Performance enhancing drugs...for the brain?

Today Shelley and Janet both have interesting posts about the ethical issues surrounding the growing use of cognitive enhancers among students (and in academia in general). They both make interesting points on the issue, their posts and the Nature commentary that spurred the discussion are definitely the recommended readings for today.

I'm crunched on time but wanted to offer a few brief thoughts on the issue. First, attention/cognition boosters are nothing new. Caffeine is possibly one of the most ubiquitous drugs in the country, and the unofficial Ritalin market is now well established. There has been a recent explosion in the market for energy drinks and other forms of "boosters." Many of the advertisements seem to focus on aiming these "energy boosters" at athletes, but there is a high demand for them in terms of boosting brainpower as well. At my university, drink machines around campus sell many of these products, and they have a hard time keeping them stocked during finals.

There is obviously a high demand for for substances that will allow people to increase their attention, memory, stamina, etc. Provigil (the brand name for the drug modfinil) is a controversial new drug that is supposed to be a "wakefulness promoting agent" as opposed to a traditional stimulant. Its original purpose was to treat narcolepsy, but it is now often prescribed off-label for ADHD or just for patients (pilots, truck drivers, stressed college students, etc) that a doctor thinks are justified in needing a sleep suppressor.

Public demand for something doesn't say much about the ethics of the underlying issue, however. If Student A takes a substance to achieve ultra-study mode and supress sleep, and Student B goes into a test "clean" but having spent less nighttime hours hunched over the textbook, is the situation fair? How would you view the situation differently if Student A had relied on liters of coffee instead of a pill?

It's an interesting case of a fuzzily defined continuum, I think (how's that for scientific terminology?). One question that I think is crucial, though, is what are the long term results of this kind of study pattern? You stay up for hours, cram for the test, and manage to pull an A. Whew, relief, now you can go home for the holidays and eat turkey with no worries.

You held onto the information for the exam, but how well will you remember it a month later, six months later, etc? Is your goal to get an A, or is your goal to assimilate knowledge that you'll need later on in life? The two don't have to be mutually exclusive, but achieving one does not necessarily result in the other. Would you want to see a doctor that passed most of his exams in medical school by relying on chemicals to cram tons of facts into his short-term memory? Last spring I spent many hours studying various equations and models for my ecology class, and I was able to reproduce them and use them successfully on my final exam. Done, check that one off the list of things to worry about, right? But I didn't want to just throw them out of my brain afterwards, because know I'm going to need them for later upper-level classes and in my own career. My Wildlife Management class this semester would have been a lot more difficult if I hadn't been able to retain and integrate much of the "old" information from my Ecology and Conservation Biology courses.

Whether it is unfair to Student B for Student A to swipe her roommate's Ritalin is a very thorny issue. One position I can definitely take, however is, that it is not fair for people to use these drugs because they are doing an injustice to themselves. Even if they remember that information in the long term, relying on pills or shots of boosters in order to succeed is not a healthy way to get by in the world. If I took one of those substances to get through finals, I would always have the "what if" question in the back of my mind: "Could I have pulled the A even without the pills? Did pointlessly put myself at risk for side effects or legal consequences, or did I really require artificial enhancement to pull the grade?"

How do you define "drug," though? I wrote the above paragraph with things like Ritalin, Provigil, etc in mind, but readily I admit I wouldn't take the same position if we were discussing coffee. I have a friend that is so reliant on caffeine that it sometimes hurts me to watch him sometimes (example: during a study session at his apartment I observed that he consumed three cans of Mountain Dew and three large mugs of black coffee, all between the hours of 9:00 and 11:30 pm). He is intelligent, responsible, etc, and I have no doubt he could pull A's without the caffeine....but he never consider "detoxing" and trying out a decaf semester.

It's a topic that certainly deserves discussion, although there aren't any easy answers. Despite being a hard issue to pin down, however it seems like it would be useful for at least some official guidelines to be established.