In my previous post, I presented the argument that discouraging the use of cognitive enhancement (CE) would be the most legitimate public policy. I argued that taxation and other measures could appropriately protect the interests of all citizens and even generate funds for medical needs; however the question of how that might be achieved remained.
In my paper "Toward a Legitimate Public Policy on Cognitive Enhancement Drugs" I argued that CE drugs could further disadvantage and impoverish people already lacking basic necessities. The two most important reasons for this are long-term side-effects (which are mostly unknown) and indirect coercion. I will have more to say about the first reason in future posts, but for now I'd like to elaborate a bit on the second.
Short term positional gains
CE drugs are used by individuals as a means to obtain undeserved positional advantage. Furthermore, they could be used to ensure the positional advantage of corporate actors. If students use Ritalin during an exam because they are diagnosed with ADHD they are merely being given a fair opportunity to compete with other students on an equal footing. However, if they use it as enhancement, they are taking a chance with the unknown long-term side-effects in order to gain advantage over others. Such practices could lead to a situation in which all students need to use CE drugs to be able to compete. A more problematic scenario is if employers subtly coerce employees to use these drugs. In this scenario, employees would have to take on the risks of long-term effects because they are not in the position to refuse. At the same time, they are robbed of the ability to decide for themselves whether or not to use enhancements and forced to bear consequences of their use. Is this far-fetched? Surely, who would do that?
The example of truck drivers
Consider the example of logistics companies in a more or less laissez-faire market economy. Let's say that the most profitable trucking route is 1250 km long. The run could be achieved in just one day, but the stress and the fatigue are too much to handle. As such, without enhancement drugs, companies offer the service of two-day transport. Accommodations for the truck-driver are included in the price. That would make the return trip last 4 days.
Let´s say that company A decides to hire to truck-drivers who have no problem using Modafinil (the medical treatment for narcolepsy) in order to stay alert and make the run in just one day. The company offers the service for the same price, thus gaining extra profit, but for half the duration. Company B, the chief competitor of Company A, responds by offering the “overnight express” service and accordingly gives current employees the following choice: either they will start using Modafinil in order to cope with the requirements of the job, or they will be laid off.
The effects on the market are not hard to foresee. Other companies would either adopt similar policies, or go out of business. The truck-drivers would either use Modafinil (or some other drug) or be out of work. Their choice is dictated by market forces completely beyond their control. So what could be done to prevent such abuse?
Is there a solution?
In my last post, I discussed available policies and identified “discourage use” as an approach that might help. However, it is unclear how exactly to regulate CE drugs and whether this would achieve the socially desirable effects. For example, prohibitive policies on alcohol have proved to be disastrous, even though very real social problems are caused by alcohol abuse. On the other hand, “discourage use” policies use taxes, fees, insurance requirements and other measures as economic disincentives for the use of certain substance. This in no way infringes on the rights of those that would like to use these substances, but this, along with other measures such as the prohibition of use in certain places or situations, ensures that the rights of others are respected as well. Smoking is a case in point here – cigarettes are heavily taxed and smokers are subject to other disincentives (e.g. more expensive insurance) and forms of regulation (e.g. no smoking indoors). A similar policy might do the trick with CE drugs.
The Economic Disincentives Model (EDM)
Under the economic disincentives model (EDM) an already existing government agency (e.g. FDA) would offer a licensing procedure to pharmaceutical companies to market CE drugs for healthy adults. This way all citizens could have legal access to CE drugs, but with the imposition of taxes, fees and additional insurance requirements, it creates financial and regulatory burdens for their use.
EDM envisions an additional licensing procedure for users - in order to use CE drugs citizens would have to pay fees for a course about known effects and side effects, and pass an exam as proof of knowledge. Furthermore, additional medical insurance and obligatory annual medical tests would need to be taken in order to obtain (and renew) a license to use CE drugs.
Is this just a ploy to make the pharmaceutical industry even richer?
Recall that a very important issue in the debate on CE was justice. Justice demands that funds obtained from those who seek advantage by enhancement be allocated to the least advantaged. That is why under EDM the prices of CE drugs would be regulated – they would contain the standard costs of production and distribution, the profit margin would be limited and an additional tax would be imposed. The companies earning profits obtained from CE would be further taxed and obliged to invest extensively in “orphan drugs”. The funds gained by such policy would be invested in providing medical necessities for the least well-off and any remaining funds would be allocated to finance education.
Is EDM realistic?
It could be objected that EDM could have considerable drawbacks: The procedures could turn out be expensive and bureaucratic and involve considerable work and time from the would-be users. However, this objection fails to undermine the model. For example, the licensing procedure for driving vehicles is bureaucratic and involves considerable time and work from would-be drivers, and it is still efficient and legitimate. Furthermore, EDM would function as an addition to - and not a further drain on - public funding. This policy would efficiently and legitimately ensure that all citizens could have legal access to CE drugs, and with the imposition of taxes, fees, and requirements of additional insurance, it would offset any positional advantage from using CE drugs.
A different objection could be that such a model is not necessary. Is there really danger of indirect coercion? In another article I provide the answer. In the meantime, stay tuned for more...