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Are Better Brains Better? By Trey Popp

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Last December, Martha Farah joined six other academics in authoring a Nature commentary titled “Toward responsible use of cognitive-enhancing drugs by the healthy.” It called for the “presumption that mentally competent adults should be able to engage in cognitive enhancement using drugs.” Medications like Ritalin and modafinil, “along with newer technologies such as brain stimulation and prosthetic brain chips,” they posited, “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.”

Anjan Chatterjee is more hesitant to make this step; when the British Medical Journal asked him to argue in favor of endorsing Ritalin as a performance-enhancer for a point-counterpoint feature in June, he elected to write the contra position instead. Yet his fatalism and the feeling that “there are no straightforward answers” about pharmacologic enhancers have convinced him of the need for scientific investigation of their efficacy and risks.

In that respect he concurs with Farah, whose imprint was evident in the Nature piece’s insistence that “an evidence-based approach is required to evaluate the risks and benefits of cognitive enhancement.”

“I’ve gotten a certain amount of flack for not condemning these drugs,” Farah says. “But I feel like we don’t really know enough. We need to learn more about what these drugs do to normal, healthy people who are taking them for brain enhancement.”

In other words, Farah wants to move the debate over cognitive enhancement into a new phase in which experimental evidence—not philosophical rumination—will determine the appropriate uses and limits of new drugs and devices. Recently she and Chatterjee teamed up to take a step in this direction, tackling the contentious but unsettled question of whether stimulants enhance focus at the cost of creativity.

As usual, The Onion got there first. “Ritalin Cures Next Picasso,” the satirical newspaper proclaimed in a 1999 headline.

WORCESTER, MA—Area 7-year-old Douglas Castellano’s unbridled energy and creativity are no longer a problem thanks to Ritalin, doctors for the child announced Monday. “After years of failed attempts to stop Douglas’ uncontrollable bouts of self-expression, we have finally found success with Ritalin,” Dr. Irwin Schraeger said. “For the first time in his life, Douglas can actually sit down and not think about lots of things at once.” Castellano’s parents reported that the cured child no longer tries to draw on everything in sight, calming down enough to show an interest in television.

Swap out Ritalin for Adderall, and that’s the basic proposition Farah and Chatterjee decided to test.

“Individuals who tend to be creative tend to also be a little spacey—a little subject to distraction, not good at maintaining their focus on a single thing for a long time,” Farah explains. “So if all these college kids who are going to be the leaders and workers of tomorrow are developing these thinking styles that are very narrow and focused, because they’re doing their work on Adderall and similar drugs, that could have the terrible effect of decreasing overall the amount of creativity we have in our workforce.”

A small experiment involving healthy subjects, Adderall, and laboratory tests of creativity—which Farah allows “may sound like an oxymoron” but are “actually not-bad methods that cognitive scientists have developed”—yielded somewhat surprising results. “For two of the tests we found no effect whatsoever,” Farah says. “In one task it actually improved people’s performance. And in another task it improved the performance of students who had initially scored low on creativity, but actually impaired the performance of the people who had initially scored high.” She says ongoing work has shown this pattern to be a common one, that in some circumstances, cognitive-enhancement may serve to equalize differences, not amplify them. “I wonder to what extent these ambitious young college students who are taking Adderall, thinking it’s going to help them do well, are actually impairing their performance,” she muses. “If they’re already at the high end, they may be screwing themselves up.”

It is not hard to imagine other ways a research-based program of risk-benefit analysis might turn the cognitive-enhancement debate on its head. Jonathan Moreno pointed me toward a recent report titled “Opportunities in Neuroscience for Future Army Applications.” It discussed a 2008 finding that transcranial magnetic stimulation—a noninvasive method of using high-frequency magnetic fields to alter neural function—enhanced visuospatial attention. “They go so far in that report,” Moreno says, “to say that in the middle term—which is sort of 10 years—you could get an in-vehicle transcranial magnetic stimulator.” He adds, “The concept is applicable to civilian drivers too: a biosensor that can tell whether you were fading or not focusing, and a stimulator that can give you a little zap.”

If a prosthetic brain device proves safe and effective at maintaining alertness in fighter pilots for long stretches of wakefulness, one might argue on public-safety grounds that long-haul truckers be required to use it. “If superior performance by the few is deemed necessary for the greater good,” Chatterjee observed in his BMJ piece, “[medical] residents might be forced to take enhancements after being on call to mitigate cognitive deficits brought on by sleep deprivations. Perhaps doctors older than 50 would be required to pharmacologically stave off their fraying cognitive edges.” There is no telling how far such an approach might creep. If the effectiveness of a memory-enhancing drug turns out to be a function of uninterrupted use, the license to practice surgery might be made contingent on its continued ingestion by surgeons who relied on it during their training. Alternatively, if there proves to be a cognitive tradeoff between increased memory abilities and problem-solving skills, which some research seems to indicate, maybe those same surgeons should be compelled to disclose the contents of their medicine cabinets to patients or medical insurers.

Those scenarios seem unlikely in a society that counts liberty and the right to privacy as bedrock values, but our current experience with off-label stimulant use suggests that the pressure to enhance need not come from above. “I don’t think there are leaders who are rallying folks to take an interest in enhancement,” Farah says. “I think it’s grassroots, and it’s driven by a kind of striving or competitive mindset.” And a striving mindset can persuade its owner to do just about anything. In the rather stunning words of one respondent to the Nature poll, “As a professional, it is my duty to use my resources to the greatest benefit of humanity. If ‘enhancers’ can contribute to this humane service, it is my duty to do so.”

Says Jonathan Moreno, “Unless people are persuaded the downside is too great, people are going to move ahead and do this.” What they actually stand to gain or lose is the next question that faces us. In the meantime, the only thing we can be reasonably sure of is that regardless of whether these hypotheses are tested in the laboratory, there are already people who are willing to test them on themselves.

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Last modified 10/28/09