CBS and 60 Minutes aired a show recently on a topic named Cosmetic Neurology. It is also known as cosmetic pharmacology. This is the idea that a person could use a drug to temporarily improve their mental performance (not to be confused with Nootropics). Katie Couric interviewed a group of college students who discussed their use of prescription medications to, in their opinion, improve their performance in school. The students purchased, almost always illegally-distributed drugs that were designed to aid other students with behavior issues such as attention-deficit syndrome, hyperactivity and narcolepsy. The students claimed the drugs aided their ability to concentrate, remember the material and focus longer with less rest and with higher precision on their exams. I found this reporting to be flawed and irresponsible, even while I found it fascinating, because the interview likely without intending to, normalized the behavior without explaining the more complex aspects of this controversial subject.
Modern medicine supports two basic ideals, that it should do no harm and that medicine should do what it can to improve the lives of people who utilize it. Within those ideals, there are two camps. One says that medicine should be used to repair damage and provide therapy from the ravages of disease or dysfunction. A second camp proposes another idea; medicine should be used to improve, augment or enhance the human condition. It is this second camp that my article will attempt to address. Enhancement Medicine asks the question: If we have the ability to help people recover from injuries or genetic issues, as Primary Medicine suggests, it stands to reason that we could apply that technology to people who are well and make them better than normal; and if we did not violate the tenet of “Do No Harm” why shouldn’t we then do so?
For almost all of human history, the struggle for medicine has been to use it to cure injury and disease, first external issues, later internal ones and recently genetic diseases have come under the auspices of medical study. But as each realm of study gained ground and medical practitioners gained new understand of the human body, experimental technologies began their encroachment on the human experience. But strangely enough, medicine seemed to draw the line at creating technology that would potentially augment humans outside of anything beyond the human norm. And just as perverse, humans have taken many opportunities, to study and learn as much as they could about these very topics, often led by military leaders and their scientists seeking an advantage on the battlefield. Many of these ideas have been discredited, disproved or are completely disapproved of at a societal level (i.e. eugenic engineering of human beings, Aryan Superiority or human genetic engineering).
With this in mind, I propose that as a culture, we disapprove of anything that gives an “unfair” advantage to any single person or group. Otherwise, you would not be able to explain the cultural distaste for the use of anabolic steroids in athletic competition. We may not always punish the users, but in certain sporting events (the Olympics, for example) if you are caught using any form of performance-enhancing substance, you are banned and your medals are stripped from you. In the common parlance, it’s called juicing or doping. And while our understanding of the human condition has improved, our ability to create new ways of improving human performance has as well. And yes, there are numerous issues with steroid use, including deleterious long-term physical effects, mental stability and emotional issues to name just a few. Yes, you become, in the short run, stronger and faster, more capable than your unaltered counterpart. But you pay a price for this enhancement at some point in the future. This brings up ethical issues in the nature of the competition, as well. In general , society disapproves of using chemically-induced medical enhancement because it cannot be done well without causing harm to the user, even if that harm can be delay in its onset.
Strangely enough, humans have a less rigid viewpoint toward the altering of the mental state. Indeed many of our common foods have the potential to alter our mental state, albeit in a mild and temporary state. These drugs include the alkaloids found in chocolate, tea and coffee, and nicotine and to an even greater extent the use of ethanol as a form of intoxicant has been allowed in almost every major culture on Earth since Neolithic times. There are also many other known intoxicants in a variety of plants and animals all over the world. Humans have also created a variety of artificial variants on these substances in an effort to harness the mind’s influence and control of the body. One of the most well-known attempts was the adoption of amphetamines during World War II to help soldiers resist fatigue and increase alertness during the war. This was ultimately deemed a failure as it had unexpected side effects and they were later banned and relegated to the ranks of controlled substances in the early 1970’s. Primary medicine experimented with other mind-altering substances in an effort to combat mental disorders and have had limited success with behavior-modifying substances such as Adderall (racemic amphetamine aspartate monohydrate) and Ritalin (methylphenidate) which are used to treat attention-deficit hyperactivity disorder and narcolepsy.
Blame College Life
Here is where the story starts to get interesting. College students have, likely as long as there have been colleges, sought out things that would help them stay awake longer, to help them be able to remain focused to help carry their extreme school workloads. Coffee, Mountain Dew, herbal teas, No-Doze, Red Bull, Jolt (for their caffeine doses) Reds, speed, or crank (also know as amphetamines) have all been extolled as the way to push past the physical limits and cram longer. And with the except of amphetamines all of these substances have been legal and have limited effects as far as their perceived ability to improve test performance, they mostly allowed students to study longer (not necessarily better), until now.
The students in the interview on 60 Minutes claimed, their generally accepted use of drugs Adderall and Ritalin, allowed them to remember more, able to stay awake longer, able to solve more complex equations more elegantly and, to them, with no perceived side effects. They described the relative ubiquity of these drugs on campus, stating that “everyone was using them.” There is an almost blase attitude of everyone interviewed as to the use, ubiquity and overall rightness with the world and the use of this drug. During the broadcast, it was estimated that 30% of the freshman and sophomore classes were using these drugs with the claim of “better memory, better focus and ability to focus longer on the subject, even if it were uninteresting.” The numbers increased as the students stayed in school longer, so juniors were at 40% and seniors better than 50% used these performance enhancers. With the tacit assent of the media, we have told the next generation of college students, they can do whatever they want without any consequence at all. I expect those numbers of these drug users to rise as the difference in grade levels, despite general grade inflation, to continue to rise between those that use and those that don’t.
It is an understatement to say that an entire generation of students is now fast-tracking their educations, their careers, their livelihoods, and ultimately our civilization using non-medically monitored, not legally prescribed medications designed to treat mental diseases that almost none of them actually have, seeking an edge in their highly competitive educational quest which will likely lead them into the most important positions and careers our civilization has to offer. It is not as if these drugs do not have known side-effects including an addiction profile as potent as cocaine and can cause impair impulse control and decision-making abilities. Prolonged use can also cause psychological dysfunction, neuroses and psychoses over time as well as potentially permanently rewiring the brain’s neural circuitry. There may be physiological damage incurred with long term use as well.
Another unusual and potentially critical consideration is the potential that the knowledge being learned under this influence can only be recovered if the brain remains under the influence of said medications. This is called state-based learning. Once without the drugs, their brains would lose access to any information gained in this manner. To be fair, our society has not made the most effective long-term decisions regarding mind-altering substances, (nicotine, caffeine and alcohol to name three) but that is no excuse to allow an entire generation to believe that their future (and ours) relies upon their continued use of a series of drugs not even designed for them to treat conditions they do not even have?
I want to take this even farther than 60 Minutes did and ask a few questions that were not addressed during the interview. No one seemed even remotely interested in asking the question about the ethical concern of fairness, either in the use of the drugs or if they actually did boost performance, in the fact that many students did not use or have access to the drug and the performance boost. When the students were asked about using the drug versus not using it, their response was built around the idea that if others were using it and they were not, they were at a disadvantage that needed to be balanced as quickly as possible. The interview also revealed that the students believed they were a letter grade better performers because of the drug use. Some believed they might have even improved two letter grades.
So here is my question: Is there any reason to believe that people who will utilize any means of getting ahead of the curve will not apply that same mentality to anything they are involved in? Our country’s current economic ills are a direct result of such an ethical conflict of interests between big banks, regulatory agencies, and real-estate finance agencies. It has come to light, some of those agencies were able to make money even when they knew what they were doing or the derivatives they were selling were absolutely without value in the long run, and yet they continued anyway because they would make money whether the market prospered or failed.
Yes, this is a basic sign of greed, but let’s look at the primary signs of addiction: poor impulse control and poor quality decision-making. When considered under this light, the economic collapse does not look so implausible now, does it? A group of highly motivated, highly intelligent, very capable people with poor decision making abilities and poor impulse control decide they can do almost whatever they want without fear of consequence or retribution. They do not seem to have an ethical compass and decide that the ends justify the means. They do not feel they did anything wrong and do not understand why the rest of us settle for being second class citizens when we have the power to change that. I would expect that behavior from someone who was addicted and needed an intervention. But when these people occupy some of the most powerful seats in the country, who is able to give them an intervention and make it stick? What will it cost to clean up the next series of events caused under similar circumstances?
These young people will graduate from college with advanced degrees and move into the workforce as middle managers or lower level executives. If they are exhibiting any of the less socially acceptable mental conditions from their drug use, they may simply be too far up the food chain for anyone to recognize it until it too late to do anything about what they may be involved in; and if they are successful at whatever they are doing, no one may think to look at what they are doing until it is too late to stop it. We have a responsibility to ensure that young people who are graduating from college are in a state of mind that is relatively whole and undamaged. We should not have to worry that their illegal use of prescription medications has secretly turned them into psychotic or sociopathic individuals without moral compass, ethical behavior, or even a basic understanding of right and wrong and having the power to disrupt entire systems of resources, staff, or information. (Yes, some of them might already be sociopaths, I am aware of that possibility, but this way seems statistically more likely to produce a significantly greater number than the norm.)
There was one other issue that was only briefly addressed in the video. There was a question of the drugs actual ability to improve performance for everyone that used them. In addition to the psychological affects and the physiological addiction, there was mention of a chance that the users would instead of experiencing improvement would over time become less creative, myopic and experience a form of mental tunnel-vision. This affect may not happen immediately but if it were to occur later after years of maintaining this habit, it could be detrimental to any industry employing such people. With creative innovation and creative leadership being two attributes our knowledge-based society will need in ever-increasing supplies, can we risk a sudden lack of that in our future leaders due to their secret addiction to Adderall or Ritalin?
Other anecdotal interviews with recent graduates indicates that most of them continue their Adderall use after college and most of them continue to believe their abilities are improved with their continue use. But this begs me to ask my last and most important question: Since nothing is being done, relatively speaking, are we as a culture condoning this behavior and if so, are we saying that when the eventual side-effects of these drugs; the lack of impulse control, the lack of quality decision-making, the psychological and physical addictions, the damage such drugs have on the bodies and minds of their long-term users, the loss of knowledge capital, the damage to the creative ability, the damage to their physical bodies, (brains, endocrine systems, immune systems, livers, kidneys, stomachs) when these effects come due to our society all at once, and they likely will, because no studies have been done yet, are we prepared for the economic catastrophe that this generation of over-achieving drug-addicted, ethically-challenged youth, who are trying to be the best they can be, will unleash upon a world that should have asked just a few more questions before they turned away and decided that it was worth it, right up to the point when it wasn’t?
One young girl was asked, if she knew she was addicted would she stop using Adderall? Her reply was reminiscent of the responses of the Goldman Sachs executives under interview by Senator Levin: I believe if I knew I was addicted, I would do the right thing and to stop right away. Every addict says the same thing, I can quit anytime I want to. But so few do so before they hit the bottom of their careers, their lives and destroy everything they touch in the meantime. And since, for a while, they will be amongst the best and the brightest, they will touch everything in the world… We might want to start asking what we are going to do about this now, while we still have lights, electricity, computers, food and all of the other amenities of the modern age. One day, they may have access to nuclear weapons and, in a failure of judgment, decide that a nuclear weapon is just the solution needed for the next international incident.
If you have read this far, you may feel that this article is a bit alarmist and is very unlikely to happen. You may consider this instead to be a worst-case scenario and you might even be right. But I would like you to consider this; since all of the world’s systems are slowly becoming more and more integrated, we would like to think that everyone who will be participating in their creation, use, management, design and implementation would be of sound mind and body and that they would be working toward making the world a better place.
Knowing that an entire group or generation of students for a period of let’s say five to twenty years will be people like the ones we describe above: 1.5 million basic BA degrees per year multiplied by 5 years is 7.5 million and if only 1% of them experiences conditions like we described earlier that is 75,000 highly intelligent, highly motivated, ethically challenged, drug addicted individuals running your country. Multiply that by 20 instead and you see why this might not be a scenario we even want to contemplate.
The worst part of it all is that I do not see an easy answer to this problem. We have a society that encourages people, using financial incentives, to do the best they can and not to worry about what happens as a consequence; unimpeded greed is the watchword of the day. The last question I would have to ask is even knowing all of this: Why would they consider NOT using these substances when their perceived fate will be to be, in their minds, less financially successful, considered less effective, less important, have less satisfying careers and to be considered less successful overall? When was the last time you heard anyone value sanity as an asset?