A commentary in today’s issue of Nature authored by a group of attorneys, psychiatrists, M.D.’s and journalists proposes making cognitive-enhancing drugs (so called brain boosters) available to mentally healthy people. The argument that the group puts forward is that enhancing our brains is something that we should strive for as a species, making use of any available technologies to do so. Cognitive-enhancing drugs (CEDs) are generally stimulants like Ritalin, Adderall and Provigil that are used to treat attention deficit hyperactivity disorder (ADHD) and other neurological conditions. Seems that there is quite the black market in CEDs among college students. At some universities, 25% of students report using them in the last year – a much higher percentage than the 4-7% of students diagnosed with ADHD. More surprisingly (to me at least), a survey earlier this year in Nature found that over 20% of working scientists have used CEDs off script. The take home message is that there appears to be a market for these drugs beyond their intended use.

Well, the Nature authors have a plan – make CED’s available to mentally healthy and competent adults. As scientists are wont to do, the authors posit that “we should welcome new methods of improving our brain function”, a statement with which I tend to agree. I do not agree, however, that one of those methods should be pharmaceutical stimulants. Nor do I think that medicating healthy people, a practice that is happening with increasing frequency, is a good idea. So, from my very small soapbox in the Southern Hemisphere, I’d like to offer a brief rebuttal. Here are three issues that I think the Nature authors didn’t fully consider.

1. More drugs = more money for drug companies = more drugged consumers. In the interest of full-disclosure, I work in the pharmaceutical industry, albeit not for a drug company. That being said, I don’t think that the drug companies need any help in propagating their vanity drug markets. We are so medicated in the West, I suspect that Big Pharma isn’t really feeling the pinch in the current economic clusterfuck. Sales of Viagra may be down a bit, but I doubt that a lot of people are going without their cornucipias of hastily prescribed magic pills.  In 2006, global spending on prescription drugs topped $643 billion, half of which came from the U.S. alone. I’m sure that execs at Novartis, Shire Pharma and Cephalon did a fair bit of dancing and squealing when they saw the Nature editorial. Two of  the seven authors of this editorial, in fact, disclose that they have consulted, hold shares in or have received grant money from companies that could benefit from easing of regulations on CEDs. In a delicious tidbit of irony, one of the authors is a bioethicist.

Leaving aside dodgy dealings, my biggest issue is not stimulating the pharmaceutical industry with, well, stimulants but the fact that as a culture we are just overmedicated. I’m not talking about life saving drugs, if you can treat crippling disease with a pill, then by all means do so. But their are literally hundreds of so-called vanity drugs on the market – pills that make you feel at ease at your office Christmas party, pills to help you lose weight without doing any work, pills to help you sleep, pills to help you stay awake, pills to arouse you, pills to calm you, pills to make your boobs bigger, pills to give you a sun tan, and on and on. The simple truth is that in an unholy alliance between Big Pharma and Big Advertising we are slowly being programmed to believe that the secret to happiness comes in pill form and making CEDs more readily available will just push that agenda a little bit further into the public consciousness. Do you want to be smarter? Go and read a book.

2. Harmful side-effects and addiction. There are a huge number of reports of harmful side-effects of CEDs. One of the Nature authors admits herself that long term efficacy and toxicology studies have not been carried out on most of these drugs and to be fair, in their commentary they propose that these tests be undertaken. I’m not going to go there, because I don’t have the time and inclination to wade through the research. One of the Nature authors admits herself that long term efficacy and toxicology studies have not been carried out on most of these drugs. But what I can write a little about is the potential for addiction to and dependence on CEDs if they are made more easily accessible. I’m not a puritan nor a prohibitionist. I think people should be able to have a good time and for a lot of people booze or other drugs is a means to that end. I think that most recreational drugs should be legalized, regulated and heavily taxed by the government – could go a long way to improving health care and reducing prison populations as well as helping third world farmers. But, I doubt even if drugs were legal, that the scientific community would get behind heroin use by healthy people as an anti-anxiety medication. This is largely because heroin is extremely addictive and most responsible scientists recognize the danger of drug addiction and dependence.  Most CEDs are quite potent stimulants as are things like caffeine, cocaine and methamphetimine. And like these other stimulants, there is evidence to suggest that CEDs are potentially very addictive substances. However you feel about the War on Drugs™, I’m not convinced that making more addictive substances more widely available and encouraging their use is necessarily the best approach. I’m not sure that creating a population of amphetamine users is a good way to solve society’s ills.

3. Social issues. Something that the Nature authors don’t address is the social costs of their proposal. In most of the world, where medicine is handled by the state, brain boosters for everyone puts an immense burden on the already overburdened health services. Do the authors propose that the NHS in Britain or Medicare in Australia pay for everyone’s brain boosters? Where will the money come from? If the national health services will not pay, or in the U.S. and the other handful of countries in which the government does not insure the health of its population, this gives a decided advantage to those who have the money to buy CEDs. If we assume that they work then a person who can afford the drugs has a decided advantage over one who can not. This potentially causes further social stratification in Western countries in which the divide between rich and poor gets bigger each day.

The authors of the Nature editorial call for “enforceable policies concerning the use of CED’s to support fairness, protect individuals from coercion and minimize enhancement-related socioeconomic disparities.” That’s great, but how does it work? Let’s assume that a worker on Adderall is more productive than his non-drugged coworker. The speed-freak will move up the corporate ladder more quickly, making more money with which to buy more and better CEDs. We’re already moving toward an effective plutocracy in the West, if you can improve mental performance in a cash dependent way, well that just gets worse. The fairness thing, sounds good, but how on earth do you enforce it? Using the same example, how do you prevent employers from showing preference to the higher performing speed freak? How do you prevent employers from ‘encouraging’ unwilling teetotalers from getting on the brain booster train?

My two cents. Maybe I’m being a prude. Maybe I’m being a luddite. Maybe a paranoid. What do y’all think?

————————-

Image credits:

Pill head

Pretty pink pills

New York’s Panda Bear (of Animal Collective) got a fair bit of well-deserved press for last year’s melodic, Beach Boys inspired “Person Pitch” which is available on Panda Bear - Person Pitch.

 
icon for podpress  Panda Bear - "Take Pills": Play Now | Play in Popup | Download

Popularity: 45% [?]