Sir

The Commentary 'Towards responsible use of cognitive-enhancing drugs by the healthy' (Nature 456, 702–705; 2008) raises a wider issue of perceived responsibility. The traditional role of physician as healer does not sit with the category of enhancement. Plastic surgery serves as a good analogy here, with views remaining varied on the ultimate responsibility. But with planned, novel, pharmacological intervention, physicians must surely be party to the cause, and thus a broadening of their role would be necessary.

Ultimately, the call for risk–benefit research and a fuller understanding of mechanisms is therefore welcome, but the real beneficiaries, at least in the short term, are likely to be dominated by the genuinely needy — neurological and psychiatric patients. These groups have had their needs for cognitive enhancement unmet for far too long.

See also Risks and benefits may turn out to be finely balanced Much ado about cognitive enhancement A medical view of potential adverse effects Recall of learned information may rely on taking drug again Patterns of drug use have varied throughout history Careful use helps me do better research, and society benefits