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While supporting the concept that healthy adults should be able to use brain-boosting drugs, the authors called for:
More research into the use, benefits and risks of such drugs. Much is unknown about the current medications, such as the risk of dependency when used for this purpose, the commentary said.
Policies to guard against people being coerced into taking them.
Steps to keep the benefits from making socioeconomic inequalities worse.
Action by doctors, educators and others to develop policies on the use of such drugs by healthy people.
Legislative action to allow drug companies to market the drugs to healthy people if they meet regulatory standards for safety and effectiveness.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, said she agreed with the commentary that the nonprescribed use of brain-boosting drugs must be studied.
But she said she was concerned that wider use of stimulants could lead more people to become addicted to them. That's what happened decades ago when they were widely prescribed for a variety of disorders, she said.
"Whether we like it or not, that property of stimulants is not going to go away," she said.
Erik Parens, a senior research scholar at the Hastings Center, a bioethics think tank in Garrison, N.Y., said the commentary makes a convincing case that "we ought to be opening this up for public scrutiny and public conversation."
One challenge will be finding ways to protect people against subtle coercion to use the drugs, the kind of thing parents feel when neighbor kids sign up for SAT prep courses, he said.
And if the nation moves to providing a basic package of health care to all its citizens, it's hard to see how it could afford to include brain-boosting drugs, he said. If they have to be bought separately, it raises the question about promoting societal inequalities, he said.
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