Gavin Enck

Bryan Frances’s recent argument is for the epistemic position called Live Skepticism. The Live Skepticism Argument (LSA) attempts to establish a restricted set of skeptical conclusions. The LSA’s “skeptical hypotheses” are scientific and philosophical positions that are “live actual possibilities” in an intellectual community. In order to “rule out” live hypotheses, an expert must know them to be false. However, since these are live hypotheses in this expert’s intellectual community—endorsed by others who have parallel levels of knowledge, intelligence, and understanding—this expert is unable to rule them out. Consistent with the LSA is the outcome that people not exposed to these live hypotheses can know what these experts cannot. However, in this paper, I defeat the LSA by developing and defending a counterexample that focuses on the phenomenon of genius testimony. Everyone, including the LSA’s proponent, can and should allow that expertise comes in degrees. While in many cases a person’s intelligence, understanding, and knowledge are parallel to others in the field, there are some who are extraordinary in their intelligence, understanding, and knowledge (geniuses). If an expert meets with a genius, it is possible that the genius provides this individual with beliefs that can rule out a skeptical hypothesis. Therefore, an expert can have knowledge, even if the skeptical hypothesis is live and endorsed by others who have parallel levels of knowledge, intelligence, and understanding. After providing this counterexample, I present three potential objections, and show how people can know global warming exists and that smoking does not give someone cancer. I conclude by defending this counterexample from a likely reply by proponents of the LSA involving luck and knowledge.

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality.

Emerging data indicates the prevalence and increased use of pharmaceutical enhancements by young medical professionals. As pharmaceutical enhancements advance and become more readily available, it is imperative to consider their impact on medical professionals. If pharmaceutical enhancements augment a person’s neurological capacities to higher functioning levels, and in some situations having higher functioning levels of focus and concentration could improve patient care, then might medical professionals have a responsibility to enhance? In this paper, I suggest medical professionals may have a responsibility to use pharmaceutical enhancements. In some situations, having higher functioning levels of focus and concentration is conducive to providing the best possible care to a patient. In these circumstances medical professionals should use pharmaceutical cognitive enhancements. I conclude by examining the limitations and implications of this responsibility in the practice of medicine and areas for future research

Discussions about the permissibility of students using enhancements in education are often framed by the question, “Is a student who uses cognitive-enhancing drugs cheating?” While the question of cheating is interesting, it is but only one question concerning the permissibility of enhancement in education. Another interesting question is, “What kinds of students do we want in our academic institutions?” I suggest that one plausible answer to this question concerns the ideals of human excellence or virtues. The students we want in our academic institutions are virtuous or, at least minimally, possess certain virtues. I argue that a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement. That a virtuous student may choose to use cognitive-enhancing drugs for reasons of self-improvement illustrates that under certain conditions motivation can determine the permissibility of using enhancements. Building upon this I suggest a virtues-based institutional rule for governing and guiding student-use of cognitive enhancers in an academic institution to be for the right reasons. This ideals of human excellence or virtues approach offers interesting and unique insights for issues of enhancement in education, as it might turn out, that uneasiness many people have about students using cognitive-enhancing drugs has less to do with issues of enhancement and more to do with the motivations and character of students

Conducting “difficult conversations” with patients and caregivers is one of the most difficult aspects of the medical profession. These conversations can involve communicating a terminal prognosis, advance care planning, or changing the goals of treatment. Although they are challenging, the need for these conversations is underwritten by the tenets of medical ethics. Unfortunately, medical professionals lack adequate training in communication skills and overestimate their abilities in conducting difficult conversations. I suggest that one way to improve that ability would be the strategic use of pharmaceutical neuroenhancements. Pharmaceutically augmenting a professional’s capacity for recognizing masked emotional expressions might conduce to his or her development of open and responsive communication with patients and caregivers. I conclude by examining the limitations and objections to this use of a communication enhancement by illustrating that it would still require the development of, and indeed a greater emphasis on, communication skills in medical education and training.