Medicines that make you smarter

10 September 2012
Posted by Ginny Smith.

Humans have always devised ways to overcome our shortcomings- we couldn't fly, so we invented aeroplanes; we couldn't breathe underwater, so we invented submarines and scuba-diving equipment; we couldn't analyse huge amounts of data in our heads, so we invented computers. This ability to devise machines to enable us to do things that would otherwise be impossible has allowed us to expand to fill almost every corner of the planet, and to perform feats of science, art and engineering that would be impossible for any other animal.

CoffeeAs well as creating machines to help us, we have always searched for ways to make ourselves more efficient, faster, stronger, and smarter. Millions of people rely on the caffeine in their morning cup of coffee to give them the kick to get out of bed, and sport is a minefield of legal and illegal drugs and techniques designed to help athletes to perform to the best of their abilities (or even better!). Now a new generation of drugs are being used expressly to enhance our mental capacity. These tablets can, quite literally, make you smarter.

Chemical structure of methylphenidateMost of these drugs were originally developed to treat various medical conditions, and have only recently begun to be used by the healthy population for a mental 'boost'. Ritalin, for example (the chemical name of which is methylphenidate), is a stimulant related to amphetamine, and is prescribed mainly for the treatment of attention deficit hyperactivity disorder (ADHD). It is useful in these cases as it increases attention and helps prevent the easy distraction that is so common in the disorder. It does this by blocking reuptake of dopamine and noradrenaline in the brain, so increasing the availability of these neurotransmitters. For the same reasons, Ritalin has become a popular drug for students to take whilst studying for exams.

Other commonly used drugs include modafinil, which is intended to help those who suffer from narcolepsy by relieving their daytime sleepiness, and beta-blockers, which help reduce anxiety. A survey by Nature found that 20% of the 1400 respondents had used one of these 3 drugs for non-medical reasons. As well as students using it to help with studying, it is used by shift workers to keep them alert, and by travellers to avoid jet lag. It has been shown that it can be effective in relieving shift work sleep disorder, however there are worries that people may become too reliant on it, or start to believe they can go without sleep at all, which could be hugely damaging to the brain.

ModafinilAside from being interesting from a scientific standpoint, these drugs have raised some fascinating ethical dilemmas, and academics seem divided on the point. In one camp are those who think that it is always wrong to tamper with a healthy brain in order to improve it. They argue that these drugs were designed to help those with a disorder, and to use them to improve the abilities of a healthy person is immoral. The worry is that if some people in a social group, e.g. students, were taking the drug, it would become almost impossible for others to compete without also taking the drug. A parallel to this was seen in the 1970s and 80s, before mandatory drug testing was introduced in athletics, where steroid use became almost necessary in order to compete.

Widespread use of cognitive enhancers could lead to a situation in which young people were forced to medicate themselves in order to compete in academic situations. As well as putting added pressure on an already stressed and vulnerable group, the question of elitism is raised. These cognitive enhancers are not going to be available for healthy people on the NHS, and are unlikely to come cheaply. There is already an educational divide, with children whose parents can afford to send them to the best schools, or pay for extra-curricular tutors, coming out with better results than those children who have not had this extra support. If only the rich could afford these drugs, that would give them another advantage, which seems unjust. It is possible that in 20 years' time, children will have to be tested for drugs before being allowed to sit an exam, much as athletes are today.

Another worry is the long term side effects of these drugs. Although they have not been shown to have any serious side effects during short term usage, they are relatively new compounds, so there is a lack of evidence about what chronic usage could do to the brain. This is particularly important due to the likelihood of the drugs being used by young people, whose brains are more vulnerable to disruption. Even in the case of Ritalin, which has been around for over 35 years as a treatment for ADHD, it is not clear what effect its chronic usage may have on the developing brain (partially as is it difficult to disentangle the effects of the drug from the effects of the disease itself). All medicines have side effects, but in most cases it is argued that their benefits, in correcting something that is wrong with the body or the mind, outweigh their disadvantages. In the case of using a drug to self-improve, rather than to medicate, however, it could be argued that the positives are not worth the risk of the negatives, in any circumstance.

However, there are also positives that could come out of the use of cognitive enhancers, and many academics do not believe they should be banned or controlled. A philosophical argument for this is based on J.S Mill's theory of Utilitarianism, which argues that adults should be allowed to do what they like, as long as it does not cause harm to those around them. Based on this argument, if a rational adult looks at the possible risks and unknowns surrounding taking a drug, and decides that its benefits make it worth taking, it is not the government or society's place to tell them they cannot do so, as long as they are not harming anyone else. A less theoretical argument looks at the possible benefits to society that could come from people taking these drugs - if a cure could be found for cancer by giving researchers cognitive enhancing drugs, conceivably that benefit would outweigh any negatives that may occur by making the drugs available.

Surgeons at workCognitive enhancers could also be helpful in many high pressure jobs. Surgeons often have to concentrate for very long periods of time when performing tricky operations, and many rely on caffeine to help them with this. Large amounts of caffeine, however, can cause side effects such as tremors, which are less than ideal when performing delicate operations. Drugs such as modafinil have been shown not to produce such side effects, and so could be used to keep surgeons alert and focused on a difficult operation. They could also be useful for pilots, whether fighter or commercial, and in any other jobs or situations where a momentary lapse in concentration could be catastrophic.

These drugs could have major benefits for our society, but the negatives of their long term use are unknown. The debate over how, or whether, to control these substances has high profile supporters on both sides, and it is unlikely the issue will be resolved any time soon. What is clear is that the field of neuroethics is growing in importance, and it is likely that as brain science progresses the need for discussions of the philosophical, medical and even political aspects of cognitive enhancement will only increase.

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