Whose Brains Get Upgraded? Cognitive Enhancement In The Global South And Wealthy Nations

In my first two columns, I explored how cognitive enhancement could create inequality within societies, and whether access should depend on ability to pay. But there is a bigger picture still: what happens when the divide runs not just between individuals, but between entire nations?

The world is not starting from the same place

Cognitive enhancement technologies, whether prescription stimulants, brain stimulation devices, or the research behind them, are developed overwhelmingly in wealthy countries. Universities, pharmaceutical companies, and technology firms in high-income nations hold most of the funding, laboratories, and patents. Naturally, the products and the priorities reflect the needs and markets of those who build them.

Meanwhile, many countries in the Global South are still working to close basic gaps in healthcare, nutrition, and education. In places where millions lack reliable access to essential medicines, advanced brain technologies can feel like a distant luxury, or an irrelevant one.

Why this gap matters

Some might say this is simply how technology works: new innovations appear first where there is money, and spread outward over time. But cognitive enhancement raises a particular concern. If enhanced focus, memory, or learning capacity becomes a real advantage in education, employment, and innovation, then countries without access may find themselves competing at a structural disadvantage in the global economy.
There is also a risk of research bias. Most studies on cognitive enhancement are conducted on participants from wealthy, Western populations. Findings may not translate neatly to people with different diets, health conditions, environments, and genetic backgrounds, yet products built on this research could still be sold worldwide.

A different risk: the unregulated market

Inequality does not only mean being left out. In some low- and middle-income countries, weaker regulatory systems can mean that unproven or unsafe “brain booster” products enter the market with little oversight. Online sales, informal pharmacies, and aggressive marketing can reach consumers who have limited access to reliable health information or medical guidance.

In this scenario, the gap is not just about who gets enhancement, but about who gets safe, well-tested enhancement, and who is left to gamble with products that may be ineffective or harmful.

What could be done?

There is no single fix, but several steps are worth considering:
Inclusive research. Studies should include diverse populations so that findings reflect people worldwide, not just those in wealthy nations.

Stronger regulatory capacity. International cooperation and support can help countries build the systems needed to evaluate and monitor enhancement products.

Fair technology sharing. Wealthier nations and companies can consider ways of sharing knowledge and technology, as has been debated for vaccines and essential medicines.

Local voices in the conversation. People in the Global South should help shape the global ethical debate on enhancement, not simply receive decisions made elsewhere.

The question we should be asking

Debates about cognitive enhancement often focus on individual choice: should a student take a smart drug, should a worker use a brain device? Those questions matter. But they can obscure a larger one: in a world where the benefits of science are already unevenly shared, who will decide how these technologies are developed, regulated, and distributed, and in whose interests?
If we leave that question unanswered, cognitive enhancement may not just reflect existing global inequalities. It could quietly widen them.

This is the third in a series exploring the ethics and policy of cognitive enhancement. The next piece will examine whether workplace pressure could quietly turn enhancement from a choice into an expectation.

Written by Caleb Atere, a Bioethics Research Student