Academics Laud Drug Use

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Six academics and Philip Campbell, the editor-in-chief of Nature Magazine, recently argued that society should move “towards the responsible use of cognitive-enhancing drugs by the healthy,” particularly drugs typically used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD).

“In this article, we propose actions that will help society accept the benefits of enhancement, given appropriate research and evolved regulation,” write the authors, who hail from prestigious universities such as

• Stanford Law School,

• Harvard Medical School,

• the University of Cambridge,
• the University of Manchester,
• the University of California at Santa Barbara, and
• the University of Pennsylvania.

They argue that “Today, on university campuses around the world, students are striking deals to buy and sell prescription drugs such as Adderall and Ritalin—not to get high, but to get higher grades, to provide an edge over their fellow students or to increase in some measurable way their capacity for learning.”

Adderall, an amphetamine, and Ritalin are drugs whose psychological effects have been compared to cocaine. According to the 2000 Congressional testimony by Terrance Woodworth, then- Deputy Director of the Office of Diversion Control (ODC) at the Drug Enforcement Administration (DEA), “Extensive scientific literature over 30 years of research unequivocally indicates that both methylphenidate [Ritalin] and amphetamine have high abuse liabilities” and “they will substitute for each other and for cocaine in a number of paradigms in both animal and human subjects.”

In addition, he states, “In clinical studies, they produce behavioral psychological, subjective, and reinforcing effects similar to cocaine.”

Adderall and Ritalin are classified by the DEA as producing “possible” physical dependency and pose a “high” risk for psychological dependency; they may also produce a “tolerance” effect.

Modafinil [aka, Provigil], also recommended by the authors, has “possible” physical and “moderate” psychological risks of dependency, and may produce a tolerance effect, according to the DEA.

The authors’ commentary, however, likens the “cognitive-enhancing” effects of these drugs to healthy behavior and the “neural changes engendered by exercise, nutrition, and sleep, as well as instruction and reading.” Opting in to such treatments is later compared to precedents in “certain branches of medicine, including plastic surgery, dermatology, sports medicine and fertility medicine.”

“The drugs just reviewed, along with newer technologies such as brain stimulation and prosthetic brain chips, 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,” they argue, later adding, “Drugs may seem distinctive among enhancements in that they bring about their effects by altering brain function, but in reality so does any intervention that enhances cognition.”

“In short, cognitive-enhancing drugs seem morally equivalent to other, more familiar, enhancements,” they conclude.

Potential areas of concern which might arise if these drugs were used for enhancement included safety, “freedom from coercion to enhance,” fairness, and regulating children’s access to these substances. Nature Magazine notes that “this article is the result of a seminar held by the authors at Rockefeller University.”

“We call for an evidence-based approach to the evaluation of the risks and benefits of cognitive enhancement,” they write. One might start with the thirty years of research on the likely abuses of these medications, as mentioned by Woodworth.

According to the University of Michigan’s 2008 “Monitoring the Future” report, released December 11, illicit amphetamine (includes all forms) and Ritalin use by 8th, 10th, and 12th graders have fallen significantly—between one half and a third, respectively—between the mid-1990s and this year. 10.5 percent of 12th-graders reported using amphetamines over their lifetime this year, compared to 15.4% in 1991. 2.9 percent of 12th-graders reported using amphetamines in the last month, down slightly from 3.2% in 1991.

46,348 students from 386 public schools participated in the 2008 survey.

To ensure educational equity, the authors suggest that schools freely distribute cognitive-enhancing drugs at school. “If cognitive enhancements are costly, they may become the province of the rich, adding to the educational advantages they already enjoy,” they write.

“One could mitigate this inequity by giving every exam-taker free access to cognitive enhancements, as some schools provide computers during exam week to all students. This would help level the playing field.”

According to the Medication Guide, requested by the Food and Drug Administration (FDA) in 2007, conditions associated with Adderall and other stimulants include

• heart problems,
• stroke,
• high blood pressure,
• “new or worse behavior and thought problems,” and
• among teenagers, “new psychotic symptoms…or new manic symptoms.”

Common side effects listed in the Ritalin Medication Guide include headache, decreased appetite, stomach ache, nervousness, trouble sleeping, dizziness, nausea and heart palpitations. It carries the same stimulant warning.

Although the article in Nature does not discuss the medical complications of the drugs it proposes become mainstream, an article in the San Francisco Chronicle and news blogs by Nancy Shute of U.S. World and News Report, and Jordan Lite of Scientific American Magazine do note these concerns. The Stanford News Service, interviewing article co-author and Stanford professor Henry Greely, ignores this important angle.

“It’s a nice puff piece for selling medications for people who don’t have an illness of any kind,” Dr. Leigh Turner, associate professor at the University of Minnesota Center for Bioethics, told the Associated Press.

Only two of the seven Nature column authors reported consulting for pharmaceutical companies. They were Barbara Sahakian from the University of Cambridge and Ronald C. Kessler from Harvard Medical School.

Bethany Stotts is a staff writer at Accuracy in Academia.