Physician attitudes towards pharmacological cognitive enhancement: safety concerns are paramount.
Physician attitudes towards pharmacological cognitive enhancement: safety concerns are paramount.
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DOI：
10.1371/journal.pone.0014322
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发表时间：
2010-12-14
期刊：
影响因子：
3.7
通讯作者：
Reiner PB
中科院分区：
文献类型：
--
作者：
Banjo OC;Nadler R;Reiner PB
药理学认知增强的伦理层面在学术界和大众媒体中得到了广泛的讨论，但对话中没有提到医生的观点，他们是将新技术应用于医疗实践的关键决策者。我们询问了加拿大和美国主要城市中心的初级保健医生，目的是了解他们对认知增强的态度。我们的主要假设是，医生给老年患者开认知增强剂比给年轻人开更舒服。医生们得到了一种假想的药物认知增强剂，该药物已被监管部门批准用于健康的成年人，其特征是安全、有效且没有显著的不良副作用。绝大多数受访者报告说，随着患者年龄从25岁增加到65岁，开认知增强剂的舒适度越来越高。当被问及他们对开出可能被认为是增强作用的现有药物(西地那非、莫达非尼和哌甲酯)或我们假设的认知增强剂对正常、健康的40岁的人的舒适度时，医生们开西地那非比其他三种药物中的任何一种都更舒服。当被问及他们回答的原因时，医生们表达的最突出的担忧是安全问题，即使面对明确的安全声明，这些问题也没有被个人提供的好处抵消。此外，许多医生表示，他们对安全声明持相当怀疑的态度。在关于药物认知增强的辩论中，提出安全性问题并将其作为一个问题一概而论已经成为一种惯例；医生们面对明确的安全性声明持怀疑态度，这表明这样的结论可能还为时过早。因此，内科医生的态度表明，考虑到药理认知的增强，应更多地重视安全性和益处之间的平衡。
The ethical dimensions of pharmacological cognitive enhancement have been widely discussed in academic circles and the popular media, but missing from the conversation have been the perspectives of physicians - key decision makers in the adoption of new technologies into medical practice. We queried primary care physicians in major urban centers in Canada and the United States with the aim of understanding their attitudes towards cognitive enhancement. Our primary hypothesis was that physicians would be more comfortable prescribing cognitive enhancers to older patients than to young adults. Physicians were presented with a hypothetical pharmaceutical cognitive enhancer that had been approved by the regulatory authorities for use in healthy adults, and was characterized as being safe, effective, and without significant adverse side effects. Respondents overwhelmingly reported increasing comfort with prescribing cognitive enhancers as the patient age increased from 25 to 65. When asked about their comfort with prescribing extant drugs that might be considered enhancements (sildenafil, modafinil, and methylphenidate) or our hypothetical cognitive enhancer to a normal, healthy 40 year old, physicians were more comfortable prescribing sildenafil than any of the other three agents. When queried as to the reasons they answered as they did, the most prominent concerns physicians expressed were issues of safety that were not offset by the benefit afforded the individual, even in the face of explicit safety claims. Moreover, many physicians indicated that they viewed safety claims with considerable skepticism. It has become routine for safety to be raised and summarily dismissed as an issue in the debate over pharmacological cognitive enhancement; the observation that physicians were so skeptical in the face of explicit safety claims suggests that such a conclusion may be premature. Thus, physician attitudes suggest that greater weight be placed upon the balance between safety and benefit in consideration of pharmacological cognitive enhancement.
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