Here’s an interesting question: “if you could take a pill which enhanced attention and cognition with few or no side effects, would you?”
Shelley says yes. Janet says no. I say it depends on that qualifier, “few or no side effects” — if that were true, I’d say “Yes! Gimme more!” This is no dilemma at all.
Of course, that’s cheating. There’s no such thing as a drug that has no side effects. The real dilemma would crop up if a cognitive enhancer were available that did have problematic side effects — then my worry would be that pressure to succeed in my classes would be driving students to harm themselves in substantial ways. That happens already. Students take no-doz or skimp on sleep to do well, so there is some unavoidable harm from the stress of learning.
So that’s the information I need before I can make any decision — this is an issue that requires weighing costs and benefits, and telling me there is no cost simplifies it too much. For instance, caffeine has costs, but they’re low enough that my choice is to drink in moderation, but not to give it up altogether.
Ugh. Glib, unrealistic thought experiments- so beloved of a certain kind of moral philosopher- are the bane of clear thinking about ethics. You are quite right to insist on the messy real-world business of weighing costs and benefits.
Well, if we have a medicine that can give you longer-lasting erections, but also heart attacks, and lots of people choose to use it, I don’t see any problem with one that would make you smarter, but cause, say, temporary impotence, or mild facial paralysis.
On the other hand, I do hate the fact of how gladly the fundies have embraced the Internet as a way to spread their poison.
I wonder: What if those same idiots go for brain enhancers in a big way, to figure out ways to be even more clever at lying to us and subverting the government?
They’d need a hell of a lot of cognitive boosting just to attain adequacy in that department. In actual fact their tactics are generally transparently stupid and fool only other stupid people.
In the beginning, the drugs will have few or no known side effects. Years later, we will know differently.
Well, PCN based antibiotics gimme a rash and diarrhea. I dont like the rash, but the instant weight loss is fine by me.
Clarification for PZ’s post:
I didn’t say I would take it, I asked why people *wouldn’t* take it, and stated, similarly to PZ that the side effects were the crux here. People already “dope” academically–caffeine, nicotine, ginseng, taurine, etc–and there are lots of ways to gain academic advantage without pharmaceuticals. So the issue seems to be, *if* there was a drug with low side effects would you take it? Its hard to argue that it would be any different than drinking coffee or taking that Red Bull before the test. You’ll be more awake than your neighbor. Is that unfair?
You’ve got it almost right. In actuality, Big Pharma will know about the serious side effects from the start, and we’ll only find out years later that they lied when they told us the contrary. Then the lawyers will have yet another big source of income.
Steve LaBonne wrote “You’ve got it almost right. In actuality, Big Pharma will know about the serious side effects from the start, and we’ll only find out years later that they lied when they told us the contrary. Then the lawyers will have yet another big source of income. “
Cheap shot at a popular bogey man. Of course the reality is often quite different, as the Vioxx withdrawal illustrates (it was Merck that uncovered the risk in phase IV trials, designed and conducted by Merck to investigate statistically insignificant trends in phase III trials before registration and it was Merck that withdrew the drug based on the results).
One of the themes most often pursued here on Pharyngula is that reason (and data) trumps mythology. Just trying to continue that theme.
If such a substance existed, it would be banned within a few years. Cf. marijuana, MDMA, LSD and Ephedra.
“You’ve got it almost right. In actuality, Big Pharma will know about the serious side effects from the start, and we’ll only find out years later that they lied when they told us the contrary. Then the lawyers will have yet another big source of income.”
Meh. Read Orac a lttile and the Big Pharma paranoia just doesn’t hold up.
unrev89- I’m afraid you’re misinformed. Merck executives’ emails discovered in the trials document that they were aware of the Vioxx risks as early as the mid-90s and fought efforts to disclose them. Of course they made the usual lame defense that the emails were “taken out of context” (but they were never able to explain the supposed innocent context).
There’s no simple way to improve intelligence without side-effects – or nature would already have done it.
The best way I know of is to choose your parents carefully and then work hard.
Stupid question.
A better question would be:
Consider that there is a drug that decreases cognition and attention.
Why are there so many people already taking this drug?
Piracetam works pretty well.
Piracetam has been found to have very few side effects, and those it has are typically “few, mild, and transient.”
http://en.wikipedia.org/wiki/PiracetamWellbutrin – step right up, folks – may be what you are looking for.
Seems to have cognitive function benefits, at least in patients with depression, SAD, ADHD, and those undergoing smoking cessation.
Many side effects are to drool over:
weight loss in those overweight; increased sexual function and sexual satisfaction in depressed patients on SSRI’s, and perhaps in nondepressed patients with diabetes-related sexual dysfunction; increased energy, mood and motivation in depressed patients; some evidence of improved sleep patterns.
Other side effects not so much drooling: seizures, insomnia, agitation, dry mouth.
Let’s see – increased focus, mood, energy, sexual function, and weight loss vs side effects common with all antidepressants……? :D
@ Steve LaBonne, unrev89–
Not to be a “you’re *both* right” appeaser or anything, but when I interned in Big Pharma, book-ending my lab days with riding the shuttle with exec and admin types in the morning and evening was most enlightening.
There are at least two starkly different cultures co-existing uneasily at the company I worked at. Based on what I heard people talking about over a period of months, it was pretty clear that the politics, ethics, and priorities of the lab scientists and the office workers under one corporate roof couldn’t be more different.
So for Merck to withdraw Vioxx based on the scientific evidence on one hand, and simultaneously to have certain executives trying to boost the stock price at any social, medical, and ethical cost on the other, is totally consistent with the cultural divide I observed at the place I interned at.
I already take tons of cognition-enhancing drugs. If there were a newer, sexier one I’d take it too.
The issue with most drugs isn’t the drug’s side-effects, it’s the pattern and type of use. By and large, responsible and moderate use of any drug won’t be much worse on you than caffeine or alcohol, if at all.
Whoops. My godless liberal hippie student leanings are showing.
My outsider’s impression as well, for what it’s worth. So while I have on the whole a lot of confidence in the competence and integrity of the scientists themselves,I have a good deal less about the information actually emerges from the other end of the sausage machine after the finance and marketing guys have done their bit.
It’s ironic what unreve89 said about the “statistically insignificant trends in phase III trials”, since one of the main topics of those emails was how to design trials so as to minimize the risks of actually seeing the negative cardiac effects that the executives were already worrying about.
Steve
The nicest thing that can be said about your claims is that they are ill informed.
But, here’s a question for you. If the odds of something occuring is 1 in 3 million, how many times must sampling be done in order to detect those odds?
You guys are all missing the point: will they be cheap enough for poor students to use? Hell, would they be cheap enough for me to afford? My cognition has really sucked for the past few years and I could use a boost.
I’ve seen multiple reports from credible news organizations quoting key portions of those emails. emails. Care to explain to me in precisely what respect I’m misinformed? While you’re at it, can you explain why they started considering no later than 2000 (and filed an actual patent application on the idea in 2001!) marketing a combination of Vioxx with an inhibitor of platelet aggregation? Or why no earlier than 1998, as disclosed in the discovered emails, they were discussing giving trial participants aspirin, and discussing excluding “high-risk CV patients” from the trials? Why were they looking for a solution to a problem they were offically unaware of?
hee-hee — le mot juste!
mostly, the discrepancy between both cultures was amusing to observe; I heard some pretty self-congratulatory and nauseating bloviation among the office types in the shuttle after Hurricane Katrina, though, the likes of which I never heard in the lab. it rather soured me on riding the shuttle with those people again.
That should be “no later than 1998”.
While a drug that enhanced attention and cognition would be nice, how about a drug that will restore what I had before I got into extra curricular activities at college. I figure that would double my current abilities.
Even assuming there were no physical side effects to such a wonder drug, it would most certainly become one of the most addictive substances known to man. “I understood this stuff better yesterday ‘on the pill’… I’d better take another one” would quickly turn to “I NEED another one, I’m not smart enough without it!” and “I need to take more smart pills to make me smart enough to figure out how to afford all these smart pills!”
A black market for stolen smart-pills would pop up, and we’d see scientists meeting with drug dealers in back alleys.
“Do you have my pills?”
“Yeah, I got watchoo need, man, an’ I know they’re for real ’cause I tested some myself.”
“How much?”
“First one’s free – just remember who it came from when you need more. Oh, an’, uh, by the way, I got some ideas on brane theory I wanted to run by ya while you’re here…”
yes, exactly–again, I worked at only one site, but pharma pholks tend to socialize, so over beers I heard about other places (through other congenial people’s filters, of course), as well.
based on that, I wouldn’t doubt for a moment that the minute anomalous results started appearing, the scientists would report those results internally, and the execs would go into full damage-control mode. nothing too surprising there, except it seems pretty clear that some execs at Merck got busted crossing a line trying to suppress info, and the documentary evidence does exist.
unreve89, I’m not sure what you’re disputing–if you don’t believe the incriminating emails exist, well, that’s pretty easy to resolve by checking the news archives.
if you think Steve’s saying that Big Pharma is monolithically evil and that’s what you’re disputing, I didn’t get that from what he wrote. I think we all agree the picture is far more complex than what some alties put out, but that wasn’t the point of Steve’s post, either.
There is a risk-free way to enhance concentration and cognition: get enough sleep. Almost none of us do. Easier said than done, of course.
Provigil, a.k.a. modafinil is reported to have positive mental enhancements, with little or no side effects.
“if you could take a pill which enhanced attention and cognition with few or no side effects, would you?”
Isn’t that, actually, a pretty good description of caffeine? And since we know PZ – and pretty much everybody else – already take it, doesn’t the question answer itself?
There is a risk-free way to enhance concentration and cognition: get enough sleep.
The problem there is the inconvenient side-effect of increasing periods of unconsciousness, senescence, and torpidity, usually associated with the hours between 10pm and 7 am.
Steve
I won’t belabor this OT point. You ask “in precisely what respect I’m misinformed?” Well, getting precise is far beyond what can be accomplished here and I am not interested in trying anyway. But I can tell you why you are misinformed. You said it yourself; you relied on media reports. As to your questions, NSAIDs such as the selective Cox2 inhibitor that was Vioxx, had long been known to affect platelet homeostasis through their effects on prostaglandin. Early registration trials, approved and vetted by FDA, suggested but did not conclude (else Vioxx would not have gotten approval) that there was an elevated risk of cardiac events in some patients using Vioxx. That is to say that although some adverse cardiac events were seen in the trial(s), there was no statistical way to associate Vioxx therapy with those events. This was never hidden and was in fact noted in literature that came with every dose.
This brings up my question to you that I notice you failed to address; “If the odds of something occuring is 1 in 3 million, how many times must sampling be done in order to detect those odds?”
This is all I’ll say on this topic. You claimed that big (evil?) pharma lies about known effects of drugs for years, presumably until it is caught. My position is that, while popular, this particular characterization of pharma is a myth. The fact that Merck pursued statistically insignificant trends in prior trials that ultimately led them to unilaterally withdrawing a huge money making part of their business suggests that the characterization of at least this Big Pharma is…well…a myth.
Well, I have Narcolepsy and I’ve spent the last year taking drug after drug trying to find one that at least takes the edge off my sleepiness and does make me feel panicked or jittery. Provigil, as mentioned above, did nothing but make me feel jittery, but a lot of narcoleptics love it.
Holy crap, Gingerbaker! I’m on Wellbutrin right now. I’m supposed to take it for a month to see if there’s any effect on me. As it is right now, you could hide it in my breakfast cereal and I’d never know I was taking anything.
So, would I take a drug to increase my mental ability with tolerable or no side-effects. Sure, if I could afford it (is bankruptcy a side-effect?). Would I take a drug that makes me feel like I’ve slept some time in the last 3 days in exchange for a little sexual “issues”. Sure.
> The real dilemma would crop up if a cognitive enhancer were
> available that did have problematic side effects — then my
> worry would be that pressure to succeed in my classes would
> be driving students to harm themselves in substantial ways.
> That happens already. Students take no-doz or skimp on sleep
> to do well, so there is some unavoidable harm from the
> stress of learning.
The responsibility for the health damage done to students by education lies completely with instructors and educational institutions. Unlike performance metrics in the real world, academic performance is measured on a purely arbitrary scale established by instructional whim and ill-considered veneration for the way things have always been done. Instructors are not forced to make habitual use of exams or to establish inhuman work tempos. With few exceptions, however, instructors choose to to do this. The net result is that the arbitrarily established workload is impossible for students to complete at an acceptable level without compromising their health through sleep deprivation and licit/illicit doping.
As a result, all students find themselves in a situation where they must either dope for 4-6 years or forgo for life the additional income and career choices that come from high standing in undergraduate work and an advanced degree. This is not a choice that anyone, least of all young adults, should be forced to make.
Any instructor who wonders why his/her students are heavily doped up (on caffeine or otherwise) and sleep deprived during assignment seasons and doesn’t immediately realize that he/she is the ultimate cause of the problem is engaging in willfully denial of reality of a magnitude similar to that found in creationists.
#32
Wow. Looks like someone got a “D” in English Lit and is Real Mad about it.
/The issue with most drugs isn’t the drug’s side-effects, it’s the pattern and type of use. By and large, responsible and moderate use of any drug won’t be much worse on you than caffeine or alcohol, if at all./
Try a dose of Interferon, goofball.
Obviously you’ve never HAD to take a medication that your system didn’t tolerate. Try Topomax (AKA Dope-a-max or Stupimax), it’s fantastic for stopping migraines but tends to create cognitive difficulties such as short term memory loss, aphasia, inability to judge direction or recognize routine routes, extreme fatigue and other wonderful side effects. Then again it does sound like alcohol, only if you tried to live your life perpetually shitfaced.
Add this drug to other antiseizure drugs and most SSRIs, SNRIs and you will find they are a tiny bit worse than caffeine or alcohol. For many people, there is a hellish choice about whether the disorder or the treatment is more difficult to endure. Don’t trivialize this issue with ridiculous generalizations.
I did not rely on the “reports” themselves but on the plain words of the emails they quoted. Unless you can show that they were quoted inaccurately, your point is irrelevant. And those emails, once again, show that the insiders were much more concerned- rightly as it turned out- about those adverse cardiac effects than your bland summary conveys. Yet their response was not caution, but damn the torpedoes and full steam ahead. That is not only an accurate summary of the chain of events, but one that your careful tapdancing around the facts does absolutely nothing to contradict.
Your repeated citation of the 1 in 3 million odds is a red herring. Subsequent studies, as you know or should know, have put the odds ratio of adverse cardiac events in patients who took Vioxx at as much 1.3 relative to controls- not exactly a major challenge to detect. And you’re also not off the hook by merely citing the FDA approval since there is also internal FDA whistleblower testimony of political interference in that decision- a decision which was publicly criticized by prominent cardiologists at the time.
I don’t know what motivates you, but you’re wise to quit now before digging your hole even deeper. There is simply no room for doubt that Merck and the FDA, in the most charitable possible interpretation, screwed up quite badly. And that’s being VERY charitable.
New Scientist did a piece on the new class of drugs which increase wakefulness and increase cognitive abilities. Some of them are just as you describe in your post PZ.
Provigil works much like amphetamines without the major rush or the suicidal letdown. It can improve concentration immensely when administered at the right dosage, but can cause the jitters at higher doses. It tends to lose efficacy after long term use.
I’ve always been much to smart for my own good. If I got any smarter I’d just be unhappier.
Is there a drug which reduces the aches engendered by compassion? Cause it hurts.
Never mind. I checked, and it’s actually self-pity. Oh well.
And this is why Merck lost in court. And lost big. And why I think you’re a apologist scum:
Merck wasn’t “innocent.” Merck FOUGHT the results. Merck LIED about the results. Merck only took the drug off the market because the FDA was going to take the drug off the market.
I also bought shares of Merck because the Vioxx scandal knocked their price down to the high 50’s and I knew they’d recover because they’re an otherwise solid company. But Vioxx was a load of shit and defending it is a load of shit. But the ACTUAL RECORD IS CLEAR THAT Merck absolutely put profits in front of safety and ignored their own warnings and concerns from 1997 through 2004.
Really? I did very well in college while taking 17 to 21 units per semester. I didn’t even drink coffee. I just followed some simple rules:
1. Start early. Surprisingly you can start most projects right after you get the syllabus. And, amazingly, by managing that time efficiently, instead of waiting to the last minute, you generally get “A’s” on them.
2. Read the chapter and try to get a basic understanding BEFORE the lecture.
3. Ask questions on materials you didn’t understand during the lecture. Even if it pisses off your fellow students who are “too cool.”
4. During the lecture, highlight the points the instructor is making. He probably thinks those are important.
5. Do the home work.
6. Don’t cram before examinations. It just leaves you tired and anxious and will negatively impact your scores. Rather, go over the material at a reasonable pace a couple of days before the exam then trust in yourself.
7. Get a good night’s sleep before the exam. Eat a healthy breakfast, but don’t load yourself up with greasy and fatty foods.
8. If you have to have a job, for every 8 hours you work, drop 3 units of college. You can’t do both well.
9. Exercise. If you can’t maintain a schedule, I suggest taking some PE electives. Fencing is very invigorating in a cardiovascular way.
10. Have FUN on the weekends. Seriously, if you try to grind you’ll eventually work yourself too hard and your performance will suffer.
I can’t even imagine a cognitive enhancer without side effects, having gone through a number of medications for both depression and ADD myself. Plus, it looks like there’s a pretty common interpretations of “cognitive enhancer” being synonymous with “drug that will keep me awake better”.
Yeah, Adderall makes me more wakeful and better able to concentrate, but it doesn’t make me any smarter. Cymbalta and Ativan (and synthroid, for that matter) help me sleep better by calming my crazy brain, so I’m more wakeful with those, too, but I know they’re not making me any smarter, either. All the other things I used had similar effects, but side effects I didn’t want to endure – and not one of them made me smarter. So when I see “cognitive enhancement”, I’m not thinking of being more focused or awake, I’m thinking intelligence increase.
The medications we have for ADD, depression, narcolepsy, etc. – all the ones I’ve seen named so far in this thread and in Shelley and Janet’s blogposts are just stimulants in normal thinkers. If you take them, you might be able to produce more work or study longer, but they simply will not make you any smarter than you already are, so how in the world could taking them be “cheating”?
I guess what I’m trying to say is that by defining stimulants as cognitive enhancers, and using the potential side effects of stimulant drugs as the side effects of cognitive enhancers, we’re not painting a valid picture here. If a cognitive enhancer actually increased intelligence, then not only would it be a more desireable drug, but it would also create a moral dilemma about its use. Plus, if it had side effects akin to the side effects of stimulants (i.e., a “crash” during which your intelligence dropped, or serious side effects on your heart or liver that could dramatically shorten your life)then you’d have to give much more thought to the risk/benefit analysis.
Sort-of-on-and-off-topic but I can’t help but think of Sam Harris’ concept drug in “The End of Faith” that would be banned solely on the basis of providing something like a spiritual experience (see LSD).
That being said, I think I’ll go give some material support to the cannabinoid receptors in my brain. Side effects include munchies and unavoidable creativity!
I was going to respond to post #32, but some of you already did and quite ably, too.
As a post-doctorate of advancing years, the thing I was pleasantly surprised at was the ability to quite easily tolerate the workload, which was similar to the number of credits I took 25 years ago, and to do so with straight A’s. All of this nonsense about cognitive abilities declining after a certain age must be incredibly specific to certain skills that must not be necessary in the first place is precisely that–nonsense. I am watching people close to my age, juggling children, spouses, jobs and full time class schedules doing quite well, while the 18 to 25 year olds are struggling with a light load, part-time jobs-struggling to keep up.
While a drug might be attractive, why bother when growing up will do the same thing? And with the regular side effects of life we already have?
Gimme, gimme, gimme!
I see no ethical problem whatsoever. The difference between doping in sports and cognitive enhancement in academia is that academia ISN’T A GAME. I want scientists to be the most knowledgable people around, and if drugs can help them be that way, go for it. We’ll all benefit.
Everyone is not created equal. (Or “created” for that matter.) So inequality is not a problem unless you’re trying to force everyone to the same level of performance.
Is that really what colleges should be doing?
We need more mad science, not less.
Boring pragmatic answer: if the drug is socially acceptable then there is little reason to stop it being used. It is just technology, like slide rules (remember them?) or calculators. If the drug is not socially acceptable then its use should be banned. In 20 years time we may be arguing the same way about whether or not brain implants should be permitted.
Urban legend from my youth: A student pulled an all night revision session ‘supported’ by amphetamines. He sat the exam the next morning. His tutors were very impressed by his exam answers – but did ask him why he wrote only in the margins of the paper…
Piracetam works well for me, too, and has no known side effects (that is one reason why it’s banned in some places, because the reasoning is, “if it has no side effects, it must have no effects at all…” Insane). It is absolutely nonaddictive. The thing to remember is to take it with sufficient lecithin to facilitate its good effects.
Piracetam is known to make the body use oxygen more efficiently. I have a certain amount of trouble with that natually for some reason, and piracetam makes the problem go away. I have increased energy and crave food less because of it, too, so not only do I think better, but I lose weight. How’s that for the perfect pill, kids. :)
Let me mention I have never used illegal drugs, abused legal drugs, or smoked, and my alcohol intake is negligible. I tried piracetam on the advice of a doctor who used it himself. It’s cheapest if you buy it in powdered form and assemble capsules yourself, since you must take several grams a day. (You can eat the stuff if you weigh it out first, but like most drugs it isn’t particularly pleasant.) Lecithin is hell to put in capsules–it is sticky–but worth the effort.
If the drug made a noticable difference, then the side effects could be pretty bad (especially over the long term), and there would be a tremendous pressure for grad students to use it. I sure would have taken some serious risks to have even a slightly better chance of getting a fellowship or a tenure track job, and I’m guessing I wouldn’t be the only one.
Don’t forget- while students ARE learning your course’s content, they are also learning about themselves, and evolving the way they work.
If they crush themselves to do in five hours what would usually take 10, and they suffer the consequences of doing so, they may very well learn the lesson of doing things that way.
who knows what they will learn from it. But content is only part of what we learn by going through college.
Barry Schwartz mentions in his lecture on Choice (on TED: http://www.ted.com/index.php/talks/view/id/93 ) how he assigns 20% less homework than he used to because students just seem to have so much more on their minds.
The more interesting dilemma would be “would you take a drug that promised these benefits and was said to have no bad side effects by its makers?”
Would you trust a pharmacutical company and/or their funded researchers? Would you trust any researcher who claimed to have such an ideal drug? Would you trust that such a drug really could make a big positive change in your body with no negatives?
I’d be suspicious? I’m over 50, and I’ve heard about way too many miracle drugs during my lifetime. I wouldn’t believe they had one that did nothing bad. Now if they had one that did some specified bad things along with the good, and I weighed the bad against the good, maybe I’d take that. But a drug with major good stuff and “no bad”? I wouldn’t touch it.
I have to agree with those touting modanafil = provigil. It works well for lots of people. Our troops invading Iraq were all on it, so I can’t imagine that there would be any adverse side effects . . . right?
If preventing cognitive decline is a goal.
Alpha Lipoic Acid and Acetyl-L-Carnitine
Commonly known as R-ALA (the bioavailable form) and ALCAR
They are available from health supplement stores like GNC. Or if you like to save money on stuff… bulknutrition.com
http://www.lef.org/magazine/mag2003/sep2003_report_alpha_01.htm
…and it’s helps mice learn mazes faster.
Flowers for Algernon. . . ? Don’s comment (#25) made me think of the story. It’s a long time since I read it, but I do remember the terrible sadness of LOSING the enhanced intelligence. That would be a terrible thing to risk. I doubt it would be listed as a ‘negative side-effect’ though. I mean, if you ended up in no way worse off than you were before you took the drug, it’s not ‘negative,’ right?
If it were a large gain but not permanent (or cheaply/easily repeatable), I would consider that a part of the equation even if there were no ‘negative side-effects.’ And I would probably say no.
The question is fundamentally flawed – there is no way that you could significantly alter your attention and cognition without side effects. Maybe not physiological side effects, but it’s certainly going to have social and psychological side effects.
Any instructor who wonders why his/her students are heavily doped up (on caffeine or otherwise) and sleep deprived during assignment seasons and doesn’t immediately realize that he/she is the ultimate cause of the problem is engaging in willfully denial of reality of a magnitude similar to that found in creationists.
So, the fact that although I give my students over a month to complete an 8 page paper, give them reminders every week about it, and collect intermediate steps to make sure they’re making some progress, the fact that some of them do nothing until 48 hours or less before the due date and then stay up the entire time to catch up is somehow my fault? Interesting.