Open Access Open Badges Research article

Attitudes towards prescribing cognitive enhancers among primary care physicians in Germany

Andreas G Franke12*, Carolin Papenburg1, Elena Schotten1, Peter B Reiner3 and Klaus Lieb1

Author Affiliations

1 Department of Psychiatry and Psychotherapy, University Medical Centre Mainz, Untere Zahlbacher Str. 17, D – 55128 Mainz, Germany

2 University of Neubrandenburg, University of Applied Sciences, Brodaer Str. 2, D – 17033, Neubrandenburg, Germany

3 National Core for Neuroethics, University of British Columbia, 2211 Wesbrook Mall, Koerner Pavilion, Room S 124, Vancouver, British Columbia, Canada

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BMC Family Practice 2014, 15:3  doi:10.1186/1471-2296-15-3

Published: 8 January 2014



Primary care physicians are gate keepers to the medical system having a key role in giving information and prescribing drugs to their patients. In this respect they are involved in claims of patients/clients for pharmacological Cognitive Enhancement (CE). Therefore, we studied the knowledge of primary care physicians about CE and their attitudes toward prescribing CE drugs to healthy subjects.


A self-report paper-and-pencil questionnaire and case vignettes describing a hypothetical CE drug were sent out to all 2,753 registered primary care physicians in Rhineland Palatine, Germany. 832, i.e. 30.2% filled in the questionnaire anonymously.


96.0% of all participating physicians had already heard about CE. However, only 5.3% stated to be very familiar with this subject and 43.5% judged themselves as being not familiar with CE. 7.0% had been asked by their clients to prescribe a drug for CE during the last week, 19.0% during the last month, and 40.8% during the last year. The comfort level to prescribe CE drugs was very low and significantly lower than to prescribe sildenafil (Viagra®). Comfort level was mainly affected by the age of the client asking for prescription of CE drugs, followed by the availability of non-pharmacological alternatives, fear of misuse of the prescribed drug by the client and the missing indication of prescribing a drug.


Although a relatively high proportion of primary care physicians have been asked by their clients to prescribe CE drugs, only a small proportion are well informed about the possibilities of CE. Since physicians are gate keepers to the medical system and have a key role regarding a drugs’ prescription, objective information should be made available to physicians about biological, ethical and social consequences of CE use.

Cognitive enhancement; Primary care physician(s); Prescription drug(s)