Werken smart drugs?november 11, 2019
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If you’re looking to make your brain work better, you have plenty of options. You can start sleeping better, invest in a juicer, spend time at a decent gym. Or—if you’re pressed for time—you can pop a bunch of pills. Amphetamine, in the form of Adderall, has been wiring people for years, as have Ritalin and newer drugs like Vyvanse and Provigil, each with their own special set of side effects. All of these drugs require a prescription, which does somewhat limit access to them. But in recent years, fueled by the fervor of enhancement-obsessed online communities and an economic arrangement that incentivizes a perma-primed brain, a whole new class of nootropics has come to wider attention: some of these nootropics, like the class of drugs known as racetams, can be bought in many gas stations. The question hanging over all of these drugs—prescribed and over-the-counter—is: do they actually work? And if they do work, what (and who) do they work for? For this week’s Giz Asks, we’ve reached out to a number of experts to find out.
Senior Lecturer in Transdisciplinary Innovation at University of Technology Sydney and Honorary Fellow in Philosophy at Macquarie University
Smart drugs work, and many people use them. I do not mean the ones you purchase from an online store that claims to be based in Silicon Valley, with cringe-worthy names like Startup HD or Turbo Snort. Don’t waste your money. Forget the fake “nootropic stacks,” the phenylpiracetams, and other pretenders which carry labels with words like “nootropic,” “cognitive enhancement,” “smart drug,” and so on. There is little or no good evidence that any of those products work. They are money-making schemes. No solid, replicated scientific studies support their claims.
When I say that smart drugs work, I’m talking about the real deal: modafinil, methylphenidate, dextroamphetamine, and (somewhat less common) pseudoephedrine, as well as (rather annoyingly) paracetamol, codeine, and a range of other medications we typically think of as treatments for diseases and disorders.
But there is one critically important thing to remember: There is no medication that, when taken, will make you smart. What makes so-called “smart drugs” smart drugs is what they enable people to do. Roughly, smart drugs are substances which, when used, enable us to do valuable things which we otherwise wouldn’t have been able to do. In particular, what people seem most interested in, when they speak of smart drugs, are things like the ability to stay awake and sharp and focused for longer, or to work faster and more efficiently. When the ability to do those things is viewed as a marker of smartness—or when using that ability leads to the acquisition of things or qualities that are viewed as markers of smartness—then we call those medications “smart drugs.”
Among the more commonly used central nervous system stimulants are methylphenidate (aka Ritalin), dextroamphetamine (which, combined with levoamphetamine, goes by the brand name Adderall), lisdexamfetamine (aka Vyvanse), and modafinil (aka Provigil, though generics include Modalert, Modavigil, Alertec and others). These CNS stimulants can all indeed be classified as smart drugs. They work, in the sense that they can enable people to do some of the things described above. But is doing those things valuable?
In the decade that I have worked on the topic of cognitive enhancement, there has been a very prominent rise in the public’s interest in, knowledge of, and use of smart drugs. We are at a point in human history when we are seldom disconnected from other people, and hence from their demands on our time. And the fact that many of us can work from anywhere, at any time we like, just means that we end up working everywhere, all of the time. We all compete for jobs and/or contracts and/or scholarships and/or graduate places in college, not just with others in our area with similar skill-sets but, potentially with everyone on the entire planet looking for similar opportunities.
Within this new context, who couldn’t benefit from smart drugs’ effects? We can only expect this trend in the increased interest in and use of CNS stimulant medications to grow. After all, whether through natural scarcity or because modern states operate as capitalist market economies, we all live in interconnected competitive societies, and thus we probably all can benefit from having an advantage over others. What’s more, we know that at least some of our colleagues and potential competitors are using these medications to obtain an advantage.
This is the stark reality of how a particular group of medications have come to be known as “smart drugs.” Because meritocratic (or, if you prefer, competitive) societies have weaponized our very bodies, brains, and precious hours of our lives. We need more time in the day to be available for work, and we need to have the ability to make better use of the precious little time we do have, if we are to remain competitive and survive. I’ll leave it up to you to decide if this really does mean that they should be thought of as smart drugs.
My second point is that if you agree that what makes something a genuine smart drug is whether it enables you to do the sorts of things I mentioned above—e.g. stay awake for longer, remain alert, enjoy your work so you have a positive reason to keep doing it, as well as ignore distractions for the very same reason, and memorize and recall things better—I honestly do not understand why a range of other medications and non-medications are also not on this list.
We have all become such habitual smart drug users that when we are asked to find them, we do not notice what’s there right in front of our noses, and we spend our time searching for something more novel, preferably with the words “nootropics” or “cognitive enhancer” or “smart drugs” emblazoned on the pill containers or blister packet. However, those are not the drugs you’re looking for. If it says “nootropic” on the packet, it is probably a money-making scam. The ones you want, you’re probably already using, and I suspect quite heavily (caffeine, for instance). The ones you’re not yet using, though, because they are illegal to obtain without a doctor’s prescription, or because they have a scary medical side effect profile, are another matter.
If you think you might have ADHD, invest the time to learn about the condition, its symptoms, potential treatments, and their potential effects and side effects. Then, go see the best psychiatrist you can find, and together with them figure out if you really do have a condition called ADHD, and thus whether you really might benefit from treatment with the otherwise-illicit medications. You may, of course, find out that you are actually already functioning at your peak, and that you would not benefit from these meds. Alternatively, you may discover that if you treat your environment (e.g. your workplace, or school) as a constant, then in that environment you will indeed appear to be dysfunctional and to adjust to that environment you will need a diagnosis of ADHD and a prescription for the relevant medications. The open question for me, however, is whether you’d be better off getting yourself out of those environments that require you to drug yourself to function within them, or whether those environments are so valuable that drugging yourself is worth the price of staying put within them.
Assistant Professor, Philosophy and Religious Studies, North Carolina State University, and the author of Neuroethics, Justice and Autonomy: Public Reason in the Cognitive Enhancement Debate
Drugs like methylphenidate (Ritalin), modafinil (Provigil) and amphetamine (Adderall) do work, in the sense that they’re FDA-approved treatments which help specific populations.
But whether they work for people who are fully rested and who want a boost at work or on test scores—they most certainly do not.
Modafinil, for instance—which the military has begun prescribing to pilots in lieu of amphetamine, which can be dangerously addictive—does work for its intended purpose. Pilots, who might have commissions lasting 30 hours, are successfully kept awake by it. Anyone who is tired and takes a tablet of modafinil will be able to work longer, with fewer mistakes and fewer effects of fatigue. More work gets done, certainly. But modafinil has not made anyone smarter, or improved anyone’s baseline performance.
Amphetamine is approved for the treatment of ADHD, and since the 1990s has displaced methylphenidate as the main drug prescribed for this disorder. I believe this change has been driven by the subjective feelings of being better at doing something that amphetamine generates, as well as its addictive properties. I think we have an epidemic that is in the shadow of the opioid epidemic—specifically, student populations are increasingly addicted to stimulants. Though they might help a student cram for an exam, long-term use can be a very bad idea, and will actually reduce effectiveness. And there is a profound risk of addiction.
As for over-the-counter nootropics, it’s very hard to generalize. The whole label is fraught with difficulties. The issue is that most of these are supplements, which means the FDA isn’t regulating them, as the FDA lost that battle in the 1990s. That means it’s difficult to say if any single supplement is doing anything, because what’s written on the label may not actually be what’s in there. We don’t know if these are actually working in any way, shape or form. The term “nootropic” implies that these are improving baseline performance, but I very much doubt that. They might help with maintenance, like coffee. But again, long-term use might lead to tolerance, and a situation where you need the substance to perform at your baseline.
Associate Professor, Medicine, Cambridge Health Alliance
It’s important to understand that there are two routes that drugs appear on the US market. One pathway is after clinical studies have proven efficacy and safety followed by FDA approval. The second route is directly to consumers in supplements, no human testing required. When drugs are sold direct to consumers as supplements, the quantities on the label are often inaccurate. Worse, there is no need to perform studies in humans to demonstrate that the drug works or that it is safe before it’s available for sale. This leaves the consumer at the mercy of the supplement company.
What we have found in our research is that brain enhancing supplements may contain active drugs at unpredictable doses. There is no way to ensure that the supplement contains what is listed on the label, nor that it is safe to consume, so I recommend avoiding all brain enhancement supplements until we can be assured that the bottles contain only what is listed on the label and there is some evidence of safety.
Therapeutic Cognitive Neuroscience Professor, Professor of Neurology and Cognitive Science at the Johns Hopkins University and School of Medicine and the Editor-in-Chief of Cognitive and Behavioral Neurology
If by “smart” is meant an actual increase in vigilance and/or intelligence, then over-the-counter so-called nootropics have never been reliably proven to work, nor is it very plausible that they really would work. Being “smart” is the result of a great many, finely-synchronized mental functions, which get orchestrated in different ways to tackle different mental challenges. And even relatively elemental mental functions don’t have a straightforward correspondence with the brain mechanisms that may be responsible for them. (To the extent such correspondences are somewhat known or suspected.) So even it were possible to tweak a specific brain mechanism, the overall system might not work any better, and might even work worse. Imagine as a rough analogy trying to speed up the CPU in a computer, without increasing the speed of memory access.
Professor of Neuroscience and Psychology at Yale University
It is very hard to truly enhance cognition. Cognitive functioning requires an intricate and precise pattern of neural activity, usually involving the newly evolved prefrontal cortex. It is challenging to improve this process, and easy to mess it up. Over the counter “meds” like Prevagen are mostly BS to make money. Compounds such as Adderall and Ritalin can indeed help improve prefrontal function in many people if the dose is right. These medications increase the release of dopamine and norepinephrine in the prefrontal cortex, which are essential to prefrontal function. The same can be said for caffeine, which leads to an increase in acetylcholine, a neuromodulator that is also necessary for prefrontal function. But too much caffeine or stimulant actually worsens function—the prefrontal cortex needs just the right amount of dopamine, norepinephrine and acetylcholine—too much impairs.
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