The Physical, Social, and Societal Consequences of “Smart” Drugs

By Sunidhi Ramesh

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris in Summer 2016.

Sunidhi Ramesh, an Atlanta native, is entering her third year at Emory University where she is double majoring in Sociology and Neuroscience and Behavioral Biology.  After experiencing an educational environment in high school that was so competitive that it practically forced students into taking study drugs, cheating, and cutting corners, she founded “The Prism Project,” an initiative that revolves around anonymous stories that highlight the problems that exist within the American education system. She plans to pursue a career in medicine and has served on College Council’s Admissions and Scholarships committee, is presently active on Emory’s Committee of Academic Integrity, and is involved in the Indian Cultural Exchange organization at Emory. 

“I remember the night I first took one. A friend of mine had some extra, so he handed me one the night before a big test. This test was important; I was doing pretty badly in the class, and I knew that my performance on it would decide my final grade. I wasn’t the type to take Adderall to get ahead. But I was desperate. And I thought it was only going to be this one time.

My grades skyrocketed. Like, you don’t understand. I played football and had to take care of my mom after school; the main reason I did so badly before was that I didn’t have the energy to put into school that I wanted to. But these pills… these pills gave me that. The energy I didn’t have.”

This quote is from an anonymous submission to The Prism Project, a page that shares the stories of students who feel as if the education system in the United States does less than it should. The topic of the quote is a subject of heated debates—“smart drugs.”

“Smart drugs,” also known as “nootropics,” are “supplement[s] that [are] ingested primarily for [their] effects on the brain [such as] an increase in cognition, focus, alertness, or well being (1)” in healthy individuals. Although the vast majority of these drugs were initially produced to treat symptoms of attention deficit hyperactivity disorder (ADHD) (2), the global demand for them (primarily for use in schools and work settings) has created a massive, up-and-coming “billion dollar business of being smart (3).”

Image courtesy of Deviant Art

And while most studies and scholars disagree on the actual effects of these drugs (ranging from “none” to “modest” improvements (4)), most researchers have expressed concern regarding their ethical implications and the consequences we may face when similar, more effective compounds are developed in the future (5).

One of the primary concerns involved is “challenging what it means to be normal.” Picture this: one student begins using these drugs to focus more and perform better on exams. He succeeds. The next student, feeling disadvantaged and conflicted, begins doing the same to keep a level playing field. And, suddenly, within weeks, a cycle of frustration and competition forces these little pills to become rampant around an entire school. This is the slippery slope that surrounds cognitive enhancements—the pressure that “normal” individuals begin to feel to become “enhanced.”

And what does this say about the future of our workforce? If our students are primed to only perform well under “enhanced” conditions, will they be able to work efficiently in their future jobs without these “smart” drugs?

Furthermore, the long-term effects of these drugs are largely unknown. A study done in doctors that “deprived [them] of sleep overnight and [gave them] a dose of 200 milligrams of Modafinil or placebo” found that “the doctors taking Modafinil had cognitive improvements, including flexibility of thinking, and reduced impulsivity.” (6) These are the positive (?), known, short-term effects. But what are the consequences of taking such medication often— for months or years at a time? Because these drugs are fairly new, nobody knows. So, should we be concerned? Of course.

Consider, also, the social consequences of a “pressure to perform” and the temptation that workers and students will face “to risk their own health to gain a competitive edge.” Is that a problem of it’s own? Taking into account the trust issues, mild paranoia, and mental stress that would inevitably ensue, I’m willing to bet it is.

What is odd and disturbing about this new trend is how idealistic people seem to be about its infectious spread. “Why would this be bad?” some people seem to claim. “One day, we will all be taking this medication to become smarter and more intelligent than ever before!” The core problem not addressed in this argument is that these medications cost money—money that only a small percentage of the American (or world) population can afford to spend on cognitive enhancement methods such as this one. This then becomes a justice problem. Is it fair to produce and allow products that, realistically, can only enhance a portion of the population?

Image courtesy of Flickr user eliz.avery

Advocates and opponents of these enhancers disagree significantly as to what exactly constitutes these “smart drugs.” Can caffeine products, such as coffee, be considered brain enhancers as well? Well, coffee and its stimulating effects are natural products of the coffee bean. More importantly, it is readily available to the masses, legal for public consumption, and free from most forms of stigma. On top of the fact that coffee has been consumed since the 10th century, there is ample evidence to ensure that its consumption does not come with any unwanted, long-term side effects. And, from a neuroethics standpoint, coffee does not bring into question concerns of justice, readiness, public involvement/understanding, integrity, and governance/ regulation. Convinced? Good.

With all this in mind, I can’t help but wonder why we (including myself!) have such a large problem with expanding our own potential as human beings. When would “smart drugs” be something desirable? Can we make our doctors more alert during 15 hour surgeries? Or soldiers more active in battle? Our pilots more attentive during international flights? Would we want this any more than we would want enhancements to the general population? I would think so. But why? What does this say about our values and our society?

Frati et al. (2015) may get into answering these questions (7), claiming that “the vast abuse of [these drugs] rises from the mental association between the therapeutic use for ADHD treatment and its misuse in order to improve learning skills in healthy subjects.” Frati’s group further states that “[the medication’s] improper use is based on exceeding the marked borderline between health and disease, which appears in the eyes of abusers increasingly blurred until it disappears (7).” So, as a result, “treatment” starts becoming synonymous with “enhancement” to dissenters around the country.

In terms of getting to the roots of the questions presented here, that’s a start.

We must stay alert when it comes to any large-scale changes that challenge what it means to be “normal” and “human” in modern society. And although larger studies on these drugs still need to be conducted to even begin to tackle the dozens of issues surrounding this topic, the “smart drugs” of today need to be discussed, debated, and monitored to avoid serious, undesirable consequences in the world of tomorrow.

References 



1. Nootropic - Scientific Review on Usage, Dosage, Side Effects. (n.d.). Retrieved June 11, 2016, from https://examine.com/supplements/nootropic/



2. Larimer, M. P. (2005). Attention deficit hyperactivity disorder (ADHD) research developments. Nova Publishers.



3. Chinthapalli, H. U. K. (2015). The billion dollar business of being smart. bmj, 23.



4. Arria, A. M., Wilcox, H. C., Caldeira, K. M., Vincent, K. B., Garnier-Dykstra, L. M., & O'Grady, K. E. (2013). Dispelling the myth of “smart drugs”: Cannabis and alcohol use problems predict nonmedical use of prescription stimulants for studying. Addictive behaviors, 38(3), 1643-1650.



5. Cakic, V. (2009). Smart drugs for cognitive enhancement: ethical and pragmatic considerations in the era of cosmetic neurology. Journal of medical ethics, 35(10), 611-615.



6. Sahakian, B. (n.d.). The Ethics of Smart Drugs. Retrieved June 11, 2016, from http://www.cam.ac.uk/research/discussion/the-ethics-of-smart-drugs



7. Frati, P., Kyriakou, C., Del Rio, A., Marinelli, E., Vergallo, G. M., Zaami, S., & Busardò, F. P. (2015). Smart drugs and synthetic androgens for cognitive and physical enhancement: revolving doors of cosmetic neurology. Current neuropharmacology, 13(1), 5.





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Ramesh, Sunidhi. (2016). The Physical, Social, and Societal Consequences of “Smart” Drugs. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2016/07/the-physical-social-and-societal.html