Pharmacological enhancement of performance in doctors
BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c2542 (Published 18 May 2010) Cite this as: BMJ 2010;340:c2542
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I apologise for a serious omission in my response earlier today. I
failed to mention that His Grace the Duke of Wellington was the joint
victor at Waterloo.
May I solemnly assert that this error was not an unpatriotic act -
merely the result of lack of hydration.
Yours in shame
JK Anand
Competing interests:
None declared
Competing interests: No competing interests
To: Mr C Anderson
During the second world war (so I have read) some RAF pilots and some
American pilots used amphetamine to ward off fatigue. It must have been
supplied by the authorities.
The Senior Service issued rum to the seamen routinely. Presumably
the rationale of the ration of rum was to enhance performance - make the
chaps insensible to fatigue and fear.
Our cousins in the Low Countries used gin instead of rum (remember
the phrase Dutch Courage?)
On the eve of Waterloo - so I have read - the Emperor's troops were
unhappy until they had their wine rations restored. The victorious Prinz
von Bluecher drank German beer (and rubbed garlic over his bruises) before
the battle. Doubtless His Grace the Duke warmed his insides with a glass
of whisky before the guns thundered and the lances flew.
IF ONLY Grouchy ,the Marshal of France had refreshed himself with
champagne, his Emperor might have won.
JK Anand
Competing interests:
None declared
Competing interests: No competing interests
I've been trying to think of examples of medical intervention where
the intention is neither to correct a condition, nor cosmetic (which might
be considered as resolving a psychological impairment), but purely to
enhance professional performance. Apart from drug use by athletes, which
is frowned upon, I can think of only two: the unlilateral masectomy said
to have been practiced by Amazons, and castrati. Perhaps readers can
suggest others.
Competing interests:
None declared
Competing interests: No competing interests
My concern about drugs which enhance cognitive performance is that
there will be pressure, explicit or implicit, on doctors to take such
drugs. I would not like to be a junior doctor seen as the weakest member
of a high-performing team and subject to pressure to up her game. And
while it may well be helpful to take something to get you through the last
two hours of a 12 hour shift, I fear that the shifts would then be
extended to 14 hours.
Competing interests:
None declared
Competing interests: No competing interests
Re:Performance Enhancement Drugs for Doctors - Unnecessary and Harm-full.
Whilst commenting that more evidence and research is required, it is
quite shocking that the authors of this article feel that it would be
reasonable for doctors to take performance enhancing drugs for the
"greater good" even though it would "almost inevitably place themselves at
risk of harms at an individual level." Furthermore, they suggest that when
deciding whether or not to take these drugs, primacy should be given to
the consequences for patients and society rather than the individual's own
health!
The answer to fatigue does not lie in pharmacological enhancement and
it is rather naive to imagine that it does. Equally, using pharmacological
means in non-fatigued individuals to improve performance is misguided and
reflects a lack of understanding of the human person. To promote such an
idea in full knowledge that it could be harmful to the individual taking
the medication is appalling.
The authors quite rightly point out the possibility of explicit or
implicit coercion but then go on to suggest that the views of the public
must be included and "acted on" and suggest that the public would be
supportive. The implication that a majority vote could require doctors to
take such medication is staggering. Surely the views and freedom of
individual doctors to refuse to ingest an unnatural and harmful substance
should be given a higher priority and also be acted on?
It is not even a question of benefits and risks - the human person
does not require any performance enhancement other than that which can be
achieved through living a self-caring life. It is a sad indictment of
society and the medical profession that most people do not know how to
live a "self-caring life" and thus end up fatigued or in states that
prompt them to seek stimulants and "performance enhancers".
Eunice J Minford MA FRCS Ed.
Consultant Surgeon
Competing interests: In addition to working as a General Surgeon, I have an interest in holistic health and esoteric healing.