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Open Access Research article

Generating genius: how an Alzheimer’s drug became considered a ‘cognitive enhancer’ for healthy individuals

Lucie Wade145, Cynthia Forlini136 and Eric Racine1234*

Author Affiliations

1 Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montréal, QC H2W lR7, Canada

2 Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4, Canada

3 Departments of Neurology and Neurosurgery, 3801 University Street, Montreal, QC H3A 2B4, Canada

4 Division of experimental Medicine and Biomedical Ethics Unit, 1110 Avenue des Pins Ouest, Montreal, QC H3A 1A3, Canada

5 Ethics Program Office, Jewish General Hospital, 3755 Cote-St-Catherine Road, Montreal, QC QC H3T 1E2, Canada

6 The University of Queensland, UQ Centre for Clinical Research, 3755 Cote-St-Catherine Road, Herston, QLD 4029, Australia

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BMC Medical Ethics 2014, 15:37  doi:10.1186/1472-6939-15-37

Published: 12 May 2014

Abstract

Background

Donepezil, an acetylcholinesterase inhibitor used in the treatment of Alzheimer’s disease, has been widely cited in media and bioethics literature on cognitive enhancement (CE) as having the potential to improve the cognitive ability of healthy individuals. In both literatures, this claim has been repeatedly supported by the results of a small study published by Yesavage et al. in 2002 on non-demented pilots (30–70 years old). The factors contributing to this specific interpretation of this study’s results are unclear.

Methods

We examined print media and interdisciplinary bioethics coverage of this small study, aiming to provide insight into how evidence from research may be shaped within different discourses, potentially influencing important policy, ethics, and clinical decisions. Systematic qualitative content analysis was used to examine how this study was reported in 27 media and 22 bioethics articles. Articles were analyzed for content related to: (1) headlines and titles; (2) colloquialisms; and, (3) accuracy of reporting of the characteristics and results of the study.

Results

In media and bioethics articles referencing this small study, strong claims were made about donepezil as a CE drug. The majority of headlines, titles, and colloquialisms used enhancement language and the majority of these suggest that donepezil could be used to enhance intellectual ability. Further, both literatures moved between reporting the results of the primary study and magnifying the perceived connection between these results and the CE debate that was alluded to in the primary study. Specific descriptions of the results overwhelmingly reported an improvement in performance on a flight simulator, while more general statements claimed donepezil enhanced cognitive performance. Further, a high level of reporting accuracy was found regarding study characteristics of the original study, but variable levels of accuracy surrounded the presentation of complex characteristics (i.e., methods) or contentious properties of the CE debate (i.e., initial health status of the study subjects).

Conclusions

Hyped claims of CE effects cannot be completely accounted for by sheer inaccuracy in reporting. A complex interaction between the primary and secondary literature, and expectations and social pressures related to CE appears to drive enthusiastic reports.