

By Andrew Hessert, Andrew Medvecz, Jimmy Miller, Jacquelyn Richard

Barry Bonds elevated his game to the next level with “the clear” and “the cream”, shattering legendary records in the process. Are scientists, students, and other academics about to do the same?

While stars such as Barry Bonds and Jason Giambi continue to defend themselves against their alleged use of performance-enhancing drugs, a new debate over the use of a different kind of performance-enhancing drug has begun to rage in the scientific world.



Cognitive enhancers like Adderall and Ritalin have commonly been used as a treatment for behavioral disorders such as Attention Deficit/Hyperactivity Disorder. However, these drugs are now becoming popular “performance enhancing” substances for healthy individuals trying to gain a competitive edge by boosting their overall cognitive function.

Henry Greely, a Stanford Law Professor, advocates for unrestricted availability of these drugs, claiming the enhancers will level the “cognitive playing field” and spark a new era of increased innovation. But Greely and other advocates fail to recognize the severe personal and societal consequences that such availability would generate, looking instead to a pharmaceutical solution that would, in the end, cause more problems than it would solve.

How They Work

Ritalin and Adderall have been on the market since the 1960s to treat conditions like ADD and ADHD (Center for Substance Abuse Research, 2005). While the specific mechanisms of these disorders have yet to be fully elucidated, cognitive enhancers have been successful in controlling or mitigating symptoms in patients. Ritalin (methylphenidate) and Adderall (dextroamphetamine) both inhibit dopamine reuptake, allowing dopamine signals to remain active for longer periods of time (Jones, Joseph, Barak, Caron, & Wightman, 1999). Provigil (modafinil), an alternative to the potentially addictive dopaminergic drugs, operates in similar fashion, but instead blocks reuptake of the neurotransmitter norepinephrine.

The increased neurotransmitter activity induced by these drugs stimulates many areas of the brain (see right), including the prefrontal cortex, which is responsible for a person’s ability to focus and strive toward a specific goal. This stimulation theoretically counters fragmented synaptic signaling in the brain, one suspected cause of ADD and ADHD.

While these drugs increase focus and concentration for people with attention disorders, they can also increase prefrontal cortex stimulation among people without such disorders (Devilbiss & Berridge, 2008). The increased ability to focus and concentrate on specific tasks is clearly of great social utility. These benefits, however, are not without negative consequences; numerous side effects including hallucinations, headaches, nausea, and depression have been documented.

How They Are Being Used

A growing number of healthy Americans are using cognitive enhancers in an attempt to gain a mental edge in our competitive society. The popularity of these drugs is rapidly increasing in many areas of society and has become particularly prevalent among corporate executives, academics, and college students.

An article in the January issue of TIME Magazine describes a high-level executive who uses Adderall to “continue the lightning pace and constant multitasking his job requires” (Szalavitz, 2009). Since receiving the prescription from his doctor, he says he has been better able to maintain his high level of performance, a development he attributes to his use of cognitive enhancing drugs.

The TIME article also addresses the rising use on college campuses (Szalavitz, 2009). Studies have found that 7% of college students have used a cognitive-enhancing drug for non-medical purposes, and on some campuses up to 25% of students have used enhancers to aid studying. Unsurprisingly, usage rates are higher at prestigious institutions, where students feel the need to keep pace in an overly-competitive academic atmosphere. Taking a cognitive enhancer the night before a final can help you focus for an extra hour or two, and many students believe that hour may mean the difference between an A and a B.

Improving academic achievement, however, is a complex issue—popping pills may not be the cure all for low grades. Studies have shown the association between sleep and learning; shorting on sleep to study may still lead to lower grades even with cognitive enhancers (Curcio et. al, 2006).

Among the scientists polled in a Nature study conducted in 2008, nearly 20% reported having used cognitive enhancing drugs for non-medical purposes (Maher, 2008). The most popular motivation was the desire to increase concentration, with other reasons including increasing focus, counteracting jet lag, and other miscellaneous responses. Interestingly, over half of the respondents reported experiencing negative side effects yet still continued taking the drugs.

Arguments FOR Use with the General Population

Stanford Law Professor Henry Greely is a leading proponent for making cognitive enhancers available to the general population. In his hotly-debated article in Nature, he argues that research into the benefits of the use of cognitive enhancers among the healthy population should be explored. Greely claims that the term “enhancement” has been marred by its comparison to athletics, saying “better-working brains produce things of more lasting value than longer home runs” (Greely, 2008).

In one of his main points, Greely argues that using a cognitive enhancer is analogous to any other practice intended to improve mental function, such as sleep, nutrition, and exercise. Just as these practices provide cognitive enhancement, so would the use of drugs like Adderall, Ritalin, and Provigil. These drugs have the potential to be very beneficial, and “we should welcome new methods of improving our brain function,” says Greely.

Greely further contends that cognitive enhancers may potentially “level the playing field,” allowing disadvantaged students to overcome educational gaps. Take the example of standardized tests like the SAT, which many colleges like Notre Dame use in evaluating applicants. These tests have been shown to be statistically biased against African Americans, Hispanics and other ethnic minorities (Freedle, 2008). It is possible that the use of cognitive enhancers could help them overcome this bias, promoting greater acceptance rates of minorities at prestigious universities. Used in this way, the drugs would be elevated beyond the individual desire to gain a competitive edge, and be employed as a tool to remove educational barriers, a significant cause of socioeconomic inequality.

Research focusing on the use of cognitive enhancers by healthy individuals is sparse. Greely recommends that studies in the area of cognitive enhancement be developed in order to build a knowledge base concerning usage patterns, benefits, and associated risks of these drugs. These studies could then be employed in developing an informed legal policy aimed at preventing coercion and mitigating the potential for abuse.

In a recent New Yorker article entitled Brain Gain, Margaret Talbot presents a more moderate defense for the legalization of cognitive enhancers. Talbot compares the use of cognitive enhancers to elective cosmetic surgery—both are personal choices, with inherent risks and benefits, designed to enhance particular attributes.

While not as far reaching as Greely’s assertions, Talbot’s arguments against a ban on cognitive enhancers focus on practicalities; cognitive enhancers are already in wide circulation and are being used responsibly among academic and business professionals. While cognitive enhancer use may not be ideal, Talbot argues that people should be allowed, after being informed of the risks and benefits, to make their own decisions about enhancement of their minds and bodies.

Argument AGAINST Use with the General Population

While many support Greely and Talbot’s positions, they are not without opposition. Our arguments against popular use of cognitive enhancers stem from ethical, medical, and social concerns. We believe that promotion of cognitive enhancers in the manner described by Greely is irresponsible and neglects the more fundamental issues at the root of the problems he addresses. Talbot, while more moderate than Greely, still fails to consider the social and cultural consequences of widespread usage.

Among the many troubling aspects of cognitive enhancers are the potential negative side effects. Little is known about the long term effects of these drugs, and many of the documented short term side effects would likely affect healthy users as much as those with disorders. Imagine getting a headache from taking Provigil when you are trying to prepare for an exam the next day. In this case, the drug you are using to improve your cognitive ability is ultimately hindering it.

More serious side effects such as depression and insomnia, while not fully understood, can cause severe harm to someone who would not have otherwise developed these conditions. The striking recent instance (April 22) of a young boy hanging himself while taking ADHD meds and other incidents like it raise significant questions about the safety of these drugs, especially among people for whom the drug is a luxury and not a necessity.

Also, because Ritalin and Adderall act on the mesolimbic dopamine system, the pathway commonly associated with addictive substances such as cocaine, users run the risk of developing a dependency or becoming addicted (Volkow, Fowler, & Logan, 2009). Addiction is a high price to pay for using a drug that provides limited benefits.

Of further concern is the likely inevitable consequence that widespread use of cognitive enhancers would lead to intense social pressure and even forms of coercion. It is already clear that some executives feel these substances are necessary to remain competitive. More students at competitive universities would likely be pressured to use these drugs when they see other users getting better marks. General availability of cognitive enhancers in our society could easily make these drugs a necessary component for success rather than an optional boost.

Furthermore, the disparity that Greely proposes would be overcome by cognitive enhancers may instead be exacerbated. The financial means that are required to obtain these substances restricts their availability to those who can afford them. Look back at the earlier example of ethnic minorities using cognitive enhancers to improve SAT scores. Traditionally these minority groups are also economically disadvantaged and would lack the means necessary to acquire these drugs.

The real benefactors from widespread availability would be the rich, who already perform better on standardized tests. Promoting the use of cognitive enhancers would likely serve to widen the already significant divide between socioeconomic groups. Reducing the disparity within a population cannot be accomplished by using cognitive enhancers; the drugs would only reinforce the present socioeconomic barriers.

Talbot, on the other hand, places too much emphasis on personal freedom as a justification for legalization, glossing over the social and cultural implications sure to follow from widespread usage. Within her own article she recounts the story of a poker millionaire who made his fortune with the help of cognitive enhancers. His use of these substances was an isolated personal choice but had social consequences as well, allowing him to gain an unfair competitive advantage over the other players.

Justifying cognitive enhancement in the academic and business worlds on the basis of individual freedom ignores the social consequences of unfair neurological advantages in the extremely competitive context of these cultures. Cognitive enhancer legalization cannot be framed in a purely individual context; legalization will have widespread social consequences.

Conclusion

Greely and others are right in asserting that the debate over cognitive enhancers is not entirely analogous to baseball’s steroid scandal. Cognitive enhancers do provide significant long term mental benefits and arguably some social benefits. However, as we have argued, these benefits are outweighed by the physical side effects and social ramifications that such use would entail.

Moreover, any suggestion that these drugs could level the playing field fails to account for the complexities inherent in such problems. Issues like educational disparity and social pressure to boost achievement demonstrate these complexities and are fundamentally socioeconomic and cultural problems. Throwing drugs at these issues will not bring resolution. Rather a cultural- and sociological-based approach is best suited for this task. While we recognize the benefits of these cognitive enhancers, their use should be restricted to the treatment of cognitive disorders.

Bibliography

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Tansey, B. (2008, December 8). Experts urge wider use of brain-boosting drugs. San Francisco Chronicle.

Volkow, N. D., Fowler, J. S., & Logan, J. (2009). Effects of Modafinil on Dopamine and Dopamine Transporters in the Male Human Brain: Clinical Implications. Journal of the American Medical Association , 1148-1154.