Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
15 Dec

Dear Mark: Brain Pills

336279872 38a7255a59Dear Mark,

I’ve been a faithful reader of your blog for a couple of months now since Tony Horton turned me on to it at one of his fitness camps. Anyway, the reason I am writing today is to refer you to an article about some scientists who are proposing “cognitive enhancing drugs” for healthy people. I had to check the dateline to make sure it wasn’t recycled from April 1st. I’m sure you’ll be interested in it and I’m sure your readers would enjoy your commentary on it:

Scientists Back Brain Drugs for Healthy People

Thanks to reader Dave for forwarding the article. A number of people I know actually sent me the news with various questions and comments of their own. It’s made for a lot of interesting conversations, shall we say, in the last several days.

I always invite readers to go to the source and read for themselves, and this is no exception. Here’s the original proposal from the Nature journal issue. I’ve heard it’s accessible for free until later this week. Grab your coffee or tea (or stress ball) before sitting down to this one. It’s a long one.

The gist is this. A group of American and British scientists/academicians (two of whom consult for the pharmaceutical industry – surprise, surprise) are proposing (in the context of certain ethical considerations and policy suggestions) that “mentally competent adults should be able to engage in cognitive enhancement using drugs.” The authors include examples of pharmaceuticals like Adderall and Ritalin (stimulants prescribed for ADHD), Aricept (prescribed for the dementia of Alzheimer’s) and Provigil (prescribed for narcolepsy and other serious sleep disorders). They argue that these drugs can offer us regular folk cognitive benefits that we shouldn’t be denied. In fact, we apparently shouldn’t bat an eye about partaking, according to these experts. Cognitive-enhancing drugs, they say, are “morally equivalent” to the “other, more familiar enhancements” conferred by “exercise, nutrition…sleep…instruction and reading.” Yes, Virginia, you read that right. That Primal style salad you ate for lunch? The choice to turn in early last night? Those laps at the gym this morning? That novel you picked up over the weekend? The moral equivalent of uppers. In their words, all of the above everyday actions/efforts are interventions that “alter brain function” just as drugs do – the same principle if not the same process. Try telling that to your 8th grade language arts teacher.

And we should be chomping at the bit to get on board, they suggest. To support their belief that, as one author puts it, “Almost everybody is going to want to use it,” they cite the rise of stimulant and other pharmaceutical use on college campuses. (No, this is not an Onion piece.) A recent survey, they report, showed that nearly 7% of college students in the U.S. had taken prescription stimulants for academic purposes. (Hmmm. Would I be a total cynic to wonder how many of these students took it in order to get their studying done without having to curtail their “socialization” activities? Pessimistic misanthrope, I am, for assuming anything but the most noble motivations in our young people.)

But I digress… The authors, in their infinite wisdom, offer what I’ll call academic lip service to “managing risks” by acknowledging three “concerns” for the use of these drugs by healthy individuals. Safety, they say, is of concern. (Gee, really?) Aricept has, for example, been shown to offer benefit within a reasonable harm ratio for Alzheimer’s. However, that benefit/harm ratio will be different, they admit, for sheer beefing of the brain. Side effects for Aricept include seizures, heart arrhythmia, slowed heartbeat, arthritis, fainting and respiratory problems. Stimulants like Ritalin? Side effects include addiction, depression, anxiety, aggression, heart palpitations, heart failure, suicidal thoughts or behavior. (I wonder what exactly they would deem an “acceptable” risk for the benefit of a slightly enhanced memory or extra bit of concentration….) And, as they mention in their ethical discussion of children’s safety, there’s the rather inconvenient and unpleasant burden of not ever being able to filter or forget.

Another concern of theirs? Freedom from coercion. “Well, Jim, our HR policy now states that we expect stimulant use in all our sales staff. Keeping up with the competition, you know.” The authors cite the requirement of military personnel to take medications deemed important for their “military performance.” It’s true that military service requires some truly super-human demands at times, and the government chooses to incorporate this strategy into what they see as a matter of public and national security. A complicated issue that defies simple comparison, I’d say. But our authors seem conflicted over the freedom for the rest of us. We should have it, they say. But again, why would we want it when we can pop a pill and be so enhanced? As one responder said in the Nature comment section, this theoretically promises nothing short of setting off a “cognitive arms race.” In the authors’ infinite sensitivity, they at least let the seedlings off the hook again but not before making the analogy of coercive medicating of children with compulsory schooling. No April-foolin’ here, folks. Another one for your 8th grade teacher.

Oh, but there’s more. The final “concern” is fairness. Essentially, cognitive performance enhancing drugs will solely benefit those who can financially afford them. To this point the authors argue that socioeconomic status in our society already confers an upper hand in educational opportunity. True enough – I’ll give them that. But in the same second that they have me nodding in agreement for once, I’m back to clutching the chair in disbelief when they suggest that offering free drugs to everyone is akin to schools making computers available to students on campus during finals. What is it with these huge leaps of logic? Gee, let’s compare apples and antelopes! And just how to they propose to pay for this altruistic gesture? Good luck getting the Bill and Melinda Gates Foundation to sponsor that scheme.

So, what is finally the point of this exercise in absurdity? To float the idea of safety testing and legal marketing of certain prescription drugs to healthy individuals? (Some of them are on the pharmaceutical industry’s payroll, after all.) To argue a point simply for argument’s sake? (If so, why waste space in an otherwise decent scientific journal?) To drum up publicity? I guess the science fields are tired of politics getting all the attention and hoopla. By their own admission (despite their ludicrous analogies and attempts at justification), the “concerns” essentially make their proposal almost impossible to implement. The end of their proposal includes a call for collaboration among physicians, legislators, and other groups to create policy toward this end, but come on. Of all the issues facing this country, I don’t seem to think this proposal anywhere near skirts the top of the list for the American public. Hmm… let’s consider the impact on health care costs, insurance premiums and options. How about the massive redirection of research dollars and time into this fool’s errand and away from real diseases and health concerns? Gee, how about we encourage Big Pharma to focus on how to further medicate healthy people and let them off the hook even more in the need for treatment of legitimate disease? That’s rich. And, hey, with the added load on prescriptions benefits, let’s run the medical care system in this country totally into the ground!

One the one hand, I can shrug off these authors’ endeavor in the same way one expert and critic, Leigh Turner from the University of Minnesota Center for Bioethics: “It’s a nice puff piece for selling medications for people who don’t have an illness of any kind.” I agree with her point. There’s something about this proposal that stinks like yesterday’s garbage.

Nonetheless, there’s something about this that can’t let me dismiss it out of hand. The journal article has incited a firestorm of discussion and criticism this past week – a mix of disbelief, condemnation, and a fairly surprising amount of support (strategically couched in “pragmatism”).

My problem here, what sticks in my craw, why I can’t quite let this one slide? These authors (again scientists, academics from prominent institutions) aren’t advocating balance or health: they’re peddling tricks, pills to pull a fast one on your body. Funny thing about the body though. If you try to isolate and tinker with one system, it somehow catches wind that things are out of whack and generally tries to correct a situation it knows it didn’t initiate. (I have that old “Dry Bones” song going through my head now.) The point is, it’s all connected! When you’re dealing in neurological “revision,” I tend to think you’re especially playing with fire. The brain is the least understood organ. The most complex. We’re not talking Ginkgo Biloba here. These folks are promoting psychotropic drugs for the general population, pharmaceutical concoctions capable of shifting emotional experience, social perception, personality, and overall health.

These drugs appear to do something important for those with legitimate neurological diseases and conditions. (Although in some cases, I’d argue, other non-pharmacological means could offer equal benefit with much less risk.) But for people without these conditions, what would these drugs do?

Sure, I’m all for the impact of good nutrition, exercise, meditation, sleep, etc. (Moral equivalents, my you-know-what….) And I absolutely believe in the power of many nutritive and some herbal substances to bolster overall health, including the hormonal and biochemical balance that supports healthy neurological functioning. But the key here is balance – natural stability and equilibrium that various aspects of modern life (stress, environmental toxins, modern agricultural shifting of nutritional values, etc.) can throw out of whack. This “cognitive enhancement” proposal? It flies in the face of natural equilibrium in its pharmacological pursuit of superhuman practices I argue aren’t sustainable without significant health impact. (Long term stimulant use, anyone? Not a pretty picture.)

And the worst of it is that after someone goes down this “enhancement” road and finds his/her own shade of physiological ruin at the end of it, they’re on their own. They’re left holding the bag. A Faustian bargain if I ever heard one.

Here’s something the use of cognitive enhancement drugs will never offer or enrich: a sense of perspective. A New York Times commentary on the Nature proposal last week quoted Francis Fukuyama’s book Our Posthuman Future: Consequences of the Biotechnology Revolution. (It’s a good read if you’re looking for something to sink your teeth into.) As the Times highlights, he has this to say about the state of modern medicine: “’The original purpose of medicine is to heal the sick, not turn healthy people into gods.’” Personally, I think medicine’s mission should be first and foremost to educate and promote prevention, a foundation of true wellness and not simply the absence of measurable disease, and to use all the complementary tools in the box to heal those who are sick. But Fukuyama’s point stands here. Promoting a pharmacological revision of the general population (or at least the tier who would be able to access this “enhancement”) has the potential to unravel any grounded sense of wellness (let alone a host of other sociological and humanistic values that I’ll leave for others to analyze). Our physical limits can teach us as much as our abilities. They help circumscribe the bounds and interconnectedness of overall well-being after all. I’m a personal believer that “medical” care and the lifestyle choices that support it should be all about enhancing the health and happiness of the individual. Being healthy offers the physical energy as well as mental vigor and stability to fully experience the world – the intellectual but also the bodily, the emotional, the social. Enhancing one aspect of living to the detriment of the rest, I have to say, leaves me cold.

As always, thanks for reading and keep the questions, comments and suggestions coming! I’d love to hear your thoughts on the journal proposal. Have at it!

Mr. Physics Flickr Photo (CC)

Further Reading:

Science News Roundup: Brain Health

The Power of the Placebo

Move Your Body for Your Brain

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Hurray, more drugs for everyone!

    Zen Frittata wrote on December 15th, 2008
  2. My thoughts on this… scary, scary, scary and terrifying. How can we be expected to take health for the masses in the right direction when there is so much being done counter-productively to take it in the wrong direction. Especially when the wrong direction info is usually back by those with the “accreditation” and money behind them.

    The SoG

    Son of Grok wrote on December 15th, 2008
  3. Wait! Mark, you don’t think that the POTENTIAL to have an extra, let’s say, hour of concentration is worth the chance of having a seizure, swallowing your own tongue, and dying? You must be crazy….

    Well, definitely not as crazy as those “scientists”. How many people are going to blindly follow these supposed scientists, waste their money on this magic pill, and then have real health problems. I agree with Son of Grok… scary, scary, scary, and terrifying.

    Holly wrote on December 15th, 2008
  4. I don’t know, I can’t look upon this one too darkly. As much as it would be preferable for Big Pharma to throw their resources into beating malaria (although I gather that’s looking a bit more promising these days), I know this usage of prescription (and street) drugs is going on in my industry and I guess I’d feel somewhat better about it if it was sanctioned and monitored. Not to mention it’s not too dissimilar to the many, many people medicating mood disorders, some of which could be treated with diet and exercise.

    Kim wrote on December 15th, 2008
  5. If prescription drugs are the answer to healthy people becoming even better, shouldn’t we consider illegal drugs too? I mean it’s proven that methamphetamines and cocaine can help with weight loss and weight control. Marijuana is great for relieving stress. Ecstasy and meth can give you superhuman amounts of energy. Look at the side effects of those drugs, they sound a lot like the ones for the prescription drugs, and at least we actually know the benefits, instead of theorizing about them. It’s all in the name of improving our health after all.

    Vern wrote on December 15th, 2008
  6. I’ve got to be honest and admit that a drug that helps my brain function is mildly tempting.

    Nevertheless, I don’t think I’d actually ever take it. Big Pharma is basically evil, period.

    FoodRenegade wrote on December 15th, 2008
  7. Mark,

    I’m on board with your concept of balance with regards to this issue. Coming from someone with a solid case of ADHD, I find it funny that the “experts” are now saying that normal people should be taking the same pills in order to get that upper-hand back again. It’s hilarious, they’re pitting the general public against each other while we’re just jumping from hoop to hoop to keep up.

    This generation can be, unfortunately, defined by trying to “one-up” their peers. Flaunting wealth, skills, and ability are bad enough but now everyone is trying to increase/promote those tendencies and behaviors?? Yikes man!

    In any case, provocative read, thank you for the post!

    All the Best,

    Andrew R

    Andrew R - Go Healthy Go Fit wrote on December 15th, 2008
  8. Before we start consuming these drugs in great quantities we should all try omega 3 fish oil pills. Good for the mind AND the body.

    Dr Dan wrote on December 15th, 2008
  9. Just last week I saw the documentary Bigger, Stronger, Faster, which was about steroid use in sports. In one section the writer/director compared them to the use of cognitive enhancements among musicians and students, and wanted to know why using steroids was considered cheating when cognitive enhancements weren’t. I don’t consider them “cheating”, but I was rather appalled by the assumption that they were considered “normal”.

    dragonmamma wrote on December 15th, 2008
  10. In a previous article titled “Beginning of the End: Statins for Children” could not have been any more on the mark, Mark. It really does seem that we are going to become the most drugged and sedated people in history. It really is sad how doctors have become nothing more than legal drug dealers. I remember my childhood friend. He was an artistic and somewhat introverted person but never truly sick. Fast forward 8 years, his shrinks have put him on a whole coctail of drugs. This was not the friend I remembered. In fact, he looked and even spoke like a Zombie. Worse yet, no one ever said anything about his intake of soda (almost half a gallon a day.) It made me realize that this is what we are becoming: a country and soon, a world, of sedated, fat, depressed automatons. The future looks bleak for us if this is to continue.

    JE Gonzalez wrote on December 15th, 2008
  11. Honestly, I don’t see that much difference between this and vitamin supplementation.

    There are all sorts of folks who don’t think that you should be able to take/manufacture/sell supplements because it’s “unregulated/unsafe/uneccessary/a scam/you don’t need it.”

    I think it’s safe to say almost anyone who reads this site knows that’s untrue…

    But the point being, if someone else wants to use supplements, drugs or chemicals in what they consider the worthwhile pursuit of whatever they’re looking for in life, who’s to say they shouldn’t? Live and let live.

    Hell, food has some of the most profound effects on brain chemistry and physiology [yes, food=a drug] but no one says that someone can’t have a cheeseburger or a chocolate bar, if they want. [Well, some people try, but... you know...]

    No says you have to take these drugs, but should you prevent others who want to? I don’t think so.

    Rob wrote on December 15th, 2008
  12. I agree with Rob, let everyone do as they wish to themselves. The concern for “fairness” seems silly to me. If those drugs enhance some peoples productivity everyone gains. The people lamenting the “unfairness” of a world where some people are more productive and hence better paid revelas a sentiment I just don’t get.

    Arne wrote on December 16th, 2008
  13. The whole Big Pharma is evil gets tiring.

    The research for these drugs is out there. If you don’t trust it because one of the scientists works for Big Pharma, fine. If the studies were designed poorly, fine. But I missed the part where they said that these pills were going to be inserted into our water supply? No one is forcing you to take these pills. And for those that _choose_ to take them, let them be.

    Review the evidence objectively. Yes, I for one do not want to pop a pill that makes me drone like my cracked out Ritalin nephew but if there were ever a time where I could take a pill and have the memory of Kim Peek and I had come to the conclusion that the choice was right for me, then so be it.

    Quit protecting me from myself. Instead fight for full disclosure, intellectual honesty, self responsibility and let evolution sort us out.

    Jim Jones wrote on December 16th, 2008
  14. I disagree with the idea that we should let Big Pharma off the hook and just say it’s no big deal if medical experts and organizations encourage unsafe behavior.

    Gee, who is going to have to pay for all these people’s health problems that result from these medications? Personally, I’m tired of seeing my health premiums go through the roof. I don’t need to pay more for other people’s mistakes. I’m not about to leave millions of people without health care, but I am all for anyone and everyone (MDA included!) going after these so-called experts and Big Pharma for their role in encouraging these ridiculous schemes! I think the paying public needs to know what they’re being asked to pay for.

    Mark, keep up the rants. People need to know what’s happening!

    Jen wrote on December 16th, 2008
  15. “But I missed the part where they said that these pills were going to be inserted into our water supply? No one is forcing you to take these pills.”

    Actually, according to Michael Eades, an authority I trust, a proponent of statins has said just that.

    No one is forcing adults to take anything, true. But there is flouride in the drinking water “for our own good”. No thanks. As for children, I’m sure plenty of parents have been prosecuted for neglect for not giving their kids chemo, though. And are you aware that the American Academy of Pediatrics official recommendations to stem obesity problems in children include low fat milk and statins for 8 year olds? Let’s not see the day when one can be prosecuted for neglect for not giving a fat kid his daily dose of statins.

    Monica Hughes wrote on December 20th, 2008
  16. Thanks, I’ve recently been seeking for details about this subject matter for ages and yours is the best I’ve found so far.

    Junior Mannino wrote on May 16th, 2012
  17. Hey mark,

    I realize where your comming from and see why something like this would upset you. But this really seems like a morally bias article; your are criticizing their jumps in logic with jumps in logic of your own…something that is not typical for you in your usually diet and healthy living advice (usually very informed, rational, and scientifically accurate). I think it would have at least at the minimum been appropriate here to compare the physiological differences between drugs like adderall and something I know you drink everyday, coffee. Those mind altering stimulants that you deem okay in terms of living a primal lifestyle (coffee) was not even mentioned. I would be very interested to hear about a more in depth look at stimulants and your opinion. Please don’t mind the criticism, I am a huge fan…just some thought from a like minded guy.

    Josh

    Josh friedman wrote on February 21st, 2013
  18. I think what kills your whole argument is that you regularly use cognitive-enhancing drugs in the form of caffeine.

    Evan Hobbs wrote on June 24th, 2014

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