Botox for the brain

Richard Dawkins promoted the idea of an "extended phenotype." He tried to convince us that the phenotype should include the effects that genes have on an organism's environment, as mediated by behavior. For example, the beaver has genes that allow it to fell a tree and control its environment. Similarly, humans were able to fan out all over the globe due to advancements in cultural evolution, such as the use of fur pelts to keep warm.

Most people accept that scientific advancements, like the advent of antiseptic cleansers, were a net win for the human race. But the same people are against the use of steroids in professional sports. What about people who decide to undergo cosmetic surgery to increase their attractiveness, and thereby reproductive fitness? The latest controversy involves cosmetic neurology: the use of drugs to improve cognition.

Margaret Talbott examines this issue extensively in The New Yorker.¹ In 2005, Susan Esteban McCabe, of the University of Michigan Substance Abuse Research Center, found that

4.1% of American undergraduates took prescription stimulants for off-label neuroenhancement. This figure rose to 25% at one school. Interestingly, a large proportion of students taking these stimulants were in fraternities. Students looking for these stimulants could easily find someone with extra pills who was advertising on-line.

One example of these drugs is Adderall, a stimulant composed of mixed amphetamine salts - prescribed for children and adults with attention-deficit hyperactivity disorder (ADHD). Although the mechanisms of action are not clear, some of these stimulants seem to increase dopamine levels in the brain, while others may alter acetylcholine levels.

Experts believe that when healthy individuals take prescription stimulants, they do not enjoy the same surge in performance as would be experienced by, say, someone who really had ADHD. Experts believe that the drugs can raise the level of performance from 40 or 50% of capacity to 80%. Perhaps similar to a cup of coffee, that really helps someone who is kind of tired, but not someone who is totally wired or incredibly tired. Similarly, smokers may credit cigarettes with improved cognitive capacity -- but the tide seems to have turned against that drug.

Stimulant manufacturers report that compounds like Adderall and Ritalin have certain side effects, such as a loss of appetite (which sorority girls might appreciate), dependency, and serious cardiac problems. Those who take such stimulants point out that many sectors of society operate on the tournament model, in which the winner takes all and tiny advantages can result in disproportionate rewards. The down-side, of course, would be the brain surgeon who pops a pill to pass his certification exam and then decides to go off the drug. What happens to the patient then?

Also, those weighing the costs and benefits of these drugs are in a different position than other patients suffering from cancer or heart conditions. Do you really want to run the risk of serious cardiac problems so that you can go out to the party and then write the term paper?

Companies selling new psychiatric drugs operate on the assumption that neuroenhancing drugs have ways of creating markets for themselves. It surely seems as if those taking the drugs believe that they are working. Even for those who rule out any placebo effect, it is not clear whether these drugs enhance thinking or merely compensate for a deficit in cognitive ability - in someone who's not that bright or just sleep-deprived. One professional poker player who popped pills found that he was able to focus for a longer period of time than ever before. Similar testimonies from other drug users suggest that neuroenhancers are not going to make you smarter, just better able to use the tools you have for a sustained period.

Scientists are currently engaged in research efforts to determine whether enhancing one kind of thinking takes a toll on others. Does improving focus detract from creativity? The Eureka phenomenon is when people get that earth-shattering revelation while in the bathtub, or while taking a walk. Unfortunately, the research currently performed is inherently reductionist. Lab tests that examine students' ability to remember strings of numbers may not accurately reflect the complexities of real thought.

Some argue that while there is no real benefit to society when athletes hit more home runs, human civilization benefits when the brainpower of the elite works at maximum capacity. But it seems like these drugs aren't going to help the best and the brightest surge forward. Instead, the baseline competitive level in average environments may shift. For example, tons of parents forced their kids to take SAT prep classes. These classes don't help the smartest students very much, but can offer huge jumps for those in the middle of the bell curve. It may be a coincidence, but after the huge boom in SAT prep businesses, the whole test was redesigned - so that the score is now out of 2400 rather than 1600.

Let's hope we don't all have to Botox our brains.

¹Talbot, Margaret. "Brain Gain," The New Yorker, April 27, 2009.

The Scitable website has a great article on the genetic enhancement of learning and memory: http://www.nature.com/scitable/content/Genetic-enhancement-of-learning-and-memory-in-29823