Sunday, December 14, 2008

This is your Nature on drugs

In college I was once shocked to learn that an engineering classmate routinely took caffeine pills to fuel all-night coding sessions. Some years into medical school, after learning to love coffee, I found myself discouraging a friend from boosting his study efficiency with Adderall. A 12/07/08 commentary in Nature forces me to examine this aversion. Seven authors—experts in fields from law to neuroscience—call for policies supporting “responsible use” of cognitive-enhancing drugs by healthy adults.

Most of us would not deny cognitive-enhancing drugs to Alzheimer’s patients, but the Nature authors assert that such tools should be accessible to all adults, within safety limits. A cognitive-enhancing drug, they argue, is fundamentally no different from cognitive-enhancing activities like sleep, exercise, nutrition, and Kaplan review courses. They stress the need for research programs and policies that promote evidence-based evaluation of the risks and benefits of cognitive enhancements, particularly unknown long-term effects on memory or personality. Current regulations and social norms, however, have set up inconsistent barriers to use of and research on mind-altering substances. Caffeine and nicotine are cheaply available, Ritalin and Modafinil require prescriptions, and forget about cannabis! Although many restricted drugs are indeed too dangerous to be used freely---and like physique-enhancing steroids might rarely be appropriate for children even if rules change for adults---the Nature authors suggest that some resistance is based on puritanical or naturalistic notions that unhelpfully impede progress. Imagine if the first books were burned as "unnatural" memory aids or if Edison's light bulb was extinguished for fear it would raise expectations for human productivity.

We in medicine must address this issue, both personally and professionally. Medical students endure academic challenges that call for every aid possible, and likely many of us rely on cognitive-enhancing drugs to some extent. Sleep-deprived residents face an even starker need, with life-or-death consequences for themselves and patients. Should on-call doctors be given free (or compulsory) alertness drugs? Even if we survive training without pharmacological help, those of us in primary care and psychiatry will undoubtedly face patients eager for such drugs in absence of any disease. Let us have the discussion now so we will be prepared to respond thoughtfully as new drugs are developed and demand increases.


Science Among Friends said...

As regulation of the use of cognition-enhancing drugs is virtually impossible, the Nature editorial is the sensible response. What must be assessed (scientifically) is the long term consequence on behavior and memory deposition. Then, a more systemic change may be mandated in academic performance assessments and perhaps medical residency scheduling.

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