhancement drugs within a practicewill be all the greater where the refinement of technical skills is linked toexternal goods such as status and money contingently related to thatpractice. The danger is that the use of enhancement drugs will be seen asa means for improving our technical skills, no longer with an eye towardenriching the internal goods and ends of the practice, but rather as a wayof better securing the external goods attached to the practice. The result:what Macintyre calls a practice–the pursuit of human excellence andachievement for its own sake–devolves into a set of skills, capacities orabilities now coveted for their instrumental value in securing externalgoods. What remains is not a practice in Macintyre’s robust sense but acrass competitive enterprise that no longer values the pursuit of humanexcellence for its own sake.
An example of how a practice can be made vulnerable to competi- tive pressures through the introduction of new technologies can beobserved within the world of academe. Postman writes that the innova-tion of grading student papers first appeared in 1792 at Cambridge Uni-versity when, thanks to the efforts of a tutor named William Farish,students could now be quantitatively evaluated with this new technol-ogy.43 Nowadays professors despair that so many students are moreinterested in knowing what will be on the next exam than they are in thejoy of learning; and we suspect that many students no longer value educa-tion and learning for their own sake but only as a means for acquiring the Steven D. Weiss: Our Brave New Pharmacological World degree that will land them a good job. The fact that many students useRitalin to boost their SAT scores is an example of how William Farish’ssimple innovation altered the culture of academe in a way that distancesus from the internal goods and ends of the practice and threatens to turneducation into a mere means for securing external goods. The generalthreat posed by pharmacological agents that parade themselves as perfor-mance-enhancement drugs is their potential to reduce our practices tonothing more than competitive struggles between participants seeking tooutdo one another in their quest for external goods. This threat is tied towhat Postman calls the “ecological” tendency of new technologies: theinnovations they introduce into culture are rarely piecemeal or isolated intheir impact. In the same way an invasive species alters the entire charac-ter of an environment, new technologies rapidly transform the culturaland social landscape of our lives in ways we never anticipated.44 Althoughwe narrowly focus on and debate the efficiency of the computer as ateaching tool, Postman urges that we consider how this technology altersour entire concept of learning and education.45 Technologies, he argues,are rarely neutral in their application or impact: how they are put to use isdetermined by their structure; or, to put it differently, form dictates func-tion.46 It is this structure or form that gives a technology its “ideologicalbias,” its tendency to remake the world and human beings in its ownimage. While we typically think about technologies as ways of manipulat-ing and altering the world, we often fail to consider the ways in whichthey can work upon and change us, for as Postman points out: “Newtechnologies alter the structure of our interests: the things we think about.
They alter the character of our symbols: the things we think with. Andthey alter the nature of community: the arena in which thoughtsdevelop.”47 Given this dynamic of technological innovations, the criticalquestion is how pharmacological enhancements will alter the very way wethink about ourselves, our values, our skills, capacities, powers and activi-ties–how they will alter the ecology of our practices in Macintyre’s richsense. A second way in which enhancement drugs distort our practices and the activities they sustain is dramatically illustrated at the end of Plato’sPhaedrus where Socrates recounts the legend of the Egyptian god Theuthwho, as the inventor of numbers, calculation, geometry, astronomy, dicegames and, most importantly, writing or letters, presents his arts (technē)to the Egyptian king, Thamus, and requests that they be distributed to allEgyptians. After listening to Theuth explain the merits of each invention,King Thamus praises some and condemns others, but when he considers the art of letters he issues a stern warning, charging that Theuth has com-pletely misunderstood the nature of his invention. Socrates continues hisnarration: The story goes that Thamus said many things to Theuth about each art—both pro and con—the details of which wouldtake too long to go through. When speaking about letters,Theuth said: ‘This branch of learning, my king, will make theEgyptians wiser and will improve their memory.’ The drug(pharmakon) for memory and wisdom has been discovered!’– Towhich the king responded: ‘Oh, Theuth, the greatest of techni-cians, one person is granted the ability to beget the things ofart, another the ability to judge what measure of harm and ben-efit they hold for those who intend to use them. And now you,father of these letters, have in your fondness for them said whatis the opposite of their real effect. For this will produce a for-getting in the souls of those who learn these letters as they failto exercise their memory, because those who put trust in writ-ing recollect from the outside with foreign signs, rather thanthemselves recollecting from within by themselves. You havenot discovered a drug for memory, but for reminding. Youoffer your students an apparent, not a true wisdom. For theyhave heard much from you without real teaching, and they willappear rich in knowledge when for the most part there’s anabsence of knowledge, and they will be difficult to be withsince they appear wise rather than really being wise (275a-b).48 The word “pharmakon” carries a double meaning in Greek, indicatingeither a medicine or a poison. As the proud inventor of the new technē ofwriting, Thamus is unable to see that what he takes to be a boon forhumanity—his pharmakon for enhancing memory and wisdom—is in facta slow acting poison which will have the opposite effect. Several aspectsof the king’s criticism of Thamus’ innovation of writing shed light on theproblematic nature of performance-enhancement drugs within the con-text of Macintyre’s practices. Theuth’s chief complaint about the pharmakon of writing is that it does exactly the opposite of what it promises to do: instead of boostingour memory it will produce a creeping forgetfulness. He contends thatthose who rely on the technē of writing will no longer exercise their mem-ory and therefore become forgetful as they “recollect from the outsidewith foreign signs, rather than themselves recollecting from within bythemselves.” And so, not only will our memory be impaired, but by com- Steven D. Weiss: Our Brave New Pharmacological World ing to depend on writing to recollect what we used to remember on ourown, we sacrifice a part of our agency for the false promise of thispseudo-medicine: we now resort to an external drug, something indepen-dent of the exercise of our own capacity and agency, to do what we usedto do on our own without this new technē. While the king contemptuouslytells Thamus that writing is in fact not a pharmakon for improving mem-ory but a mere tool for reminding, he realizes all too well that this drug ispotent enough to create the illusion of genuine memory and knowledge,and that those who ingest it “will be difficult to be with” for they willappear wise and most likely even believe that they are wise, when they arenot. As the technē of reminding replaces the exercise of genuine memory,our very capacity and conception of what it means to exercise our mem-ory will be so diminished that we may lose sight of what we were capableof remembering on our own before we availed ourselves of this newtechnology.
The first objection leveled against the use of performance-enhance- ment drugs charged that these agents distract us from the internal goodsof the practice by misdirecting the exercise of our technical skills towardsecuring external goods, thereby demoting a cooperative activity to thestatus of a competition. But an apologist for these drugs might very wellargue that the case against them has been overstated: the use of perfor-mance-enhancement drugs is not inherently antithetical to the promotionof the internal goods of a practice and need not necessarily degrade thepractice; rather, as the argument continues, these drugs may be applied toimproving–enhancing–our technical skills in ways that better allow us torealize the internal goods of the practice. Drawing on the myth ofTheuth, a second objection to performance-enhancement drugs con-tends that, contrary to the apologist’s claim, these chemical agents inevi-tably weaken the link between the exercise of the powers and technicalskills associated with a particular practice and the internal goods andends that can only be realized by striving to achieve the standards ofexcellence of that practice.
It may be helpful at this point to return to closer examination to Macintyre’s definition of a practice as well as his analysis of the role andsignificance of technical skills within a practice. Once again, a practice isdefined as any coherent and complex form of socially established cooperative human activity through which goods internal tothat form of activity are realized in the course of trying toachieve those standards of excellence which are appropriate to, and partially definitive of, that form of activity, with the resultthat human powers to achieve excellence, and human concep-tions of the ends and goods involved are systematicallyextended.49 As Macintyre explains, a number of things transpire when we strive toachieve the standards of excellence peculiar to a practice. First, the inter-nal goods of the practice are realized or brought to completion by thepractitioners, where, again, these goods may be a) an excellent product oraesthetic object, b) the excellence manifested in the activity or perfor-mance that gave rise to the object, and c) the intrinsic good of living outa particular kind of life as informed by that practice. Beyond this, how-ever, Macintyre states that as a result of the realization of these internalgoods something else comes to fruition: both the human powers that areput to work as we strive to excel and our understanding of the goods andends of the practice are “systematically extended.” Our practices changeus as the human powers called upon by the activity of the practice aresharpened, strengthened and expanded; we become better at the specialactivity of the practice as a result of our efforts to achieve excellence.
Furthermore, in the same way that practitioners are transformed by theirpractice, they too act upon and transform their practice. The very goodsand ends promoted within a practice never remain static: in the processof striving to realize the practice’s internal goods practitioners may dis-cover new ends and goods, or they may modify traditional goods andends to explore different ways of excelling within the evolving tradition. What Macintyre calls “human powers” are all those talents, abilities and capacities that are engaged by the characteristic activity of the prac-tice. In the process of striving for excellence these powers undergo atransformation: they are refined and “systematically extended” tobecome the technical skills that enhance practitioners’ ability to achievethe standards of excellence within their practice. Macintyre postulates areciprocal, dynamic relationship between these cultivated human powersor technical skills and the ends and goods of the practice which thesepowers and skills serve. Our striving to realize the goods and ends of apractice has the effect that the human powers called upon by this activityare transformed into sophisticated technical skills as they are developed,refined and strengthened in the pursuit of excellence. This transforma-tion does not occur automatically but is the result of conscious, self-directed activity that engages these human powers and, through practice,training and discipline, molds them into technical skills. At the same time,these developed human powers or skills–now excellences in their own Steven D. Weiss: Our Brave New Pharmacological World right–not only serve the goods and ends of the practice but modify themin the process.50 As a result of this reciprocal, transformative processexcellence is conferred on certain human powers now elevated to the sta-tus of technical skills which serve the goods and ends of the practice;conversely, the goods and ends of the practice are modified by their tech-nical skills in ways that allow practitioners to explore or create new formsof excellence by altering the traditional boundaries of the practice. It isthis dynamic relationship between human powers and their correspond-ing technical skills, on the one hand, and the goods and ends of practiceswhich they serve, on the other, that is disrupted by the injection of per-formance-enhancement drugs within these special domains of humanexcellence and achievement. Exactly how this link between human powers and the goods and ends of the practice which they serve is weakened by performance-enhancement drugs can be better understood by attending to threeaspects of the myth of Theuth. First, like the pharmakon of writing, thesedrugs function in a way that is external to the human powers or technicalskills they are said to enhance. These drugs are of course ingested andthus are not external in the sense that Theuth’s technē of writing dependsupon a system of signs and symbols physically external to the individual-as-agent. Rather, these enhancement drugs are external to the display ofhuman powers and skills within the practice in the sense that they standoutside the exercise of human agency and effort. The promise of thesedrugs is that they allow us to achieve our goals and ends more quicklyand efficiently: performance is chemically enhanced by circumventinghuman agency and effort that depend on the exertion of will. Thus, whilesome classical musicians turn to alternative therapies such as yoga andaerobic exercise to help them overcome stage fright, others are impatientwith the slow progress of these activities and prefer the “quick fix” ofbeta-blockers to calm their nerves while performing.51 The second fea-ture of the myth of Theuth that merits attention is Thamus’ warning thatby depending on the external technē of writing (which he says is not a drugfor memory but simply for reminding) our powers of true recollectionthat spring from within will atrophy. Finally, Thamus cautions that thepharmakon of writing creates the appearance of genuine memory andknowledge that masks the absence of knowledge and our diminishedpower of memory.
The internal goods of a practice are realized in the very process of practitioners striving to achieve the excellences peculiar to their practice.
But the insinuation of performance-enhancement drugs into this activity presupposes that these internal goods can be achieved or better achievedwithout any additional human effort or exertion. One of these internalgoods, however, just is the excellence of the performance or activity ofthe practice, which may or may not terminate in the production of anobject such as a painting or a poem. The excellence of this activity residesin the display of human powers and refined skills, along with the achieve-ment they facilitate through the effort of the practitioner: the activityshows us what human beings are capable of accomplishing, and we mar-vel at those who have achieved excellence in their practices. Because theywork on us from outside our human agency, performance-enhancementdrugs cannot contribute to the excellence of the human striving to mea-sure up to the standards of the practice; in fact, by resorting to thesedrugs practitioners diminish the value of their performance since theycan no longer claim that their achievement was wholly the result of theireffort and discipline. Even where the activity of the practice produces adistinct object, it is a mistake to think of the human powers and the tech-nical skills which contribute to the production of the object as mereexternal or instrumental means which could be replaced or supple-mented by more efficient means. For Macintyre, these human powersand technical skills function as internal means to the end of the activity–inthis case an aesthetic object–such that the object cannot be identifiedindependently of a characterization of the means which produced it.52 Itis, after all, the excellence in the exercise of the technical skills in the pro-duction of the object which in part gives rise to the excellence of theobject. We therefore marvel at the excellence of object both in itself andas an expression of the excellence of the human powers, technical skillsand effort which contributed to the object’s excellence.
The technical skills refined within a practice contribute therefore to the excellence of the object. But the exercise of these skills is also par-tially constitutive of the very activity unique to that practice: part of whatit means to accomplish a virtuoso violin performance is to exhibit a mas-tery of these skills during the performance. And so the excellence mani-fested in the exercise of these technical skills is captured within theexcellence of the entire performance. Since these skills represent theunique way in which practitioners strive for excellence within their prac-tice, to the extent that performance-enhancement drugs are substituted,even partially, for these skills, the excellence of the object and the excel-lence of the activity which produced the object are diminished. Apartfrom their contribution to the excellence of the activity and the objectwhich might be produced within the practice, Macintyre supposes that Steven D. Weiss: Our Brave New Pharmacological World the exercise of human powers and technical skills within the practice canbe valued and enjoyed for their own sake.53 But performance-enhance-ment drugs threaten the intrinsic value that derives from the exercise ofthese powers and skills. If Thamus’ prediction is correct, these humanpowers and skills will atrophy to the extent that we come to rely onmeans external to our agency and effort. And while it is highly doubtfulthat performance-enhancement drugs will ever replace the training andpractice needed to develop and refine the human powers and technicalskills put to work within practices, the temptation is to suppose that thesedrugs can give us an extra boost or allow us to better utilize our powersand skills. However, the authors of Beyond Therapy: Biotechnology and the Pur-suit of Happiness argue that in many instances “[t]he capacity to be improved isimproved by using it; the deed to be perfected is perfected by doing it.”54 The humanpowers and technical skills exercised within a practice are thereforeimproved by the type of training, practice and exercise which puts thosevery powers and skills to work. Furthermore, many of these powers andcomplex skills will lose their edge if not constantly exercised and devel-oped. Since performance-enhancement drugs do not engage and exerciseour powers and technical skills but instead seek to enhance our perfor-mance without additional effort or discipline, they create the appearance ofimproved performance but at the expense of diminishing our powers andskills by failing to fully exercise and engage them.
Even the best of performance-enhancement drugs do not, strictly speaking, enhance performance since a performance is something we do,something we accomplish as a result of our own effort to achieve thestandards of excellence within our practice. Thus, in the same way thatthe technē of writing creates the illusion of memory and knowledge, per-formance-enhancement drugs create the appearance of improved perfor-mance where performers cannot lay claim to any kind of excellence oraccomplishment they achieved entirely on their own. Consider the fol-lowing scenario: During a series of three performances, a trumpet player in a professional orchestra consistently plays a difficult solo pas-sage flawlessly each time. Her colleague in the trumpet sectionmarvels at her ability to play so well, since he knows that he andother professional players are unlikely ever to play that particu-lar passage with consistent perfection. His assessment of hiscolleague’s luck and talent changes, however, when he learnsshe takes ten milligrams of the drug propranolol before eachperformance that requires her to play difficult solo passages.55 Instead of promoting the ends and goods of a practice, drug use dimin-ishes the excellence of the performance and impedes the realization ofthe internal goods of the practice which can only be generated and expe-rienced by those who actively engage their human powers and technicalskills in their striving to excel: it is this effort and these goods that weadmire.
Finally, the use of enhancement drugs undermines the ongoing cre- ative dynamic of practices described by Macintyre where our striving toexcel strengthens our human powers and sharpens our technical skillswhich, in turn, transform and enrich the goods and ends of the practice.
Within a practice the excellence of our human powers and skills, on theone hand, and the internal goods and ends they serve, on the other,mutually inform and transform one another. Since psychotropic drugsproduce an effect which is not the outcome of human effort, we fail tofully exercise and develop our human powers and skills; as these skills fal-ter and atrophy the goods and ends of the practice stagnate without thechallenge posed by our heightened human powers and skills. So-calledperformance-enhancement drugs promise much but produce only simu-lacra; they cannot engender and sustain the virtues and excellences, thegoods and ends of practices. Instead of promoting human excellence andachievement, these drugs serve the god of technical proficiency, seducingus into thinking that this is what constitutes human excellence, as we arealready beginning to forget the intrinsic value of the goods and ends thatanimate our practices and enrich our lives.
1 Francis Fukuyama, Our Posthuman Future: Consequences of the Biotechnology Revolu- tion (New York: Farber, Straus and Giroux, 2002), p. 7.
2 Ibid, p. 46.
3 Ibid.
4 Ibid.
5 Stephen Braun, The Science of Happiness: Unlocking the Mysteries of Mood (New York: John Wiley & Sons, 2000), p. 8.
6 Aldous Huxley, Brave New World and Brave New World Revisited (New York: Harper Perennial, 2005), p. 300.
7 Braun, The Science of Happiness, p. 6.
Steven D. Weiss: Our Brave New Pharmacological World 8 Huxley, Brave New World, p. 301.
9 Fukuyama, Our Posthuman Future, pp. 46-48.
10 Whitehouse and Juengst, “Enhancing Cognition in the Intellectually Intact,” Hastings Center Report 27, no. 3 (May/June 1997): 14-22, at 14-5.
11 Fukuyama, Our Posthuman Future, pp. 51-52.
12 Ibid, p. 49.
13 Chatterjee, “Cosmetic Neurology: The Controversy Over Enhancing Move- ment, Mentation, and Mood,” Neurology, no. 63 (Sept. 2004): 968-973, at 968.
14 Erik Parens, “How Far Will the Treatment/Enhancement Distinction Get Us as We Grapple with New Ways to Shape Our Selves?” Neuroethics: Mapping the Field (San Francisco, CA: Dana Press, 2002): 152-58, at 154-55.
15 Chatterjee, “Cosmetic Neurology,” p. 968.
16 See Carl Elliot, Better Than Wel : American Medicine Meets the American Dream (New York and London: Norton & Co., 2003).
17 Chatterjee, “Cosmetic Neurology,” p. 972.
18 Michael Gazzaniga, “Smarter on Drugs,” Scientific American Mind 16, no. 3 (2005): 33-37, at 34.
19 James, Griffith, Pearson, Newbury, “Effect of Oxprenolol on Stage-Fright in Musicians,” The Lancet (Nov. 5, 1977): 952-954.
20 Carl Elliot, Better Than Well, pp. 54-6. 21 Stephen Hall, “The Quest for a Smart Pill,” Scientific American 289, no. 3 (Sept. 2003): 54-65, at 63.
22 For a defense of cognitive enhancement drugs see John Harris, Enhancing Evolution: The Ethical Case for Making People Better (Princeton, N.J.: Princeton University Press, 2007).
23 For a fuller treatment of these issues see Michael Sandel, The Case Against Perfection: Ethics in the Age of Genetic Engineering (Cambridge, Mass: The Belknap Press of Harvard University Press, 2007). 24 Fukuyama, Our Posthuman Future, p. 7.
25 Ibid, p. 150.
26 Ronald Cole Turner, “Do Means Matter?” in Enhancing Human Traits: Ethical and Social Implications, ed. Erik Parens (Washington D.C.: Georgetown Univer- sity Press, 1998), pp. 151-161 at 156-7.
27 See Leslie Stevenson’s Seven Theories of Human Nature (New York: Oxford University Press, 1987).
28 Fukuyama, Our Posthuman Future, p. 130.
29 Alasdair Macintyre, After Virtue: A Study in Moral Theory (Notre Dame, Indi- ana: University of Notre Dame Press, 1984), p. 187.
30 Ibid, pp. 187-8.
31 Ibid, p. 188.
32 Ibid, p. 190.
33 Ibid.
34 Ibid, p. 189.
35 Ibid, pp. 189-90.
36 Ibid, pp. 190-1. 37 Ibid, p. 188, 191.
38 Ibid, p. 184.
39 Ibid, p. 191.
40 Ibid, p. 194.
41 Ibid, p. 193.
42 Neil Postman, Technopoly: The Surrender of Culture to Technology (New York: Vintage Books, 1993), p. 13.
43 Ibid.
44 Ibid, p. 18.
45 Ibid, p. 19.
46 Ibid, p. 7.
47 Ibid, p. 20.
48 Plato, Plato’s Phaedrus, trans. Stephen Scully (Newburyport, MA: Focus Pub- lishing, 2003), p. 65. 49 Macintyre, After Virtue, p. 187.
50 Ibid, p. 193.
51 Blair Tindall, “Better Playing Through Chemistry,” The New York Times, Arts and Leisure 12 (Oct. 12, 2004): 1, 33.
52 Macintyre, After Virtue, p. 184.
53 Ibid, p 193.
54 A Report by the President’s Council on Bioethics, Beyond Therapy: Biotechnol- ogy and the Pursuit of Happiness, Chairman Leon Kass (New York: HarperCollins Publishers, 2003), p. 127.
55 Jacquelyn Slomka, “Playing with Propranolol,” Hastings Center Report 22, no.
4 (July/August 1992): 13-17 at p. 13.

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