Would you boost your brain power?
Sarah Tomlin
Wednesday, 12 December 2007 18:35 UTC
Credit: PHOTOTAKE / Alamy
UPDATE JAN 31ST: This week, Nature is publishing two pages of correspondence responding to the Sahakian and Morein-Zamir Commentary. We’re also launching an anonymous online survey to build on the informal questionnaire that the Commentary authors sent to academics on the usage of brain boosting drugs. In aggregate, the survey results will guide future editorial content on this topic. Check back here for more updates.*
Two scientists writing a commentary article in the December 20 issue of Nature want to stimulate your brains – in more ways than one.
Barbara Sahakian and Sharon Morein-Zamir from the Department of Psychiatry at Cambridge University argue that the increased usage of brain-boosting drugs by ill and healthy individuals raises ethical questions that cannot be ignored. An informal questionnaire Sahakian and Morein-Zamir sent to some of their scientific colleagues in the US and UK revealed fairly casual use by academics, and we now want to hear your views on the topic..
The authors arguments can be read in more detail here. An earlier Nature editorial also discussed some of the ethical issues surrounding drug-based enhancement in healthy individuals inspired by a longer discussion paper from the British Medical Association.
To trigger broader discussion of these issues Sahakian and Morein-Zamir propose the following questions:
> Should adults with severe memory and concentration problems be given cognitive enhancing drugs?
> If such drugs have only mild side effects, should they be prescribed more widely for other psychiatric disorders?
> Do the same arguments apply for young children and adolescents with neuropsychiatric disorders, such as those suffering from ADHD?
> Would you boost your own brain power?
> How would you react if you knew your colleagues – or your students – were taking cognitive enhancers?
> How should society react?
Please contribute to this online discussion. We especially want to hear from you if you’re already using these drugs – or if you know people who are. What are your reasons for taking, or not taking, these drugs?
For the next two weeks the authors of the Nature commentary will be joining in the conversation here. Barbara Sahakian also discusses cognitive enchancers on Nature’s podcast, extract posted here
Get ready to expand your mind..
Updated 30 January 2008 18:46 UTC
-
Replies
Jump to resultsResults
-
A few points of clarification in response to issues raised by peter freer:
Regardless of the debate about the over-use or misuse of Ritalin in the classroom, our points still stand. I believe that drugs and indeed any additional interventions to alleviate and improve impairment by whatever mechanisms (ideally coordinated and combined) are warranted. Specifically in the paper we proposed that in the case of impairment ”that medication choice, dosage and timing, therapeutic effects and safety should be monitored for individual patients by a healthcare professional.”Perhaps what has arisen here is the potential to appreciate the limits of current research design and the need to expand on the repertoire of evidence one should consider in regards to the effects of a given treatment for a given disorder.
Current evidence based methodology regards the double-blind placebo-controlled study as the gold standard and rightly so, for many questions this is an ideal tool.
However, as scientists, we are mindful of the gap between the lab and the ‘real world’. This is undoubtedly true for most if not all research areas. There is no ideal or perfect way to do research and address a scientific question, and so every study must necessarily compromise and consequently suffer from some flaws. The source of the problem stems from the complexities of the world, society, of people and their biological systems, and the interactions between all of the above. Current research designs are rather good at isolating a single or a few factors and examining them. However, this leads the design to treat everything else as ‘noise’. To examine the efficacy of a treatment for a certain disorder, the design must overcome countless sources of ‘unwanted’ variance such as the disorder having a spectrum, the severity of the disorder, the biology and psychology of the individual (e.g., additional health problems etc), and very importantly the interaction of the individual with their environment (e.g., physical and social interactions). Add to these the constraints of actually doing research over time with real people with real lives and families, in settings that necessitate a considerable degree of bureaucracy. All these factors together play off each other and can account for the same treatment having a dramatic range of effects within a seemingly uniform group, and of course to a study being less than perfect and flawed. What we, as individuals, are ultimately left to rely on when faced with need for treatment is the available resources we have, our common sense and that of those involved in the treatment (family members, doctors etc). The same treatment or combination of treatments may work wonders for one and be completely useless or worse in another. That is why the pros and cons have to be considered for the individual.
Thus, whilst the recent results of the MTA and additional studies are certainly suggestive, this study suffers from many of the same problems that have plagued previous studies and thus is far from providing a conclusive answer to this enduring debate.
New developments, such as pharmacogenomics, acknowledge important sources of variation and attempt to include factors such as treatment-relevant genetic variation, into the research design. Perhaps in future, new and completely different methods of research will be devised. Ones that can take into account a large number of sources of conflicting variation and move away from the linear model which is at the base of contemporary research design. -
Anyway,I don’t think that it’s necessary for me to use that “drug”. It’s not only because i’m smart enough and always have confidence in myself,but I don’t see there being any way for us to “improve” ones intelligence by using drugs.
To be frank with you,there’s still an awful lot yet waiting to be discovered about what life really is and how it works ,though we seem to have achived “much”.
-
Would I boost my brain power? Absolutely, and I do. The problem is that is took so many years to figure out that I needed it (ADD not identified until I was almost fifty, everybody just thought I was lazy) and that it was difficult to get the medications once it was identified, and even after it was formally diagnosed. Life got much better after a few months, but when I had a mild stroke (now completely reversed) my then-doctor insisted I drop the methylphenidate in favor of a number of things that didn’t get the job done because the drug can elevate blood pressure.
When I changed doctors, we did a daily test of blood pressure, and there was absolutely no increase in those readings during the weeks I was taking the drug. Alas, I had let the previous doctor call the shots, by the time I was back in control I’d lost my house.
Not only did the distribution structure which requires a physician and a pharmacist to hand me pills interfere with managing my situation, it appears to drive the cost up by three orders of magnitude. It just happens that I wrote on this only four days after this story appeared on nature.com. See Gatekeepers and the Cost of Health Care on If I Were King.
Van
-
I suggest that we have to consider also the role of scientists and of industry. Once we have cognitive enhancers, it will become impossible to restrain their use. I know, there is off label taking. But, except for that,why must we go on researching for enhancing pills and afterwards complaining and talking about neuroethics? We could remember that many biothech companies are run by neuroscientists willing to develop drugs based on their patents. And those drugs are aimed to boost brain powers and not to treat disabilities. One, of course, can welcome every finding in science, but he has to be ready to confont its consequences.
-
Anonymous
I apologize for ignoring the authors questions, but todays cognitive enhancers (at least from my modest experience) aren’t very effective for people without concentration problems. This is especially true for us as scientists, where creativity outranks diligence as a desired trait.
A far more interesting class of drugs has been ignored, despite it’s prominent role is both science and art in the last 50 years. Hallucinogenic drugs have had a profound effect on our society and were vastly used, as stated by Nobel winner Karry Mullis (“Back in the 1960s and early ’70s I took plenty of LSD. A lot of people were doing that in Berkeley back then. And I found it to be a mind-opening experience. It was certainly much more important than any courses I ever took.”, Q&A interview published in the September 1994 issue of California Monthly, from Wikipedia). The fact that most (but not all) of them are illegal shouldn’t matter for the scientific discussion, especially considering that a large portion of the use of cognitive enhancers falls under the same category.How would you react to a student of yours using LSD over the weekends in order to come up with bright ideas on Monday ? I guess the thoughts running in some of my readers minds just from asking the question are the reason why I checked the “Hide my identity” box. Never the less, not everyone are aware of the high safety (when properly used) and extremely low toxicity of many of these substances.
In an era when we try mainly to think outside of the box, cognitive enhancers will at best be a poor substitute for self discipline (for health people). This is not to say that it is not essential (the discipline, not the drugs), but despite producing amazing results in some cases, like that of Paul Erdős, expecting cognitive enhancers to do more then raise lab productivity by a few percent is very optimistic. Psychedelic drug on the other hand, along with multi-disciplinary scientific training and a free hand to experiment and try new thing, might represent a more promising way to improve the quality of the work done.
A word of caution, many psychedelic drugs are illegal, some of them are very toxic and almost all of them can cause outbreaks of dormant mental conditions, like schizophrenia.
-
I have been using 50 mg of Modafinil on an almost daily basis for over a year.
I am a clergyman with doctoral degrees in both theology and psychology (doctoral dissertation on Depression). For most of my life, I have struggled with fatigue and highly reduced brain function every afternoon. This is part of my family history (both my father and grandfather, respectively a physician and clergyman, structured naps into their afternoon schedules). To overcome our tradition of “family fatigue”, I briefly tried both caffeine and nicotine but found that they were either not effective or had unpleasant side effects (jittery nervousness).
In the 1980’s I used Desipramine but was distressed with the side effects (eye-dryness is barely tolerable for scholars).
Then, in the 1990’s it was Paxil with a brief foray into Welbutrin. By 1998, I decided that the side effects were not worth the minimal benefits and I stopped all such medications and went the route of my ancestors: one or more brief afternoon naps. I wasn’t fully satisfied with such a regimen,
Then, I discovered Modafinil. At first I used it only infrequently and then only when I desired an extended high-level of focus and attention. (I have worked carefully on the fracture-mechanics of high-silica stone in the replication of ancient techniques of flaking stone tools). I found that in the mornings, I could work competently in fracturing stone (knapping points) for about one hour. However, with Modafinil, I could continue at this high level for almost three hours. It most certainly did not make me “smarter”, but extended the length of concentrated focus.
I next used Modafinil when driving three days across country from our cottage in Michigan. Earlier, on driving from New Mexico to Michigan without Modafinil, I had made a potentially disastrous lapse of attention (mistaking a turning-lane for a through-lane) and narrowly avoided a head-on collision. Therefore, on the return trip, I used Modafinil (50mg a.m.) and found not only that I had no such lapses but that the consequent alertness enabled me to enjoy the trip (cross-country driving had previously been extremely tiring and difficult).
I recognize that a 50mg dose is quite low. However, for me, 100mg does not increase the level or length of focus and can result in some nervousness. This is particularly true if I am in an emotionally stressful situation.
There is good reason to be wary regarding the abuse of some drugs. However, I have not seen any data suggesting that Modafinil is either habit-forming or easily abused. I would think that over-dosing would be self-correcting. That is, inasmuch as no “high” is achieved and no additional benefits accrue, the person taking too high a dose would soon cut the amount of medication to a level below that which results in agitation or anxiety. I have not at all considered the use of Modafinil with children and have not seen any studies in this area.
As to the bug-bear of “competitive advantage”, that is not a public health issue at all but a personal ethical and philosophical question. Today I will give my 7-year-old granddaughter a piano lesson, lead her in a chemistry experiment, listen to her sums, and encourage her to enter any new words of her vocabulary into her personal dictionary. Do I intend to nurture her toward a “competitive advantage”? Oh, you bet! Do I anticipate that will she will need “brain pills”? No, not at this time. However, if she develops signs of our “family fatigue” (the signs are quite clear in those that have it), that issue could be addressed when needed.
-
Is anyone willing to speak up for
the microbial menagerie living in the brain
matter. That,after all, have a very large
stake in this discussion? -
Posted on behalf of Nick Bostrom, Oxford University
I think the target discussion piece is a fine one. I agree with the point that that has been made by several of the commentators, that there is a need for better understanding of the long-term effects of the use of potential cognitive enhancers in an ecological setting. It is one thing to show a short-term positive effect on some artificial lab task. It is quite another to show that long-term use actually leads to sustainable performance gains on important real-world tasks (such as improved academic output). The latter is harder to demonstrate, but it is what ultimately matters.
Unfortunately, progress on developing effective cognitive enhancers, and on understanding their long-term effects, is slower that it could have been because there is a shortage of focused research in this area. In general, the potential of enhancement medicine has yet to be fully appreciated.
Prevailing patterns of medical funding and regulation are organized around the concept of disease. Every pharmaceutical on the market with alleged cognitive-enhancing effects was developed as a treatment for some pathology. The nootropic virtues in healthy adults were discovered as fortuitous side effects. This disease-centric framework impedes the development of safe and effective enhancing medicine. In particular, it has the following consequences:
First, it makes funding hard to come by; it also makes it hard to obtain regulatory approval for enhancement drugs. The result is that those who wish to research cognitive enhancement must often mask their work under the guise of addressing some “respectable” disease.
Second, in order to get access to the benefits of a cognitive enhancer, the user must first be classified as sick. This leads to the expansion of diagnostic categories and the invention of new pathological conditions – sometimes to cover cases that in earlier times would have been regarded as normal human variation.
Third, it contributes to inequity in access. The main obstacle for someone who might be interested in trying modafinil or some related drug is not cost (which is similar to a Starbucks coffee) but information: knowing that the drug exists, and how to obtain it. This discriminates against people with low social and informational capital.
With the cockcrow of enhancement medicine, we need to retool or regulatory paradigm. It is not only special occupations like military commandos and air traffic controllers who would benefit from good enhancement drugs. Many jobs are as important and intellectually taxing – including the jobs of many scientists and academics. Anything that may help our humble brains deal better with the complex challenges of the 21st century is to be not only welcomed but actively sought. But it will require substantial investment to develop interventions that are both safe and effective in long-term use.
Nick Bostrom, PhD
Future of Humanity Institute, James Martin 21st Century School, Oxford University -
Firstly, thank you to the authors for their excellent article.
My question is a simple one: won’t this eventually make us all dumber rather than smarter as we’ll take a pill to save us the hard work of concentration?
Should appeal widely to students?
-
Regarding the suggested use of cognitive enhancers to reduce the care costs associated with an ageing population, there are a number of important ethical and moral issues which have not yet been discussed in this blog. I would like to point to a few important concerns:
1) Perhaps the most obvious issue is the medicalising and pathologising of an otherwise normal but perhaps health-vulnerable segment of society, with the attendant message that the treatment for this ‘old age pathology’ is cognitive enhancement via medication. The side-effects of some if not all cognitive enhancers (as has been already well stated in this blog) in long term use appear to be largely unknown. As older people can have altered drug metabolism it seems reasonable to expect that drug interaction effects and other iatrogenic issues due to polypharmacy are likely to be significant in some individuals, particularly if used in an unregulated way. There are other unwanted psychosocial effects, however, of medicalising the ageing process.
2) The raised expectation (without adequate evidence of efficacy and/or safety) that cognitive enhancers will significantly delay or ameliorate serious illness such as dementia might increase unwarranted demand for these drugs, leading to potential exploitation and financial abuse of older people. Without making any specific accusations of impropriety, we know that the pharmacology industry already makes a huge amount of dosh from older people, and regards anti-dementia drugs as the Holy Grail. The recent debate in the UK over the revised NICE guidelines for anti-cholinesterase drugs shows that many who have studied the evidence base remain unconvinced over the value of these substances in the care and treatment of dementia.
3) With the expectation of increasing care costs and the use of emotive phrases such as ‘burden’ and ‘demographic time-bomb’ society may induce an exaggerated sense of guilt and fear in older people which could add to the likelihood of experimentation with such substances. Scientists, drug companies, health services and commentators have a responsibility to avoid the use of inflammatory language.
4) Perhaps the most important and compelling issue is the largely overlooked evidence base pointing to the value of psychosocial and interpersonal interventions such as cognitive stimulation therapy, to improve cognitive functioning. As with children who can get a leg-up from an enhanced parental or scholastic environment (op cit), the potential environmental and interpersonal influences upon cognitive functioning with older people have been widely written about but have yet to be taken up in the health and social care services within the UK in any widespread way. Instead we see an over-prescribing of drugs and an under-investment in psychological interventions to facilitate improved cognitive and behavioural functioning, despite the existence of RCT evidenced efficacy of such approaches showing benefits on cognitive tests on a par with anti-cholinesterase inhibitors (e.g. Spector et al, British Journal of Psychiatry, 2003). Equally important to wellbeing in older age is the detrimental effect upon cognitive functioning of ‘malignant social psychology’ and isolation written about by Tom Kitwood.
Before we get too excited about the use of cognitive enhancers for ourselves or our parents we need to give serious thought to the kind of society we want to live in, even if these drugs were to deliver on their hype. I am grateful to Sahakian and Morein-Zamir for opening up this debate.
Results
-
