I read recently that the United States Air Force was "making available" the drug modafinil (Provigil®) to pilots on long missions. Modafinil is a type of stimulant approved by the FDA for narcolepsy and sleep apnea (resulting in severe daytime problems staying awake). I knew that stimulants like Ritalin® and Adderall® had extended far beyond their medically recognized use for Attention Deficit Hyperactivity Disorder (ADHD) and, like modafinil, were increasingly used by high school and university students to improve their performance on tests and papers. Those already in highly competitive financial and legal jobs were also discovering these drugs in order to keep up with the pace and productivity that success seemed to demand. It is now a reality that stimulant drugs have developed a role beyond their FDA approvals and become "neuroenhancers" - medications to improve memory, concentration, and mental functioning. They seem to provide an edge, a way of defying fatigue, achieving greater focus, and overcoming the boredom of everyday repetitive tasks. I started to wonder if I could use some modafinil.
In late 2007 the British Medical Association (BMA) took up the medical and moral challenges of neuroenhancers by publishing a "discussion paper" called Boosting your brainpower: ethical aspects of cognitive enhancements. Trying to "encourage debate" on efforts to "improve upon nature" they stressed that enhancers are creating vexing problems about how to balance individual freedom to improve performance with public health and ethical concerns about potential short and long term harm - for adults as well as the children whose parents will see fit to try to add octane to their child's brainpower. A commentary in late 2008 in the prestigious journal Nature called Use of Cognitive Enhancement Drugs implied the inevitability of these agents and that "...Society must respond to the growing demand...by rejecting the idea that 'enhancement' is a dirty word." Their policy recommendations aim to insert some intelligence and control into what appears to be the future of a society built on cognitive enhancers "...increasingly useful for improved quality of life and extended work productivity." But I thought, when they say that something is too good to be true, it usually is too good to be true.
Fortunately, Dr. Nora Volkow, director of the National Institute of Drug Abuse (NIDA), and colleagues have been studying modafinil and in March 2009 published their findings in the Journal of the American Medical Association (JAMA). They were able to show that modafinil exerts its effect by increasing brain dopamine (as do the rest of the stimulant drugs, including cocaine and methamphetamine). What this means is that they have the potential for tolerance and abuse where more of the drug is needed to achieve the same effect and the brain craves for the drug if it is not present. The piper in these drugs may play quite a tune but you will have to pay the piper.
If you, your child or your loved one has a medical condition like ADHD or narcolepsy then the benefit of stimulants is likely to outweigh the risk (especially if combined with cognitive behavioral interventions). But if you do not, you are entering the world of performance enhancement - not the same thing as the treatment of a disorder - where many have tread and paid a great price. Neuroenhancers stand to become yet another cautionary tale in which promise is soon eclipsed by problems. So, I have decided to stick to coffee and tea, nourishing foods, learning a language or doing crosswords, reading and writing more, and getting some needed sleep - all of which ages of experience have shown enable us to think and perform better, safely, the old fashioned way.
Some would argue (and have argued) that with my IQ, and with my proven ability to succeed in a demanding technical field, that it is unfair to others for me to use modafinil. There is no need for me to “level the playing field” when already I am above it, and that claiming a disability such as ADHD cheapens other peoples struggle with such learning disabilities.
But at what point does a person “need” help treating their problems? When the problem hinders their ability to function at the same level as everyone else, or when their problem hinders their ability to function at their best?
I look forward to reading your thoughts and comments on this topic.
Regards,
Mike
New, let me draw a parallel to the case of nootropics, and about my personal issues.
I have been tested and diagnosed with severe ADHD several times over my lifetime. The most recent tests (in the last month) were extensive, including the WAIS-III, IVA+Plus, WAIT-II, Brown ADD, Nelson Denny and WMS-III tests.
These tests also indicate that my IQ is 132, and that the IQ score is highly suppressed by the ADHD as indicated by the extreme intra-test and inter-test scatter in the various subsections of the test.
Despite the ADHD, I have succeeded in coming from a situation of having no formal education and being self taught, to obtaining a B.S and M.S in physics, and am on track for a PhD.
Doing so required lots of hard work, study and repetition that many others in my class did not seem to have to go through.
Then I tried modafinil as a treatment for my ADHD, and the difference I perceive is profound. What used to take several repetitions now takes one. Transfer of short term to long term memory is easy compared to before. ADHD is considered partly to be a slowing down of processing speed and problems transferring information from short to long term memory, for me at least the modafinil seems to help greatly in reducing these symptoms.
Concluded on next post.
In your article you point out some of the moral -not to mention medical- issues that face the general populous in using modafinil. You state that the addiction and side effect factors of using modafinil are ameliorated in people with true ADHD.
Are there special biological issues people with ADHD face that make the negative side effects not as prevalent (such as the paradoxical calming effects of stimulants such as methylphenidate or caffeine) or is it a case where the benefits far outweigh the negatives?
As for the moral implications: You state that you will stick with working out your mental muscles via crossword problems and learning a language etc. This seems to indicate that you regard nootropics as a mental equivalent of steroids.
Let me ask a what if question: At what point does the use of a drug that enhances performance in an individual give that individual an unfair advantage?
For instance let’s consider the case of a physical athlete; say that they are a world class sprinter, but they also have severe exercise induced asthma. Even without taking bronchodilators their max Vo and other lung capacity indicators are superior to a vast majority of not only the general population, but of their athletic peers. Does this mean taking a drug that has the ability to further enhance the athletes performance is unethical, even if it treats a valid medical condition?
Cont. on next post: