“Cosmetic Neurology”—the Cost of Cognition Enhancement…

I just helped my son move to the University of Victoria where he will live in residence for a year as he pursues his post-secondary education. It was a momentous event and I have to admit that tears were shed (though I pulled it together enough to shed them after we parted). My son is a grounded, emotionally mature young man and he admitted to feeling the jitters about the move. But he was stoked too and looking forward to university life. He’s bright and motivated to work, though he likes to “party” like the rest of them. So, I’m not worried. I have faith in his wisdom (he is a lot wiser than me in some respects!) and his balanced approach to life.

But… he has also grown up in a culture where the stress of high-performance in school and work is ever growing and where overworked professionals are openly seeking help from cognitive enhancement drugs.
How many of my son’s classmates have grown up using or will soon adopt prescription drugs as study aids? Evidence shows that teenagers have casually used attention deficit drugs like Adderall and Ritalin as study aids, often buying them on the internet.

In the December 2008 issue of Business Week, Ellen Gibson described this potential scenario for a recent grad… Facing an important interview the college graduate searches her closet for the perfect outfit, then rifles through her medicine cabinet for just the right cognitive-enhancement pill. Adderall, perhaps, to help her concentrate. Or Provigil, for alertness…or maybe a beta blocker to combat jitters?

According to the Economist cognitive enhancers work on the neural processes that drive mental activities like attention, perception, learning, memory, language, planning and decision-making, usually by altering the balance of the chemical neurotransmitters involved in these processes. A recent report from the Academy of Medical Sciences suggested that scientists are working on more than 600 drugs for neurological disorders and that a large number of such brain-affecting drugs are likely to emerge over the next few decades.

Dr. Anjan Chatterjee, a neurologist at the University of Pennsylvania Hospital, coined the term “cosmetic neurology” for the use of cognition-enhancing drugs. He was comparing their use to the advent of cosmetic surgery. Cognition drugs are already a billion dollar market, said Gibson. Adderall XR (the extended version of the ADHD drug) earns Shire Pharmaceuticals $1 billion a year. The Alzheimer’s drug, Aricept, clocked sales of $1.6 billion in the U.S. in 2007. Cephalon earned $840 million for the narcolepsy treatment drug, Provigil in 2007. Healthy people use it to stay awake, said Gibson.

“From assembly-line workers to surgeons, many different kinds of employee may benefit from enhancement and want access to it,” said Martha J. Farah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania in the journal Nature.

With the aging of baby boomers experiencing “senior moments” more and more, memory drugs are big business. The U.S. Food and Drug Administration (FDA) is currently reviewing more and more treatments for Alzheimer’s and age-related dementia. The largest boon will come to the company that comes up with the first evidence-based memory treatment drug for use by still healthy adults.

But, as Shakespeare once said, “To sleep: perchance to dream: ay, there's the rub; For in that sleep of death what dreams may come When we have shuffled off this mortal coil, Must give us pause…”

On August 25, 2009 the Nature Blog reported that “Abuse of ADHD medications appears to be rising among American teens.”

A commentary in Nature December 2008 sparked headlines about the ethics of using and promoting cognitive-enhancing drugs for performance in universities and in the work place by healthy people (their definition for people who don't have ADHD or ADD, which begs another question: what is "healthy"?). For example, one response to the 2008 Nature article that advocated the use of cognitive-enhancing drugs by "healthy" individuals, was by Christopher Wanjek at Live Science, who asked “what were they smoking?” and questioned what casualties might yet arise from long-term use of said drugs. Although the online Nature article began with this statement: “Society must respond to the growing demand for cognitive enhancement. That response must start by rejecting the idea that 'enhancement' is a dirty word, argue Henry Greely and colleagues,” the authors followed with this commentary: “Safe and effective cognitive enhancers will benefit both the individual and society. But it would also be foolish to ignore problems that such use of drugs could create or exacerbate.”

Side effects of “smart drugs” range from insomnia to dependency to cardiac events. With their rampant use, the pressure to do so would become the difference between getting a job and not. It would be akin to having a bachelor’s degree or not, something else that is available only to those who can afford it. The premise behind the motion picture Gattaca and Nancy Kress's Beggars in Spain come to mind (both of which were about genetic descrimination and the latter about genetic enhancement).

But what are we really creating?

Creative insights often arise when the mind is allowed to wander, said Dr. Chatterjee. He warned that if drugs that sharpen concentration became widespread in the workplace, they might nurture “a bunch of automatons that are very good at implementing things but have nothing to implement.”

The more we rely on exterior aids like “smart drugs” to help us cope with stresses we have bought into (life is full of choices), the more we lose ourselves. The more we lose our creativity. The more we lose our unique spirit and what makes us ultimately successful as a species in a continually changing world. We will be smarter in the going but we won’t know where to go.

Nina Munteanu is an ecologist and internationally published author of novels, short stories and essays. She coaches writers and teaches writing at George Brown College and the University of Toronto. For more about Nina’s coaching & workshops visit www.ninamunteanu.me. Visit www.ninamunteanu.ca for more about her writing.