From The Times
May 14, 2007
Smart drugs for straight As
It is probably fair to say that Bjorn Stenger was not at the back of the queue when brains were being handed out. In fact, many might think there was little room for improvement, given that he had graduated with a PhD in engineering from Cambridge University. Within an hour of taking a drug called Modafinil, though, Stenger appeared to become cleverer.
Taking part in a study at the university, Stenger, 33, took the drug, commonly used to treat sleep disorders such as narcolepsy, and then performed some computerised tests. Results showed improvements in his short-term memory, attention span and reaction time. “I definitely felt a change,” he says. “It was a bit like the feeling you get after drinking strong coffee. I was somewhat more alert, but not as jittery as after I have drunk coffee. I became very focused on those tests.”
Caffeine, guarana and other stimulants have long been used to ward off tiredness or give an instant lift when needed. But their boost to the brain, by firing the entire nervous system, is short-lived. Modafinil, though, is one of a new breed of “smart” drugs that offer targeted, more powerful mental sharpening.
They are already widely used in America – studies have indicated that the black market for such drugs is rife, particularly among university students – and there are indications that the demand for chemical mental enhancement is about to take off in the UK. Modafinil is easily purchased on the internet – I bought a packet of the green tablets for £64. Such is the concern that the Government has commissioned research to review the safety of brain-boosting pills. A report by the Academy of Medical Sciences (AMS), commissioned by the Department of Health, is due to be published and presented to the Government by November.
Dr Danielle Turner, a researcher in the department of experimental psychology at Cambridge University who is working on the AMS review, says there is growing evidence that certain drugs do help the brain work better. “So far, we do not know enough about the full range of drugs that can affect thinking, but in the case of Modafinil the side-effects appear to be benign,” Turner says. “It seems to improve short-term memory, the ability to plan and process information, and helps a person to be less impulsive and more reflective about their decision-making, which lends itself to greater accuracy.”
In a 2003 study with Barbara Sahakian, a professor of clinical neuropsychology at Cambridge, Turner found that healthy, male Cambridge students such as Stenger who took a standard 200mg dose of Modafinil were found to use information more effectively and efficiently. When confronted with conflicting stimuli, the people who had taken Modafinil moved from one task to the next more smoothly and adjusted swiftly without getting stressed or anxious. Sahakian suggested that Modafinil “may be the first real smart drug” and that “a lot of people will probably take it. I suspect they do already.”
Last year it was revealed that Modafinil has been tested by British Armed Forces and was reportedly stockpiled by the Ministry of Defence before the Iraq War, although it was never given to combat personnel. But Modafinil does not stand alone in its ability to sharpen the mind. A drug prescribed for Alzheimer’s disease – donepezil – has been shown to delay loss of mental ability in patients and, more recently, to boost performance in tests of cognitive skill. In one trial, published in the journal Neurology, pilots who took donepezil for a month performed better in flight simulator tests than pilots who had taken a placebo. Another drug, propanolol, seems to erase the negative emotions associated with bad memories so that people who have taken it reel off disturbing stories as if they were reading a food label.
Ritalin, best known as a treatment for attention-deficit hyperactivity disorder, improves concentration and the ability to plan, perhaps appealing to adults who want an edge in mental multitasking. Studies have also shown that the drug boosts spatial working memory and the ability to remember graphs and diagrams, and anecdotal evidence suggests that it improves concentration levels. A study of 2,200 American students published in the journal Pharmacotherapyin 2004 found that 66 of them admitted using Ritalin as a study aid in the previous 12 months. Chat rooms on US-based websites such as the Student Doctor Network frequently discuss the purported merits of taking Ritalin and other drugs to boost mental output in preparation for exams. Research at the University of Michigan shows that 8 per cent of undergraduates report having illegally used prescription drugs most commonly to improve alertness and attention.
In many cases, scientists have stumbled across cognition-enhancing effects of drugs while researching their applications for serious neurological conditions. Stroke patients who took small doses of amphetamines an hour before therapy were found to perform better in simple motor skills (the tying of shoelaces and using cutlery, for example) and scientists confirmed that the drugs seem to promote “neuroplasticity” or the strengthening of brain connections. That led some, including Dr Anjan Chatterjee, a neurologist at the University of Pennsylvania, to question whether amphetamines might help healthy adults to learn skills more easily.
Other potential smart drugs, each operating on different parts of the brain, are in development (see box) and, provided they pass safety and effectiveness tests, are likely to become available in the next few years. One is a new class of drugs called ampakines that have already proved to be effective memory-boosters in early trials.
In marketing terms, the potential for such drugs has never been greater. By 2012, about 41 per cent of the UK population (23.8 million people) will be over 50, an age at which memory and mental acuity demonstrate a significant decline. For the baby boomer generation, the anxiety of watching their parents slip into dementia means that the prospect of delaying their own mental decline is likely to become as enticing as the possibility of preserving a youthful appearance.
Like Botox (originally developed for eye muscle problems), each of the drugs identified as having cognition-boosting effects also has genuine medical applications. Yet, potentially, they could follow the same marketing pattern as the drug that has become better known as a wrinkle eraser.
Dr Chatterjee goes so far as to suggest that the trend for what he terms “cosmetic neurology” will one day mean not only sharpening intelligence but enhancement of other dictates of the brain – attention span, memory and reflexes. Writing in the journal Neurology three years ago, he said the day when healthy individuals pop a pill before an exam or a golf lesson “is coming, and we need to know it’s coming”. It presents an overwhelming ethical dilemma, he wrote, namely that “if the purpose of medicine is to improve the quality of life of individuals who happen to be sick, then should medical knowledge also be used to enhance the life quality of those who happen to be healthy?” That is, should drugs with known cognitive benefits be restricted for use only by those with illnesses such as Alzheimer’s.
The emergence of brain-boosting drugs raises serious ethical questions. Drugs such as Modafinil can cost as much as £4 a dose on the black market: will the rich simply get smarter and the poor be destined never to catch up? In an interview with the Los Angeles Times, Professor James McGaugh, a neurobiology professor at the University of California, suggested that it is inevitable that pushy parents will one day give mind-enhancing pills to their children.
“If there is a drug that is safe and effective and not too expensive for enhancing memory in normal adults, why not normal children?” he proposed. “After all, they’re going to school and what’s more important than the education of the young? And what would be more important than giving them a little chemical edge?” But will those who don’t take them at work or school be at a disadvantage, and will the taking of drugs to boost performance become, in essence, a form of cheating and be deemed as unethical as doping in sport?
There are concerns, too, about the long-term effects of healthy people using such drugs. All drugs have side-effects, says Turner. In cases where people require them for medical reasons, they are often prepared to overlook those side-effects if the medication improves their condition. But, she says, “it would be devastating to learn that a dazzling youth of successful cognitive enhancement meant a middle-age of premature memory loss and cognitive decline”.
Perhaps most worrying is the way that these drugs might change who we are. To be human is to be in possession of a personality with a unique blend of traits; some scientists argue that changing one mental function might have an effect on others. To tinker with the mind, then, might result in better memory, focus and attention in particular tests, but limit ability to shift attention and interpret anything new or different. In short, cognitive enhancers might enable us to know everything, but to lose our sense of individuality and opinion and to understand nothing.
BRAIN-BOOSTERS: WHAT’S ON THE HORIZON?
Ampakines: research has indicated that this group of memory-modulating drugs, developed for the treatment of Alzheimer’s disease, has cognitive enhancing effects.
Donepezil: a cholinesterase inhibitor developed for the treatment of dementia that has also been shown to boost the brain function of healthy people. It increases the concentration of a neurotransmitter called acetylcholine, boosting the power of certain electrical transmissions between brain cells.
Modafinil: developed to treat the sleeping disorder narcolepsy, it has been shown in clinical trials to boost the cognitive performance of healthy young people and of helicopter pilots deprived of sleep.
Ritalin: a stimulant with a medical use as a treatment for attention deficit hyperactivity disorder (ADHD) in children. It’s easily obtained on the internet or black market (it is dubbed “vitamin R”) and studies reveal widespread use among American students looking to improve concentration and alertness.
Propranolol: a beta-blocker shown in tests to neutralise emotionally-distressing memories. A study in the journal Biological Psychiatry showed that patients in A&E departments who were given the drug had a lower incidence of posttraumatic stress symptoms.
Mem compounds: three separate compounds are under development by the US company Memory Pharmaceuticals Corporation as possible treatments for Alzheimer’s disease. Animal studies suggest that they can help to restore memory.