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What’s Wrong With Smart Drugs for All?
Is it smart to take smart drugs?
Posted April 6, 2011
There is a growing interest in the use of so-called ‘smart drugs' for the enhancement of cognitive functions. The argument often goes something like:
‘we now have some very safe drugs that help people to concentrate more effectively and that can alleviate tiredness. These drugs (such as methylphenidate and modafinil) should be seen as any other tool (such as computers) developed by humans to enhance their functioning. They should, therefore, be made available to everyone, instead of just being used by people who have impairments such as ADHD (for which methylphenidate is often prescribed) or sleep disorders (for which modafinil is often prescribed).'
I disagree.
Safety Issues
It is difficult to say what precise neurological damage that these drugs might do, having said this there is cause for concern. The point to emphasise here is that the present level of knowledge on the short and long term effects of commonly prescribed drugs of this type is based on evidence from carefully controlled clinical trials, and reports provided by qualified medical practitioners on specific effects they have noticed in patients to whom they have prescribed the drugs. One of the most commonly used drugs of this kind is methylphenidate (MPH) (brand name 'Ritalin') which is widely prescribed for Attention Deficit Hyperactivity Disorder (ADHD). There is widespread consensus among clinicians that this is a relatively safe drug when administered under medical supervision, which prescribes the dose level (which may differ considerably between individuals), frequency and method of administration. The evidence suggests that for most people an appropriate dosage produces short term improvements in the ability to concentrate and control excessive motor activity. Side effects include insomnia, headaches, stomach pains and appetite suppression. Though these effects are not experienced by all who take the medication, and these effects are usually not so severe as to outweigh the benefits to the patient, which will include an improved capacity to exert self control in home and school settings, with associated effects of being able to engage more effectively with learning tasks and have less of a tendency to be on the receiving end of punishment and nagging from exasperated adults. It should also be noted that MPH is not suitable for everyone such as individuals who have a history of seizures or who suffer from Tourettes.
Inevitably, less is known about the effects of the illegal use of MPH, though Morton and colleagues (2000) stated that 'the entire therapeutic profile [of MPH] starts to change when it is abused'. ‘Abuse' equates with use of such drugs without clinical supervision. It is known that when MPH is used for recreational purposes it is often used in much higher quantities and administered in ways which distort or exaggerate the clinically intended effects. Thus abusers of MPH sometimes crush the tablets to powder and 'snort' it, or inject a solution of MPH intravenously. These methods of administration lead to effects similar to those obtained from the use of cocaine and amphetamines. A brief state of euphoria follows that over time requires increasingly higher doses to achieve. Side effects from abuse include symptoms akin to those of schizophrenia, depression and anxiety problems, including panic attacks. Prolonged abuse has been associated with psychotic symptoms including hallucinations and paranoia.
Long term effects of abuse on the brain are not well understood, but recent evidence (Carlezon and Konradi, 2004) found that high doses of MPH in mice have led to changes in parts of the brain associated with reward systems. These affects were found to be the same or greater than those of cocaine. This finding should not be taken out of context or seen as a challenge to the relative safety of MPH when used under clinical supervision. It emphasises, however, the power of this drug and the potential dangers associated with its unregulated use
It seems sensible to conclude from this that there are enormous differences between MPH when it is prescribed and controlled and when it is abused.
Furthermore, because MPH can only be legally obtained via regulated sources, individuals who wish to abuse MPH often resort to unregulated sources (including internet pharmacies) for supplies. Such sources offer no guarantee of the composition of the substance being bought or the conditions in which it has been manufactured. This adds a further set of potential problems in terms of poisoning.
Clearly, not everyone who abuses MPH is doing so in order to obtain a 'high'. As I have already stated, some people may use it to help them concentrate better and work harder. However, the argument that is commonly used about alcohol is pertinent here: ie. that it would be not be legalised if it were discovered today because its benefits are outweighed by its potential for abuse and its toxicity.
There is also the important point that there is no association between the use of MPH under clinical supervision and addiction: addiction to MPH is only associated with abuse of it (Wilens, 2003).
Legalization
These drugs are legalized for use under clinical supervision, and this is how it should stay to reduce opportunities for widespread abuse, and to ensure, as far as possible that the drug is used for its designated purpose and with optimum attention to safety issues.
In relation to MPH there is no reason to believe that individuals who take it to help them study for exams do any better than they would if they used appropriate study methods. It could be argued that if there is any value to exams (and I know there arguments against.,..) these surely include the self organization, discipline and planning that go into to preparing for them. There are also plenty of well known strategies for improving the retention of information in memory which are useful in exams and helpful in many situations.
The use of MPH (and other smart drugs) for enhancing cognitive performance in people without impairments: should this be allowed?
Part of the problem is the relatively recent phenomenon of certain individuals and groups arguing for the legalization of drugs such as MPH for use by anyone who wants them, for example for purposes of studying more effectively or for work purposes (eg. being able to do without sleep for longer periods of time than are normally possible). Who, apart from the idividual who has taken the drug, would be happy about the idea that a person's performance in an exam has been achieved through chemical enhancement when the person next to them in the exam gets a lower mark without enhancement? This simply becomes another arbitrary way of making some people appear more competent than others. Also, I am concerned that when people who have come to rely on chemical enhancement to perform becomes unconfident about performing that function when they can't get their medication. This becomes a serious problem if the person concerned is a surgeon, pilot, air traffic controller or children's crossing warden.
Some people might argue that smart drugs are simply like any form of tool that humans use to extend their capabilities. My response to this is that there is almost always a trade off between such technologies and human needs. For example: the industrial revolution has brought enormous improvements to the world, not least in relation to improving the quality and length of peoples' lives. On the other hand, some people argue that the price of this is the destruction of important parts of the natural world, and, potentially, humankind itself. The message for me is that just because something is made easier by technology doesn't make it a good thing. For example, I like to think that I can work out, broadly speaking, whether or not I am being over charged in a restaurant, even when I have forgotten to take my calculator with me. Similarly, if I ever have the misfortune to have to measure the radiation level in dysfunctional nuclear power plant that I will have the understanding necessary to figure out if the reading I am getting from the measuring device I am using using is realistic or not.
The real question here, for me, is what would the benefit be to humankind of making smart drugs available to everyone? It might mean that people could do things with less effort than before, which might turn into the generation of more of something. we need tyo ask the qyuestion: do we really need more of the kinds things that people would produce in these augmented states? I am thinking of the kinds of outputs produced by students, academics and journalists, who already generated far more words, far more easily than their pre-digitized forebears. Has more meant better? Or, do we need more quality in those things? Would the solution be to give the smart drugs just to some (already smart) people? The problem here is the same one that attaches to all 'elites'. Who decides who is elite and who isn't? What are the consequences for those who are not deemed elite? It is usually only a matter of time before 'elite' equates with the emperors' new clothes. Remember when only 'clever' people got to go to university?
And finally, not forgetting the human tendency make weapons out of ploughshares...
It is easy to envision a situation where people would willingly take such drugs for short term gain, and then once in positions of power make overt or tacit demands on those over whom they have power to follow their example. In these circumstances the adult can say 'I refuse to do this!' But many wouldn't.
And this raises obvious concerns when we think about children. It is one thing for an adult to choose to use smart drugs, but it becomes a form of child abuse when a parent induces their child to take such medications without a prescription.
Referrences
Carelzon, W and Konradi, C (2004) Understanding the neurobiological consequences of early exposure to psychotropic drugs: linking behavior and molecules, Neuropharmacology, 47, 1, 47-60
Morton, W and SWtockton, G (2000) Methylphenidate abuse and psychiatric side effects, Primary care Journal of Clinical Psychiatry, 2-5, 159-164
Wilens, T.E., et al. (2003) Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 111, 1, 179-185
