In my previous post, I presented the economic disincentives model (EDM) as the most legitimate public policy on cognitive enhancement (CE). I argued that such measures could appropriately protect the interests of all citizens from indirect coercion. The open question was how can we be certain that there is or might be indirect coercion to use CE.
In my paper "Cognitive Enhancement, Rational Choice and Justification" I analyzed whether the fears about social pressure or indirect coercion are founded by using rational choice modeling. I used a qualitative modeling strategy because of the lack of reliable data for quantification.
The How and Why of CE use
Currently available data on prevalence varies greatly among different surveys and ranges from 5% to 35%. Furthermore, the lack of adequate information on long term effects and even short term benefits (the issue how laboratory findings of improvement in cognition relate to everyday performance is far from clear) further complicates the matter. A purely quantitative rational choice modeling strategy would require reliable data, which is not available. Bearing all this in mind, numerical payoffs in the design of dilemmas could not be assigned, and we have to make do with a qualitative analysis. This also points toward the conclusion that regulatory models which could provide the missing information would be more effective, even if their preliminary assumptions turn out to be incorrect in the long run. So how can this be modeled at this moment? The social pressure to enhance could be modeled as a multi-person Prisoners´ Dilemma.
Should Alison use CE?
Let's assume that Alison is assessing her options before an important cognitively demanding test, which could influence the availability of certain options in the future. (I have deliberately left Alison's situation as vague as possible, since this approach should be able to model choices for a diverse class of rational agents in a competitive setting – from students to employees of a corporation.) Her options could be modeled as a game in which Alison is playing against all other competitors:
Display 1: A Basic Multi-Person Prisoners´ Dilemma on CE
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Many others do not use CE |
Most others use CE |
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Alison uses CE |
Alison gains competitive advantage over others, but pays the associated health costs |
Alison gains no advantage, and pays the associated health costs. |
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Alison refrains from using CE |
Alison does not gain any advantage. She competes on equal footing with those that do not use CE. However, if resources are very scarce, her chances are reduced if at least one competitor is using CE. |
Alison does not gain any advantage, and in fact she is disadvantaged. |
Chain reaction of CE use
As can be seen from Display 1, the decision is influenced by the choices of others, and uncertainty about the use of others leads to using CE being the dominant choice under the circumstances. Furthermore, regardless of whether Alison wants to maximize her maximum payoffs or just maximize the minimum, she would have to use CE. And this does not presuppose any stance on CE. Taking CE has not been labeled as cheating nor preferable – the Prisoners´ Dilemma has been neutral toward personal preferences. When these are introduced this analysis also explains the finding that many people who would otherwise refuse to give CE to their children, would reluctantly do that if other children in the same school are using CE. The conclusion is that if a sufficient number of people expect others to use CE in a given competitive environment that might be enough to start the chain reaction. So why don't we just prohibit CE and be done with it?
Prohibition doesn't work
Consider the situation in Germany – CE is nominally prohibited there: the possession and use of stimulants such as Ritalin without a prescription is a criminal offense which could be sanctioned by up to three years in prison. Prescribing stimulants to healthy adults is also a criminal offense. And yet according to available data 33.4% of Ritalin is used off-label, while 12.6% is used without any diagnosis. Perhaps this ineffectiveness of prohibition could be offset in the future by random testing procedures, which are currently not in place.
Let´s try to model this situation again with Alison. Let´s assume that most others do not use CE (as it is prohibited) and that there is a procedure of random testing for CE (since doping tests on every exam would be too costly). Alison´s options should be modeled now as a game in which she is playing against the system:
Display 2: Dilemma on CE in a Prohibitive Environment
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There is no test |
There is an appropriate test |
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Alison uses CE |
Alison gains competitive advantage over others, but she pays the associated health costs.
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Alison gets caught. Depending on the sanctions she is either merely disadvantaged or severely limited in available options, and pays the associated health costs. |
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Alison refrains from using CE |
Alison doesn´t gain any advantage. She competes on equal footing with those that do not use CE. However, if resources are very scarce, her chances are reduced if at least one competitor is using CE. |
Alison doesn´t gain any advantage. She competes on equal footing with others.
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Prohibition wouldn't work in any case
As it can be seen from Display 2, the decision depends on the chance of being caught and the severity of sanctions, which pushes the associated costs to ever higher limits. Namely, if tests could be circumvented in any way (e.g. by bringing someone else´s clean urine samples) or if sanctions are not high enough, using CE would again be the dominant choice under the circumstances. Therefore, it would also most likely lead to the chain reaction of social pressure. But would any other policy be better?
Why don't we let doctors decide?
The so called “gate-keeper” approach - relying on health professionals to act as “gate-keepers” of CE) is a prominent proposal for regulation of CE. However, it is unclear whether such an approach would solve the problem of social pressure (or just create others) and whether it could be justified to all citizens. Let's try to test this claim by modeling the options in yet another dilemma. Alison's choice is now constrained with the decision of a Medical Doctor (MD):
Display 3: Dilemma on CE in a “Gate-keeper” Environment
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MD´s of many other competitors do not prescribe CE |
MD´s of many other competitors prescribe CE |
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Alison´s MD prescribes CE |
Alison gains competitive advantage over others, but she pays the associated health costs |
Alison gains no advantage, pays the associated health costs, but at least she is not disadvantaged. |
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Alison´s MD refrains from prescribing CE |
Alison doesn´t gain any advantage. She competes on equal footing with those that do not use CE. However, if resources are very scarce, her chances are reduced if at least one competitor is using CE. |
Alison doesn´t gain any advantage, and in fact she is disadvantaged. |
Who should have the right to decide?
It is important to note here that the decision is made by the health professional, not by Alison whatever she might prefer. On the one hand, if her preference is not to use CE, she does not consult her MD and is most likely disadvantaged. Otherwise she needs to consult a health professional. The MD makes the relevant decision: if he or she thinks that Alison's particular case is justified, CE will be prescribed, but if not, Alison has the option to go “doctor shopping”, until she finds access to CE. Now, that could be circumvented by introducing a model with sterner regulation by the state or regulatory bodies. Perhaps Alison could be limited to only one second opinion. MDs would be very careful not to overprescribe CE, while a certain amount of prescriptions would be approved. That way only some would get access, which would be unfair. So what other options are there?
How does EDM fare with rational choice modeling?
Recall (link) that I presented the economic disincentives model (EDM) as the most legitimate public policy on cognitive enhancement (CE). Would that work? Could EDM be equally acceptable to both sides and in the best interest of everyone? Let´s assume that Alison would prefer not to use CE, and the reverse for Betty. Their choices can again be modeled as a game in which each agent is playing against all others:
Display 4: Dilemma on CE in the EDM Environment
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EDM is in place so many others do not use CE |
There is no regulation and most others use CE |
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Alison (or Betty) uses CE |
She gains competitive advantage, but pays the costs for it (financial burdens, institutional inconveniences and health costs) |
She gains no advantage, but pays the related health costs. |
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Alison (or Betty) refrains from using CE |
She doesn´t gain any advantage but she doesn´t pay health costs and advantage of competitors is not significant as they pay additional costs |
She doesn´t gain any advantage, and in fact she is disadvantaged.
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Now someone could object that regulation policy would be justified only from Alison´s point of view, who doesn't want to use CE anyway. But that is clearly not the case. It has been assumed that Betty actually wants to use CE as a matter of personal preference. She has weighed advantages and health costs and she thinks the health costs are a reasonable trade-off to achieve her goals. But notice (on Display 4) that in case there is no regulation, Betty doesn't get the advantage (which is the reason she wants to use CE in the first place) but merely endures the costs. Clearly, EDM is rational and in the best interest of both Alison and Betty, and actually provides a framework in which both can follow their personal preferences.
Should we regulate all CE drugs like that?
That depends on the drug in question. Some of the CE drugs could be dangerous if introduced as a legally available commodity for the general populace. Although many assume that some (e.g. Ritalin) are safer than others (e.g. Adderall) even Ritalin has been “accused” of creating all sorts of physiological and social harmful effects, from addiction to maintaining racial inequality by overmedicating and pacifying youth of minorities. So, how to regulate these drugs? In another article I provide the answer. In the meantime, stay tuned for more...
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