Going mental

It’s time to establish rules for the use of cognitive-enhancing drugs by healthy people
May 25, 2010

Who could object to drugs that help people affected by mental disorders such as schizophrenia? Such treatments, known as pharmacological cognitive enhancers (PCEs) can improve memory, attention and motivation. Methylphenidate (Ritalin), for example, helps children with attention deficit hyperactivity disorder (ADHD) focus better in school, often making an important difference to their lives. Modafinil (Provigil) helps people stay awake and is licensed for the treatment of narcolepsy, a condition that causes sufferers to fall asleep involuntarily. So far, so good. But the past few years have seen an unprecedented rise in the use of PCEs by healthy people. For many students, the temptation to pop a few pills to aid concentration—especially at exam time—is hard to resist. Most of them see it as harmless and ethically acceptable. Others see it as cheating and, as yet, few universities have formal policies on the issue. According to a 2004 report in the Journal of the American Medical Association, around 90 per cent of modafinil is used by healthy, non-sleep-deprived individuals. In March 2009, an informal survey of 1,000 students by the Cambridge University student newspaper Varsity showed that one in ten were taking prescription drugs for cognitive enhancement. The year before, Nature conducted a poll of 1,400 scientists from 60 different countries. One in five respondents used drugs for cognitive enhancement, of which 62 per cent reported taking methylphenidate and 44 per cent modafinil, mainly to improve concentration. Fifteen per cent said they took beta-blockers for anxiety, when such drugs are normally prescribed to reduce blood pressure or irregular heart rhythms. One American professor said he obtained his drugs through his primary care doctor by claiming to have jet lag, while one British professor got his through the internet to “enhance productivity” and “for important intellectual challenges.” More worrying, a 2009 survey by the US National Institute on Drug Abuse (Nida) found that 1.8 per cent of 13 to 14 year olds, 3.6 per cent of 15 to 16 year olds and 2.1 per cent of 17 to 18 year olds abused methylphenidate. The widespread use of cognition- enhancing drugs is perhaps not surprising given that the Academy of Medical Sciences’s 2008 report on brain science, addiction and drugs suggested that a 10 per cent improvement in memory score could lead to a higher A-level grade or degree classification. Small improvements in intellectual performance can lead to significant improvements in outcomes. But what are the advantages and disadvantages of healthy people using PCEs? On the plus side, since PCEs may help those with low cognitive performance, it might be possible to mitigate the effects of poverty on the brain through their use. This could have positive effects on society and the economy as a whole: it has been estimated that a 3 per cent population-wide increase in IQ could reduce poverty rates by up to 25 per cent and increase GDP by up to 1.5 per cent. Of course, even healthy adults who normally function well do not necessarily do their best all the time, because of sleep deprivation, jet lag or other stressors. And PCEs might also enable us to perform better in pleasurable and competitive situations. For instance, Anjan Chatterjee, a neurologist at the University of Pennsylvania, reported that musicians often use beta-blockers to dampen physical tremors, improving their performance. Psychostimulants have also been used to boost soldiers in combat, shift workers and pilots. But not enough is known about the long-term side effects of PCEs, especially in the developing brain. A 2009 report by Nida found that modafinil stimulated areas in the brain known to trigger drug seeking behaviour and addiction. We must also consider why these drugs are being used. Is the pressure to do well in exams, clinch a business deal, or keep up with our “24/7 society” pushing people to use them, instead of traditional means of boosting cognition, such as exercise? Clearly, neuroscientists need to work together with social scientists, philosophers, ethicists, policymakers and other experts to establish clear, safe and ethical rules for PCE use in healthy people. This is the only way that the major advances now being made in brain science can be put to maximum benefit—and minimal harm.