Smart Pills: Brain Doping or Empty Promises?

What were once coffee and crosswords, are today “smart pills” and brain training games - an argumentation recently put forward by Chinthapalli (2015). The idea that we should not wait for millions of years for evolution to offer us a better brain and boost our IQ, but develop pills that will do the job much faster, is not new. According to Smith and Farah (2011), the Romanian neuroscientist Corneliu Giurgea is credited for first proposing it in the 1960s. More than a century earlier in 1830, the French novelist Honoré de Balzac, himself a passionate coffee drinker, in an appendix to the enhanced edition of La Physiologie du Gout by Anthelme Brillat-Savarin promotes coffee as the ultimate reviving brew to prolong the creativity of our intellects: “Coffee, Rossini told me, is an affair of fifteen or twenty days; just the right amount of time, fortunately, to write an opera.”  In Rice’s opinion (2007) the secret behind the astonishing level of eighteenth-century productivity achieved by many of its composers and writers were the drugs and drinks ingested at that time. The most notorious coffee drinkers were Rossini, Mozart, Balzac, Händel, Beethowen, who decided with German precision that exactly 60 beans were needed for one cup of coffee, Bach, who wrote a Coffee Cantata in 1732, and Voltaire, for whom fifty cups a day were hardly sufficient.

The scientific viewpoint

The oldest, most famous and widely used neuroenhancers were and still are caffeine and nicotine. Newer top choices include Adderall (amphetamine) and Ritalin (methylphenidate) — typically prescribed for attention disorders (ADHD) — and Modafinil, which is a medication for sleep disorders such as narcolepsy (Dance, 2016).

Pharmacological cognitive enhancement presents a topic of great interest in the media and in the academic literature; partly because it raises a number of different concerns. One of the most fiercely discussed is the ethical issue of consumption becoming the subject of doping. For instance, some “brain competitions” (e.g., ESL – Cologne 2015; chess tournaments) and university examinations (Duke University) include random nootropic drug testing (Chinthapalli, 2015; Dance, 2016). However, here we will focus on the question: do they deliver what they promise – smartness?

Based on several meta-analyses and review articles the main conclusion is that the overall effects of drugs appear to be modest both in healthy individuals and patient groups, and that more significant effects can be observed in subgroups whose baseline performance is poorest, or in individuals with a particular genotype. Furthermore, the reported findings are rather mixed: studies have indicated improvements in consolidation of long-term declarative memory, but the patterns of evidence for executive function and cognitive control are less clear. Over a third of findings reported no effect on cognitive function in healthy adults. Moreover, the small effects suggest that the use of these drugs would not deliver a practically significant performance advantage in healthy people, although even a small effect can still make a difference between passing or failing a test (Husain & Mehta, 2011; Ilieva, Hook, & Farah, 2015; Smith & Farah, 2011)

User opinions

Honoré de Balzac (1996): “Coffee sets the blood in motion and stimulates the muscles; it accelerates the digestive processes, chases away sleep, and gives us the capacity to engage a little longer in the exercise of our intellects.”

Mozart in 1791 wrote to his wife: “[…] then I had Joseph summon Primus and bring me black coffee, with which I smoked a wonderful pipe of tobacco; then I orchestrated almost all of Stadler’s rondo.”(Bauer & Deutsch, 1962-1975).

In an anonymous poem (1674, Rice, 2007) coffee was compared with Phoenix rising from the ashes:

“[…] Coffee arrives, that grave and wholesome liquor,

That heals the stomach, makes the genius quicker,

Relieves the memory, revives the sad,

And cheers the spirits, without making mad.”

Margaret Talbot in the New Yorker /2009/04/27/ describes three more recent neuroenhancing drug consumers: Alex (fictional name), Paul Phillips and Nicholas Seltzer.

Alex is a graduate from Harvard who is convinced that Adderall helped him to concentrate during classes and meetings, with side effects of appetite loss and a tendency to spend more time researching a topic than actually doing the job of writing the paper. In his opinion Adderall works only if you are dedicated to do the job, else you might end up obsessively cleaning your apartment. I’ll remember that next time when my wife decides that I have to clean the house.

Paul Phillips, who made a fortune writing software, began taking Adderall to enhance his ability to play poker. Within six months, he had won $1.6 million at poker events. In his opinion, this was possible because the drug helped him to concentrate, but also to resist the impulse to keep playing losing hands out of boredom. Adding Provigil to his drug regime made him even more peaceful – to float in an objective state of mindfulness. He described Adderall as a correction of an underlying condition, whereas Provigil felt like enhancement.

Nicholas Seltzer started taking Piracetam to mentally keep up with his 9 years younger girlfriend. He was especially proud of his essay about harmony as a trope in Chinese political discourse. In his opinion the drug allowed him to work within the realm of the abstract making the right associations between the ancient religious concept of harmony and modern political discourse.

Billybear185 – yet another interlocutor from the ImmInst forum (Immortality Institute, from 2011 http://www.longecity.org/) where la crème de la crème communicates opinions about  bioscience, health and nutrition – describes his self-experiment taking 10 ml of Cerebrolysin every morning via intramuscular injection, as well as 4 grams of fish oil and about 2 grams of Piracetam. The effects were two folded, first there was a noticeable antidepressant effect despite the presence of an immense amount of stress, and second, a decrease in alcohol and weed consumption which was accompanied with improvements in working memory, verbal fluency and concentration.

Instead of a conclusion

Balzac wrote that many people claim that coffee inspires them; but as everybody knows, coffee only makes boring people even more boring.

The philosopher Charles Louis de Montesquieu in his satirical Lettres persanes of 1721 stressed: In one of the coffee houses in Paris, coffee is prepared in such a way that it gives intelligence to those who drink it; at least no one, among all those who leave this place, thinks he is not four times as intelligent as when he entered.

In Dance’s (2016) opinion: “They don’t really live up to the name smart pills”

 

References

Chinthapalli, K. (2015). The billion dollar business of being smart. BMJ, h4829. https://doi.org/10.1136/bmj.h4829

Dance, A. (2016). Smart drugs: A dose of intelligence. Nature, 531(7592), S2–S3.

De Balzac H. The pleasures and pains of coffee. Michigan Quarterly Review 1996;35:273-7. http://downlode.org/Etext/pleasures_pains_coffee.html.

Husain, M., & Mehta, M. A. (2011). Cognitive enhancement by drugs in health and disease. Trends in Cognitive Sciences, 15(1), 28–36. http://doi.org/10.1016/j.tics.2010.11.002

Ilieva, I. P., Hook, C. J., & Farah, M. J. (2015). Prescription Stimulants’ Effects on Healthy Inhibitory Control, Working Memory, and Episodic Memory: A Meta-analysis. Journal of Cognitive Neuroscience, 27(6), 1069–1089. http://doi.org/10.1162/jocn_a_00776

Mozart: Briefe und Aufzeichnungen, ed. Wilhelm A. Bauer and Otto Erich Deutsch, 7 volumes (Kassel: Bärenreiter, 1962–1975), volume 4, 157.

Rice, J. A. (2007). Music in the age of coffee. Eighteenth Century Music, 4(2), 301–305. https://doi.org/10.1017/S1478570607000978

Smith, M. E., & Farah, M. J. (2011). Are prescription stimulants “smart pills”? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals. Psychological Bulletin, 137(5), 717–41. http://doi.org/10.1037/a0023825

Talbot M. Brain gain. New Yorker 2009 Apr 27. www.newyorker.com/magazine/2009/04/27/brain-gain.