Giovanna Di Sauro

I was going through my usual morning news reading, and then something in the European news section of the BBC really tickled my interest: it is the story of a once successful French cardiologist who beat his alcohol dependence prescribing himself a muscle relaxant drug.

At which point, other doctors tried to prescribe this drug – currently not approved to be used on people suffering of alcoholism – to their patients, sometimes with surprising results. This started an intense debate in the French medical community, on whether it would be appropriate to prescribe the drug to patients who could benefit from it, and whether prescription is at all a solution to alcoholism.

What really attracted my attention about this article is not the story in itself, but how this is a variant of an ethical dilemma that seems to be becoming more and more frequent: is it ethical to prescribe an untested drug, or a drug tested for other purposes, to people who seem to be in dire need of it? Depending on how we define “dire need”, we could be looking at different populations: workers trying to stay awake at night, terminal cancer patients, or people affected by all the consequence of substance dependence – and possibly, other groups I cannot think of right now. There are two more examples that I can make about the other two groups, and they are both relatively recent: the use of cognitive-enhancing drugs in healthy people, and the use of DCA, a drug not tested as an oncological treatment, in terminal cancer patients.

The main issue here is whether there is any real advantage from taking these drugs. In some cases, one could make a “harm reduction” argument, but I feel that in most cases one cannot. For instance, is the muscle relaxant really solving the issues underlying alcoholism? No, but it could be used in the context of a harm reduction strategy, where people are allowed to get off their dependence on alcohol thanks to pharmacological treatment first, but are also being provided with assistance to overcome the root causes of their dependence – which should eventually allow them to avoid taking the drug altogether. This argument could also be made for drug users being provided with drugs and/or a safe place where to inject – think of the recent Swiss heroin prescription initiative, or Vancouver’s Insite.

However, can we make the argument that it is moral to provide an untested cancer treatment to severely ill patients, or that it is moral for healthy people to use cognitive enhancement drugs currently prescribed to people suffering of cognitive difficulties such as ADHD, Parkinson’s and other disorders? I seriously doubt it: in these cases, not only there is no harm reduction, but people are being exposed to potential damage at best, and being set up for future dependence and obligation to assume pharmaceuticals at worst. It is not hard to imagine a day when, if cognitive enhancer uses went mainstream, one could be obliged by a potential employer to consume certain drugs to enhance their ability to concentrate or work longer hours.

Other readings

• Read more on the discussion about the use of cognitive enhancers
• Read more about the story behind DCA, and the way it has been marketed to desperate cancer patients
• For more science blogging, and possibly the best selection of science blogging of the year, head over to this list of posts compiled by Bora at A Blog Around The Clock.

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