The [current] system [of licensing medicines] was created to deal with traditional medicine which ais to prevent, detect, cure, or mitigate diseases. In this framework, there is no room for enhancing medicine. For example, drug companies could find it difficult to get regulatory approval for a pharmaceutical whose sole use is to improve cognitive functioning in the healthy population. To date, every pharmaceutical on the market that offers some potential cognitive enhancement effect was developed to treat some specific disease condition (such as ADHD, narcolepsy and Alzheimer’s disease). The enhancing effects of these drugs in healthy subjects is a serendipitous unintended effect. As a result, pharmaceutical companies, instead of aiming directly at enhancements for healthy people, must work indirectly by demonstrating that their drugs are effective in treating some recognised disease. One perverse effect of this incentive structure is the medicalization and “pathologization” of conditions that were previously regarded as part of the normal human spectrum. If a significant fraction of the population could obtain certain benefits from drugs that improve concentration, for example, it is currently necessary to categorize this segment of people as having some disease in order for the drug to be approved and prescribed to those who could benefit from it. It is not enough that people would like to be able to concentrate better when they work; they must be stamped as suffering from attention0deficit hyperactivity disorder: a condition now estimated to affect between 3 and 5 percent of school-age children (a higher proportion among boys) in the US. This medicalizatoin of arguably normal human characteristics not only stigmatizes enhancers, it also limits access to enhancing treatments; unless people are diagnosed with a condition whose treatment requires a certain enhancing drug, those who wish to use the drug for its enhancing effects are reliant on dinging a sympathetic physical willing to prescribe it (or finding other means of procurement). This creates inequities in access, since those with high social capital and the relevant information are more likely to gain access to enhancement than others.

Nick Bostrom and Rebecca Roache, ‘Ethical Issues in Human Enhancement’, in Jesper Ryberg, Thomas S. Petersen, and Clark Wolf (eds.), New Waves in Applied Ethics, New York, 2007