Should Cognitive Enhancement Be Available Only to Those Who Can Afford It?

In my last column, I wrote about the “enhancement gap” the risk that smart drugs and brain technologies could create a new form of inequality between those who can access them and those who cannot. That raises an uncomfortable follow-up question: if these tools genuinely work, should money be the deciding factor in who gets to use them?

The case for “it’s just a free market good”

One view says cognitive enhancers are no different from other lifestyle products people pay for gym memberships, private tutors, or premium education. In a free market, people argue, those with resources have always been able to pay for advantages, and cognitive enhancement is simply the newest version of that reality. On this view, restricting access or demanding subsidies treats enhancement differently from every other paid-for advantage in society, without good reason.
There’s also a practical argument: regulating or subsidizing enhancers could slow innovation. If companies cannot sell to willing buyers at a profit, there may be less incentive to research safer, more effective products at all.

The case against leaving it to the market

But cognitive enhancement is not quite like a gym membership or a tutor. Physical fitness and private tutoring improve a person’s own capacities through effort; many enhancers claim to alter brain chemistry or function directly, with effects that may compound advantages already tied to wealth and opportunity. If enhanced focus or memory becomes a meaningful edge in exams, hiring, or promotions, then unequal access does not just reflect existing inequality — it actively deepens it.

There is also a question of what we are comparing enhancement to. Essential medicines are often regulated and subsidized precisely because health outcomes should not depend entirely on ability to pay. If cognitive performance increasingly determines who succeeds in education and work, some argue it deserves similar treatment — not because it is a right everyone must use, but because unequal access to it could distort fair competition.

A middle path: regulate, don’t just restrict

Between “let the market decide” and “make it a subsidized public good,” there is a third option many ethicists point to: strong but sensible regulation. This could include:

Setting safety and efficacy standards so dangerous or ineffective products are not sold as enhancers

Requiring honest marketing, so people are not misled about what a product can realistically do
Creating clear rules in specific contexts — such as exams or certain workplaces — about what level of enhancement, if any, is acceptable

Monitoring long-term health effects, since many enhancers are used off-label with limited data on extended use
This approach does not eliminate the role of money entirely, but it reduces the risk of unsafe, unregulated products deepening inequality while still allowing the technology to develop.

Why this question will not go away

As cognitive enhancement technology improves and becomes more mainstream, the “pay to play” question will only become more pressing. Societies have faced similar debates before — over access to the internet, to higher education, to quality healthcare — and the answers chosen in each case shaped opportunity for generations.

The decision about whether cognitive enhancement should be a market commodity or a more carefully governed resource is not just a technical policy question. It is a question about what kind of competition in schools, workplaces, and life more broadly we consider fair.

This is the second in a series exploring the ethics and policy of cognitive enhancement. The next piece will look at enhancement in the Global South compared to wealthier nations, and whether the gap could widen globally rather than just locally.

Written by Caleb Atere
Bioethics Research Student