In defense of cognition-enhancing drugs

A commentary in this week's issue of the journal Nature argues that cognitive performance-enhancing drugs should be made widely available, and sets out an ethical and legal framework for doing so in a way that maximises the social good of being able to choose what state of mind you're in. Contributors to the article include a Stanford law prof, a Cambridge research psychiatrist, a Harvard med-school prof, and other distinguished personages.
Human ingenuity has given us means of enhancing our brains through inventions such as written language, printing and the Internet. Most authors of this Commentary are teachers and strive to enhance the minds of their students, both by adding substantive information and by showing them new and better ways to process that information. And we are all aware of the abilities to enhance our brains with adequate exercise, nutrition and sleep. The drugs just reviewed, along with newer technologies such as brain stimulation and prosthetic brain chips, should be viewed in the same general category as education, good health habits, and information technology – ways that our uniquely innovative species tries to improve itself.

Of course, no two enhancements are equivalent in every way, and some of the differences have moral relevance. For example, the benefits of education require some effort at self-improvement whereas the benefits of sleep do not. Enhancing by nutrition involves changing what we ingest and is therefore invasive in a way that reading is not. The opportunity to benefit from Internet access is less equitably distributed than the opportunity to benefit from exercise. Cognitive-enhancing drugs require relatively little effort, are invasive and for the time being are not equitably distributed, but none of these provides reasonable grounds for prohibition. Drugs may seem distinctive among enhancements in that they bring about their effects by altering brain function, but in reality so does any intervention that enhances cognition. Recent research has identified beneficial neural changes engendered by exercise10, nutrition11 and sleep12, as well as instruction13 and reading14. In short, cognitive-enhancing drugs seem morally equivalent to other, more familiar, enhancements.

Many people have doubts about the moral status of enhancement drugs for reasons ranging from the pragmatic to the philosophical, including concerns about short-circuiting personal agency and undermining the value of human effort15. Kass16, for example, has written of the subtle but, in his view, important differences between human enhancement through biotechnology and through more traditional means. Such arguments have been persuasively rejected (for example, ref. 17). Three arguments against the use of cognitive enhancement by the healthy quickly bubble to the surface in most discussions: that it is cheating, that it is unnatural and that it amounts to drug abuse.

Towards responsible use of cognitive-enhancing drugs by the healthy (Thanks, Guido!)


  1. “This person is seriously suggesting widely prescribing amphetamines?”

    No, this wide panel of distinguished experts is seriously suggesting revamping the system by which cognitive enhancing drugs are regulated to allow for more personal freedom while containing social harm.

    Jeez, you not only didn’t RTFA, you didn’t even read the blog-post, did you?

  2. Here’s the thing. Amphetamines really screw with your personality. I have ADD and they help me tune out the world, but they also make me act like a different person. I make sure to time things so they wear off by the time I have to interact in a social situations.

    Having an entire population on them might be scary.

  3. please read the article.

    My own immediate concern; I don’t trust the drug companies to do fair research and publish all the dangers and side effects.

  4. I’m not concerned about the morality of it, but the long term consequences. It turns out that taking supplemental vitamins A, C and E shortens your lifespan. ADD drugs make ADD worse in the long run. Anti-depressants frequently increase depression in the long run. Some cholesterol lowering drugs increase stroke risk. The list is endless. I’d hate to take drugs to improve my grades and accidentally lose the ability to sleep forever. At the very least, I’d wait until the drug testing and approval industry isn’t owned and operated by pharmaceutical companies. Which might be a very, very long wait.

  5. This article would have a lot more moral umph if the authors fessed up to using it. Adderall use is rampant among college professors and college students. Pretending it’s just for kids carries a stigma the authors are seeking to dispel.

  6. google “Adderall lawsuit” and get an immediate hit.
    Not good for the cardiovascular system. I wouldn’t argue “unnatural”, but I would worry “possibly unhealthy”. People have to be able to make informed choices. Think of the advertising pressure.

    My next concern: Apart from my own use, would I want my children to? If it becomes de rigeur, will they be at disavantage not to? We could agument our species by cyborg implants too. Is it a good idea? Once started, will peoople be able to opt out?

  7. We have a friend whose 10 year old son has been on something for years. I have only known him on these ADHD drugs. I watched him a few times and having him over was like having a quiet bookish twenty year old in your house. He is smart and very gentle and helpful with my kids. This summer he went off of the meds, with supervision, when he came over it was like having a rowdy ten year old boy in your house. He was still helpful, but not as quiet or gentle. In other words, he was quite normal. I don’t think society likes normal.

  8. “Jeez, you not only didn’t RTFA, you didn’t even read the blog-post, did you?”

    I read the article (well ok, most of it), but thought it surprising that the only drugs mentioned as examples of these “cognitive enhancers” were adderall, ritalin and modafinil. In my opinion there are much better examples, such as piracetam and other nootropics.

    I agree with the premise of the article, and even what I take to be your premise (that its interesting that this is being discussed in a scientific journal), but think that citing amphetamines as something that should be explored is probably not going to help their argument.

  9. I’ll limit my performance enhancing drug use to caffeine and sugar, thank you. Fortunately, they allow snacks and drinks into exams.

  10. Adderall use is rampant among college professors and college students.

    I thought the drugs of choice for faculty and students were the three Cs: Caffeine, Cannabis and Cocaine.

    Or so I have heard, at least.

  11. I do like the idea of free, legal, affordable, safe access though. Just more tools in the armamentarium. How about strict advertising controls? Specific legislation about using when driving etc?

  12. I read the whole article and found it highly problematic. I will list some of the reasons.

    If a) 7% of students have used cognitive enhancing drugs, and b) the incidence of ADHD amongst them is 4-7%, is there not an error of logic when the authors use a) to justify the use of cognitive enhancers generally? Might not a) just reflect b)?

    If, as the authors state, members of the US military are required to take cognitive enhancing drugs when it is deemed necessary for their service, could that have anything to do with any of the more apeshit military atrocities that have occurred? (I suggest this possibility, because I worked in medicine and observed the psychotic behaviour that could be induced by amphetamines in some people. I’m not saying it happens to everyone, but it does happen.)

    The authors spend a bit of time proposing regulations to ensure “freedom from coercion to enhance”. In my opinion, no matter what rules were made, coercion would become the de facto norm, in the name of performance and productivity. People with adverse reactions to stimulants (yes we exist) would then face discrimination. And so would anyone who just wanted to be themselves, or anyone concerned about the role of the pharmaceutical industry in funding all this.

    Cory I normally like the articles you point to but his is one of the most fascist things I have ever read.

  13. If, as the authors state, members of the US military are required to take cognitive enhancing drugs when it is deemed necessary for their service, could that have anything to do with any of the more apeshit military atrocities that have occurred?

    Never attribute to happy pills what can be adequately explained by the banality of evil. The devil didn’t make them do it.

  14. I don’t like the idea of performance enhancing drugs for education/work/life/etc. I’m not against drugs per se, but I always associated them with recreational use. When you start to bring them into education and work, then it becomes a problem.

    If your intelligence and skills are the result of cognitive enhancers, what happens when the enhancers become unavailable? Will your performance become impeded? Are you no longer able to do your job? Wouldn’t you have to take the drugs continuously in order to perform at the level people have expected of you? What long term health ramifications could result from this?

    Like I said, I’m not against recreational drug use. But if you make these drugs freely and legitimately available to all, then it would only be a matter of time before a company insists on mandatory drug use for its employees to get ahead of the pack. And that’s just not right.

  15. Pam, I think you missed the authors’ point regarding the military: they are arguing that coercive dosing with cognition-altering chemicals is bad and needs to be addressed in any framework that loosens restrictions on them. IOW, they included the military as an example of how things cna go wrong.

  16. I’m in academia, and while I have not used such meds, I would consider using them if it helped me focus at important times (eg writing grants/manuscripts under time pressures). I’m certainly aware of friends’ personality changes under ADD medication, but on the other hand, my personality changes dramatically with caffeine.

    More importantly, there would probably be side-effects. There always are. Take the 12+5+4 years of institutionalised study I have had to get me to where I am now. That’s a hell of a long time I could have been doing something else. I’m not saying school is a waste of time, just that it’s an opputunity cost we all take for granted. The side-effects of drugs are conceptually just the same.

  17. seems mathematical, musical and physics savants do their most creative, spectacular work in their early twenties. We owe it to the species to get them force-fed all the enhancers available so I can finally get my godsdamned flying car.

  18. So the Army can force you to take drugs? That is, discipline you if you refuse?
    That’s evil, I think.

  19. @ #5: I don’t know where you got the information regarding anti-depressants, but it is incorrect. In the words of my physician: `If used properly, a person taking anti-depressants can phase them out after a year or two of beginning treatment, after which they can function normally without medical aids. However, if treatment is terminated early, then a relapse may occur, and the medication will be less effective.’

    1. I don’t know where you got the information regarding anti-depressants

      “March 22, 2004 — The U.S. Food and Drug Administration (FDA) has asked manufacturers of the several antidepressant drugs to include in their labeling a warning statement that recommends close observation of adult and pediatric patients treated with their agents for worsening depression or the emergence of suicidality”

      “The antidepressant drugs are fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), bupropion (Wellbutrin), venlafaxine (Effexor), nefazodone (Serzone), and mirtazapine (Remeron).”

      Also, who ever gets off anti-depressants? The vast majority of US patients on anti-depressants have a bottomless prescription from a harried GP, no psychiatric oversight and are not in any kind of therapy. They’re happy pills. They can be beneficial, but like antibiotics, they’re prescribed to shut people up.

  20. I regularly use a mild stim – ephedrine – off-label as (among other things) a cognition enhancer. The effect is to sharpen my focus and make better technical decisions: I consider more angles, game out more possibilities, before deciding. I’m a better worker.

    The article talks repeatedly about more study to understand the risks. Commenters who are saying “zomg bad!” must have missed that part – though, granted, you can’t do a ten-year study with two years of data.

  21. Nanete2000 and others, bring up a very good point, if this becomes commonplace will employers demand employees use these drugs or will the pressure be that I must use them to remain competitive. One only needs to look at the Olympics and Major League Baseball to understand the pressure the successful use of performance enhancing drugs brings to bear. Many athletes became caught up in drug use just to remain in the game, even though there was a serious health risk.

    Never forget, as many of the older guys and gals here will remember, the truckers love of Black Beauties (amphetamine) and Yellow Jackets (barbiturate). One to keep you up, another to keep you down.

    The military is a life or death situation. A small unit trapped in a fire fight or sent on an extended operation uses drugs; pilots also use amphetamines. While these drugs cold save your life, there is some discussion the military is in denial about the limits this places on longer term effectiveness.

    But this article seems to understand the need and risks.

  22. Going into the mental health industry, I decided to try several of these over a short term…I can’t be expected to make recommendations if I haven’t seen first hand experience (ok, that is faulty logic, but dammit I wanted to try!)

    I have ADHD (and had it before it was called such), and had access to adderall…this works great in that all the concentration, everything that my dad would smack me upside the head and say WHY DON’T YOU LEARN TO PAY ATTENTION…well, I felt like a normal person.

    As others have said, my personality changed…I was still who I was, but I didn’t feel the need to interrupt others, I didn’t want to change the subject, I was content to listen…except when I went into motormouth mode in which you couldn’t get me to stop talking (but it was generally a single topic). The core of my personality didn’t change…but I was less distracted.

    Honestly, I do my best thinking when I’m not focused on what I’m actually doing and routinely get up in the middle of a conversation or meeting and run off to my office and finish up a problem I had been working on with fail. This doesn’t happen on Adderall. Maybe my personality did change. Maybe this is why normal people can’t multitask efficiently. Maybe this is why the general public is so task oriented because they can’t move on until they finish something, while folks with ADHD generally have a dozen tasks in front of them, all in general states of disarray (I have a team of assistants that finalize and polish anything I put out…so this works well for me!)

    Ritalin? I’ve never been high before, but I think I was on this. Hell, I was straight edge for a decade and a half with not even an aspirin in the time. I didn’t like it. It didn’t do anything for me.

    Colleagues tell me this is generally what happens to people with a different chemical version of ADHD…Adderall and Ritalin work differently in different chemistries, so it is best to make certain the patient isn’t just getting a high…actually have them come in on the drugs and measure their performance and see if it is working out. Needless to say, it didn’t do anything for me and the high just made me sick.

    Recently, I befriended a MS doctor who has been able to prescribe Provigil (modafinil) to me…I have severe rheumatoid arthritis and it makes me very susceptible to things like seasonal affectiveness disorder — mainly because I’m so tired that I catch the cues much easier these days. Mostly, when I’m in inflammation mode, anything that can make me want to sleep will.

    I gotta say, of the three mentioned, provigil has the least side effects. It keeps me up, my personality doesn’t change…I just feel like someone pushed back my bedtime. Oddly, I don’t get the attentional push I get with adderall…it doesn’t help when driving (my ADHD is bad enough that after an hour on the road, I tend to zone out to the dotted yellow lines and run off the road!#!$!) Or at least I don’t notice that it is helping (I did drive to Chicago using these once and while I found myself distracted, it wasn’t as bad as otherwise).

    I can say, my thoughts become a little clearer…no incessant need to dig deeper and deeper into minutia that seems to affect my writing on the first drug. I got better grades, but it just doesn’t FEEL LIKE it is doing anything…

    I’ve tried a few others, but side effects were near instant and I quickly discounted those…

    All this being said, I rarely use anything daily except my multivitamins and flaxseed oil. Meditation works far better than Adderall for day to day maintenance. But as a cognitive enhancer, I’m worried about the society because if EVERYONE is using these, it will severally handicap us all. Most of greatest inventors were not the kind of people that sat and slugged out a problem until they were finished, they had multiple activities…in multiple areas…all going on at the same time. I am the most creative when my ADHD is in full swing…it isn’t a handicap in the slightest other than most of society doesn’t understand how we work. Thats alright…without us, they’d be nothing!

    For slugging things out…programming? I found I could do a few hundred lines in a night AFTER I did the creative work. Practicing scales on my guitar? Sure. Writing my psychopharm term paper? I’m certainly not going to tell my prof that I did it on this, but yeah…for the rest of life? No…I don’t have time to deal with single issues that these drugs force on me…

    I just with I could jump on things like Adderall, have it react mildly like Provigil…but be able to quit it the minute I need to go back into creative mode….


  23. It’s really unfortunate that people read as far as “OMG amphetamines” and shut down their, um, cognition at that point.

    Except for a literal one-in-a-million chance of developing Stevens-Johnson Syndrome, I’d say modafinil has fewer undesirable side effects than caffeine, any day of the week. People are dying, right now, because it isn’t sold at every truck stop in the country.

  24. I was an early adopter of SSRIs. (Type 1 diabetic — several pathways between that and depression.) My doctor described SSRIs as “miracle drugs” — he literally used those words. There was no mention of any side-effects at all, and certainly not of sexual side-effects (the ones Wellbutrin claims it has a low risk of in its TV ads). Well, wouldn’t you know, after a while, something is very clearly not right in the pleasure department, and I’m referring to the experience, not the biomechanical function. There was a disassociation, a disengagement, a loss of intensity, like it was happening to someone else. Very much not in the moment.

    This became the new regime. In the absence of any warning of side-effects, I assumed this the beginning of complications of diabetes, 30 years ahead of schedule. I couldn’t believe it, since I was doing everything else right, but the change was undeniable. I couldn’t think what else it might be. It wasn’t until six years later that my doctor brought up the subject of side-effects, suggesting I should focus on “her pleasure”. (Yes, I should have brought it up myself, earlier.) Six lost years, feeling like a dead man walking. There’s a big difference between “some day in the unspecified future” and “it’s here now”.

    I’m all for cognition-enhancing drugs — medicine is just another technology, and that’s what technology is for, to make things better — as long as the result actually is an improvement. And you can’t actually know that without years and years of data. There’s no way I would take a drug with significant psychoactive effect without a decade of widespread general use in advance.

  25. This article is raising the right points. Cognitive enhancing drugs should be legal and available to healthy people so long as the drugs are generally safe, come with good information about what they do and possible side effects, and are available to all who want them.

    The same standard should apply to drugs that enhance physical performance. The problem in both cases is truly safety (steroids really do a lot of damage, just as an example). And, of course, so long as these things are against the rules, people will acquire them illegally, leading to a higher risk of bad side effects and real abuse.

    Sooner or later we’re going to get anti-aging drugs, too. As far as I’m concerned, policy wise all these things fall into the same category: They’re all things that make our lives better, but don’t treat actual disease. But they all have risks and side effects, and need to be handled carefully because drugs, after all, can actually be dangerous. (Ah, the trouble with all the lies about marijuana; it makes us all assume that everything said about any kind of a drug is a lie.)

    We need this kind of policy discussion, because the drug testing rules in professional sports gives us a textbook example of how to do things wrong.

    BTW, Ugly Canuck, yes, the army can make you take drugs. You sign away a lot of personal rights when you join the army. There was a big flap a few years ago when some soldiers refused to get vaccinated against anthrax. As I recall, there were some serious questions about the vaccine and its side effects, but the army required people to take the shots anyway. I think there were court martials over this. Both the vaccine and the flap have fallen off the radar screen, so I’m not sure how it all ended up.

  26. Poor people have trouble accessing/paying for health care. They have less access to cognitive improvers like museums, libraries, quality schools, etc. This will be one more advantage persons with money can use. I still believe talent will succeed, so don’t flame me for being an apologist for the poor.

  27. While many people may find enhancement at first, I see much potential for long term effects from the drugs I saw mentioned. The long term effects will vary a lot from the non-clinical trials I see going on all around. Most of those long term effects shouldn’t be worth it to people that can have a life without drugs. Now if there is such a thing as safe recreational usage without addiction or excessive usage thats okay by me, but it can be hard to say no today if it made you feel so good and/or smart yesterday.
    Military drug usage? say it isn’t so…
    oh yeah, marching powder. it ain’t changed much over the years.

  28. I wonder if more easily accessed ADD medication would be an alternative for people who take methamphetamines. In my experience, some of the non-prescription varieties of speed can do serious damage in terms of physical, psychological and cognitive function. A good friend described the experience of taking speed so well when she said, “I can feel it eating my soul.” I would much rather see college students taking modafinil and adderall, than trucker’s speed and meth. Seriously, for the sake of society.

    And it goes without saying that we’d all be better off if we could legally purchase small amounts of cannabis from medical dispensaries.

  29. I am with the rampant idiot on this one. I’m not sure they have the definition of “cognitive enhancement” fully thought out. Also it has been my sad experience that people who used speed always slowed down (that is their abilities get un-enhanced) later in life. Old ex-speeders are sooo slow on the uptake…their old habits make them stupider than they otherwise would have been, once they’re older and off the stuff. Once you use it regularly you cannot do without it – you backslide otherwise.
    IMO using speed to “enhance” capabilities now is like front-loading benefits, there’s a “long tail” of reduced functionality once you stop “enhancing”. The long-term may force you to pay back with interest what you thought you had got for free.
    On another point, IIRC the Army required the vaccinations ’cause they knew that the US Gov had years ago, in its wisdom, rubber-stamped the sale of some bio-weapons capacity to some tin-pot dictator, can’t recall the name, some little country somewhere, and there was a possibility – which possibility IIRC grounded the reasons for the US Army being there in the first place – of such capacity being used, this time against the said Army.
    Also IIRC ’twas argued then: “volunteer army” so “you volunteered for this”, therefore no ability to squwak (sp?) about Orders to take “drugs”.
    But vaccines are not drugs (I guess they are if food is drugs too), and I have not heard of pilots, etc. refusing (and then being disciplined therefor) the cheap pure speed they are apparently being offered to “help them through”.
    Also I think there in fact has been some compromise on the vaccine thing, but I would not know, the operations of foreign Armies are usually objectionable to me, in any case.

  30. I have multiple sclerosis which affects my brain (ability to learn, memory, etc.). I would love to have these drugs to help.

  31. I think performance enhancing chemicals should be legal. You can take caffiene now, and no one has a problem with that legal status. And last time I checked, no one has been forced to drink coffee at work. Also, as others pointed out, caffiene has negative side effects and effects people differently. This leads to some people voluntarily opting out of consumption.

    No one seemed to think that a performance degrading chemical(alcohol)should be outlawed, so why should we be able to make ourselves worse but not better? Alcohol has plenty of negative side effects, but people are allowed to decide for themselves whether to risk them or not. Which leads to the questions, why should YOU be allowed to decide what’s best for ME?


    (hiss… caffeine… my precious…)

  33. There’s an interesting account of a journalist taking Provigil (modafinil) “recreationally” here:

    It was originally designed for narcoleptics in the seventies, but clinical trials had stumbled across something odd: if you give it to non-narcoleptics, they just become smarter. Their memory and concentration improves considerably, and so does their IQ.

    It’s not an amphetamine or stimulant, the article explained: it doesn’t make you high, or wired. It seems to work by restricting the parts of your brain that make you sluggish or sleepy. No significant negative effects have been discovered. Now students are using it in the run-up to exams as a “smart drug” – a steroid for the mind.

    A week later, the little white pills arrived in the post. I sat down and took one 200mg tablet with a glass of water. It didn’t seem odd: for years, I took an anti-depressant. Then I pottered about the flat for an hour, listening to music and tidying up, before sitting down on the settee. I picked up a book about quantum physics and super-string theory I have been meaning to read for ages, for a column I’m thinking of writing. It had been hanging over me, daring me to read it. Five hours later, I realised I had hit the last page. I looked up. It was getting dark outside. I was hungry. I hadn’t noticed anything, except the words I was reading, and they came in cool, clear passages; I didn’t stop or stumble once.

    Perplexed, I got up, made a sandwich – and I was overcome with the urge to write an article that had been kicking around my subconscious for months. It rushed out of me in a few hours, and it was better than usual. My mood wasn’t any different; I wasn’t high. My heart wasn’t beating any faster. I was just able to glide into a state of concentration – deep, cool, effortless concentration. It was like I had opened a window in my brain and all the stuffy air had seeped out, to be replaced by a calm breeze.

  34. Somehow I find it hard to believe that any medication that tweaks your brain chemistry that much will turn out to be harmless, regardless of what the preliminary research says. Heroin, cocaine, and LSD all started out as perfectly legal medications that were pushed by pharmaceutical companies for being safe (Bayer sold a heroin pain pill for children for a while). Without meaning to sound alarmist, natural is probably best.

  35. Well this branch of technology will continue to kick along, so these Q’s will have to be sorted out. If not by the Public, then for the Public.
    But since only big pharma can make this stuff, it’s easy enough to control once limits (if any are needed) on use are decided and set. Look what happened to Quaaludes.
    I’ll go out on a limb and say that if reefer were legal, there would be no “meth problem”. So I restate my agreement with the idiot above.

  36. No pharma co ever pushed the use of LSD for anything, and its use, in itself, has not been shown to be harmful. Nor was such harm demonstrated prior to the banning of all research whatsoever into LSD’s uses.
    LSD ain’t like cocaine or heroin, it is not physically addictive, or even habit-forming IIRC, though since there’s no research being done, who knows?

  37. Racetams!

    Safe, legal, available in bulk, and you’ll hear little about them because most of them aren’t patentable, and they’ve never been smuggled in from Mexico in the saddlebags of a Hell’s Angel’s Harley.

    I’m taking them, and now I know how to play the flute, how to split an atom, how to construct a box girder bridge, how to irrigate the Sahara Desert and make vast new areas of land cultivatable, and how to rid the world of all known diseases.

  38. “No pharma co ever pushed the use of LSD for anything, and its use, in itself, has not been shown to be harmful. Nor was such harm demonstrated prior to the banning of all research whatsoever into LSD’s uses.
    LSD ain’t like cocaine or heroin, it is not physically addictive, or even habit-forming IIRC, though since there’s no research being done, who knows?”

    I’ll concede most of your points although it was being pushed for its medicinal value for a while there.–1.html

  39. Which leads to the questions, why should YOU be allowed to decide what’s best for ME?

    Was somebody advocating making them illegal? I thought that we were just discussing whether or not it’s a good idea. I don’t really want fourth graders having to give a urine sample before taking a math quiz.

  40. Oh, my. I normally have no problem concentrating on even menial, tedious tasks – the description of the effects of Provigil given by Jesse M @#38 sounds like much of my life.

    I wonder what effect it would have if I took it.

  41. #48 posted by bardfinn:

    I wonder what effect it would have if I took it…

    You’d gain focus intense enough to directly observe subatomic particles and affect their quantum-entangled brethren on the other side of the universe, which would really piss off the physicists over there because they would have no idea what the hell was happening to their particles.

  42. we have a society now that primarily uses drugs to dull and stupefy. Think about it, alcohol and pot? The most commonly misused prescriptions? How will the world change for us if everyone is “enhanced” all the time?

  43. I find it odd that people feel the need to be ‘enhanced”; why no be happy with what you’ve got?

  44. I find it odd that people feel the need to be ‘enhanced”; why no be happy with what you’ve got?

    Because things could always be better?

    I’m seriously disturbed by the number of people who do settle for “you’re perfect just the way you are”. It echoes Nietzsche’s last man archetype, or the naturalistic fallacy.

    If humans had remained contented with things as they are, we’d still be living in caves and foraging for food. To hell with that, bring on the man-machine symbiosis / übermensch!

  45. We arrived here by evolutionary forces both biological and social. Why stop now?

    Humans as they are now are something to be overcome / improved upon.
    (I’d consider the opposing view akin to social conservatism.)

  46. I think that is a very interesting and incredibly dangerous idea. As someone who has been prescribed those drugs before (I tested in high nineties in terms of percentile rank for ADHD as determined by a multitude of tests) and at very high dosages, I know the risks and realities of both physical AND psychological dependence, as well as abuse. Even though it helped me quite a bit, I got hooked and would take far beyond my dose whenever things got busy/overwhelming/stressful to the point i was so fixated I was counterproductive and wouldn’t get anything done. But at that time I would be locked into the cycle, having not slept or eaten for 3 days, and just popping pills like they were PEZ. All the while, though, I knew it was wrong, told myself not to take any more, and then 30 minutes later, I’d have another few, all taken orally, mind you. I knew what I was doing, and found that I was completely unable to stop myself, and so a whole month’s script would be gone in a week or ten days MAX. Eventually, I had to call my doctor and tell him to never write me another script for any kind of stimulant, no matter what I said or how much I needed it, because I couldn’t handle the responsibility.

    So here’s one of the rare times you’ll hear my voice amongst the conservatives, but I would be very worried about the ramifications of such deregulation. Combining stimulants and cognitive-enhancing drugs with our high-stakes, competitive, performance-based society could prove disastrous. In my opinion, the authors’ treatment of this issue was very inadequate and didn’t accurately gauge the severity of the risks. Their one paragraph addressing regulation and “subjective” classification of risk was almost offensive in how short-sighted it is, and appears to neglect the reality that most of these cognitive-enhancing drugs are different classes of amphetamines or other stimulants like methylphenidate, and do have a very real and demonstrated potential for dependence and abuse.

    The authors are a group of very intelligent and accomplished scholars, but the collective thinking of academics sometimes needs a little real world input to bring the realities of the situation into focus. Maybe they need to get a few former addict’s opinions…

  47. @#3: I have ADD too, and take amphetamines, but they don’t screw with my personality. So perhaps it’s time we learnt not to give drug advice as if our own personal experience will be the same for everyone else?

    @#11: “At least ADD meds are more reversible than a lobotomy. But the underlying rationale seems the same.”

    How the hell do you come to that conclusion? Do you have any idea what the complete treatment of such things as ADD entails? Any understanding of the neurology behind it all? It doesn’t sound like it.

    @#45: This part of the article says it all “self-regulate”. Amphetamines are something that should be prescribed, and in cases like this, use should be tightly monitored and controlled. Part of the problem seems that they don’t know that Dexedrine isn’t a substitute for sleep.

  48. I got a flu shot the other day. When I was sitting in the waiting room, there was a woman reading a pamphlet on how to tell if her child has ADD. That’s there so that when she goes in to tell the GP that her son has ADD, she’ll be prepped to give all the right answers. The visit with the doctor will last ten minutes. She’ll get a prescription for her son and he’ll be on it for twenty years with absolutely no monitoring whatsoever. The doctor gets the woman to shut up by giving her the scrip; the woman gets her son to shut up by giving him the meds.

  49. The writers gloss over the risk-benefit equation, but this is really the central issue. A drug whose risks would be acceptable to save the lives of dying cancer patients may not be acceptable to give college students a boost on their exams. The FDA currently doesn’t have any way to address this issue. The authors are asking them to work this out, but I suspect they would not be pleased with the results.

    All drugs have risks, all drugs have side effects. No drug is completely safe and benign. People frequently die from taking safe, FDA approved drugs according to the package instructions. Moreover, we’re talking about drugs that cross the blood brain barrier. As a pharma and biotech writer with experience working in pharma R&D, there is no way you’d get me to take anything that cross the B-B barrier unless I needed it to save my life or for very basic functioning.

    I also doubt that the effect of these drugs is as important as the authors imply (again, no clinical trials, no double-blind prospective studies, no efficacy data). No one has invented a drug that can turn a mediocre student into a Rhodes scholar. Differences in individual ability and work habits will always swamp out the effects of a “performance enhancer.” I am not worried that a cohort of adderall-enhanced frat boys that party all weekend every weekend are going to beat my unenhanced kid out for admission to Harvard Medical School. As well, anyone who wants to improve their performance badly enough to take a drug is already a member of a self-selected group that is probably going to do well regardless (unless they really do have ADD).

  50. Got anything for dread? Not fear (though fearful), not depression (though depressed). Just plain old Dread. There’s a lot of it going around and I’ve got it bad.

    And that ain’t good.

  51. @ antinious

    They are by prescription only and since I am not ADHD they would be illegal for me. They would also be illegal for any other use other than the prescribed one.

  52. All drugs have risks, all drugs have side effects. No drug is completely safe and benign.

    I think a simple standard of, “Is it equally or less dangerous than alcohol,” would generally suffice.

  53. Here’s the question. Are you willing to forego health care for conditions related to taking such drugs? And yes I know that we could apply that to drinking alcohol, skiing and eating french fries as well. Life is inherently dangerous. But what about a scenario of forty million Americans with paranoid insomnia from taking speed to improve cognition? We’re already in a massive public health disaster from the health care industry’s bad diet advice.

  54. My girlfriend got a bunch of adderal for school and I was disturbed by her nonchalance with using it to study. The only problem is that although she took pages of notes and concentrated like a fiend I discovered that when the effect wore off and I aske dher “So what do these notes mean, what do you need to know for your test?” She responded “No clue, but I have it all written down.” She did this for months and managed to just barely pass her classes. She was always frustrated that even though medication made her take incredibly detailed notes it didn’t give her any skill in critical thinking or discerning whatw as useful and what wasn’t. I think these drugs are just a band-aid to cover the over stressed and overworked, the only reason you feel you need them is because you feel you couldn’t keep up otherwise. A sad sate of affairs I’d say.

  55. #62 Antinous

    When I was sitting in the waiting room, there was a woman reading a pamphlet on how to tell if her child has ADD. That’s there so that when she goes in to tell the GP that her son has ADD, she’ll be prepped to give all the right answers.

    On the (rare) occasion when I post a stereotypical anecdote or observation like that, I get called down for it, often by you. What you really just said can be translated: “There is no such thing as ADD. Anyone ostensibly trying to educate themselves about ADD is actually engaging in drug-seeking behavior.”

    Kind of lame IMHO, and not exactly supportive of people who may be struggling with conditions that would improve with treatment.

    1. But the point is that the system is set up to funnel everybody into taking the drugs, not to screen them appropriately. I have absolutely no problem with people receiving treatment from appropriate professionals who provide good follow up care. I have a big problem with the pharmaceutical companies and the insurance companies running the health care system. And they do.

      ADD is what is known in the medical business as a ‘soft diagnosis’. There might really be such a thing as ADD, but the way that we treat it right now is a lot like the way that we treated ladies of the 19th century who suffered from ‘hysteria’ and ‘the vapors’. Handing out drugs to patients who need therapy or better parents is just snake oil.

  56. I think it’s worth noting that prescription of amphetamines for ADD is a grandfathered treatment.

    No way would kids be prescribed amphetamines today if research hadn’t been done on ADD treatments proving efficacy back when doctors were far more nonchalant about amphetamines as a drug class generally (c.f. benzedrine).

    Likewise, aspirin if it were invented today would be prescription-only, not over-the-counter (OTC), due to side-effects of gastrointestinal ulcers and stomach bleeding. Yet, aspirin remains OTC for historical reasons, and has that really been a problem?

    Not unlike how cigarettes and alcohol remain legal primarily due to historical path-dependency. (While drugs introduced more recently into the culture are criminalized or otherwise restricted.)

    That said, I’d like to quote some Ted Nelson:

    It is imperative for many reasons that the appalling gap between public and computer insider be closed. As the saying goes, war is too important to be left to the generals. Guardianship of the computer can no longer be left to a priesthood. I see this as just one example of the creeping evil of Professionalism, the control of aspects of society by cliques of insiders. There may be some chance, though, that Professionalism can be turned around. Doctors, for example, are being told that they no longer own people’s bodies. And this book may suggest to some computer professionals that their position should not be as sacrosanct as they have thought, either.

    I see Professionalism as a spreading disease of the present-day world, a sort of poly-oligarchy by which various groups (subway conductors, social workers, bricklayers) can bring things to a halt if their particular demands are not met. (Meanwhile, the irrelevance of each profession increases, in proportion to its increasing rigidity.) Such lucky groups demand more in each go-round – but meantime, the number who are permanently unemployed grows and grows.

  57. But what about a scenario of forty million Americans with paranoid insomnia from taking speed to improve cognition?

    Does that scenario occur before or after 300 million Americans die of cirrosis, lung cancer, alcohol poisoning, bleeding ulcers, diabetes, and obesity? That argument is ritalin-zombie fearmongering. It also illustrates a complete lack of trust, on your part, in people’s ability to make decisions for themselves about themselves.

    My girlfriend got a bunch of adderal for school and I was disturbed by her nonchalance with using it to study. … She did this for months and managed to just barely pass her classes. She was always frustrated that even though medication made her take incredibly detailed notes it didn’t give her any skill in critical thinking or discerning whatw as useful and what wasn’t. …

    Does she still take Adderal? I’m guessing, no. If that is the case, this supports my argument that people are capable of making their own decisions about whether or not to take these substances. The same goes for paranoid insomnia. People stop taking prescribed and OTC medications all the time because they don’t like the side-effects. Heck, people try cocaine and don’t continue using it because they don’t like the side-effects even though that chemical has been shown to be highly addictive. The person that should be making that decision is the person taking the chemicals.

    With regards to foregoing healthcare, that would depend on the consentual contractual agreement between my insurance company and myself. If they would give me a really great rate if I were to allow exceptions I might be interested. However, if I pay for total coverage, I should get total coverage. That is what insurance is for after all.

    1. I trust people to make decisions for themselves. Just not good ones. People who don’t deliberately fuck up their own health will still have to pay for those who do, either through exorbitant insurance premiums or government health care.

  58. You know I’m surprised it has taken this long for the discussion of cognitive enhancers to reach the level it has. It does not surprise me in the least that students and adults are doing this. People are always look for an edge over their competition and colleges and universities become more competitive year after year.

    I know NPR covered the topic in several on air discussions recently

    And The Brief Addiction Science Information Source (BASIS), a website/blog for current research on addiction, recently covered this topic in the first of a two part series in their online journal Addiction & the Humanities.

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