In a debate that’s only going to get more interesting, there were recently calls for universities to consider dope testing to detect the use of ‘smart drugs’ amongst their students. These drugs, also known as nootropics (an inelegant name; from the Greek roots noo-, mind and -tropo, turn, change) or cognitive enhancers are becoming increasingly widely used. If the high estimates of use are to be believed then the debate about and reporting of their use has been remarkably restrained, especially when compared to the perpetual state of conflict over cannabis classification and the coverage given to mephedrone.
Cognition enhancement by pharmaceutical means is not actually a new phenomenon; caffeine is in fact a cognitive enhancer with which we are all already well acquainted. Modern cognitive enhancers were not originally developed with the intention of improving concentration in healthy people. Methyphenidate (also known as Ritalin) was originally licensed for attention deficit hyperactivity disorder and modafinil for narcolepsy. Other drugs such as donepezil are licenced for use with people suffering from dementia. Most of the drugs effect the chemical pathways of neurotransmitters dopamine and noradrenaline in the brain.
The main effects of cognitive enhancement drugs are said to be to improved cognition, memory, intelligence, motivation, attention, and concentration. Research has found that they improve the performance of healthy people on tests of cognitive function. They are easy to purchase over the internet and appear to display minimal adverse effects. Most people agree that there are large groups of people for whom prescription of cognitive enhancement medication is extremely appropriate, such as those suffering from neuropsychiatric disorders. It is their use in the healthy which is likely to become increasingly controversial.
There are of course plenty of drugs that healthy people like to take, but most of the others have been made illegal. This prohibition been justified on basis of harm to the individual and society, but fear of the consequences of unrestricted hedonism of the proles also plays its part. This latter issue may tell us why drugs that encourage studious academic application are not causing much of a stir. Complacency may be misplaced as methylphenidate is a stimulant and does have addictive potential; anyone who works more efficiently has additional time for carousing.
Cognitive enhancers would seem unsuitable to join the ranks of banned substances and are likely to be here to stay. The current economic situation may necessitate many of us to work into our 70s, and cognitive enhancement may allow older employees to remain more competitive. They have already thought to have been used to improve the performance of soldiers in Iraq, and the UK Ministry of defence may haveacquired a supply. Baby-Boomer dementia may lead to high demand and pharmaceutical companies are unlikely to forsake a major market for their products. The appetite for regulation does not appear to be particularly strong. The Advisory Council for the Misuse of Drugs’s 2008-2009 report (sadly I can no longer find this online) only mentions that the UK Government has “asked for advice”.
Some people see no problem with using pharmaceuticals to improve on our abilities, whilst others feel that to use substances to gain advantage is unfair. Anyone who seeks to restrict cognitive enhancement drugs on this basis must answer the charge that unfair advantage is already ubiquitous and generally tolerated in our education system. Cognitive enhancers could in fact actually correct rather than exacerbate educational inequality. The argument that students will feel obliged to take cognitive enhancers should all their colleagues be doing so is a stronger one, but restricting the autonomy of all people for fear that it may influence the actions of some is philosophically fraught. Drug testing students before exams is unlikely to be practical, especially since advantage could be gained by students using cognitive enhancers using revision periods.
Maybe the most pressing concern is that many users are buying their medication off the internet. This is unregulated and possible drug interactions and side effects go unsupervised. There are also concerns about the effects of long term use of cognitive enhancers and also of their effects in the young on the developing brain. One option to introduce some supervision and expert advice would be for medical professionals to more routinely prescribe these medications, although this is unlikely to be something that publically funded health services could underwrite . Many doctors may feel uneasy about administering medication to the healthy, but it may not be long before we begin to recognise and treat “poor concentration”.
Cakic V. Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology. J Med Ethics 2009;35:611–615
Turbocharging the Brain–Pills to Make You Smarter? Scientific American October 2009