The Rise of Cognitive Steroids: A Discussion on Fairness and the Need for Regulation

If you were offered a pill that would improve memory and concentration, would you take it? If the drug had no adverse side effects, then the discussion becomes an argument of fairness: would using the drug in order to out-perform others be considered cheating? When Major League Baseball outfielder Barry Bonds broke the home run record, many critics suggested that an asterisk be placed next to the new record indicating that Bonds had taken performance-enhancing drugs. Would people suggest placing asterisks next to Nobel Prize winners’ names to indicate the use of drugs that enhance cognitive abilities? Although the fairness of using of cognition-enhancing drugs for nonmedical pur-poses is suspect, there is no doubt that use of these drugs is rising. To ensure that these drugs are safe for consumption, regulation must be implemented.

Nootropics are drugs that enhance cognition, meaning the brain processes that underlie mental activity such as attention, perception, learning, memory, language, plan-ning and decision-making [1]. For people who suffer from neurological and psychiatric disorders, nootropics can im-prove quality of life. However, according to a report by the Academy of Medical Sciences, non-prescription use of nootropics by healthy people is becoming increasingly widespread [1]. Off-label usage is particularly rampant in academic circles, where selective pressure for high performance is causing some to seek a competitive edge [2]. According to an informal survey conducted by Nature on its readers, one in five scientists and other professionals—out of 1,400 surveyed—admit to using drugs such as methylphenidates (Ritalin or Concerta), Modafinil (Provigil), and beta-blockers to improve their performance at work [3]. 

According to the Nature survey, the two most com-monly used nootropics in academia are methylphenidates and Modafinil. These drugs were developed by pharmaceuti-cal companies and certified by the FDA to treat symptoms of attention-deficit hyperactivity disorder and sleep dis-orders, respectively. Methylphenidates such as Ritalin are amphetamine-like drugs that improve attentiveness and focus; Modafinil is a popular drug reputed to offer similar benefits without the undesirable side effects, such as needing to make up for lost sleep in “sleep rebound” or develop-ing tolerance for the drug [4]. According to several studies, Modafinil was shown to reduce fatigue while improving motivation, reaction time, and vigilance [5, 6]. These observed benefits translate to increased productivity and more time that can be spent in the laboratory or cramming for exams. While Modafinil is approved to treat narcolepsy and other sleep disorders, Cephalon—the pharmaceutical company that markets Modafinil—reports that as much as 90 percent of its sales come from people who are using it “off-label” to stay awake for long stretches of time [7].

Many people use Modafinil to enhance cognition and wakefulness, but is this a potentially harmful misuse of an otherwise beneficial drug? What remains unclear is the definition of “abuse” in this context. For example, caffeine has been shown to provide temporary improvements in vigilance, learning, memory, and mood [8]. Caffeine is used worldwide to increase productivity because it staves off sleep. Despite the benefits that caf-feine confers, most people would not equate caffeine with other performance enhancing drugs such as steroids. 

As brain-boosting drugs become more so-phisticated, how-ever, when do we declare that a sub-stance has entered the domain of cog-nitive steroids? Not surprisingly, there are already people in the sports indus-try who disapprove of wakefulness- and concentration-boosting drugs. In 2004, the World Anti-Doping Agency added Modafinil to its list of prohibited drugs [9]. If a sports watchdog organization deems Modafinil unethical in athletic settings, should it also be unethical in academic settings? Increased use of nootropics in general could raise the stan-dard for “normal” academic performance and, as a result, lead to an “achievement gap” between those who can obtain these medications and those who cannot. Because so many cannot afford or access the drugs, using nootropics to gain a competitive advantage is an inherently unfair practice. 

With increased use lies the possibility of developing a severe psychological dependence on these drugs. For example, students may begin to believe that the only way they can maximize their academic performance is by taking daily doses of a nootropic. They may become reluctant to stop taking the drug for fear of losing their perceived gain in intellectual function. Here, the use of cognitive enhancers poses not only an ethical problem but also a practical one. Using drugs to boost one’s productivity may prove useful in the short run, but if one becomes dependent on the drug, then both the financial burden of continual self-medication as well as the psychological dependence may not be worth the short-term gain.

Psychological dependence at the individual level can also lead to dependence at the societal level. In a pharmaceutical race to become the best and brightest, everyone may become pressured into consuming nootropics. Workers who see their colleagues taking nootropic pills may feel compelled to take these drugs so they do not lag behind in productivity. Parents may also feel that their children will be at a disadvantage if they are not taking cognition-enhancing drugs. Although the long-term effects of methylphenidates on children are not well-documented, many researchers agree that methylphenidates do have long-term consequences on normal-functioning brains [10, 11, 12]. Due to the possibil-ity that nootropics can harm young and developing brains, protective measures should be taken to prevent the unnecessary medi-cating of children. According to an article by Mark Henderson, science editor of The Times, “more formal laws may be required to prevent coercive use of such drugs… by parents or teachers who want their children to perform better at school” [13]. But how the government should enforce such laws remains unclear.

While no student, physician, or scientist should require an exogenous substance for his or her mental creativity and performance on the job, there will undoubtedly be people who do use nootropics regularly to boost their cognitive function. Therefore, nootropics should be regulated like any other medicinal drug in order to lessen the likelihood of abuse and harm. 

Currently, drugs are developed and labeled for a specific disorder, and non-prescription usage goes largely unchecked [14]. The current “wink and nod” acceptance of off-label usage by the general public is unwise, as it provides little opportunity to assess risks. Right now, “we simply do not know what the long-term effect of the use of such drugs in healthy populations will be,” a British Medical Association report concludes [15]. 

The risks are not limited to chemical toxicity; there may be secondary hazards associated with nootropics’ intended purpose. For example, drugs that increase wakefulness sap necessary hours of sleep from their users, leading to dis-orientation, impaired judgment, and increased risk-taking that result from prolonged insomnia [16]. Such drugs make users believe that they need less sleep, but in reality people still need seven to nine hours of sleep every day, as recom-mended by the National Sleep Foundation [17]. Despite the urgent need for testing and risk assessment, it is possible that regulation of nootropics may not be implemented until a sleep-deprivation-induced accident, whether behind the wheel or on the operating table, occurs. A much healthier approach would be to accept the fact that cognitive enhancers might one day be widely used, determine which age groups to thoroughly assess effects and side-effects, and then use these results to label drugs that are offered for public consumption. In short, nootropics should be explicitly labeled as cognition-enhancers and subject to rigorous testing like any other FDA-regulated drug.

Of course, pharmaceutical companies have already picked up on the demand for nootropics. There are certainly potential profits in repackaging certain drugs so that they are marketed as cognition enhancers. However, before doing so, these companies must again go through testing to earn the FDA seal of approval. Many pharmaceutical companies are currently conducting research on the cognition-enhancing properties of drugs that are approved for other purposes. Cephalon recently sponsored a study that assesses the memory-enhancing properties of its product Modafinil. Amy DiCamillo, who heads the Cephalon-sponsored study, pre-sented a poster on this topic at the 2008 Society for Neuro-science annual meeting [18]. Her study specifically evalu-ated whether Modafinil improves short-term and working memory in rats. 

In addition to recycling old drugs, pharmaceutical com-panies are also beginning to investigate and develop novel compounds that will enhance cognition. Abbott Laboratories sponsored an animal-based study on the effects of a novel H3 receptor agonist on learning and memory, and it will not be long before testing moves from animal studies to human-based clinical trials [19]. Eventually, drugs whose primary purpose is cognitive enhancement may be manufactured for public consumption.  

From an ethical standpoint, the use of nootropics for gaining an academic advantage is inherently unfair. How-ever, there will always be people who have no qualms about taking nootropics to get ahead. Because a market for these drugs exists, the same kind of FDA regulation that is applied to all other medications should be applied to nootropics as well. Regulation places responsibility on drug companies so that their products are rigorously tested to protect the public’s health. This way, nootropic usage can become main-stream in a safe and regulated manner. The development of cognition-enhancing pharmaceuticals is moving forward at an incredible pace— yet ethics still has to catch up and define the boundaries between “fair” and “unfair.”  Despite the opposition to tampering with the brain in a way that confers unnecessary advantages, nootropics are here to stay.  

Theresa Lii is an undergraduate student at Brown University.

References:

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