Cognitive Daily

Last year, a friend of Greta’s died tragically young. He was a pillar of the community, and Greta was honored to learn that he wanted her to play the oboe at his memorial service, which would be attended by hundreds of people. Greta has performed in countless concerts, with audiences just as large, but the thought of flubbing up at a ceremony honoring the life of a great man was absolutely nerve-wracking. The problem was compounded by the fact that Greta herself was in mourning for her friend.

In the end, she was able to summon up the courage to play beautifully, and received dozens of compliments after the service. One friend, a professional musician, asked about how she handled her nerves. She honestly told him that she didn’t know: she just started playing and hoped for the best. He said that for high-pressure performances like that, he always used a beta-blocker — a prescription medication for clinical anxiety. Indeed, the International Herald Tribune reports that using such drugs is becoming routine for musicians, whose reputation can be shattered by an ill-timed crack or bobble.

I certainly wouldn’t have faulted Greta if she had sought out a prescription for such a drug when she learned of her friend’s request in the weeks before he died. It’s an exceptional situation, and if a little medication could help, wouldn’t it be better for all concerned? But if musicians routinely depend on such drugs for everyday performances, then where does it stop? Should we prescribe the drugs for students? At what age should they start?

This is just one facet of a broad debate opened up by a recent commentary in Nature magazine. Barbara Sahakian and Sharon Morein-Zamir argue that there are certain situations where cognitive enhancing drugs are perfectly reasonable. When someone suffers from a truly debilitating disorder, then if a drug can return some semblance of normal functioning, there’s little question that it should be used, especially if there’s no effective alternative treatment. But what about borderline cases?

Is it okay for a professor to take Modafinil to overcome jet-lag after returning from a conference? How about if she hasn’t traveled anywhere but finds she needs to stay up until 3 a.m. grading papers? What if another professor says he needs it just to keep up with the everyday pace of his career? One person’s occasional boost might become a chemical dependency.

I asked my daughter Nora what she thought of the idea of taking a pill like Ritalin to improve her mental ability and she said it sounded like cheating. But what if everyone was taking the pills and she was struggling to keep up? Would it be okay then? “That still sounds like cheating,” she said.

Shelley Batts argues that if a cognitive enhancing drug with no side effects was available, the decision to use it would be a no-brainer. The problem for Shelley is, we don’t yet know the full impact of these drugs, especially in the long term. I’m personally a big fan of caffeine, but as I’ve gotten older I’ve found that it gives me an upset stomach. So much for “no side effects.”

Janet Stemwedel is uncomfortable with the idea of using cognitive-enhancing drugs at all, and even feels guilty about her use of caffeine.

John Wilkins argues that these drugs may not be effective in the long term.

But what if they were? What if we really could improve our cognitive function without deleterious physical or cognitive side effects? What if we could work 18 or 20 hours a day, seven days a week? Think of what we could accomplish! One person could do the work of two, or even three people, when you count weekends. If the drug had no side effects. But at some point, doesn’t the primary effect of the drug itself become a side effect? If a person’s life becomes all work, with no down time, no relaxation, ever, I’m not sure that’s a life worth living. If that happened to me, I’m not sure I’d even be the same person I was before I started taking the drug.

Ultimately, even if we could create drugs that were truly side-effect free, I think we’d still have to regulate them in order to protect us from ourselves. Just as the regulation of steroids in athletics is done mainly to protect the athletes, so even “perfect” cognitive enhancers will need to be restricted in their use, lest we become of planet of work-immersed zombies.

Comments

  1. #1 FhnuZoag
    December 20, 2007

    The problem, though, is that academic research, for example, whilst realistically competitive, is in principle not. As a straight exercise in utility maximisation, I’d be perfectly happy if other scientists use drugs to boost their performance, especially if it gets results and gets them fast. What do I care if a new cancer treatment, for example, was derived by ‘unfair’ means? By analogy, should we be careful and try to average out funding allocations amongst groups, because a higher than normal allocation would give one research group the lead?

    Also, some of us enjoy work…

  2. #2 Abel Pharmboy
    December 20, 2007

    I may or may not get a chance to weigh in on-blog as I am on hiatus but I share your cautions, Dave, since no drug is free of side effects. For those taking these for an approved indication, reasonable risk-benefit analyses have been conducted prior to approval (but, as we’ve learned, that provides no absolute guarantee of safety). For these off-label cognitive-enhancing indications, the risks are not well-understood.

  3. #3 Jenny
    December 20, 2007

    I think if you rephrased the question to “is it OK to use cognitive performance-enhancing substances” and not “drugs,” people would be a lot more open-minded to it. How many people take herbal supplements, such as ginseng and ginkgo beloba, to supposedly improve their concentration? How many people bought Brain Age or play crosswords because they think it’ll make them smarter? Most people don’t have a problem with the idea of boosting their brainpower, but “drugs” can be scary, because the potential for side effects is higher. But really, what doesn’t have potential side effects?

    If there were a magic pill that could make me a genius, I’d probably have a bottle by my bedstand.

  4. #4 D
    December 20, 2007

    The point of sporting competitions IS the competition – no other glorious good accrues. By contrast, an Edward Witten on AdderallSuperPlus (safe, strong etc) might discover string theories even he couldn’t now. How dare we presume to save him from himself in this pursuit? And why on earth would we care to?

  5. #5 Ompus
    December 20, 2007

    Imagine that “John” is depressed and that ONLY by taking Prozac is he able to work. John wins an award for a book he wrote while taking Prozac. Didn’t he cheat? After-all, but for the drug he wouldn’t have written anything.

    For that matter, isn’t Aspirin a “brain enhancing drug”? Who can put forth their best work if they’ve got a splitting headache? And then there’s caffeine – a drug we’re happy to give to young children. Who hasn’t relied upon its mind-altering abilities to burn the midnight oil?

    My point is this: brain enhancing drugs are ubiquitous. In this discussion, there is no real difference between caffeine and modafanil. But cheating only matters when their is a game afoot. If I use brain enhancing drugs to win a prize, I’ve cheated. If I use brain enhancing drugs to get my jet-lagged body through class, I’ve cheated no one.

  6. #6 Ompus
    December 20, 2007

    D:

    Imagine that Edward Witten, while on Prozac, Adderall and Valium, proves a paradigm shifting string theory. My question is this… should he be awarded the Nobel Prize over a scientist who eschewed mind altering drugs?

  7. #7 Freiddie
    December 20, 2007

    Drugs always have side-effects. Even if it’s not physical, there’s always the universal side-effect of using them in the first place. Once one finds that it’s so useful, it becomes a habit, even if it doesn’t have physical dependence. Once a habit is made, it becomes a permanent thing in one’s life. More or less like brushing one’s teeth or eating one’s breakfast everyday – it becomes routine. And that is *never* natural (but brushing teeth and eating breakfast is still highly recommended, if not essential). Anyway, setting this aside, it’s hard to find any drug that doesn’t have a particle of side-effect.

  8. #8 Tony Jeremiah
    December 20, 2007

    IMO, Sahakian and Morein-Zamir’s most relevant comment is the use of neuroenhancers in certain circumstances, since it is consistent with the law of diminishing return. Such substances are likely to show significant benefits for persons at the low (and perhaps intermediary) points of a performance distribution curve, but its likely that no significant benefits would arise for persons at the upper ends of such a curve. As an example, it’s doubtful that neuroenhancers would have allowed a Newton, Einstein, Witten, (or ironically) a Hawking, to have any greater insights than their known accomplishments since they likely represent the extreme end of human performance in a particular domain.Alternatively, persons on the lower or average points in this particular performance domain might show levels of performance matching those of the known greats. However, this assumes similar knowledge and experience.

    Diminishing return can already be observed in sports. As an example, for the 100M sprint, the world record (starting when electronic timing was introduced) was 9.95 (1968). The current record is 9.74 (2007). The first publicized case of steroid use for this particular event was Ben Johnson (1988) who ran 9.79. If the other athletes didn’t use steroids (probably likely from the 1968 performance), this would seem to suggest a maximum limit on human speed whether it is artificially induced or not. In fact, I suspect the limit is probably around 9.6 given that the fastest 100M ever recorded (9.69) had assistance of a different kind–a tail wind that greatly exceeded the legal limit for recording a world record performance. A person born capable of running 9.6 seconds most likely will run that whether they use steroids or not, and will likely not run any faster assuming that 9.6 is the limit of human speed.

    To run faster (or to think at levels that exceed hypothetical human limits of performance), one would have to engineer organisms that, technically, would be superhuman. In such an instance, one would eventually need to address the serious social and ethical ramifications associated with the creation of Cyborgs, and more generally, what seems to be a quickly emerging transhumanization era.

  9. #9 Dan Armak
    December 20, 2007

    > Ultimately, even if we could create drugs that were truly side-effect free, I think we’d still have to regulate them in order to protect us from ourselves [...] lest we become of planet of work-immersed zombies.

    Why do you assume we would use cognitive enhancement to do more work, especially the kind of work we don’t enjoy? If I had a drug that cut my sleeptime by half, I’d use the extra time to enjoy myself. If I had a drug that helped me think better or faster, I’d finish my daily work more quickly and so work less, not more.

  10. #10 bigTom
    December 20, 2007

    Tonies is the most interesting post. Lets assume that after a long period of testing (decades likely) we have some substance which improves IQ by say 10 points on average, and has been shown to have few to no side effects. Would we consider it cheating to use it on the general population -or barbaric not too? If as Tony suggests it has more effect on the lower end than the upper, i.e. the bell curve is compressed as well as displaced that is probably a good thing. At least we seem to try that in education, with more resources provided for special education -so I presume compression of the spectrum is assumed to be of positive social value.

  11. #11 Dave Briggs
    December 20, 2007

    But at some point, doesn’t the primary effect of the drug itself become a side effect?

    A very good point Dave! I have mentioned on Janet’s blog that a lot of times the legality of some substance is the first thing to consider, and that is a quick process. But what if it is legal? Throw in the everybody is doing it and the situation gets much more complicated!
    You also mentioned about the unknown long term side effects, which is something we have been facing since all the wonder drugs started showing up 50 years ago.
    I think this whole issue is going to have to work itself out over time.
    Based on individual drugs and individual lives with no quick, clean answer in sight! So goes life sometimes! :~)
    Dave Briggs :~)

  12. #12 steppen wolf
    December 20, 2007

    About the writer or Prozac, I would like to make a short comment. People with mental illnesses take medication to be able to perform the work healthy people can perform, so that the rest of their life is not affected negatively (at least, not completely) by their mental illness.

    If you have healthy people taking these drugs to enhance their capacities, what is going to happen to the mentally ill? Are we going to have to start thinking of some wunder-drug to bring them up to speed with the new population of addicted healthy people?

    Also, it is also important to realize that some expectations in today’s world are not realistic. And no, sport is not exclusively about competition and winning. That is what your sponsors’ aims are. And being a good researcher/scientist should not require pills, but the right to have a good night’s sleep and feel no guilt about it whatsoever.

    Again, this is only my humble opinion.

  13. #13 Peter Hollo
    December 20, 2007

    A LOT of musos take beta-blockers routinely before performing, and many of the ones I knew when I was studying music did so from student age and presumably can’t perform (at least as soloists or in high-profile situations) without them.
    I think this is a real shame, and not just because they don’t both to learn the discipline to calm their nerves without help. It’s just a shame to become dependent on something which, as has been pointed out, likely does have adverse side-effects. It can only get harder and harder to copy without them as time goes on.

  14. #14 D
    December 20, 2007

    Ompus –
    1. I’m having a hard time imagining a drug that’d give someone as big an advantage as Witten’s freakishly clever head already gives him. Should we disqualify the naturally gifted for possessing unfairly good genes?
    2. What matters most is the scientific progress, not whether the people who make it are as nature intended. It’s like what matters is how good the sex was, not whether Viagra had something to do with it.
    3. With science, literature or cinema, the awards matter because the work does, not vice versa. That’s a fundamental difference between these things and, say, pole vaulting.

  15. #15 Simfish InquilineKea
    December 20, 2007

    Paul Erdos was a well-known amphetamine user, and he probably was the most prolific mathematician in the 20th century.

    No one seemed to care about his use of drugs (except for the effects they had on his health).

  16. #16 tom B
    December 21, 2007

    Using enhancers would clearly be a no-brainer–IF tand only if it had zero side-effects. Pretty unlikely, in my view.

  17. #17 Fixer Dave
    December 21, 2007

    With the rapid advances in biology, amazing new discoveries on top of new discoveries, that are heaped on us every day, it is hard to remember just how little we really know about how the human body actually works. Personally, I take a very cautionary approach. Unless I face immediate death or a complete loss of quality of life, I’m not taking the drug, any drug. I’ll cut a little slack for caffeine or alcohol, as they’ve been tested for centuries and the effects are pretty well known, but I’m still debating on aspirin. As for the rest, I’ll let other people do the experimenting.

    However, I suspect future generations will be hooked on performance enhancers, and it will start with the parents. When little Bobby isn’t reading by age 3, unlike Sally next door, I’m sure his parents will be rushing off to the doctor for a “SuperTots” prescription (like Sally most assuredly is on). After all, what parents don’t want the best for their child. Or, in evolutionary terms, the genes of parents predisposed to drugging their child with performance enhancers will tend to out-compete the genes of parents who don’t. This of course assumes that the performance enhancers A) work, and B) don’t otherwise damage the child’s ability to reproduce.

    In other words, if performance enhancers really work then, sooner or later, we’re going to use them as a matter of course. Our culture will adopt them and, eventually, so will our genes. Personally, I’ll wait.

  18. #18 fullerenedream
    December 21, 2007

    @ Freiddie: Yes, drugs have side effects, and yes, if a drug gives consistently useful results a person is likely to continue using it. This isn’t always a bad thing. You have to weigh the risks and benefits. For many women, the benefit of not being pregnant is worth the side effects of hormonal birth control, even for decades of daily use.

    On cheating – is it cheating use a computer? This is a heavy enhancement over the “natural” state of humans. Computer use is habit-forming and has noticeable side effects. Should scientists stop using computers for their research?

  19. #19 Freiddie
    December 21, 2007

    Actually, I’m making the exception for those who are disabled or have some form of disease. The ones I was criticizing are those that give a benefit (above average) rather than fix something wrong (restoring to average).

  20. #20 Michael Chermside
    December 21, 2007

    A related (and interesting) blog post I saw recently: “http://godplaysdice.blogspot.com/2007/12/why-mathematics-doesnt-need-mitchell.html“. Basically, Isabel points out the when you’re competing against other people it’s thought of as cheating, but when you’re just out to solve the mysteries of the universe (ie, doing actual science) then it’s NOT thought of as cheating. There’s even an Erdos tale.

  21. #21 libbyblue
    December 21, 2007

    how do we define “average,” though? i have a hefty laundry list of disabilities. i am also very smart. i can pull off average academic performance, even in competitive post-sec settings, under difficult circumstances without the assistance of most of the medications i’m on. does this mean i’m cheating by taking prescription meds and attaining above-average levels of academic success? or am i simply recognizing my personal (above-average) potential by controlling my bipolar swings and taking nsaids to keep myself mobile? are we to judge “average” by academic or professional norms of success, or by ability to cope with basic life tasks like grocery shopping and securing consistent physical shelter?

    i taught myself to read before my third birthday, according to my mother. there were no medications in the picture at that point. does that mean i’m entitled to preserve above-average performance through medication, or are my concessions to my doctors’ recommendations a form of cheating? are my disabilities some sort of ethical leveler that i am immorally circumventing with meds? just because i could still make the dean’s list blindfolded doesn’t mean i should have to if there are medications that will let me see.

  22. #22 Vasco Figueira
    December 21, 2007

    ┬źUltimately, even if we could create drugs that were truly side-effect free, I think we’d still have to regulate them in order to protect us from ourselves.┬╗

    We help people protect from themselves with information, pedagogy. Not with regulations. I would certainly dismiss any forceful attempt to protect me from myself. I therefore strongly disagree with the paternalistic tone of yours in which it’s implied the engagement in a broad prohibition of cognitive enhancers. That would be, in my opinion, humongously stupid, politically speaking.

  23. #23 Lambert Heenan
    December 21, 2007

    This topic came up a couple of decades ago in the world of professional snooker. A certain Canadian player who had high blood pressure was taking beta-blockers for his condition and the snooper players professional body decided it was indeed an unfair advantage and banned their use.

  24. #24 --Lisa S.
    December 21, 2007

    Wow, what a provocative post. I especially appreciated the comments of Peter and Libby.

  25. #25 ADHD and a masters
    December 21, 2007

    I’ve taken ritalin for well over a decade, ever since I was diagnosed with ADHD two years out of school.

    I think it- the diagnosis and effective medicine- saved my life. I don’t think my heart could have survived additional years of the severe stress undiagnosed ADHD gives.

    I remember the side-effects of not taking a medication for ADHD. In college I was constantly stressed, because what took my peers / other students 3 hours to do would take me 6. I took classes on “how to be organized”: they didn’t help. I also did (and do) Tai chi and meditation- they help with stress, yes, but they do not make the brain more focused.

    I learned to accept B’s and C’s, because it was not possible for me to get more than a few A’s. (This is compared to other students with similar majors, workloads, and part-time jobs.)

    After graduating and starting a full-time job, it became worse. What took my co-workers 4 hours to do would take me 6, or 8, which meant that I was the last person to leave the building night after night.

    And then the occupational health nurse referred me to a psychiatrist who knew that adult women can have ADHD. After tests and whatnot he diagnosed me with ADHD.

    In *one afternoon*, one prescription, I learned for the very first time what focus felt like. I could follow conversations in a meeting. I could do the same work as my colleagues in the same amount of time, and leave at 6pm.

    I’m glad I got that diagnosis then, but I work hard to not think about what could have been if I’d been diagnosed in school. I was a B-/C+ student who only got into grad school because of my 99th percentile GREs. Somehow I finished my masters: to this day I’m not sure how.

    After the diagnosis I went back to each and every one of my professors, to let them know what I had and to encourage them to not discount the possibility in other students.

  26. #26 Tony Jeremiah
    December 22, 2007

    @24

    That’s a good anecdote concerning your experience with ADHD. Two points:

    (1) During my undergraduate days, I had a roommate who was diagnosed with ADHD (not sure whether it was a correct diagnosis or not). However, he stopped taking ritalin because from his subjective experiences, it was not helping him. Also, as a former student-athlete, I knew a number of student-athletes that I suspect were ADHD. IMO, some “disorders” might actually be helpful in certain performance domains and a hindrance in others. I’ve always thought of ADHD as a job requirement for most team sports given that the inability to pay attention to any…one…thing for long periods of time (ADHD should really be called AHD), would be an advantage if a primary skill requirement is to remember where everyone is at any given moment (especially true for quarterbacks). However, ADHD would be a hindrance if you’re a golfer.

    Sport psychologists have a construct called attentional style/bandwith in athletes. I’m not sure if they’ve specifically focused on the relationship between ADHD and sport performance.

    (2) Concerning performance domains more closely connected with academia, some “disorders” also seem to have advantages. Libby(@20) reports having bipolar disorder. It seems that a significant portion of highly creative persons (e.g., writers, musicians, artists, comedians) have bp. Further, a significant portion of bp individuals report greater creative output and boundless energy during their manic states. The real problem occurs when it gets out of control. Even schizophrenia appears to have some advantages if it does not get out of control. As an example, nobel laureate John Nash (portrayed in the movie “A Beautiful Mind”) reported being able to see mathematical solutions more easily when off his medication (although, I’m not sure whether this was a Hollywood dramatization).

    But these (sometimes subjective) advantages do seem to explain why in many instances, some persons diagnosed with these (presumed mental disabilities) avoid taking their meds. However, the existence of mental disorders that seem to afford certain advantages, does support the general hypothesis that there’s probably a line that cannot be crossed as it concerns human cognitive functioning, best summarized by an old cliche that suggests there’s a thin line between genius and madness.

  27. #27 Moodraft
    December 22, 2007

    It’s not “cheating.” Some people are naturally born smarter, faster, with better memory, and so forth. Side effects or not, cognitive enhancing drugs will become standard in the future.

    People have been using coffee for awhile, despite its side effects, especially when abused. Piracetam and friends, Modafinil and low doses of amphetamine occasionally aren’t going to cause much harm, if any. Nicotine is also used as a nootropic. It’s a stimulant and really boosts concentration and memory. I know more than a handful of people who slap on nicotine patches or chew nicotine gum during finals week.

    In the future, we will accept the fact that we don’t need to experience sadness to be happy, or hard work to be wise. A decade from now, you will be able to go to a pharmacist and say “My wife is forcing me to go to an opera..got anything for that?” and you will be given a drug that makes the experience enjoyable.

    The biggest hurdle is going to be the negative stigma that drugs have – instant pleasure, intelligence, creativity, and so forth. Right now, what scares people away from performance enhancing drugs are the potential side effects. But the demand for these types of drugs is definitely there, and the market for them will be huge once we uncover more about the brain and develop drugs that have no side effects.

  28. #28 Debi
    December 24, 2007

    As a conservatory trained musician, I completely understand why some performers take beta-blockers. No, it is not cheating. If the anxiety is so overwhelming as to impair normal function, then take the drug. Anxiety meds, just like other psych meds are meant to help those who can not function normally. Steroids in sports are not taken to restore functionality, but to enhance normal talents. This is quite different than functioning normally. It really doesn’t give an advantage to the performer, they still have to perform at a level that a psych med would not help them to achieve. I don’t take beta-blockers because my performance anxiety isn’t crippling. There are professional opera singers who have literally turned around on stage to vomit into the hands of a chorus member, then turned around and continued performing. They are the ones that would benefit. If taking anxiety meds as a performing artist is ‘cheating’, then isn’t psych meds for a performing schizophrenic or glasses/contacts for a researcher? How about hearing aids, wheelchairs and accessibility equipment? I’m sure no one would consider Steven Hawking as ‘cheating’.

  29. #29 Farne
    December 30, 2007

    Sorry, Moodraft (@26), I can’t agree with you. I think that you do have to experience ‘sadness’ to understand ‘happiness’ and any wisdom that comes cheaply is not worth the name. We are at risk of reducing our experience of the world to the trivial. ‘Sadness’ does not require medication. Depression may, major depression almost always does; it’s not to make them ‘happy’ but to allow an experience something other than the overwhelming black dog – to allow ‘normal’ functioning. If all that you’ve ever felt is ‘happy’ perhaps you will find this ‘boring’ and start looking for something to give you a contrast.

    My real concern with anti-fatigue drugs is that when they become commonplace there will be no choice- anyone NOT working 15 hours each day (‘cos you don’t need to ‘waste’ time on sleep anymore) will be a poor choice for an employee. I don’t believe that you will really get the choice to spend the extra time how you please. Where are the productivity gains from using computers?

  30. #30 DuWayne
    April 1, 2009

    Ompus -

    My question is this… should he be awarded the Nobel Prize over a scientist who eschewed mind altering drugs?

    Absolutely. His mind, his ideas. Drugs don’t suddenly make you smarter, at best they make it easier to access more of your potential.

    I use mind altering drugs every day. For the most part, I’ve used them all my adult life – it’s just that now I am taking prescription drug and for very good reasons. Smoking pot helped, drinking help – the hallucinogens, probably not so much. But Ritalin, Welbutrin, Clonidine and the occasional Xanax seems to be working out pretty damned good. Though I think it’s important that people better understand what exactly it is that the stimulant therapy does for people. It doesn’t help me avoid sleep more – I sleep a couple hours more than usual with the drugs I take. It doesn’t provide some general clarity of though – to the contrary, it slows my brain down enough that I can functionally focus on just a couple ideas at once.

    The work that I do and ideas that I have are most assuredly mine, whether I happen to be using legally prescribed drugs for my issues or I happen to be smoking pot or dropping acid.

  31. #31 Brunner Markus
    January 16, 2010

    Hello, if anyone needs Ritalin,

    just send a mail to

    brunnerm_82@gmx.at

    best regards

    markus

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.