The Neuroethics of Smart Drugs

by Moheb Costandi

December 4, 2012

In recent years, the number of healthy people using drugs that enhance cognitive functions has soared. While this has raised ethical concerns, these so-called “smart drugs” also have other uses that could be of great potential benefit to society. In a lecture at the annual meeting of the Society for Neuroscience, held in New Orleans in October, Barbara Sahakian of the University of Cambridge discussed the various uses of smart drugs, and their potential impact.

Sahakian described some of her work showing that the number of prescriptions for stimulants has doubled over the past 10 years in the U.K. She also pointed to research carried out by Martha Farah, a neuroethicist at the University of Pennsylvania, showing that the number of prescriptions for Ritalin, a stimulant widely used to treat attention deficit hyperactivity disorder (ADHD), has also increased in the U.S.

While these increases partly reflect greater recognition of ADHD, and more accurate diagnoses of the condition, especially in children, the prevalence of the condition alone does not account for the increasing use of the drug.

Sales figures of other smart drugs tell a similar story. The global market share for modafinil—a stimulant used to treat narcolepsy—exceeded $700 million in 2008, Sahakian noted, and it is estimated that around 90 percent of the time it is used "off-label," by healthy individuals.

 “You can go into the libraries at top U.S. universities and see people passing around smart drugs to improve their concentration and do better in their exams,” said Sahakian. “For students who have put off work, or are not very strong academically, these drugs can remedy or counteract their problems.”

Surveys conducted on university campuses show that the use of smart drugs is increasing among academic staff, too. In 2007, Sahakian surveyed her colleagues at Cambridge, and found that non-medical use of smart drugs is widespread among them. This triggered the journal Nature to conduct its own survey the following year and this, too, found large-scale use within academia: Of the approximately 1,600 academics from 60 countries who responded to an online survey, one in five said they had used the listed smart drugs for non-medical reasons, in particular to enhance their focus, concentration or memory.

Together with her Ph.D. student Danielle Turner, Sahakian performed a study to examine the effects of modafinil in healthy people. They gave their participants low or high doses (100 or 200 milligram) of the drug, and found that it led to significant improvements in their performance on a task involving planning and problem solving. The effects were particularly noticeable during the more difficult version of the task—those participants given a high dose of modafinil made far fewer errors.

The use of smart drugs by healthy individuals has numerous potential benefits. “Many people start off being dealt a bad deck of cards,” said Sahakian. “They come from poor socioeconomic backgrounds and face poverty and other difficulties. If we can remove unfair disparities in society, then maybe we should.”

Which performance to enhance?

Smart drugs can also be of great help to people who work long shifts, and to those who have to maintain high levels of performance under stressful conditions. The U.S. military, for example, uses modafinil to combat fatigue among its troops—soldiers are given the drug to help them stay awake and alert during missions. And earlier this year, Sahakian and her colleagues reported that the drug also improves higher cognitive functions in fatigued doctors

Sahakian also described work carried out by her group that shows that smart drugs can also improve cognitive functions in people with various neuropsychiatric disorders such as Alzheimer’s disease, ADHD, depression, and schizophrenia, many of which usually involve problems with processes such as attention, learning, memory, and reward and motivation.

Last year, Sahakian and her colleagues published evidence that modafinil significantly improves the recognition of sad facial expressions in patients with a first episode of psychosis and could therefore enhance their social functioning.   

“If we can pick up on these problems early on, there may be a possibility to help protect patients’ cognitive abilities,” said Sahakian. “We could ensure that they’re treated effectively, both with anti-psychotic medication and also with add-on cognitive enhancing medication.”

Despite these benefits, the use of smart drugs, particularly by healthy people, raises a number of concerns, not least of which is the lack of regulation. 

“Modafinil is available online without a prescription and this is of great concern,” said Sahakian. “This is a very dangerous way of getting drugs, because you don’t really know what you’re getting, and I’ve been trying to find out what can be done by the government about this problem.”

Sahakian also pointed out that the side effects of long-term use of these compounds are still unknown. Of particular concern is the use of smart drugs among people aged 18–25. According to the surveys, non-medical use of smart drugs is highest in this age group. Recent research shows that the brain continues to mature until the late twenties and beyond. Yet no one knows the consequences of long-term use of stimulants on the developing brain.

Another concern is that people could be coerced into using smart drugs. People who could enhance their cognitive function by using these drugs could gain an unfair advantage over others, pressuring those who may not want to use the drugs into doing so to keep up. The use of smart drugs could also increase social inequalities rather than reduce them, because not everyone can afford them.

“Pharmacological enhancement is one possible solution to improving society,” said Sahakian, “but we would not want to preclude other solutions such as extra help in the classroom, life-long learning, and exercise.”

“If we all work together to discuss the consequences of cognitive enhancement, we can go a long way to ensure these technological advances are put to maximal benefit with minimal harm.”