Barry Bonds. Shawne Merriman. Alex Rodriguez. Marion Jones. The list goes on, and so too does the ethical debate that surrounds athletes and their use of performance enhancing drugs. In the shadows of this ever-evolving controversy, though, lies an ethically similar but contextually different issue: “brain doping.“
Last year, as an April Fools‘ joke, a faux-press release by The National Institutes of Health (NIH) circulated the Internet. It stated that there were new initiatives to combat the use of brain enhancing drugs. The World Anti-Brain Doping Authority (WABDA) was to enforce the set of regulations among scientists.
The release was the work of self-proclaimed “mischievous prankster,” Professor Jonathan Eisen of the UC Davis department of evolution and ecology.
“Originally, the idea just seemed like an absurd joke,” he said. “And the best jokes are ridiculous in hindsight even if they are believable initially. But this one was scooped by reality.
“After I wrote the fake press release, around 20 different scientists and colleagues told me that they actually do take cognitive enhancing drugs,” Eisen said. “Just like students who have to stay up until five in the morning to finish a paper, these scientists are taking drugs to stay up to keep their minds clear while they write grants.“
Eisen’s “brain doping” colleagues were unavailable for comment.
Soon after Eisen’s prank surfaced, coincidently, the journal Nature released the results of an informal online survey conducted of its readers‘ uses of brain enhancing drugs – also known as smart drugs, neuro enhancers, cognitive enhancers and nootropics.
According to the poll, of the 1,400 readers from 60 countries surveyed, one in five said they had used cognitive enhancing drugs for non-medical purposes. For those who chose to use, 62 percent reported using methylphenidate (Ritalin), a drug that treats ADHD; 44 percent reported using modafinil (Provigil), a drug used to improve wakefulness in narcoleptics; those surveyed also reported the use of Adderall, an amphetamine comparable to methylphenidate. The sample was mostly representative of self-identified scientists, academics and journalists, but there was insufficient data to determine the sources of the drugs by the majority of respondents.
“Stimulants like methylphenidate and modafinil induce the neurotransmitters dopamine and norepinephrine, crucial components to attention and memory function,” said Dr. Michael Minzenberg, UC Davis research psychiatrist. “They inhibit and block the reabsorption and reuptake of these neurotransmitters used by neurons in the brain, so their action persists.“
The side effects associated with the use of methylphenidate, modafinil and amphetamines – anxiety, insomnia, upset stomach, headaches, dizziness and increased blood pressure – vary in severity according to dosage and sensitivity of the individual, Minzenberg said.
Reasonably healthy individuals often use cognitive enhancers for off-label purposes to improve concentration, memory, wakefulness and focus, he said.
UC Davis alumnus Nicholas Seltzer, a researcher at a defense-oriented think tank in Virginia, said, as reported recently by The New Yorker, the use of cognitive enhancers “is like customizing yourself – customizing your brain.” And for people like him, it’s important “to increase mental horsepower.“
“There isn’t any question about it – they made me a much better player,“ said Paul Phillips, who attributed the help of Adderall and Provigil with his more than $2.3 million earnings as a poker player, in an L.A. Times article.
Scientists, journalists, poker players, business professionals – the list goes on, and so too does the ethical debate that surrounds the use of cognitive enhancing drugs.
Hank Greeley, professor of law and bioethics at Stanford, said as evidenced by the discussion and coverage of these issues by the media and in journals, the bar has been set for a need to work toward an ethical consensus.
“Like all ethical issues, sometimes a position emerges, sometimes it doesn’t,” he said. “But a knee-jerk reaction to ban all cognitive enhancers is a mistake. First we need to explore the ethical issues concerning safety, fairness and coercion.“
While the logic used to consider the ethics and utility of enhancement in sports and cognition is the same, it’s important not to confuse the two. The contexts of the issues are very different, he added.
“While sports enhancers like anabolic steroids might improve someone’s bench press or ability to swing a bat, cognitive enhancers developed in the future might have the potential to influence achievements in science and perhaps a greater good,” he said.
Questions of safety currently present points of ambiguity.
“We don’t know very much about the long-term health effects associated with Adderall, Ritalin or Provigil in otherwise healthy adults,” said Heather Knapp, Ph.D., UC Davis center for mind and brain, in an e-mail interview.
“There is a big spectrum for the seriousness in using cognitive enhancing drugs, though,” said Adina Roskies, professor of philosophy and the neurosciences at Dartmouth University. “Caffeine is probably the most widely used cognitive enhancer. But no one thinks twice about someone who drinks five cups of coffee.“
“These cognitive enhancers are just the latest addition to the self-efficacy toolbox,” Knapp said. “But I do think that we need to be aware of the fact that they are Schedule II controlled substances that have the potential for dependence, and that their use by healthy individuals is, to a very great extent, unmonitored.“
Matters of fairness are similarly vague.
“Everyday we participate in cognitive enhancement,” Greeley said. “The computer is an amazing cognitive enhancer. Language and the written word are cognitive enhancers. I am a teacher and every day my students engage in cognitive enhancement when they learn.”
Issues of coercion, too, are blurred.
“There are also potential legal issues in play for cognitive enhancements,” Knapp said. “I can imagine a variety of situations in which individuals who feel slighted or misled when cognition-enhancing drugs were used to gain a workplace advantage might attempt to seek legal recourse.“
The prevalence of cognitive enhancers is clear. And while scientists are not yet subject to urine tests, while the “World Anti-Brain Doping Authority” has yet to raid labs for “smart drugs” and while asterisks do not yet appear by the names of authors on published studies, the use of cognitive enhancing drugs among professionals will continue to provoke questions: questions that Professor Greeley believes, for now, can only be answered by the sum of a lawyer’s two favorite words – “it depends.“
DAVID LAVINE can be reached at email@example.com.