Brain Drugs

There seems to be an accelerating drumbeat of calls for the legalization of "cognitive-enhancement" drugs. Nature, the scientific journal, has been at the forefront, with featured articles in December 2007 and December 2008. There have been supportive articles in the New York Times and the New Yorker, with another rumored for The Atlantic this summer. Last year the National Academies published Emerging Cognitive Neuroscience and Related Technologies, focusing on possible military applications. The Brain Matters conference this fall will feature several presentations on cognitive enhancement; judging by their titles, some are skeptical while others are supportive of the concept.

Nature conducted a poll (voluntary, so not necessarily accurate) to which 20% of responding scientists replied that they had taken Modafinil (Provigil), Methylphenidate (Ritalin), or Beta blockers such as propranolol (Inderal) "to improve concentration or cognition." This fits with widespread reports that Provigil is "the 'entrepreneur's drug of choice' around Silicon Valley." Another drug used by some people looking for an edge is Adderall, an amphetamine-based stimulant that is legally prescribed for attention-deficit hyperactivity disorder (ADHD).

Responses to this issue have been notably polarized. Nature's 2008 piece drew the classic "What were they smoking?" response from both George Annas and Christopher Wanjek, and a flood of comments such as "I think this is probably the silliest idea I have yet heard being suggested by some otherwise really smart people." Proponents, however, vigorously assert that, for instance: "Reading is utterly unnatural and learning to do it is a big cognitive upgrade. So is, for that matter, taking an elementary principles of reasoning course."

Psychology Today has been warning for years about the dangers of off-label use of Ritalin. For children, there are particular issues with brain development, but long-term use in adults may well have as-yet-unknown side effects. The present discussion seems to be based on an assumption that these and similar dangers can and will soon be eliminated, which is highly unlikely, as Annas points out: "Very little in the body is isolated from everything else."

That's a general physical concern. In addition, there are questions about the objective value of the drugs that some users are convinced help them. For example, a proponent in the New Yorker piece describes his experience:

I alternated between speaking too quickly and thoroughly on some subjects and feeling awkwardly quiet during other points of the discussion. ... It's always hard to eat much when on Adderall. ... [I spent] too much time researching a paper rather than actually writing it -- a problem, I can assure you, that is common to all intellectually curious students on stimulants.

Joshua Foa, a journalist who tried self-medicating in 2005, noted "a nagging suspicion that I was thinking with blinders on" that has led some to suggest that such drugs may in fact reduce creativity (while perhaps increasing the subjective feeling of being creative). He quotes Eric Heiligenstein, clinical director of psychiatry at the University of Wisconsin:

It's something I've heard consistently. These medications allow you to be more structured and more rigid. That's the opposite of the impulsivity of creativity.

Another possible problem, should use of "cognitive enhancers" become legal, is coercion to participate, either directly (from employers, including the military) or indirectly. That could also lead to social problems: What if a pill that could help you pass an exam was so expensive that you could not afford it -- but some of your fellow-students could? Stanford professor Hank Greely et al., writing in Nature, considered this issue. Their response:

One could mitigate this inequity by giving every exam-taker free access to cognitive enhancements, as some schools provide computers during exam week to all students. This would help level the playing field.

But then, what if that pill helped with the exam but doubled your chances of developing, say, kidney disease later? You might choose not to take it, but your peers might -- ambitious young people are notoriously likely to take risks and careless of the future. (One survey of Olympic-class athletes found that more than half would take a performance-guaranteeing drug that would kill them after five years of success.) If a significant percentage of students were willing to dope, the rest would slip down the grading curve. Indeed, some of the better long-term candidates might, under this system, fail.

"Cognitive enhancement" for willing adults is undeniably appealing; so are superpowers and Batmobiles. Let's at least hope that deeper and broader discussions will spread a note of caution and common sense. Fantasies are no basis for public policy.

Cross posted at CGS's Genetic Crossroads blog at the website of Psychology Today.

Previously on Biopolitical Times:

• "A conspiracy of hype"
• Baseball Enhances Philosophy
• Hank Greely on CGS and Human Genetic Modification
• Enhancement: Of breasts and bottom lines
• Congrats on the Great School Work! Here’s a New Nose