Carl Elliot has a piece over at Atlantic.com arguing that beta blockers should not be viewed as enhancement, but rather as leveling the playing field between individuals who suffer anxiety while performing a particular task (for example public speaking or pistol shooting) and those who do not. His basic tenet is sound - that we should evaluate people based on the content of their actions rather than a distraction such as anxiety, which really has nothing to do with performance per se. Carl concludes with the convincing argument that we would all likely prefer a neurosurgeon whose hands did not shake while they were slipping sharp metal objects into our brains, and if beta blockers were required to insure that was the case, so be it.
The clever part of Carl's line of reasoning is that it eliminates the arm's race aspect of the enhancement debate: if enhancers become widely available, and everyone takes them, the bar for average performance rises for all. The inherent features of beta-blockers - that they work only for those that need them - makes this argument moot. It is too early to tell whether a similar situation will arise with cognitive enhancers, but there have been rumours to the effect that these agents may be more effective for those with less cognitive endowment than those whose cognitive capacities are already at or near peak. Not only would this reduce (but not eliminate) the problem of off-label use by younger individuals, but it would also diminish the likelihood of these drugs triggering an arms race of cognitive enhancer use for many of the same reasons that Carl invokes for beta blockers. It may be wishful thinking to hope that pharmacological effects align with societal values, but the case of beta-blockers demonstrates that sometimes wishes do come true.
[The photo is an image of propanalol crystals courtesy of Richard Howey's Crystal Gallery]