Healthy people should have the right to boost their brains with pills, like those prescribed for hyperactive children or memory-impaired older folks, several scientists contend in a provocative commentary.
College students are already illegally taking prescription stimulants like Ritalin to help them study, and demand for such drugs is likely to grow elsewhere, they say.
"We should welcome new methods of improving our brain function," and doing it with pills is no more morally objectionable than eating right or getting a good night's sleep, these experts wrote in an opinion piece published online by the journal Nature. The commentary calls for more research and a variety of steps for managing the risks.
As more effective brain-boosting pills are developed, demand for them is likely to grow among middle-aged people who want youthful memory powers and multitasking workers who need to keep track of multiple demands, said one commentary author, brain scientist Martha Farah of the University of Pennsylvania.
Experts agree issue needs attention
"Almost everybody is going to want to use it," said Farah. "I would be the first in line if safe and effective drugs were developed that trumped caffeine," said another author, Michael Gazzaniga of the University of California, Santa Barbara.
The seven authors, from the United States and Britain, include ethics experts and the editor-in-chief of Nature as well as scientists. They developed their case at a seminar funded by Nature and Rockefeller University in New York. Two authors said they consult for pharmaceutical companies; Farah said she had no such financial ties.
Some health experts agreed that the issue deserves attention. But the commentary did not impress Leigh Turner of the University of Minnesota Centre for Bioethics. "It's a nice puff piece for selling medications for people who don't have an illness of any kind," Turner said.
The commentary cites a 2001 survey of about 11 000 American college students that found 4% had used prescription stimulants illegally in the prior year. But at some colleges, the figure was as high as 25%. "It's a felony, but it's being done," said Farah.
The stimulants Adderall and Ritalin are prescribed mainly for people with attention deficit hyperactivity disorder, but they can help other people focus their attention and handle information in their heads, the commentary says.
Guidelines set out
Another drug called Provigil is approved for sleep disorders, but is also prescribed for healthy people who need to stay alert when sleep-deprived, the commentary says. Lab studies show it can also perk up the brains of well-rested people. And some drugs developed for Alzheimer's disease also provide a modest memory boost, it says.
Ritalin is made by Switzerland-based Novartis AG, but the drug is also available generically. Adderall is made by UK-based Shire PLC and Montvale, New Jersey-based Barr Pharmaceuticals Inc., and some formulations are also available generically. Provigil is made by Cephalon Inc. of Frazer, Pennsylvania.
While supporting the concept that healthy adults should be able to use brain-boosting drugs, the authors called for:
- More research into the use, benefits and risks of such drugs. Much is unknown about the current medications, such as the risk of dependency when used for this purpose, the commentary said. Also, according to the Food and Drug Administration, Adderall, for example, is an amphetamine that carries warnings about possible sudden death, heart attack and stroke, especially for people with heart problems.
- Policies to guard against people being coerced into taking them.
- Steps to keep the benefits from making socio-economic inequalities worse.
- Action by doctors, educators and others to develop policies on the use of such drugs by healthy people.
- Legislative action to allow drug companies to market the drugs to healthy people if they meet regulatory standards for safety and effectiveness.
Addiction a real concern
Dr Nora Volkow, director of the National Institute on Drug Abuse, said she agreed with the commentary that the non-prescribed use of brain-boosting drugs must be studied. But she said she was concerned that wider use of stimulants could lead more people to become addicted to them. That's what happened decades ago when they were widely prescribed for a variety of disorders, she said.
"Whether we like it or not, that property of stimulants is not going to go away," she said.
Erik Parens, a senior research scholar at the Hastings Center, a bioethics think tank in Garrison, New York, said the commentary makes a convincing case that "we ought to be opening this up for public scrutiny and public conversation."
One challenge will be finding ways to protect people against subtle coercion to use the drugs, the kind of thing parents feel when neighbour kids sign up for courses to prepare for aptitude tests required for college admission, he said.
And if the nation moves to providing a basic package of health care to all its citizens, it's hard to see how it could afford to include brain-boosting drugs, he said. If they have to be bought separately, it raises the question about promoting societal inequalities, he said. – (Sapa, December 2008)
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