Mental enhancers widely used now are merely a precursor

By Karen Kaplan and Denise Gellene, Tribune Newspapers: Los Angeles Times12:58 PM CST, December 20, 2007

Forget sports doping. The next frontier is brain doping.

As Major League Baseball struggles to rid itself of performance enhancing drugs,people in a range of other fields are reaching for a variety of prescription pills toenhance what counts most in modern life.

Despite potential side effects, academics, classical musicians, executives, studentsand even professional poker players have embraced the drugs to clarify their minds,improve concentration or control emotions.

"They made me a much better player," said Paul Phillips, 35, who credited theattention deficit drug Adderall and the narcolepsy pill Provigil with helping himearn more than $2.3 million as a poker player.

The medicine cabinet of so-called cognitive enhancers also includes Ritalin,commonly given to school children for attention deficit hyperactivity disorder, andbeta blockers such as the heart drug Inderal. Researchers also have beeninvestigating Aricept, which is normally used to slow the decline of Alzheimer'spatients.

Effects on brain well-known

These drugs haven't been tested extensively in healthy people, but theirphysiological effects in the brain are well-understood.

They are all just precursors to the blockbuster drug that labs are racing to develop.

"Whatever company comes out with the first memory pill is going to put Viagra toshame," said University of Pennsylvania bioethicist Paul Root Wolpe.

Unlike anabolic steroids, human growth hormone and blood-oxygen boosters thatplague athletic competitions, the brain drugs haven't provoked similar outrage.People who take them say the drugs aren't giving them an unfair advantage, justenabling them to make the most of their skills.

In the real world, there are no rules to prevent overachievers from using legallyprescribed drugs to operate at peak mental performance. What patient wouldn't wanttheir surgeon to be completely focused during a life-or-death procedure?

"If there were drugs for investment bankers, journalists, teachers and scientists that

made them more successful, they would use them too," said Charles Yesalis, adoping researcher and professor emeritus at Penn State University. "Why doesanyone think this would be limited to an athlete?"

The growth of the brain drugs bears a resemblance to the evolution of plasticsurgery after World War I -- developed to rehabilitate disfigured soldiers but laterembraced by healthy people who wanted large breasts and fewer wrinkles.

The use of cognitive-enhancing drugs has been well-documented among highschool and college students. A 2005 survey of more than 10,000 college studentsfound 4 percent to 7 percent of them tried ADHD drugs at least once to remainfocused on exams or pull all-nighters.

The ubiquitous stimulant is coffee. But as scientists were developing drugs to treatserious brain disorders, they found more potent substances.

Sharon Morein-Zamir, a psychologist at the University of Cambridge in Englandwho writes about the ethics of brain enhancement, said her interest in themedications was largely academic. But when someone she knew who had beentaking Provigil for a neurological condition offered her some pills, her curiosity waspiqued.

"I knew the literature and wondered what it felt like."

The drug helped her focus as she worked at her computer for hours straight. But shewondered if it was a placebo effect.

Phillips, the poker player, started using Adderall after he was diagnosed with ADHDfive years ago and later got a prescription for Provigil to improve his focus. ADHDdrugs work by increasing the level of the brain chemical dopamine, which is thoughtto improve attention. Provigil's mechanism of action is not well understood, butboosting the impact of dopamine is thought to be part of it.

The drugs improved his concentration during high-stakes tournaments, he said,enabling him to track all the action.

"Poker is the sort of game that a lot of people can play well sporadically, buttournaments are mostly won by people who can play close to their best at all times,"he said. "It requires significant mental effort to play in top form for 12 hours a day,five days in a row."

In the world of classical music, beta blockers such as Inderal have become nearly ascommonplace as metronomes. The drugs block adrenaline receptors in the heart andblood vessels, helping to control arrhythmia and high blood pressure. They alsoblock adrenaline receptors in the brain.

"You still have adrenaline flowing in your body, but you don't feel that adrenalinerush so you're not distracted by your own nervousness," said Dr. Bernd Remler, aneurologist at the Medical College of Wisconsin in Milwaukee.

That's why Sarah Tuck, 41, a flutist with the San Diego Symphony, takes them tostave off the jitters that musicians refer to as "rubber fingers." She estimates thatthree-quarters of musicians she knows use the drugs at least occasionally.

Prescriptions for Inderal and other beta blockers can be readily obtained byphysicians. Tuck said some doctors told her they use the drugs to calm their nervesbefore making presentations at medical meetings.

Drugs have a downside

But cosmetic neurology, as some call this practice, has risks. Ritalin, Adderall andother ADHD drugs can cause headaches, insomnia and loss of appetite. Provigil canmake users nervous or anxious and bring on headaches, while beta blockers cancause drowsiness, fatigue and wheezing.

One Stanford University study found low doses of Aricept improved theperformance of healthy pilots as they tried to master new skills in a flightstimulator, but the side effects -- dizziness and vomiting -- were less than desirablefor a pilot.

No one has conducted thorough studies about how brain-boosting drugs wouldaffect healthy people after weeks or months of use, said Dr. Anjan Chatterjee, aneurologist at the University of Pennsylvania.

Negative consequences may not be limited to people who popped the pills.

Martha Farah, a bioethicist at the University of Pennsylvania, said she is beginningto detect resentment toward students who use the drugs from classmates who don't.

In an article Thursday in the journal Nature, Morein-Zamir and neuroscientistBarbara Sahakian say that clear guidelines are needed. It may be reasonable to banthe drugs in competitive situations, such as taking the SAT. But in other cases, theywrote, people such as airport screeners, air-traffic controllers or combat soldiersmight be encouraged to take them.