This Is Your Brain on Smart Drugs

Americans are no strangers to the idea of better living through chemistry. We’ll try anything to boost our brainpower, from eating more salmon, nuts and avocados to popping potentially worthless ginkgo biloba supplements like candy. And then, of course, there’s coffee, the country’s black, bitter fuel. Eighty-two percent of us drink the stuff, and over half of us reach for a cup every day.

But what if, instead, we could simply pop a pill to become smarter? A medication that could make us more alert, sharpen our concentration – even make learning easier. Wouldn’t we clamor for such a wonder drug?

Imagine the benefits, even just for the gaming community. No more choosing between late-night guild raids or sleep. Laser-sharp concentration for all those Halo matches. Even casual players could benefit, chemically amplifying their alertness while they go for that million-point combo in Bejeweled.

But here’s the dirty little secret: The pills are out there, just prescribed for different conditions. Healthy individuals are secretly taking drugs that fix ailing hearts and help kids with ADHD sit still in class, to make themselves smarter.

It’s a trend called “cosmetic neurology,” a term coined by Dr. Anjan Chatterjee, a neurologist at the University of Pennsylvania’s Center for Cognitive Neuroscience. And it’s the future of thought. After all, when it comes to being smarter, who wouldn’t want an extra dose of genius?

But using drugs to enhance your intellect, say experts, is fundamentally different than swilling a cup of coffee. So-called “smart drugs” or “cognitive enhancers” have “the potential to alter the core of a person’s identity by significantly changing her personality,” says Richard Dees, bioethicist and philosophy professor at the University of Rochester. That might lead to, as he says, “unexpected effects.”

Street Smarts: Prescription Stimulants
The most popular cognitive enhancers fall into two main categories: prescription stimulants and beta blockers.

Stimulants – like Ritalin, Adderall and Provigil – are common medications for ADHD and narcolepsy. Although we still don’t understand exactly how these drugs work, researchers believe they bind to transport molecules that clear out certain hormones from the brain after they’ve carried out their functions. Those hormones include dopamine, which effects movement, emotional response and the experience of pleasure and pain, and norepinephrine, which governs attention and impulsivity.

By binding to these transporters, stimulants increase the levels of dopamine and norepinephrine swimming around the synapses, smoothing out any imbalances that may exist. This leads to a “focusing” effect, which reduces impulsive behavior, boosts alertness and improves concentration overall.

Which is probably why students, in particular, so often turn to these drugs. A 2005 survey of more than 10,000 college students found that 4-7 percent had sampled prescription stimulants at least once. At some universities, that rate was as high as 25 percent. “That, in itself, might be an under-reporting,” says Chatterjee, “because people might be reluctant to admit they do this.”

Use is especially high among students enrolled at competitive colleges, who come from highly educated families and get mostly B’s instead of A’s before getting pharmaceutical help. “This is a particular population that feels pressured to perform,” he says.

Among teens, the usage rates may be even higher. A Partnership for a Drug Free America study, surveying 7,300 teenagers in grades 7-12, found that one in five had tried prescription stimulants. What’s more, teenagers felt using the meds was no big deal: Forty percent thought prescription drugs were safer than illegal ones, and a full third said they weren’t addictive.

Students aren’t the only group leaning on stims to keep up. Various doping scandals in the world of sports have revealed the widespread use of stimulants, especially Provigil, by pro athletes. Professional poker player Paul Phillips, who’s won nearly $2.3 million in his career, credits Adderall and other ADHD medications for his success. Even the military has considered stocking up on Provigil, especially for soldiers in sleep deprivation situations.

Street Smarts: Beta Blockers
The other major smart drug category is beta blockers, or meds like Inderal and Lopressor, designed to aid failing hearts.

A weak heart tries to compensate for its feeble beats by pumping faster, but that can strain the muscles even further. Beta blockers slow down the heart by obstructing its “beta receptors,” or proteins that register adrenaline (the “fight or flight” hormone that increases heart rate). That means beta blockers can also reduce symptoms of anxiety, like tremors or a pounding heart.

Although the FDA has been slow to approve beta blockers as an anti-anxiety treatment, that hasn’t stopped many from relying on them to quell their nerves – especially in the classical music world. Often, musicians will rely on them to extinguish stage fright or jitters before important auditions and performances. A 1987 survey by the International Conference of Symphony Orchestra Musicians revealed that 27 percent of its performers had tried beta blockers at least once. More than 20 years later, experts suspect that percentage is now much higher.

Some athletes rely on beta blockers, too, especially shooters and archers, who need precision and steady aim. Using the drugs, marksmen can slow down their pulse, shooting between heartbeats and avoiding a jolt when their weapon fires. (The International Olympic Committee got wise, however, and in 2002 the organization banned the use of beta blockers in its competitions.)

Warning: Side Effects Of Thinking May Occur
Despite their usefulness, smart drugs can also trigger nasty side effects. Ritalin, for example, can cause moodiness, insomnia and psychosis, while Adderall can lead to depression and even anorexia. (Plus, because it contains amphetamines, the drug is highly addictive.) Beta blockers make strenuous physical activity dangerous, and their users can easily become dizzy and nauseated.

Few studies have explored smart drugs’ long-term effects on the body, especially in already healthy individuals. Its one thing to demonstrate a drug is harmless and effective over a six-month clinical trial, but another thing entirely to prove its harmlessness and effectiveness under real-world conditions and years of continued use.

“Most of the drugs that are of any interest have not been tested for long enough periods to know whether they are safe in the long term,” says Dees. “So people have plenty of reason to be cautious.”

That said, any medicine has its risks. “If you’re treating a disease, you’re making a calculated cost-benefit trade off,” says Chatterjee. “To improve your health, some risks in medications are worthwhile.” Those who choose to take brain-boosting drugs often do so in spite of the risks, because “they see some professional benefit.” he says.

But, he wonders, “If you don’t have any disease, is taking any risk worthwhile?”

The Ethics Of Chemical Intelligence
Safety isn’t the only issue; smart drugs evoke several ethical concerns, too. First of all, since insurance companies are unlikely to pay for neuroenhancing therapies, smart pills will probably be available only to those who can front the out-of-pocket expense. “Certainly those with resources would have access to it in a way others wouldn’t,” says Chatterjee.

Therefore, if only the rich can afford smart drugs, could this lay the foundation for a modern, de facto aristocracy, where the upper class isn’t just wealthier, but smarter, too?

If that’s the concern, says Chatterjee, then we have other problems to tackle first. “We don’t live in a culture where fairness is given a lot of priority,” he says. He points to a familiar example: college admissions. An upper-class, suburban high schooler has access to better schools, SAT prep courses, even music and sports clubs that look good on college resumes. An inner-city kid, however, is considered a success story simply if he makes it through 12th grade; college is irrelevant.

“There is no level playing field. People talk about it, but the facts on the ground don’t bear that out,” says Chatterjee. “We’ve already accepted gross inequities in our culture. I think the same would apply to [smart pills].”

Second, if the potential benefits of brain boosting drugs are that persuasive, what’s to stop us from forcing individuals to take them?

It’s not that far-fetched an idea. Precedent already exists in the military; during WWII, soldiers and pilots were often given amphetamines to stay alert, despite sleep deprivation. The practice still occurs in some places.

And there’s no reason the trend would remain confined to the military. One study demonstrated a common smart drug given to Alzheimer’s patients made commercial airline pilots better flyers and more responsive in emergencies. So if smart drugs help pilots fly better, why not require them to take the medication? And what’s to stop similar requirements for ER doctors, politicians, even journalists?

Even if they’re never explicitly coerced, professionals could feel implicitly pressured to take neuroenhancements just to keep up with their peers. “If everyone around you is taking these drugs, and you don’t take them, you feel like you’re just going to fall behind,” says Chatterjee.

But perhaps the biggest ethical concern is one of character. Does taking smart pills degrade our identities, or hamper us from living “authentic” lives? “I find this problem to be the most difficult to deal with,” Chatterjee says. “This might be a situation where it’s impossible to take a position.”

Some critics argue that struggle and failure aren’t just part of the human experience, they’re how we learn. Making yourself smarter via chemistry is somehow cheating, or worse – physiologically harmful. If we rely too heavily on smart drugs, could we fundamentally disrupt the way our brain forges new memories? Could we become a society of roving Algernons, dependent on medication to maintain our intelligence?

Probably not, says Dees. “I don’t think it’s possible to become ‘too smart to fail,'” he says. “I am sure there will always be ways to fail, and learn through our failures.”

More worrisome, he says, is the idea of chemically manipulating your personality to become more focused, driven and determined – essentially, someone who isn’t you.

But “changing our personalities is not itself immoral,” Dees argues. “Otherwise, psychotherapy, religious conversions and boot camps would be immoral,” too.

Thinking of the Future
Currently, no laws prevent overachievers from using legally prescribed drugs to enhance their intellect. In fact, little government attention has focused on this issue at all.

But as America’s population ages and cognitive disorders become more widespread, the issue is destined for greater public debate. “I think we have a spectrum of people: those who definitely want these kinds of medications, [and those] to the other extreme, who want everything to be natural,” says Chatterjee.

For example, everyone could probably agree to ban smart drugs from competitive or assessment situations, like Jeopardy or the SATs. But “I don’t know how you would ever enforce that,” says Chatterjee. “What the long-term consequences of cosmetic neurology are, that’s anybody’s guess.”

And on the ethical side, we’ve still got plenty to figure out. “While I think most of these drugs are not, in principle, immoral, I do think we have reason to be very cautious with them, and only partially for safety reasons,” says Dees.

“We should think carefully about anything that can change the core of our identity. We need to be sure that we know what we are doing, and why.”

Lara Crigger is a freelance science, tech and gaming journalist and frequent contributor to The Escapist. Her email is lcrigger[at]gmail[dot]com.