Going to work on smart drugs

Will employers pressure staff to take brain boosters?

While most people start their day with a cup of coffee, Jeremy Cole, an operations manager at an aviation company in Denver, Colo., ingests a little white pill called modafinil. For those with debilitating sleep disorders such as narcolepsy, which can cause individuals to pass out at all hours of the day, the drug’s energizing qualities offer a ray of hope for a normal life. But the thing is, Cole doesn’t suffer from narcolepsy. Instead, he’s part of a growing throng of otherwise healthy individuals popping high-powered pharmaceuticals to add some zing to their grey matter. “It’s not like coffee, it doesn’t make you feel buzzed or amped up,” says Cole, who began to take the drug 10 months ago. “It’s as if a fog has been lifted off your brain.”

By now, many have heard the stories of university students popping Ritalin to help them cram for exams. But in recent months there have been signs the phenomenon has spread to scientists, academics and even office workers. This past spring the journal Nature conducted an informal survey of its readers to gauge how many of them have used so-called smart drugs. The survey found that one in five respondents had turned to pharmaceuticals to enhance their concentration, focus and memory. Then, in July, a popular technology blog in Silicon Valley proclaimed Provigil (the brand name for modafinil) to be the “entrepreneur’s drug of choice.” The blog cited executives at upstart tech companies who rely on it to keep them energized through 20-hour workdays.

Now a report entitled “When the Boss Turns Pusher” in last month’s issue of the Journal of Medical Ethics warns that some employers may soon pressure workers to take brain boosters as a way to improve their performance. The report argues legislation is urgently needed to protect workers’ rights before the practice of healthy people using smart drugs becomes more common. “I’m a strong supporter of individual autonomy and I think people should be able to enhance themselves all they want,” Dr. Jacob Appel, a bioethics lecturer at Brown University in Rhode Island and the report’s author, told Maclean’s. “But my concern is that employers will try to compel individuals to do that.”

It’s hard to know exactly how many healthy adults are doping their brains. Anecdotal evidence on the Internet suggests an underground enhancement culture is taking shape not unlike what occurred in the early days of steroid use in bodybuilding. In online forums devoted to cognition enhancement, participants rhyme off their pharmaceutical regimens the same way other people swap cocktail recipes. Except in this case, the ingredients are some of the most powerful compounds on the market, approved to treat not just narcolepsy and attention deficit disorder, but also Parkinson’s disease, Alzheimer’s and depression.

What would lead healthy people to experiment with drugs originally designed to treat serious ailments? A number of factors are at work, say experts. In some cases, it’s as simple as trying to cope with long work hours or jet lag. But there’s also a sense among many of those seeking cognitive enhancers that mankind just wasn’t cut out to sit at a computer all day crunching numbers and splicing spreadsheets. “A lot of enhancers are more or less about fitting us into the modern world rather than the African savannah where our ancestors roamed,” says Anders Sandberg, a research fellow at Oxford University’s Future of Humanity Institute. “Cognitive enhancement drugs are going to involve trade-offs with evolution.”

At the same time, a greying population means some people are on the hunt for ways to keep their mental faculties sharp. While modern medicine has extended the best-before date of the human body, the same can’t be said for the brain. That’s a problem for the millions of baby boomers who plan to continue working well into old age. This point was driven home earlier this year when the U.S. military put out a call for companies to develop a smart drug that could keep its aging soldiers in fighting form, both physically and mentally. Such a drug would also have huge commercial potential. “The world contains approximately 4.2 billion people over the age of 20,” the U.S. army noted in its call for bids. “Even a small enhancement of cognitive capacity in these individuals would probably have an impact on the world economy rivaling that of the Internet.”

In the meantime, there’s no shortage of people willing to experiment with existing pharmaceuticals. One poster on an online forum recently boasted that by mixing deprenyl, a drug developed for Parkinson’s sufferers, and Inderal, a hypertension treatment, he was able to give speeches and presentations better than ever before. Talk like that scares Zack Lynch, executive director of the Neurotechnology Industry Organization, which represents neuroscience companies. “People need to realize these drugs haven’t been clinically tested on healthy individuals,” he says. “It could be that serious side effects don’t show up until 20 years down the road.”

Part of the problem is that there is no regulatory process for the study and approval of cognitive enhancement drugs among healthy individuals. Health agencies in Canada and the U.S., for instance, require that drugs target a specific illness, and feeling like your brain is groggy doesn’t count. Once a drug is approved to treat a neurological disease or disorder, though, doctors are then free to prescribe it “off-label” to treat other ailments. This was how Cole obtained his modafinil. After spending a year researching the drug online to ensure it was safe, he says he found a local doctor who prescribed the drug to treat “working-related somnolence.” By some estimates, 40 per cent of all prescriptions in the U.S. are now off-label.

Far more alarming is the brisk trade in black market pharmaceuticals over the Internet. In cases where it’s impossible to get doctors to fill out off-label prescriptions, many are simply ordering the high-powered drugs online from companies in Europe and India, who ship right to the front door. It’s a black market trade that experts expect will only increase.

Aside from the health risks, many ethicists are opposed to cognitive enhancement on a more fundamental level. Some argue that since smart drugs come with hefty price tags, only the rich will be able to afford them. There are also worries the drugs will create an unfair playing field between those who use them and those who don’t. When Britain’s Academy of Medical Sciences released a report earlier this year on cognitive enhancement, one panel member suggested schools might introduce urine tests at exam time to test for smart drugs. Lastly, some academics draw the line at the drugs being used for anything other than treating genuine illnesses. “The original purpose of medicine is to heal the sick, not turn healthy people into gods,” wrote Francis Fukuyama in his 2002 book Our Posthuman Future: Consequences of the Biotechnology Revolution.

Cole has heard all these complaints before and he’s not buying it. “We’re in a competitive world—it’s either sink or swim,” he says. “From people to machines, we’re pushing ourselves further with modern technology and medicine. This is the reality of the world we now live in.”

Yet in all the debate over cognitive enhancement drugs, the question that often gets overlooked is whether they really work. On that front, the results are decidedly mixed. Tests have found modafinil does enhance short-term memory in healthy individuals, enabling them to better recall a longer string of random digits than those people not taking the drug. And in studies involving pilots in flight simulators, moda?nil was shown to improve the alertness and reaction time of subjects. Yet the gains were minimal amongst those pilots who already performed well without the drug. Likewise, Ritalin is far from the golden study-drug it’s made out
to be. Researchers at the Society of Nuclear Medicine recently tested how healthy people performed at cognitive tasks when using the drug. Those test subjects who already performed well without the drug did improve with Ritalin, but those who performed poorly actually saw their results deteriorate.

So how to explain the glowing online reviews for smart drugs and their actual tested results? Sandberg chalks it up to the placebo effect. At a recent academic conference he attended, it turned out everyone at the table had tried modafinil. As everyone described their varied experiences with the drug, from mental stimulation to becoming more social, it became obvious at least some of the results were in their heads.

Still, it’s obvious there’s a large and growing market among people for drugs that enhance and sharpen the mind. And that means a public debate needs to get under way now, says Appel. As newer and stronger treatments for neurological disorders are developed, their effect on healthy individuals will grow more pronounced, as will pressure for everyone else to try them. “Eventually, employers will begin to demand that their employees accept neurological enhancement as a condition for employment and promotion—and the working stiffs of the world will not have the financial power to resist,” he wrote in his recent paper. “That’s a no-brainer.”

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