The implications of Methylphenidate use by healthy medical students and doctors in South Africa

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• 作者：Chad Beyer (7)
  Ciara Staunton (7)
  Keymanthri Moodley (7)
  
• 关键词：Methylphenidate ; Ritalin ; Healthy ; Medical students ; Doctors ; Utility ; Cognitive ; Enhancement
• 刊名：BMC Medical Ethics
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：15
• 期：1
• 全文大小：186 KB
• 参考文献：1. Medication guide Ritalin http://www.fda.gov/downloads/Drugs/DrugSafety/ucm089090.pdf
  2. Mitler MM, Shafor R, Hajdukovich R: Treatment of narcolepsy: objective studies on methylphenidate, pemoline and proptriptyline. / Sleep 1986, 9:260鈥?64.
  3. Forlini C, Racine E: Disagreements with implications: diverging discourses on the ethics and non-medical use of methylphenidate for performance enhancement. / BMC Med Ethics 2009. doi:10.1186/1472鈥?939鈥?0鈥?
  4. More students turning illegally to 鈥楽mart鈥?drugs. http://www.npr.org/templates/story/story.php?storyId=100254163
  5. Emanuel R, Frellsen S, Kashima K, Sanguino S, Sierles F, Lazarus C: Cognitive enhancement drug use among future physicians: finding from a multi-institutional census of medical students. / J Gen Intern Med 2013,28(8):1028鈥?034. CrossRef
  6. Brown N: Hope against hype 鈥?accountability in bio pasts, presents and futures. / Sci Stud 2003, 16:3鈥?1.
  7. Schermer M, Bolt I, de Jongh R: The future of psychopharmacological enhancements: expectations and policies. / Neuroethics 2009, 2:75鈥?7. CrossRef
  8. Aoyama T, Kotaki H, Sasaki T: Nonlinear kinetics of threo-methylphenidate enantiomers in a patient with narcolepsy and in healthy volunteers. / Eur J Clin Pharmacol 1993, 44:79鈥?4. CrossRef
  9. Repantis D: Modafinil and methylphenidate for neuroenhancement in healthy individuals: a systematic review. / Pharmacol Res 2010, 62:187鈥?06. CrossRef
  10. Outram SM: The use of methylphenidate among students: the future of enhancement? / J Med Ethics 2010, 36:198鈥?02. CrossRef
  11. Balanza-Martinez V, Rubio C, Selva-Vera G, Martinez-Aran A, Sanchez-Moreno J, Salazar-Fraile J: Neurocognitive endophenotypes (endophenocognitypes) from studies of relatives of bipolar disorder subjects: a systematic review. / Neurosci Bio behav Rev 2008, 32:1426鈥?438. CrossRef
  12. Verster C, Van Niekerk AA: Moral perspectives on stimulant use by healthy students. / S Afr Med J 2012,102(12):909鈥?11. CrossRef
  13. Efron D, Jarman F: Side effects of methylphenidate and dexamphetamine in children with attention deficit. / Pediatrics 1997, 100:662鈥?66. CrossRef
  14. Kollins SH, MacDonald EK, Rush CR: Assessing the abuse potential of methylphenidate in nonhuman and human subjects: a review. / Pharmacol Biochem Behav 2001, 68:611鈥?27. CrossRef
  15. Faraone SV, Wilens TE: Effect of stimulant medications for attention-deficit/hyperactivity disorder on later substance use and the potential for stimulant misuse, abuse and diversion. / J Clin Psychiatry 2007, 68:15鈥?2. CrossRef
  16. Larriviere D, Williams MA, Rizzo M, RJ B: Responding to requests from adult patients for neuroenhancements: guidance of the Ethics, Law and Humanities Committee. / Neurology 2009, 73:1406鈥?412. CrossRef
  17. Chatterjee A: Is it acceptable for people to take methylphenidate to enhance performance? No. / BMJ 2009, 338:338. CrossRef
  18. Harris J: It acceptable for people to take methylphenidate to enhance performance? Yes. / BMJ 2009, 338.
  19. Chatterjee A: The promise and predicament of cosmetic neurology. / J Med Ethics 2006, 32:110鈥?13. CrossRef
  20. Carey B: / Brain Enhancement is Wrong, Right?. The New York Times; in press
  21. Greely H: Towards responsible use of cognitive enhancing drugs by the healthy. / Nature 2008, 456:702鈥?05. CrossRef
  22. Haisma HJ: Gene doping. / Int J Sports Med 2006, 27:257鈥?66. CrossRef
  23. Forlini C, Racine E: Autonomy and coercion in academic 鈥渃ognitive enhancement鈥?using methylphenidate. / Neuroethics 2009, 2:163鈥?77. CrossRef
  24. Proust J: Cognitive enhancement, human and bioethics. / J Int Bioethique 2011, 22:153鈥?99. CrossRef
  25. Horn G: / Brain Science, Addiction and Drugs. Great Britain: Academy of Medical Sciences; 2008. [ / An Academy of Medical Sciences Working Group Report]
  26. Fischman MW, Foltin RW: Utility of subjective-effects measurements in assessing abuse liability of drugs in humans. / Br J Addict 1991,86(12):1563鈥?570. CrossRef
  27. Fr枚ding BBE: Cognitive enhancement, virtue ethics and the good life. / Neuroethics 2011, 4:223鈥?34. CrossRef
  28. Darley J, Batson C: 鈥淔rom Jerusalem to Jericho鈥? a study of situational and dispositional variables in helping behavior. / JPSP 1973, 27:100鈥?08.
  29. Greene JD, Sommerville RB, Nystrom LE, Darley JM, JD C: An fMRI investigation of emotional engagement in moral judgment. / Science 2001,293(5537):2105鈥?108. CrossRef
  30. Insel TRHT: A gender-specific mechanism for pair bonding: oxytocin and partner preference formation in monogamous voles. / Behav Neurosci 1995,195(4):782鈥?89. CrossRef
  31. Liao SM, Savulescu J, Wasserman D: The ethics of enhancement. / J Appl Philos 2008,25(3):159鈥?61. CrossRef
  32. Van Niekerk AA: Ethics theories and the principlist approach in bioethics. In / Medical Ethics, Law and Human rights: A South African perspectiv. 1st edition. Edited by: Moodley K. Pretoria: Van Schaik; 2011:20鈥?4.
  33. Miller G: Cognition enhancing drugs: just say yes. / J Philos Sc Law 2010., 10:
  34. Rawls J: / A Theory of Justice. 1st edition. Cambridge, MA: Harvard University Press; 1971.
  35. Bostrom N, Sandberg A: Cognitive enhancement: methods, ethics, regulatory challenges. / Sci Eng Ethics 2009, 15:311鈥?41. CrossRef
  36. Dubljevic V: Principles of justice as the basis for public policy on psycho- pharmacological cognitive enhancement. / Law Innov Technol 2012,4(1):67鈥?3. CrossRef
  37. Warren OJ, Leff DR, Athanasiou T: The neurocognitive enhancement of surgeons: an ethical perspective. / J Surg Res 2009, 152:167鈥?72. CrossRef
  38. Senior NHS doctors claim more than 拢150,000 overtime for out-of-hours care (which boosts their salary to 拢300,000). http://www.dailymail.co.uk/news/article-2420989/Senior-NHS-doctors-claim-150-000-overtime-provide-hours-care-boosts-salary-300-000.html
  39. Erasmus N: Slaves of the state 鈥?medical internship and community service in South Africa. / S Afr Med J 2012,102(8):655鈥?58. CrossRef
  40. Harris J: / Chemical Cognitive Enhancement: Is it Unfair, Unjust, Discriminatory, or Cheating for Healthy Adults to use Smart Drugs. Oxford: Oxford University Press; 2011:265鈥?72. [ / The Oxford Handbook of Neuroethics. edn]
  41. Glannon W: Psychopharmacological enhancement. / Neuroethics 2008,1(1):45鈥?4. CrossRef
  42. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1472-6939/15/20/prepub
  
• 作者单位：Chad Beyer (7)
  Ciara Staunton (7)
  Keymanthri Moodley (7)
  
  7. Centre for Medical Ethics and Law, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, South Africa
  
• ISSN：1472-6939

文摘

Background The use of medical stimulants to sustain attention, augment memory and enhance intellectual capacity is increasing in society. The use of Methylphenidate for cognitive enhancement is a subject that has received much attention in the literature and academic circles in recent times globally. Medical doctors and medical students appear to be equally involved in the off-label use of Methylphenidate. This presents a potential harm to society and the individual as the long-term side effect profile of this medication is unknown. Discussion The implication of the use of Methylphenidate by medical students and doctors has not been fully explored. This article considers the impact of this use on the traditional role of medicine, society, the patient and suggests a way forward. We discuss the salient philosophy surrounding the use of cognitive enhancement. We query whether there are cognitive benefits to the use of Methylphenidate in healthy students and doctors and whether these benefits would outweigh the risks in taking the medication. Could these benefits lead to tangible outcomes for society and could the off label-use of Methylphenidate potentially undermine the medical profession and the treatment of patients? If cognitive benefits are proven then doctors may be coerced explicitly or implicitly to use the drug which may undermine their autonomy. The increased appeal of cognitive enhancement challenges the traditional role of medicine in society, and calls into question the role of a virtuous life as a contributing factor for achievement. In countries with vast economic disparity such as South Africa an enhancement of personal utility that can be bought may lead to greater inequities. Summary Under the status quo the distribution of methylphenidate is unjust. Regulatory governmental policy must seek to remedy this while minimising the potential for competitive advantage for the enhanced. Public debate on the use of cognitive enhancement is long overdue and must be stimulated. The use of Methylphenidate for cognitive enhancement is philosophically defendable if long-term research can prove that the risks are negligible and the outcomes tangible.