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12-03-2013 | Article

Medical committee takes an ethical stance on pediatric neuroenhancement

Abstract

AAN statement

medwireNews: A significant number of physicians are taking issue with the increasingly common practice of prescribing drugs to boost cognitive function in healthy children and teens, viewing the practice as misguided.

The ethics position paper was developed by the Ethics, Law and Humanities Committee, which was a joint commission comprising the American Academy of Neurology and other medical organizations.

"There is a large consensus behind this paper," explained author William Graf (Yale University, New Haven, Connecticut) to medwireNews. "A physician should be sticking to the basic principles that define our profession. And yet the numbers are enormous [in terms] of doctor visits for ADHD, diagnoses being made, prescriptions being prescribed, and the amount of drug being produced, manufactured, and consumed."

Graf's statement in Neurology refers to recent parent-report surveys, which found that in the past 20 years there has been an overall increase of 21.8% in the prevalence of attention-deficit/hyperactivity disorder (ADHD) in the USA, with older teens and Hispanic children experiencing a significant 42% and 53% jump.

Since 1992, 4.2 tons of methylphenidate were manufactured in the USA, or 139 million defined daily doses. In 2012, 51 tons of the active ingredient to treat ADHD were produced (1.5 billion defined daily doses) - a 10-fold increase.

A 2008 longitudinal study by Monitoring the Future found nonmedical use of methylphenidate by 1.6% of 8th graders, 2.9% of 10th graders, and 3.4% of 12th graders. Overall, Graf's study said that a proportion of nonmedical stimulant drug use is for neuroenhancement as opposed to recreational use.

"What we don't know about the drugs is how they impact mood, rational thoughts, self-perception, and things like that. Those are areas of brain function that nobody has explored," Graf said. "But through an institution and medicine, you're allowing for non-medical use. So the standards of safety need to be much higher."

While ADHD is recognized as a real condition that causes functional impairment, "the standards have to be higher for people that are well," Graf observed. "If you didn't need the drug to begin with, who is at fault here? [A] kid asked for the drug so he got it but the doctor was part of it [too]."

"At the present time… neuroenhancement in legally and developmentally nonautonomous children and adolescents is not justifiable," the authors conclude in the paper. "Attention is needed to determine the long-term effects of neuroenhancement medications."

By Peter Sergo, medwireNews Reporter