This post is a first attempt at analysing cognitive enhancement research using the ITN framework and cost-effectiveness estimates. Several interventions enhance cognitive functions such as intelligence and decision making. If we identify effective, cheap and scalable cognitive enhancement interventions, they may be competitive with GiveWell charities.
In the long term, cognitive enhancement may act as an accelerator for technological development. There are concerns that this rapid development could increase the ability of small groups to cause harm and therefore increase anthropogenic existential risk. However, improved decision making in the long term would be desirable.
The two barriers to tractability are poor coordination in the research field and regulatory barriers to licensing medications. Current developments in cognitive enhancement have happened mainly as byproducts of other research fields. It lacks a cohesive scientific community. There are no apparent evolutionary barriers to solvability. However, there are significant regulatory barriers as new medicines must be licensed to treat a specific medical condition.
Cognitive enhancement research is neglected in comparison to similar fields. There is considerable uncertainty around funding from non-public, pharmaceutical and government sources. Overall, there may be impactful funding opportunities for effective altruists in cognitive enhancement research.
I am currently a Junior Doctor working in the UK. I wrote about cognitive enhancement for my medical ethics dissertation and became interested in it as a cause area. Subsequently, I have worked with Jan Brauner and Fabienne Sandkühler on trials investigating the effectiveness of creatine as a cognitive enhancer. Although I am not an expert in cause prioritisation or cost-effectiveness estimates, I hope this post will be helpful as a first attempt at assessing this cause area.
I have received funding from EA Funds to work on this cause profile and on creatine RCTs with Jan Brauner.
Cognitive enhancement research is not currently a focus area for organisations within effective altruism, although it has been written about extensively by writers associated with effective altruism.1–5
I use the functionalist definition of cognitive enhancement: something which “...improves the ability of a person to perform a specific task, either by improving an existing capacity or by creating a new capacity.”6 Many interventions within effective altruism aim to increase cognitive abilities, such as salt iodisation, de-worming, and lead exposure elimination. However, unlike cognitive enhancement, these are generally treatments for a disease or deficiency.
There are many forms of cognitive enhancement. Considered broadly, many common interventions such as schooling, writing, optimising sleep and computer software can be a cognitive enhancement. Other novel technologies, such as genetic interventions, transcranial magnetic stimulation and neural implants, may also be cognitive enhancers. However, I will only consider pharmacological cognitive enhancement in this post. I also include ‘nutraceutical’ interventions such as creatine, where dietary supplementation may have cognitive effects. I don't include broad interventions because they have been covered extensively elsewhere. I don’t consider novel interventions such as transcranial magnetic stimulation or neural implants as I cannot accurately assess them. Further work evaluating the relative importance of each of these interventions would be valuable.
This post will include an attempt to estimate the cost-effectiveness of developing new cognitive enhancement interventions through research. The cost-effectiveness estimate only includes short term effects on income. But the main effects of widespread cognitive enhancement would be improved decision making and accelerating technological development. After this, I will identify potential risks associated with cognitive enhancement. I will use the ITN framework to assess the importance, tractability and neglectedness of research into cognitive enhancement interventions.
The first few chapters deal with short-termist effects. If you’re mainly interested in longtermism, consider starting reading at Long term effects.
Importance: The degree to which people would be affected
Short term effects: Effects on the person that is enhanced
This section will consider the short-term effects of cognitive enhancement interventions divided into increases in intelligence and improved decision making. After this, I will consider possible indirect effects, negative effects, and unintended consequences.
The main direct effect of cognitive enhancement is increasing intelligence as measured by IQ. GiveWell has evaluated multiple interventions based on IQ increases. To estimate the impact of short term increases in intelligence, I have used the effect sizes of current interventions in table 1. I then considered possible future interventions with larger effect sizes. In the cost-effectiveness estimate, the theoretical intervention increases IQ by 1 standard deviation (15 points). The theoretical intervention could be a single intervention or a combination of interventions with smaller effect sizes. I assume that the impact of increasing IQ by 1 point is a 1% increase in wages, as this is the method used by GiveWell in their assessment of salt iodisation.
|Intervention||Treatment Effect Size||Outcome||Projected IQ improvement if 100% correlation||Source|
Raven's Advanced Progressive Matrices
Backwards digit span
|Modafinil||0.10||Overall effect size from meta-analysis including tests of attention, executive function, memory and processing speed||1.5||9|
|Nicotine||0.16 - 0.44||fine motor, alerting attention-accuracy and response time (RT), orienting attention-RT, short-term episodic memory-accuracy, and working memory-RT||2.4-6.6||10|
|Exercise||0.097||Overall effect size from Meta-analysis, includes information processing, reaction time, attention, crystalised intelligence, executive function and memory||1.5||11|
Table 1: Treatment effects sizes of current interventions
The table includes three commonly discussed cognitive enhancement interventions and exercise as a comparison. The effect size is from a meta-analysis where possible. For creatine, no meta-analysis was possible; I included the range of results from RCTs. I used GiveWell’s method of multiplying the effect size by 15 to project IQ improvement. *As the result for Creatine is not drawn from a meta-analysis it should be interpreted with more caution. It may only apply to the study population of young vegetarians/vegans.
Next, I considered the demand for cognitive enhancers. Caffeine stands out with extremely high usage. 30% of UK students reported using caffeine tablets to enhance cognition.12
Newer pharmacological enhancement interventions are less popular. Usage depends on the country, local regulation, and the availability of prescriptions. Singh et al, estimated lifetime prevalence of use was 6.2% for modafinil, 4% for methylphenidate, and 2% for Adderall.12 However, usage of newer cognitive enhancement interventions is increasing worldwide. Between 2015-2017, the proportion of those surveyed using prescription stimulants (for cognitive enhancement) in the last 12 months increased from 3.2% to 6.6% in all countries surveyed.13 Barriers to access, such as requiring a prescription, are a critical factor in usage.
It seems plausible that if research identified more effective, safe, cheap cognitive enhancers, there would be significant demand for them. The number of people affected is likely to be a high percentage of the future population. In cost-effectiveness analysis, I estimated that 30% of the global total labour force would use a cognitive enhancer. I used world bank data on the global total labour force being 44% of the world population.
Table 2: The table shows all the values included in the cost-effectiveness analysis, adapted from GiveWell's assessment of salt iodisation.
|GiveWell's 2020 Cost-effectiveness analysis - version 2|
|Duration of long term benefits of Cognitive enhancement(Average duration of adult working life)|
|Cost per person per year|
|Initial costs: $1 billion in drug development, modelling 1 billion users = $1 each from initial cost, then continued costs in production/distribution source: https://www.lshtm.ac.uk/newsevents/news/2020/average-cost-developing-new-drug-could-be-15-billion-less-pharmaceutical Cost per dose: Modafinil costs NHS 22p per dose. Assuming it was taken every day=£80.3 , 105.31 dollars + 1 and rounded.|
|Internal validity (IV)|
|External validity (EV)|
|Leverage (dollars of impact per dollars spent)|
|% of benefit of cognitive enhancement that lasts for the long term|
|Declining effectiveness over time|
|Household coverage achieved|
|https://data.worldbank.org/indicator/SL.TLF.TOTL.IN everyone in total labour force offered drug|
|Probability that cognitive enhancement has an impact on IQ/wages|
|% of population that benefit|
|Estimated due to side effects, medical conditions causing contra-indications or difficulties in distribution|
|Equivalent increase in wages from cognitive enhancement|
|Benefits of cognitive enhancer|
|Benefit on one year's income|
|Present value of the sum of the lifetime benefits per worker (in terms of Ln(income))|
|Present value of the sum of the lifetime benefits per worker (in terms of Ln(income)), with IV/EV adjustments|
|Total benefits (Ln(income)) per person per year of treatment, adjusted for coverage and targeted population|
|Total units of increase in ln(consumption) per dollar|
|Total units of increase in ln(consumption), per $100,000 donation to cognitive enhancement|
|Value assigned to increasing ln(consumption) by one unit for one person for one year|
|GiveWell 2020 Cost-effectiveness analysis - version 2|
|Total units of value generated with hypothetical donation ($100,000) to Cognitive enhancement|
|Total units of value generated with hypothetical donation ($100,000) to GiveDirectly (unconditional cash transfers)|
|GiveWell 2020 Cost-effectiveness analysis - version 2|
|Cognitive enhancement vs cash|
You can edit these parameters based on your own views here.
|Value altered||Reason Changed||Change||Comparison to cash transfers|
|Cost per person||Intervention may be cheaper||$10 cost per person||10.30|
|Increase in wages||More effective intervention||30% increase in wages||2.06|
|% of the population that benefits||Increased adoption||70% adoption||2.40|
Table 3: Includes different scenarios included in the cost-effectiveness estimate
Limitations of the cost-effectiveness estimate
There are several limitations of the cost-effectiveness model. The cost of developing a new cognitive enhancement intervention and distributing it is uncertain. I used the average cost of developing a new medication and the current price of modafinil doses.14 I am uncertain about the estimated cost, which would be affected by the development and production method. Table 3, includes an estimate of a low-cost intervention at $10 per person per year.
Unlike interventions into diseases or deficiencies, the benefit would not end after successfully eradicating the disease or deficiency. I expect a cognitive enhancement intervention would become more beneficial if population growth continues, as it targets healthy people.
The cost-effectiveness model does not include potential harms or other benefits. For example, improved decision making, reduced errors, or long term effects such as altering existential risk. The cost-effectiveness estimate does not include counterfactual situations where another organisation would have produced the cognitive enhancer in the same time frame.
Negative effects on the individual
There are negative effects of cognitive enhancement interventions, both observed and theoretical. Many current enhancers are stimulants, so their use may cause tolerance, addiction, or withdrawal.15 Modafinil has a range of documented side effects such as headaches, dizziness, nausea, and palpitations.16 Pregnant women should not use Modafinil due to the risk of malformations.17 Future cognitive enhancers would likely have side effects which would range in severity.
There may be trade-offs when increasing cognitive ability. For example, Christian & Griffiths argue there may be good reasons that humans forget things. They suggest that increasing memory may have costs such as slow recall and ‘cognitive decline’.18 Similarly, substances that reduce the need for sleep may have an overall negative effect because reducing sleep causes adverse effects.1 Long term negative side effects are difficult to identify. But, this is the case for almost any new medical intervention.
Conclusion: Short terms effects on individuals:
Intelligence increases make cognitive enhancement a promising intervention. However, these benefits are sensitive to cost, adoption, and effectiveness changes. Overall cognitive enhancement interventions may be competitive with cash transfers. Further research is required so we can make evidence-based decisions on cognitive enhancement, being mindful of potential harms and trade-offs. In the next section, I will discuss the short term indirect effects of cognitive enhancement on society.
Short term: indirect effects on society
Improved decision making
Cognitive enhancements may improve decision making. Executive function is a combination of cognitive processes, including short term memory, fluid intelligence and decision making. Cognitive tests can assess executive function. Modafinil improves decision making as measured by One Touch Stockings of Cambridge/Tower of London tasks.19,20
Many professions involve making decisions with potentially harmful consequences. For example, cognitively enhanced scientists, healthcare professionals, engineers, judges, or pilots making better decisions may prevent harm. However, it is difficult to quantify the amount of harm caused by poor decision making in each field.
One measurable estimate of harm is medical errors. Medical errors cause a considerable amount of harm (an estimated 44,000 - 98,000 deaths per year in the United States).21 There are many methods of reducing medical errors, such as reducing working hours to prevent fatigue. 22 We should prioritise reducing working hours over cognitive enhancement methods. However, this may be impossible in some situations or already in place. If researchers identify effective and safe forms of cognitive enhancement, this may help reduce the amount of harm caused by decision-making errors.
Negative social outcomes
Coercion and poor working environments
It's essential to consider potential adverse social outcomes due to cognitive enhancement. For example, many ethicists have raised concerns about coercion as a possible negative effect of cognitive enhancement.23,24 The concern is that the availability of enhancements may lead to direct or indirect pressure on people to enhance. High-risk environments for coercion are the military, healthcare, or transport.
Governments use forms of coercion for broad enhancements such as education. Education “...is required for almost all children at some substantial cost to their liberty, and employers are generally free to require employees to have certain educational credentials or to obtain them”.23 Coercion to enhance may already be happening in the military.25
Another concern is poor working environments. Dubjlevic raises concerns that the availability of enhancement substances may cause employers to reduce the quality of work environments or increase anti-social working hours.26 Specific policies may be required to reduce the risk of enhancements contributing to harmful working environments.
Cognitive enhancement may lead to worsening inequality. Cognitive enhancement may only be available to those with significant financial resources. Through cognitive enhancement, they may compound this advantage.3,27 However, the characteristics of some enhancement agents may reduce this risk. Bostrom and Roache argue enhancement technologies may offer the greatest benefit to those who start with lower cognitive functioning.3 They draw a study on modafinil by Randall et al, which saw more significant cognitive improvement in the lowest IQ group. However, this group still had an above-average IQ.28 This raises the possibility that enhancement may reduce inequality, although further evidence would be required from lower than average IQ participants to confirm this.
Even if improving cognitive enhancement effectiveness increases inequality, other benefits of enhancement may outweigh this harm. At the same time, responses such as prohibition have their own negative consequences.29 Governments could reduce the risk of worsening inequality by controlling distribution or pricing.
Long term effects
This section will focus on the long-term effects, particularly the impact of cognitive enhancement interventions on existential risk. I will consider two potential effects of cognitive enhancement, accelerating development and improving decision making. These effects are more speculative than the short term effects.
Cognitive enhancement may speed up the rate of discovery and development. By increasing the productivity of researchers, cognitive enhancement may act as an accelerator for the development of technologies. Due to the acceleration effect, we must consider where we want cognitive enhancement to fall on an ‘ideal shopping list’ of new technologies.
Differential technological development is defined by Bostrom as: “trying to retard the implementation of dangerous technologies and accelerate implementation of beneficial technologies, especially those that ameliorate the hazards posed by other technologies”.30 One approach could be trying to speed up the development of policies or other technologies which would reduce existential risk, or being neutral to the rate of growth of a particular technology.
The acceleration effect may have a variable impact in different fields of research. The magnitude of impact could depend on the limiting factors in individual fields. Although these fields are interlinked, so there could be some general acceleration effect. Cognitive enhancement may have the most significant impact in cognitively constrained fields. Fields that are cognitively constrained may have adequate funding, considerable attention, and plentiful academic resources but fundamental problems which remain extremely difficult to solve.
Another variable is the type of researchers in each field. If a field has a higher percentage of younger researchers who may be more likely to use enhancement, this could alter uptake and acceleration effects. Some fields may have a long-term interest in cognitive enhancement and may become early uptakers, causing the acceleration effect to occur earlier.
One area of interest is artificial intelligence, as this field may be cognitively constrained. Cognitive enhancement could disproportionately accelerate the development of artificial intelligence.
This acceleration effect may increase the risk of harmful actions. Persson and Savulescu are concerned that accelerating scientific progress may make it easier for small numbers of people to cause harm.31 They argue that before cognitive enhancement, we should first focus on developing moral enhancement.
Harris puts forward several arguments against prioritising moral over cognitive enhancement:
- Moral enhancement may be undesirable or impractical at a large scale.
- Immoral people acting intentionally may not be the biggest risk—instead, negligence or lack of knowledge that causes the most harm.
- Cognitive enhancement may be a crucial component in developing moral enhancement or an effective form of moral enhancement in itself.32
Cognitive enhancement may improve decision making and lead to solving more complex problems. Certain problems may be beyond the current capability of humans but are highly desirable to solve. Cognitive enhancement may be one of the technologies which enable us to solve these problems.
A useful heuristic for considering if cognitive enhancement will have good or bad overall consequences is the reversal and double reversal test.33 The test aims to identify status quo bias.
The reversal test states that if someone argues that an increase in a trait is bad, then they should consider a decrease in the trait. If they also consider a decrease to be bad, then they would need to explain why things can't be improved by altering this trait. If they can’t explain this they may have status quo bias. Applying this to the use of cognitive enhancement, if someone argues that increasing or decreasing cognitive performance would increase existential risk, they must explain why we are currently at an optimum level of cognitive ability.
The double reversal test considers the situation where a natural scenario threatens to increase a trait. For example, improving nutrition worldwide may start improving cognitive function. If someone argues that we should not increase this trait, they would have to consider if it would be good to counterbalance this natural scenario.
Increasing intelligence may improve decision making. Anomaly et al suggest that intelligence scores are a useful predictor of patience and foresighted behaviour.34 They suggest that increased intelligence is associated with delaying gratification, such as forgoing an immediate lump sum of money for a future higher amount. Further work on the impact of increasing intelligence on traits like patience would be valuable.
Conclusion: Long term effects
Cognitive enhancement may act as an accelerator for technological development. Increasing the speed of development could increase the ability of small groups to cause harm and increase anthropogenic existential risk. However, there may still be reasons to prioritise cognitive over moral enhancement as cognitive enhancement may be an effective form of moral enhancement. The potential risk has to be balanced against the benefits of improved decision making at each stage of development. Furthermore, there is also a risk of disproportionately accelerating development in specific fields such as AI. Further research into the likely effects of accelerating development would be valuable.
Tractability: The fraction of the problem solved by increasing the resources by a given amount
Is pharmacological cognitive enhancement of humans even possible?
This section will cover the tractability of cognitive enhancement by considering barriers to the development of new interventions. Substances such as modafinil and creatine show that pharmacological enhancement is possible. 35 7 However, the extent to which this enhancement can be sustained long term is uncertain. It is also unclear if other cognitive enhancements could have greater effect sizes.
The main argument against cognitive enhancement being possible is the evolutionary argument: Brauner characterises this counterargument as: “Higher cognitive performance is better. Thus, evolution already optimised for cognitive performance. Thus, it's unlikely that simple changes to brain chemistry could improve cognitive performance. Thus, cognitive enhancement research (and particularly research into nootropics) has low tractability.”36 As Brauner notes, although this may be a good general principle, there are exceptions put forward by Bostrom and Sandberg that are relevant to cognitive enhancement.4 These include changed trade-offs, value discordance and evolutionary restrictions.
The first counterargument against the evolutionary argument is changed trade-offs. There are differences in the resources available today compared to our evolutionary past. Therefore we might be able to optimise systems for performance in current environments. Limiting the metabolic activity of the brain may have been more necessary in a time of food scarcity. Changes to our environment may also be harming cognitive performance. The brain may benefit from specific conditions for functioning that are no longer present. One example of this is that creatine intake may have been higher in palaeolithic times than today due to the way our ancestors prepared meat and fish.37
Another counterargument is value discordance. Evolution may optimise for different values than those we currently hold. For example, we value cognitive abilities beyond those required for survival and therefore may want to exceed the abilities generated by evolution.
Bostrom and Sandberg base the final counterargument on evolutionary restrictions. They contend that we have access to various tools, materials, and techniques unavailable to evolution. Therefore, with these alternative tools, we may be able to produce preferable outcomes based on our values.
Overall, there are reasons to believe that cognitive enhancement is possible. There are no strong reasons to think that evolutionary forces have already optimised to the point where we cannot improve our cognitive abilities further.
Is it possible to a significant degree?
It is difficult to predict the degree of improvement enhancement can achieve. Forecasters on Metaculus answered the following question: “By 1 January 2050, will it be possible to increase a healthy adult human's IQ by at least two standard deviations in less than 30 days?” Forecasters predicted this has a median probability of 5% and a mean probability of 15% after 350 predictions. However, this includes other forms of enhancement not discussed here. I think there is a good chance that further research will uncover cognitive enhancers that are moderately effective(~1 standard deviation). There is a small probability that researchers identify highly cognitive enhancers which improve cognitive abilities by two standard deviations.
Practically achievable - are these things possible to achieve within current academic systems?
There are challenges involved in research on cognitive enhancement. Experimental work involves potential risks to participants, and there is no disease being cured. This can make obtaining ethics approval and funding more difficult. However, some nutraceutical interventions, like creatine supplementation, are very safe, and obtaining ethics board approval for these is quite easy.
It is unclear where cognitive enhancement fits within current scientific disciplines as most areas of medical research focus on curing disease. The lack of a clear scientific discipline could make cognitive enhancement research more difficult as there is no clear path for working on it.
In addition to these barriers, there is also a lack of reputable journals and conferences focusing on cognitive enhancement. I could only find one journal, The Journal of Cognitive Enhancement, which started in 2016. However, many psychology and general science journals have published cognitive enhancement papers. I could not identify a reputable cognitive enhancement conference during a brief search. The lack of coordination in cognitive enhancement research could make things more difficult for early-career researchers and may be a barrier to further development. These factors also indicate high neglectedness.
Foreseeable barriers which would make it not worthwhile?
There are several societal barriers to cognitive enhancement development and use, with concerns such as it being cheating, unnatural and unsafe. There may also be some public disapproval of cognitive enhancement. When asked about when enhancement would be acceptable, “34% of lay participants responded that no such situation exists.”38 However, there is also considerable interest in the cognitive enhancers currently available.
There appears to be significant demand for safe and effective cognitive enhancement. So why has there not been more investment and progress in the area by pharmaceutical companies? Jones predicted in 2005 that due to the large market for cognitive enhancement products, industry efforts to develop them would experience rapid growth in the next 20 years.39 This does not seem to have occurred. This mismatch could indicate hidden costs or barriers.
Pharmaceutical companies may avoid investing in cognitive enhancement research due to the regulatory environment. In the US/UK, it is challenging to conduct such research as regulators currently licence medications to treat diseases. Bostrom and Sandberg suggest it would be difficult for a pharmaceutical company to get regulatory approval for a new drug aimed at cognitive enhancement of healthy participants.5 Overall, regulatory barriers are likely to discourage some pharmaceutical investment into cognitive enhancement.
One option may be new regulatory bodies for cognitive enhancement research. In 2008, the Academy of Medical Sciences in the UK recommended the development of new regulatory bodies for cognitive enhancement. Still, progress appears to be slow.40 Solving regulation issues may be a critical bottleneck in developing cognitive enhancement interventions.
Neglectedness: The amount of resources already going towards solving the problem
Current direct resources funding pharmaceutical cognitive enhancement
Direct investment into cognitive enhancement research is likely very low. I searched for direct resources such as grants. As most cognitive enhancement research is done indirectly on treatments for dementia, insomnia, or ADHD, it is difficult to estimate the current direct resources. The NIH is the largest public funder of biomedical research. Cognitive enhancement is not one of the 291 categories of research funding in the NIH funding estimates. I searched the NIH RePORTER database for funded projects with keywords “Cognitive enhancement” “Modafinil” “Nootropic” and found no funded projects in healthy individuals. EEA and Norway Grants have made grants for investigating the ethical acceptability of cognitive enhancement, equivalent to $1.1million.41
There has been funding from Effective Altruism sources. Effective Altruism funding has enabled the replication study Rae et al which I helped with (soon to be published).7 It seems likely that several Effective Altruism sources would be open to funding future cognitive enhancement research.
Current indirect resources
Health research funding
Research areas related to cognitive enhancement, such as Alzheimer's research ($2,240 million) and ADHD ($70 million), had significant research funding. However, it isn't easy to estimate the proportion of this funding that indirectly impacts cognitive enhancement. A rough estimate would be <1%.
Many pharmaceutical companies are developing cognition improving treatments for patients with neuropsychiatric disorders.42 Wallace wrote this review in 2011, listing 50+ drugs in development.42 This shows a substantial investment by pharmaceutical companies in drugs aimed at cognitive enhancement as a treatment for diseases. However, as many potential cognitive enhancers are either food supplements (creatine) or existing medications, pharmaceutical companies may have reduced incentives to fund research into their cognitive enhancing properties.
Governmental agencies are another source of funding. The Defense Advanced Research Projects Agency (DARPA) has a Continued Assisted Performance Programme which aims to investigate methods that allow soldiers to stay alert and awake.25 There is likely to be some cross-over between these projects and cognitive enhancement. A similar DARPA programme Preventing Sleep Deprivation (PSD) gave out $100 million in grants. 25 Although the nature of these organisations makes it difficult to get clear values on funding for cognitive enhancement, it seems likely that international governments provide a non-trivial amount of funding for cognitive enhancement. One downside of this funding is that the findings may not be openly available.
Other non-traditional resources
Several groups are using non-traditional resources for cognitive enhancement research. “Psychonauts” self-experiment with psychoactive substances, including potential cognitive enhancers. They often use internet forums(such as Reddit Nootropics) and darkweb sites to purchase and discuss this self-experimentation.43 Although subjective reports are of limited use as academic evidence, this may identify substances for further investigation. Gwern has used self-blinding and randomisation during self-experimentation, which may improve the quality of data from self-experimentation studies.44
Total funding is estimated to be between $5-25 million per year over the last decade. The wide range is due to the potential for non-public government spending and indirect funding. Based on this estimate, cognitive enhancement research may be neglected. A similar reference would be spending on ageing research estimated at $1.8 billion-4.5 billion.45 If we can overcome the barriers to research, there may be a significant amount of low-hanging fruit in cognitive enhancement research.
Several cognitive enhancement interventions may increase intelligence in healthy people. If we develop more effective, cheap and scalable cognitive enhancement interventions, they would be competitive with current GiveWell charities. In the short term, improved decision-making may also be of interest to effective altruists, although the impact is less certain.
In the long term, cognitive enhancement may act as an accelerator for technological development. However, there are concerns that this rapid development could increase the ability of small groups to cause harm and therefore increase anthropogenic existential risk. The balance between moral and cognitive enhancement for reducing existential risk requires more research. Improved decision making in the long term seems likely to be beneficial compared to reduced or static decision making.
Current developments in cognitive enhancement have happened mainly as byproducts of other research fields. It lacks a cohesive scientific community such as conferences, journals and research centres. There are no clear scientific barriers to solvability as the evolutionary argument fails to consider changed trade-offs, evolutionary restrictions and value discordance. However, there are regulatory barriers to the development of cognitive enhancement due to the way medicines are currently developed.
Compared to similar fields, like ageing research, cognitive enhancement research is neglected with small amounts of publicly identifiable funding. However, there is considerable uncertainty around funding from non-public sources such as pharmaceutical and classified government funding.
Overall, cognitive enhancement research's importance, tractability, and neglectedness suggest there may be impactful funding opportunities and direct work opportunities for effective altruists. Particularly as enhancement as a field is generally neglected by health research and commercial incentives may dissuade pharmaceutical investment. These funding opportunities could focus on the suggested research areas outlined below.
Future research ideas
- Prioritising between different methods of cognitive enhancement
- Mapping current regulatory frameworks and analysing the likelihood of licensing future cognitive enhancement medications.
- Analysis of the variability in cognitive enhancement effectiveness due to pre-enhancement ability
- Policy analysis to prevent harmful societal outcomes such as coercion, worsening inequality and harmful working environments.
- Research into the risks and benefits of technological advancement acceleration and the impacts on fields such as artificial intelligence
- Mapping of the academic field of cognitive enhancement
- Identifying potential cognitive enhancers and prioritising research on the most promising ones
- Getting real-world evidence of the effectiveness of cognitive enhancers
Who can help?
Direct work in this field may be of interest to those with a background in neuroscience, psychology, pharmacology or clinical medicine.
Thank you to Jan Brauner for coming up with the idea for this cause profile and encouraging me to take up this project. Thank you to Carl Shulman, Max Schons, Edo Arad, Ozzie Gooen, Paal Fredrik Skjørten Kvarberg, Jan Brauner and Max Altman for feedback and comments on drafts of this post.
1. Savulescu, J. & Bostrom, N. Human Enhancement. (OUP Oxford, 2009).
2. Sandberg, A. & Bostrom, N. Converging cognitive enhancements. Ann. N. Y. Acad. Sci. 1093, 201–227 (2006).
3. Bostrom, N. & Roache, R. Ethical issues in human enhancement. New waves in applied ethics 120–152 (2008).
4. Bostrom, N. & Sandberg, A. The wisdom of nature: An evolutionary heuristic for human enhancement. in Philosophy and Medicine 189–219 (Springer Netherlands, 2017).
5. Bostrom, N. & Sandberg, A. Cognitive enhancement: methods, ethics, regulatory challenges. Sci. Eng. Ethics 15, 311–341 (2009).
6. Engelbart, D. Augmenting human intellect: A conceptual framework. Summary report. Stanford Research Institute, on Contract AF 49, 1024 (1962).
7. Rae, C., Digney, A. L., McEwan, S. R. & Bates, T. C. Oral creatine monohydrate supplementation improves brain performance: a double-blind, placebo-controlled, cross-over trial. Proc. Biol. Sci. 270, 2147–2150 (2003).
8. Avgerinos, K. I., Spyrou, N., Bougioukas, K. I. & Kapogiannis, D. Effects of creatine supplementation on cognitive function of healthy individuals: A systematic review of randomized controlled trials. Exp. Gerontol. 108, 166–173 (2018).
9. Kredlow, M. A., Keshishian, A., Oppenheimer, S. & Otto, M. W. The Efficacy of Modafinil as a Cognitive Enhancer: A Systematic Review and Meta-Analysis. J. Clin. Psychopharmacol. 39, 455–461 (2019).
10. Heishman, S. J., Kleykamp, B. A. & Singleton, E. G. Meta-analysis of the acute effects of nicotine and smoking on human performance. Psychopharmacology 210, 453–469 (2010).
11. Chang, Y. K., Labban, J. D., Gapin, J. I. & Etnier, J. L. The effects of acute exercise on cognitive performance: a meta-analysis. Brain Res. 1453, 87–101 (2012).
12. Singh, I., Bard, I. & Jackson, J. Robust resilience and substantial interest: a survey of pharmacological cognitive enhancement among university students in the UK and Ireland. PLoS One 9, e105969 (2014).
13. Maier, L. J., Ferris, J. A. & Winstock, A. R. Pharmacological cognitive enhancement among non-ADHD individuals-A cross-sectional study in 15 countries. Int. J. Drug Policy 58, 104–112 (2018).
14. Wouters, O. J., McKee, M. & Luyten, J. Estimated Research and Development Investment Needed to Bring a New Medicine to Market, 2009-2018. JAMA 323, 844–853 (2020).
15. Esposito, R. et al. Acute effects of modafinil on brain resting state networks in young healthy subjects. PLoS One 8, e69224 (2013).
16. Repantis, D., Schlattmann, P., Laisney, O. & Heuser, I. Modafinil and methylphenidate for neuroenhancement in healthy individuals: A systematic review. Pharmacol. Res. 62, 187–206 (2010).
17. NICE-The National Institute for Health & Excellence, C. BNF: British national formulary - NICE.
18. Christian, B. & Griffiths, T. Algorithms to live by: The computer science of human decisions. (Macmillan, 2016).
19. Turner, D. C. et al. Cognitive enhancing effects of modafinil in healthy volunteers. Psychopharmacology 165, 260–269 (2003).
20. Müller, U. et al. Effects of modafinil on non-verbal cognition, task enjoyment and creative thinking in healthy volunteers. Neuropharmacology 64, 490–495 (2013).
21. Institute of Medicine & Committee on Quality of Health Care in America. To Err Is Human: Building a Safer Health System. (National Academies Press, 2000).
22. Landrigan, C. P. et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N. Engl. J. Med. 351, 1838–1848 (2004).
23. Greely, H. et al. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature 456, 702–705 (2008).
24. Khushf, G. The use of emergent technologies for enhancing human performance: Are we prepared to address the ethical and policy issues. academia.edu.
25. Moreno, J. D. Mind wars: Brain research and national defense. (2006).
27. Sandberg, A. & Savulescu, J. The social and economic impacts of cognitive enhancement. in Enhancing Human Capacities 92–112 (Blackwell Publishing Ltd, 2014).
28. Randall, D. C., Shneerson, J. M. & File, S. E. Cognitive effects of modafinil in student volunteers may depend on IQ. Pharmacol. Biochem. Behav. 82, 133–139 (2005).
29. Veit, W. Cognitive Enhancement and the Threat of Inequality. Journal of Cognitive Enhancement 2, 404–410 (2018).
30. Bostrom, N. Existential risks: analyzing human extinction scenarios and related hazards. J. Evol. Technol. 9, (2002).
31. Persson, I. & Savulescu, J. The perils of cognitive enhancement and the urgent imperative to enhance the moral character of humanity. J. Appl. Philos. 25, 162–177 (2008).
33. Bostrom, N. & Ord, T. The reversal test: eliminating status quo bias in applied ethics. Ethics 116, 656–679 (2006).
34. Anomaly, J. & Jones, G. Cognitive Enhancement and Network Effects: how Individual Prosperity Depends on Group Traits. Philosophia 48, 1753–1768 (2020).
35. Battleday, R. M. & Brem, A.-K. Modafinil for cognitive neuroenhancement in healthy non-sleep-deprived subjects: A systematic review. European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology vol. 26 391 (2016).
36. The evolutionary argument against cognitive enhancement research is weak - EA Forum. https://forum.effectivealtruism.org/posts/yM7ry84bhZiPd5dEt/the-evolutionary-argument-against-cognitive-enhancement.
37. Brosnan, M. E. & Brosnan, J. T. The role of dietary creatine. Amino Acids 48, 1785–1791 (2016).
38. Jotterand, F. & Dubljevic, V. Cognitive Enhancement: Ethical and Policy Implications in International Perspectives. (Oxford University Press, 2016).
39. Jones, R., Morris, K. & Nutt, D. Chapter 8 - Cognition Enhancers. in Drugs and the Future (eds. Nutt, D., Robbins, T. W., Stimson, G. V., Ince, M. & Jackson, A.) 241–283 (Academic Press, 2007).
40. Horn, G. et al. Brain science, addiction and drugs. 220 (2010).
41. Naturalness in Human Cognitive Enhancement. https://eeagrants.org/archive/2009-2014/projects/CZ09-0019.
42. Wallace, T. L., Ballard, T. M., Pouzet, B., Riedel, W. J. & Wettstein, J. G. Drug targets for cognitive enhancement in neuropsychiatric disorders. Pharmacol. Biochem. Behav. 99, 130–145 (2011).
43. Squier, A. H. & Fisk, N. Becoming a nootropics user: how online communities enable cognitive enhancement. Rensselaer Polytechnic Institute (2013).
44. Branwen, G. Nootropics. (2010).
45. Cost-Effectiveness of Aging Research - EA Forum. https://forum.effectivealtruism.org/posts/JsL2kPWJYRxn9rCWR/cost-effectiveness-of-aging-research.