Experts back brain boosters for all

ANNE McILROY

From Friday's Globe and Mail

Your son is in his final year of high school and says some of the other students are taking Ritalin to help them concentrate while they study and write exams.

The drug may help him get into the university of his choice or win a scholarship. He wants to try it. What do you say?

Surveys suggest that in the United States, an increasing number of healthy university students are using so-called cognitive-enhancing drugs such as Ritalin and modafinil to improve their academic performance. One found that on some campuses, as many as one in four students used these kinds of drugs to get better marks, and that over all 7 per cent had done so.

The trend is likely to spread, experts say. In this week's edition of the journal Nature, a group of scientists and ethicists say it's time we all started thinking about the benefits of healthy individuals taking drugs to boost their brain power.

Many people consider the non-medical use of these kinds of drugs to be cheating, in the same way that athletes who take performance-enhancing drugs are breaking the rules.

But in their commentary in Nature, Stanford University's Henry Greely and his colleagues argue that taking Ritalin before an exam is no different from eating well or getting enough sleep.

The seven authors, from the United States and Britain, include ethics experts and the editor-in-chief of Nature as well as scientists. They developed their case at a seminar funded by Nature and the Rockefeller University in New York. Two authors said they consult for pharmaceutical companies. The others reported no such financial ties.

"Recent research has identified beneficial neural changes engendered by exercise, nutrition and sleep. In short, cognitive-enhancing drugs seem morally equivalent to other, more familiar enhancements," they argue in the commentary.

It is not an uncommon view among experts who have considered the ethical issues surrounding these drugs.

"Normally, our society reveres self-improvement," says Tim Caulfield, Canada Research Chair in Health Law and Policy at the University of Alberta.

"Doing yoga? Good for you. Taking guitar lessons? Impressive. Learning a new language? How mind-expanding. Speed reading lessons? Nice. Cognitive enhancers? You unworthy cheaters," Dr. Caulfield says.

Putting aside the issue of whether these drugs are safe when used in this manner, he says, it is tough to come up with reasons why taking them should be banned.

"Even though they seem like 'cheating,' in what qualitative way are they different from other forms of enhancement? Coffee is an enhancer. Should students be banned from using it before an exam?"

All education is pharmacological, Dr. Caulfield says. "Learning changes brain chemistry."

But isn't allowing some students to use the drugs while others don't similar to giving only half the people in a class calculators for a math exam? Dr. Greely and his colleagues argue that this kind of unfairness already exists.

"Differences in education, including private tutoring, preparatory courses and other enriching experiences give some students an advantage over others," they write.

The question of whether these drugs work remains unanswered, but there is evidence that many scientists and academics think they do.

Earlier this year, the journal Nature published the results of an online poll that asked readers if they were using drugs such as Ritalin to improve their performance. About 20 per cent of the 1,400 respondents said they had tried to improve their memory, concentration and focus by taking drugs for non-medical reasons.

They were asked about the following: Ritalin (also known as methylphenidate), a stimulant used to treat attention-deficit hyperactivity disorder; modafinil (sold under the brand name Provigil), offered by doctors as a treatment for sleep disorders but also used "off-label" to fight fatigue and jet lag; and beta blockers, which are usually prescribed to treat irregular heartbeats but can reduce anxiety. Ritalin was the most popular.

The people who read Nature are mainly academics and scientists, and 5.5 per cent who participated in the survey were from Canada.

Half of those who took the drugs said they obtained them through prescriptions, while a third said they ordered them over the Internet and 14 per cent said they bought them at a drugstore.

Learning more about how the drugs work might lead to greater acceptance of people taking them for non-medical reasons, Dr. Greely and his colleagues say.

If these medications improve long-term learning, they offer the potential of new discoveries and innovations, they write in Nature. You can't say that about an athlete taking steroids to win Olympic gold.

While scientists understand how steroids help build muscles, they don't know why these drugs may hone mental prowess in healthy individuals.

In this week's edition of the journal Science, Michael Minzenberg, with the department of psychiatry at the University of California, Davis, and his colleagues offer the first glimpse of what modafinil does in the human brain.

Brain scans of people who had taken the drug showed a decided shift in their mental state; they went from being easily distracted to being in "the zone," and more focused on a task, Dr. Minzenberg says. But he says he doesn't take it himself or prescribe it to healthy individuals.

"I don't do that under any circumstances."

Evidence suggests drugs such as this one would do more to help people of low to normal intelligence than individuals with high IQs, he says.

As for long-term effects, he notes, a four-year study that followed patients taking modafinil for narcolepsy showed no significant problems or signs that it was addictive.

Still, safety remains a big issue, and the academics who wrote the commentary piece in Nature call for more research into how the drugs affect healthy individuals.

Using any drug carries a risk. The online survey conducted by Nature found that half of those who had used cognitive-enhancing drugs reported unpleasant side effects, including headaches, trouble sleeping, or feeling jittery or anxious.

Other side effects of Ritalin include dizziness, nausea, vomiting, diarrhea, chest pain and shortness of breath. Modafinil can cause constipation, sweating, itchiness, mouth sores and hives.

So what do you tell a son or daughter who wants to take drugs to get better marks?

"This is a tough one," Dr. Caulfield says. "As a parent of four kids, this is my biggest concern - especially if they don't have the safety issues nailed down.

"But I tell my kids to get a good sleep before a big test. I tell them to have a good breakfast. I tell them to study. All of these are enhancement activities."

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