A particular mental and, in many respects, also physical ability to achieve are increasingly considered to be a precondition for a successful career and life management in modern industrial society. This social trend is manifested in various sectors and is influenced by diverse economic, social and scientific developments. One important basis for this is research in pharmacology and medical technology and the resulting knowledge and products that are in fact primarily designed and developed for treating illnesses. Many of these substances and technologies make it possible to treat or at least alleviate certain mental or physical problems on the one hand, while on the other hand intentionally increasing certain aspects of an individual’s physical or mental ability to achieve by a more than a “normal” degree (e.g. capacity to concentrate, muscle strength). At the same time, it is becoming increasingly difficult to draw a line between pharmacological applications or (neuro-)technical interventions that are clearly medically indicated, those that are medically justifiable (“off-label use”) and those that are not medically indicated (or even misused). It is to be expected that the potential improvements in an individual’s performance that result will enter into more and more spheres of life, even without us being sufficiently conscious of the consequences of such a development towards “enhancing daily life”.

In addition to the increasing opportunities offered by science and technology, other factors deemed to particularly promote this development are changes in our social and individual understanding of health and illness and the creation of new structures for the distribution of products and information (worldwide availability eluding the traditional structures for drug control, for example). For some time now, concepts such as neuroenhancement, brain doping and enhancement have been used to focus the attention of science and the public on the associated causes and dimensions of the consequences. Several projects recently completed at the Office of Technology Assessment (TAB) have provided indications for the increasing development and availability of drugs and other medical procedures—including (neuro)technical interventions— for enhancing certain aspects of an individual’s performance in everyday life situations (TAB Working Report no. 117 “Brain Research”, TAB Background Paper no. 16 “Converging Technologies” and TAB Working Report no. 124 “Gene Doping”). On the basis of the results of these three reports, the current “TAB Newsletter No. 33” (only in German) focuses on the topic of enhancement.

Major uncertainties, however, continue to surround many of the scientific and technical possibilities, their level of development, and the resulting time frame for a wider availability, as well as the possible side effects and the degree and nature of the social consequences. The Committee on Education, Research and Technology Assessment of the German Parliament commissioned TAB to conduct a project on the topic “Pharmacological and Technical Interventions for Improving Performance: Perspective of a More Widespread Use in Medicine and Daily Life” (or, in short, “Enhancement”).

Objectives and approach

On the basis of a survey of the trends that can already be recognized, the project aims to examine the social causes, the possible dimensions of the related consequences, and the resulting issues for politics and society. The latter appear to be extremely diverse and include particular aspects of security, fair distribution, the self-image of physicians, economic consequences, and questions of procedure and responsibility. Some factors indicate there is a need for the political parameters to be clarified and, furthermore, for all of society to discuss these issues. Decisive questions for Parliament might be whether regulation is needed and which form such regulation could take. A very sound factual foundation is a condition for answering these questions.

The challenge of this technology assessment project is to determine, describe and analyse the diverse scientific developments, the relevant fields of technology and the possible social consequences in a comprehensive fashion while focussing on the politically relevant issues. To this end, the project is divided into two phases, an exploratory phase and an in-depth phase.

The purpose of the exploratory phase is to develop a broad survey of the current situation, determine the focal points and identify the analytical concept to be used in the in-depth phase. In particular, the study aims to work up the following:

• What can be counted as “pharmacological and technical interventions” (research and development: What is already available? What is to come?).
• An initial overview of the existing empirical data regarding how widespread the forms of enhancement already are today (empirical experience: What is used by whom, how, when and for what reason?).
• A collection of assessments of the current and future significance of the phenomenon of enhancement in different areas of society (relevance), including a first discussion of the possible socioeconomic causes (driving forces), and of questions regarding the distinction and distinguishability between the medical and nonmedical utilization of new technologies and drugs (transitions and borders).

To this end, the project will evaluate the considerable number of recently completed and currently ongoing studies on enhancement, including those supported by the Federal Ministry of Education and Research (BMBF), EU-sponsored projects, and activities of other European technology assessment institutions.

In the phase of detailed study, the socially relevant opportunities, risks and ethical issues will be examined and discussed for selected procedures. Examples are health risks and the possible negative consequences for social relations, changes in our concept of illness, competitive advantages, fair distribution, etc. There will be a special focus on questions related to the future formation of political opinion on socially desirable and undesirable trends, to the possible need for regulation and to the structure of the legal framework at the national and the international levels.