this is a very very bad idea. what we're talking about here, the kids at striver say, is actually the old days. because today, now, there's something new on campus-- rememberall. just developed. and this is a spectacular drug. i mean, this is something that was developed for alzheimer's. but in the context of strivers university, all of a sudden, you don't have to take adderall. you don't have to stay up for the exam. you just study with rememberall and wow, the effects are incredible! what's likely to be the usage rate, josh, at strivers now that we're in the rememberall era? if there's anything that you can get that's gonna give you an edge over your fellow classmates, you're gonna take it. provided it's safe, a lot of people will think about taking it. and you? me, i don't know. i think i would try it, possibly. it depends also whether it's illegal. even if some students are using these really dangerous drugs responsibly, all of the sudden the student's gonna take adderall and rememberall.

you're cramming a lot of stuff into your system once you've done that. since there're no studies on the interactions between adderall and rememberall as far as i know. and once lots of students are doing this, even though they're doing it responsibly, the pressure will be on - all of them to do it. - so what do you do? i don't know that there is much we can do about it, and this is a scary feature of our time. hockenberry: dr. hurlbut, what would you do if it was-- i think i agree with it. it's a scary feature of our times. we're-- for all of human history, the-- how ever long we as a species have been on the planet, 100,000 years or more with a five million year background for our genus. we've been shaped by the forces of natural process to be a balanced kind of organism. we're a general purpose organism. when you take a laser beam approach and zap in on one strength, that's not necessarily cognitive enhancement. hockenberry: but what do you actually do?

do you do anything concrete at the school to try to control this or deal with it? i tell my students, at stanford, "you have ferrari minds. why do you want to put buttermilk in the gas tank?" well, but they may think that it's casterol gtx they're putting in their brain, and-- look, we all know this is a huge experiment. i mean we're-- this is, like, human beings are stepping up to be potentially poisoned. i don't understand why people would do this in the first place. the more i learned about medicine, the more i learned to stay away from medicines and use them only for serious purposes. you take something as simple as tylenol. it changes, up-regulates, or down-regulates hundreds, maybe thousands of genes. we're not talking about a system here that's sort of like, you know, your hair style. you might say they're concentric circles of significance in life. there's some areas that we are expressing ourselves through, but there are others that the infrastructure of our very being,

of our very personality. and if you go fooling around with those, you're gonna get things you didn't bargain for. i'm sure of it. i have to say, i don't agree with that at all. i think that there may be a design from evolution, if you want to go there, but what worked on the plains of africa or what helped the ice man cross the alps is of no relevance to the kid at strivers. he knows that his parents began at age four to try and figure out what nursery school to get him into. then they sent him the message that he had to stay after school and do at least 14 different activities in order to get into strivers. so now he says, "there's a little boost i can get from taking this. i'm not gonna change my fundamental human nature. i'm just gonna remember a little better. and every message i've had since i was four said, - "do better!" - so it's fine. why now is everybody having a conniption when i got the-- i got the message. i understand the message."

but this suggests is another fact about strivers that you forgot to mention, john. and that is not only the rate of the use of rememberall or adderall, but also the rate of use of anti-depressants by these kids. and i think that's-- - and the faculty. - ( laughter ) that's 20-25% in many places. i think that's not unrelated to this narrative that art has just described. hockenberry: whether it's related or not... these kids are pressured and groomed-- ...and whether there's pressure or not, we've got these drugs that you seem to all think are very dangerous, yet i don't hear anyone saying that they're actually going to do something about it. what we can do is to try to find other ways of measuring promise than is leading to this crushing kind of nursery school to high school experience.

- foer: i mean... - josh. what i haven't heard anybody say so far is if we really think this is a problem, the university can pass a rule in it's honor code. that says, "if you took a test on rememberall, you will be expelled." and i think that would dissuade a lot of students from taking these drugs. there is no such line in the honor code of most universities about adderall. if there was, i think a lot of students wouldn't take it. one quick twist to this story, justice scalia. your son has come home from strivers. he's in his junior year. you've been worried about him for years. but wow, he comes home with an outstanding report card. and he says, "well, you know, dad, i used rememberall." what's your response? what would you say to him? i'd tell him that he's crazy to do that, and i'm sorry he did it. and i hope he won't do it next year. talk to josh, he's your son. foer: we're gonna have some interesting dinner-time conversations, dad. josh, look it. the most important thing in the world

is not to get out of striver college with the best grades. that's just not what counts most. what counts is character. i sent you to college, not to make you a millionaire. but so that you could understand who you are. that's the main thing i wanted to get out of your liberal education. you have relatives who didn't even go to college that you know who are happy people. maybe happier than i am, although i went to college. to throw all of that normalcy away in order to take some memory-enhancing or intelligence-enhancing drug seems to me crazy. you are what god made you. and it is enough that you work with-- with the nature that you've been given. i find it offensive to set out to alter your mind. i hope you'll think about that. - well, pops, like most things-- - ( laughter ) most parental advice you give me, it sounds good. but, listen i-- you know--

grades don't matter? grades do matter. i want to go to yale law school, and so i need to get the best grades i possibly can. then once i'm in yale law school i need to get the best possible grades so i can get a clerkship in my dad's chambers. and without that, i'm never gonna be a supreme court justice like my father. this matters immensely. when you say, "the best grades you possibly can." i mean, possibly within what limits? are you willing to cheat to do it? are you willing to steal to do it? of course not. this is just one of the obstacles along the way. and i would advise you to put it on this side of the line. one of the things you don't do to get the best possible grades, is to alter your mind. well says who? i mean, i'm not going to cheat. i'm not going to break any rules. if they tell me i can't do this and it's going to be a violation of an honor code, i'm not gonna do it. i think you are breaking rules. i think you're breaking maybe rule number one: you play the hand you've been dealt.

well, i mean, you sent me to the princeton review prep classes. - i regretted doing that. - ( laughter ) i'm just not clear, dad, on why this is so wrong. all the other kids in the class are doing it. hockenberry: well, as touching as this father-son-- - no, i have to give my last piece of advice... - hockenberry: all right. ...which is actual advice that i've often given to my kids-- the single most important piece of advice i ever gave to my kids. what did i tell you when you were young? you're not everybody else, okay? "everybody else is doing it." - we'll talk at dinner. - okay. all right, any comments on this idea that you play the hand you're dealt? caplan: well, since the justice's son was talking to him wearing eye glasses, he wasn't playing quite the hand that he was dealt. he was using some artificial means to do better.

we didn't send him off to college and make him leave his computer behind. we didn't send him off to college and say he couldn't turn on his hearing aid. so he looks enhanced somewhat to me. all right, given this discussion of widespread use of rememberall, and it's been on the market for about 10 years in our little scenario here. it is not shown to have side effects in any significant way. its safety has been proven, yet there's this tremendous sort of after market or black market for the drugs themselves. the board of hope pharmaceuticals has assembled to consider the following proposition. and that is: should we consider thinking about this as an over-the-counter remedy in some form? i think it's a terrible idea. if the drug is actually enhancing the biochemical mechanisms that lead to memory, and encoding the memory, using it chronically by a normal person

is very likely to affect the cognitive structures that they're building, okay? in other words, when you encode memory, it's just not a simple matter of saying, "here's a series of numbers. i'm sticking this in my head." if you enhance those bio-chemical processes, you'll change the way the memories are organized. you'll wind up with a different kind of... - almost a different kind of person. - right. abramson: as a shareholder in hope, i'm gonna call for you to be fired. you're not fulfilling your responsibility. well, however the responsibility to the shareholders of hope are that five years from now we don't have a bunch of people walking around who are now saying, "oh my god, i suddenly have different structures in my head, and i'm seeing the world differently. you know, i'm going to hell in a handbasket here, and it's because i've been taking your drug." but gary, your answer again is predicated on the expectation that the drug is not safe. and i personally would expect that there will be safety issues that emerge. but the real question is: so what happens if in reality

there is nothing wrong with this drug, except you can memorize a verse of shakespeare in one evening instead of a week? okay, the problem is and when you say, "it's been safe for 10 years." it's been safe for 10 years for people that have a major memory problem, all right? when you get into the area of cognitive enhancement, and you move from people that have frank disturbances to normal population, you can't transpose these data safely across that condition. i'm worried about people being altered in ways that are not obvious initially, that develop with time. hockenberry: art, you're on the board, what's the responsibility of a corporation to deal with this sort of under the table market kind of situation? caplan: i've had 10 years of data here. i think we've got something that's more like a sleep aide, or something like one of the erectile dysfunction drugs. it's not that harmful, guys. it's a drug that isn't gonna twist your mind into something different.

we're not affecting major pathways. we get a little boost. you know how much effect we have in the brain. it's tiny, but it makes a difference. yeah but, art, you're the non-scientist on the board. - caplan: i am. - and that's-- - and i've been taking the pill for a while. - ( laughter ) and now you're the real non-scientist on the board. but there are-- it's just the thing that we know there are basic neuroscience principles and basic rules. and if you play with these rules, you play with fire. we got one out of five kids on this drug right now in every school in the country. why aren't we taking advantage of that market? why should some dealer do it? tully: why aren't we studying it... - do it more systematically. - ...with a funded legitimate trial? because we have real good reason to think that there will be consequences down the road. if we're going to go in that direction-- and this is a growing problem for pharmaceuticals-- if we're going to go in that direction, we've got to commit ourselves to an enormously expensive trial.

i say we've been drugging the body, changing the body, intervening in the body, pouring drugs-- all kinds of things into the body. - i keep telling you about the natural foods business. - i think we all agree... do you know how much stuff they're taking out there that nobody's monitoring? i think we all agree in the end, when we're on our deathbed, that our role with hope pharmaceuticals would have been to make the world a better place. - to figure out-- - if we can remember it. - ( laughter ) - no, to figure out how to produce better health for less money, and to do it in a way that doesn't expose our kids to danger. and this is going one path, which is quick profits-- yes, absolutely, you'll get quick profits-- but will we make the world-- will it make our children healthier and happier? the angst-filled discussion of what to do about rememberall comes to a sputtering end at the board. and no decision is made at this time. but the favorite part of all the board meetings begins at this point when one member of the board raises her hand and asks, "what do we have coming down the pipeline?

what sort of neuro-enhancement research is going on at our company right now, as we look out 10, 15, 20 years?" dr. tully? more drugs that do more specific things-- the anti-shyness drug, the happy drug, the get-rid- of-your-depression- in-the-morning drug, the don't-worry- about-the-alcohol- you-had-last-night drug. i mean, you can imagine lots of different things becoming somewhat tailored to particular issues that we deal with with our brain and body every day. gazzaniga: here's a real possible drug that's right on the cusp. and it's the drug that will selectively erase a memory. - so let's say you didn't like the year 1961. - ( laughter ) right? you just want that out of your life, or one guy put it to a colleague of mine, "i'm trying to forget my ex-wife," you know, call her name up and take the drug and boom--

delete character. now this is being worked on-- that's actually within the realm of feasibility from what we understand. that touches on some deep questions of what it means to have a life experience. you might meet her and marry her again. i mean, jeez. ( laughter ) or you might not propose the next time. - scary. - no, i think the most science-fictiony but conceivable possibility is i don't think that we're that far removed now, as the science progresses, from looking at compounds that are genuine cognitive enhancers-- not drugs that keep you up longer, not drugs that let you study longer, not drugs that simply remember all. but compounds that will literally make it possible for you to do things that human beings cannot normally cognitively do. we can define the limits of a thought that you can hold right now. i can say you can have this complex a thought and that's the limit.

that's as much as you're gonna do. suppose we thought of drugs that would let you have a larger thought, a more complex thought, a richer thought. but there's a bigger problem with cognitive manipulation, and that is that remembering and forgetting are not just cognitive faculties. they're moral faculties. remembering is bound up with justice. forgetting is bound up with forgiveness. and striking the balance between them is a moral challenge. and so the danger of manipulating cognition with drugs, even if it were safe 10 years or a 100 years from now, is that it would risk obscuring these fundamental moral aspects of the human capacities to remember and forget. that's the real problem. tully: they're obscured already. what we remember changes with time, and we forget things we don't want to.

and the brain is fluid in this regard, so morality then must be fluid. but my point is, i don't see that affecting how much we can remember or how much we forget is any different than the natural condition, and consequently doesn't really address the moral issue. - no, it does. - the difference is-- think about-- think about the truth commissions that wrestle with the balance of remembering and forgetting when there've been great atrocities committed. now in some ways you would say what we ideally would want would be a drug so the victims of those atrocities could forget the harrowing vision of their family members being slaughtered in a genocide. - yeah. - but then what would become of the moral work, and the moral dilemmas of truth and reconciliation commissions where men and women with burdened histories

try to sort out the balance between memory and forgetting? that's a moral faculty that's essential to what it means to be a human being. and if you're gonna try to deal with that with drugs, you're gonna wipe away that important part of what it is to be a human being. but that moral issue was exactly why hope pharmaceuticals developed a drug that's coming down the pipe called trauma gone, which basically allows a memory that is associated with trauma to be blunted. you don't forget that the experience happened. suddenly the option potentially exists to give drugs to traumatized veterans. would you prescribe a drug like this, dr. satel? - to me it would be up to the patient. - exactly. if it was something he was interested in. a lot of people wouldn't-- i think dr. sandel may overestimate how many people are clamoring for this kind of relief. i've worked with veterans, in fact, and a lot of them

draw a lot of strength and passion from those experiences, and trying to affect changes so it doesn't happen again, or order their life in some way that has meaning and is born out of that experience. i don't think people would be popping this right and left. i think some who are horribly tortured and feel it would be helpful to them, might try it. i'd really much prefer to leave this up to the person once we know it's relatively safe. - dr. lawler? - if you think about it though, we don't have the wisdom to know what memories we want to remember and what memories we want to forget. i might think i want to forget-- i don't have an ex-wife, but if i did... but if i could will that forgetfulness, i might well regret it, because i wasn't wise when i did it. i might think i want to have less anxiety or less alienation. i don't want to be anxiety free. i don't want to be alienation free. otherwise i couldn't understand johnny cash anymore or something.

so so... there's some kind of designer middle that i think i want. but in order to construct the designer middle i think i want, i would actually have to be able to abstract myself from myself. so memory control with happiness and wisdom in mind is absolutely impossible for us. we don't know enough. and just having power over memory doesn't change that fact at all. if i'm running the international center for victims of torture, if i'm trying to do the veterans administration program, where i'm looking at my 80% patient population alcoholic, if i'm wondering about the suicide rate coming from women who are victims of mass rape in africa, i want that pill handy. what do we do about the soldier, though, who yearns to have some way of turning off the memory of his actions in battle, of his actions killing people in battle? he wants this drug.

yeah, and i mean, somebody needs to make the decision - whether he gets it or not. - hockenberry: what would your decision be? peter says none of us has the wisdom to make that call. but, you know, you do the best you can. there might be some cases where the soldier, or the rape victim, or the person with the difficult ex-wife makes the wrong choice. but i don't see why that means that most of the time it might not be a good thing. - would you-- - dr. sandel, the soldier doesn't want to remember all that killing that he did. do you give him the drug? i would distinguish between a victim who wants to forget a traumatic event that was done to him or her and the perpetrator of a heinous act, even on the battlefield. i'm not talking about crime. the soldier's in battle. he's fighting for you. i understand...

i think it's more dangerous for the soldier who wants to forget something in which, even though he had to do it, he was morally culpable. because that's not only blunting the memory, but it's partly cleansing the conscience. and the drug should not be for that. that's why it's different for a victim say of a rape or a crime. it is interesting question whether when you lose your memory you lose the wisdom that came along with that experience. all of a sudden, the wrinkles you have on your face are worth nothing, right? all of the experiences that you've had over your life are just washed out? and you become as stupid as you were when you were 18? hockenberry: what would you do in the case of the soldier? or as unwise as you were when you were 18? hockenberry: what would you do in the case of the soldier, justice scalia? what would i do in the case of the soldier? unless he was suffering from a, you know, post-traumatic stress syndrome, or-- i'm not a doctor, so i don't know what the disease is--

he keeps on talking about illness and treating illness verses enhancement. well, you sit around thinking and thinking on where's that line, where's that line? in the extremes it's very easy. but in daily practice i can tell you-- a burdened conscience is not a disease. i just think you can't-- it's not that easy. the line between enhancement-- abramson: when we name a disease, we tend to think that it's a-- that it has an ontological substance, and it doesn't. post-traumatic stress syndrome blurs into ordinary events. and because we doctors know how to say it in one breath without grasping for it, doesn't mean-- it's not like a strep throat. dr. hurlbut, is there no emotional-memory suffering that you wouldn't treat with a drug like this? i think psychiatrists treat emotional suffering with drugs. but first of all, even if something is defined as a disease, we try not to treat it with anything that invades the system if we can help it.

what about the soldier case? soldier coming back from iraq who wants to forget the memory of all that killing i did for my country. i think there's a more positive way to deal with that. i've seen people with post-traumatic stress syndrome. it's a very disabling condition, and i think you try to get the person back to functioning. i see psychiatric medicines as sort of like the analogy of a cast around a broken leg. you try and get the personality back so it can heal itself. but i don't like the idea of manipulation of self. and by the way, i don't agree with art caplan's analogy that the eyeglasses that judge scalia wears is somehow the same as a drug that goes to the very core of the person. i think there's a big difference in that. that's a tool. thank you, 'cause i really need these. hurlbut: it's a tool. it's not invasive. it aids the person, but it doesn't in some way violate the person. doesn't go in and remake the person, reshuffle the person.

josh-- i mean, you're young enough to imagine going to iraq-- how would you deal with the soldier situation? if you had the opportunity to eliminate suffering like that, would you take it? i think it's a very complicated question and i'm not sure where i would come down ultimately. but we go to great efforts to get rid of physical pain. why shouldn't we also go to great efforts to get rid of emotional pain? it seems reasonable to me. you had a comment, dr. satel. i don't believe that this drug you're talking about will exact a kind of surgical excision of the memory, so there is absolutely no recall at all. you can imagine where the anxiety and the distress surrounding the memory is reduced, but the moral distress is still profound. and then when you have someone who is less symptomatic, they may actually be able to make restitution in a much more effective way. so attached to these complicated molecules that are coming down the pike, are enormously complicated moral questions.

art caplan, what are the tools that we need as we go forward to think about how these moral judgments will be made responsibly as these new technologies emerge? well, you need to have some sense, you know, hurlbut and i have been dueling about this. but you do need to have some sense of what you want to believe about human nature. we do have to talk more about this idea of who we are, what makes us who we are. i think it is important to do that. i think we need two other kinds of tools as well. some of what's coming is the opportunity to shape us to a social system that we live in, or change in social system rather than trying to continue to wail away at ourselves with drugs or technologies to make us fit. that's a tough politics questions. we never asked the politicians to answer it. we may ask each other here, but we haven't really put that on the agenda to say, "if truck drivers have to stay awake 48 hours, shouldn't they be told they can only drive 24?"

the last i would suggest. you really have to start getting younger people to talk about this in the schools. they're gonna be taking the pills, not us. we'll be just dim memories that they'll probably try to forget by taking some kind of trauma-removal drug. but that's where the future is of this battle. so the more we can, in a sense, raise it into their consciousness. i think it would be to the good. art caplan, and the rest of the panel, thank you very much for your thoughtful participation. and thank you.

announcer: ethics in america is a presentation of the fred friendly seminars at the columbia university graduate school of journalism. fred friendly seminars is solely responsible for its content.