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Dear Mark: Brain Pills
Posted By Mark Sisson On December 15, 2008 @ 9:45 am In Big Pharma,Dear Mark,Health,Prevention | 18 Comments
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:
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!
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 article: http://news.yahoo.com/s/ap/20081207/ap_on_he_me/med_brain_pills
 original proposal: http://www.nature.com/nature/journal/vaop/ncurrent/full/456702a.html
 highlights: http://www.nytimes.com/2008/03/09/weekinreview/09carey.html
 Mr. Physics: http://www.flickr.com/photos/mr_physics/336279872/
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