ARTICLE: Brain Enhancement Is Wrong, Right?

The New York Times
March 9, 2008

Smartening Up

Brain Enhancement Is Wrong, Right?

By BENEDICT CAREY

SO far no one is demanding that asterisks be attached to Nobels, Pulitzers or Lasker awards. Government agents have not been raiding anthropology departments, riffling book bags, testing professors’ urine. And if there are illicit trainers on campuses, shady tutors with wraparound sunglasses and ties to basement labs in Italy, no one has exposed them.

Yet an era of doping may be looming in academia, and it has ignited a debate about policy and ethics that in some ways echoes the national controversy over performance enhancement accusations against elite athletes like Barry Bonds and Roger Clemens.

In a recent commentary in the journal Nature, two Cambridge University researchers reported that about a dozen of their colleagues had admitted to regular use of prescription drugs like Adderall, a stimulant, and Provigil, which promotes wakefulness, to improve their academic performance. The former is approved to treat attention deficit disorder, the latter narcolepsy, and both are considered more effective, and more widely available, than the drugs circulating in dorms a generation ago.

Letters flooded the journal, and an online debate immediately bubbled up. The journal has been conducting its own, more rigorous survey, and so far at least 20 respondents have said that they used the drugs for nonmedical purposes, according to Philip Campbell, the journal’s editor in chief. The debate has also caught fire on the Web site of The Chronicle of Higher Education, where academics and students are sniping at one another.

But is prescription tweaking to perform on exams, or prepare presentations and grants, really the same as injecting hormones to chase down a home run record, or win the Tour de France?

Some argue that such use could be worse, given the potentially deep impact on society. And the behavior of academics in particular, as intellectual leaders, could serve as an example to others.

In his book “Our Posthuman Future: Consequences of the Biotechnology Revolution,” Francis Fukuyama raises the broader issue of performance enhancement: “The original purpose of medicine is to heal the sick, not turn healthy people into gods.” He and others point out that increased use of such drugs could raise the standard of what is considered “normal” performance and widen the gap between those who have access to the medications and those who don’t — and even erode the relationship between struggle and the building of character.

“Even though stimulants and other cognitive enhancers are intended for legitimate clinical use, history predicts that greater availability will lead to an increase in diversion, misuse and abuse,” wrote Dr. Nora Volkow, director of the National Institute on Drug Abuse, and James Swanson of the University of California at Irvine, in a letter to Nature. “Among high school students, abuse of prescription medications is second only to cannabis use.”

But others insist that the ethics are not so clear, and that academic performance is different in important ways from baseball, or cycling.

“I think the analogy with sports doping is really misleading, because in sports it’s all about competition, only about who’s the best runner or home run hitter,” said Martha Farah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania. “In academics, whether you’re a student or a researcher, there is an element of competition, but it’s secondary. The main purpose is to try to learn things, to get experience, to write papers, to do experiments. So in that case if you can do it better because you’ve got some drug on board, that would on the face of things seem like a plus.”

She and other midcareer scientists interviewed said that, as far as they knew, very few of their colleagues used brain-boosting drugs regularly. Many have used Provigil for jet lag, or even to stay vertical for late events. But most agreed that the next generation of scientists, now in graduate school and college, were more likely to use the drugs as study aids and bring along those habits as they moved up the ladder.

Surveys of college students have found that from 4 percent to 16 percent say they have used stimulants or other prescription drugs to improve their academic performance — usually getting the pills from other students.

“Suppose you’re preparing for the SAT, or going for a job interview — in those situations where you have to perform on that day, these drugs will be very attractive,” said Dr. Barbara Sahakian of Cambridge, a co-author with Sharon Morein-Zamir of the recent essay in Nature. “The desire for cognitive enhancement is very strong, maybe stronger than for beauty, or athletic ability.”

Jeffrey White, a graduate student in cell biology who has attended several institutions, said that those numbers sounded about right. “You can usually tell who’s using them because they can be angry, testy, hyperfocused, they don’t want to be bothered,” he said.

Mr. White said he did not use the drugs himself, considering them an artificial shortcut that could set people up for problems later on. “What happens if you’re in a fast-paced surgical situation and they’re not available?” he asked. “Will you be able to function at the same level?”

Yet such objections — and philosophical concerns — can vaporize when students and junior faculty members face other questions: What happens if I don’t make the cut? What if I’m derailed by a bad test score, or a mangled chemistry course?

One person who posted anonymously on the Chronicle of Higher Education Web site said that a daily regimen of three 20-milligram doses of Adderall transformed his career: “I’m not talking about being able to work longer hours without sleep (although that helps),” the posting said. “I’m talking about being able to take on twice the responsibility, work twice as fast, write more effectively, manage better, be more attentive, devise better and more creative strategies.”

Dr. Anjan Chatterjee, an associate professor of neurology at the University of Pennsylvania who foresaw this debate in a 2004 paper, argues that the history of cosmetic surgery — scorned initially as vain and unnatural but now mainstream as a form of self-improvement — is a guide to predicting the trajectory of cosmetic neurology, as he calls it.

“We worship at the altar of progress, and to the demigod of choice,” Dr. Chatterjee said. “Both are very strong undercurrents in the culture and the way this is likely to be framed is: ‘Look, we want smart people to be as productive as possible to make everybody’s lives better. We want people performing at the max, and if that means using these medicines, then great, then we should be free to choose what we want as long as we’re not harming someone.’ I’m not taking that position, but we have this winner-take-all culture and that is the way it is likely to go.”

People already use legal performance enhancers, he said, from high-octane cafe Americanos to the beta-blockers taken by musicians to ease stage fright, to antidepressants to improve mood. “So the question with all of these things is, Is this enhancement, or a matter of removing the cloud over our better selves?” he said.

The public backlash against brain-enhancement, if it comes, may hit home only after the practice becomes mainstream, Dr. Chatterjee suggested. “You can imagine a scenario in the future, when you’re applying for a job, and the employer says, ‘Sure, you’ve got the talent for this, but we require you to take Adderall.’ Now, maybe you do start to care about the ethical implications.”

REVIEW: On Deep History and the Brain, by Daniel L. Smail

The New York Times
March 16, 2008

I Feel Good

By ALEXANDER STAR

ON DEEP HISTORY AND THE BRAIN
By Daniel Lord Smail.
271 pp. University of California Press. $21.95.

Why do horses snort? Sometimes, at the approach of a stranger or the appearance of a plane high above the pasture, a horse will widen its eyes, flare its nostrils and send a stuttering column of air out into the world. On other occasions, horses have been known to snort for no reason besides their own boredom. By suddenly creating a sound, the slack-minded horse elicits an automatic “startle response” — flooding its brain with chemicals, delivering a jolt of excitement and relieving, at least for a moment, the monotony of a long day in an empty field. The horse has in effect fooled its own nervous system — and benefited from the self-deceit.

If horses can alter their own brain chemistries at will (and have good reasons to do so), what about human beings? In “On Deep History and the Brain,” Daniel Lord Smail suggests that human history can be understood as a long, unbroken sequence of snorts and sighs and other self-modifications of our mental states. We want to alter our own moods and feelings, and the rise of man from hunter-gatherer and farmer to office worker and video-game adept is the story of the ever proliferating devices — from coffee and tobacco to religious rites and romance novels — we’ve acquired to do so. Humans, Smail writes, have invented “a dizzying array of practices that stimulate the production and circulation of our own chemical messengers,” and those devices have become more plentiful with time. We make our own history, albeit with neurotransmitters not of our choosing.

Historians by and large take biology and the deep past for granted: natural selection endowed our ancestors with their impressive bodies and brains, and then got out of the way. These days, it’s chiefly nonhistorians like Jared Diamond and Tim Flannery who seek to trace the long arc of the species and write macrohistory in a scientific key. Smail, who teaches medieval history at Harvard, would like his peers to join their company. If historians have become accustomed to studying midwives and peasants, the marginal and often illiterate members of recent societies, why shouldn’t they extend their curiosity to the most peripheral human subjects of all — the prehistoric? Even today, Smail laments, the curriculum is shaped by the prejudice that history began only when our ancestors started to write or to farm or to think of themselves as actors in a grand pageant of historical change. The presumption is curiously convenient. In the schema of “sacred history,” history began with the expulsion of Adam and Eve from the Garden of Eden — that is, in Asia, a few thousand years before Christ. In the modern schema, history begins in much the same place, at much the same time. “The sacred was deftly translated into a secular key,” Smail writes, as “the Garden of Eden became the irrigated fields of Mesopotamia and the creation of man was reconfigured as the rise of civilization.”

Taking Paleolithic man seriously, Smail argues, requires us to understand that history and biology always shape each other — there is no ascent from the tyranny of brute instinct to the freedoms of civilization. Some evolutionary theorists stress that cultural innovation allows human beings to overcome the blind stumblings of natural selection: we deliberately solve a problem and pass on that solution to our descendants, who improve on it in turn. Smail takes a different tack. The imperfect copying of past behavior and small, often unconscious preferences can push a society in a new direction, even without anyone aiming toward a particular goal. It’s possible, for instance, that early men decided to make sharper spear points with the intent of drawing more blood from their prey; Smail would rather suppose that these spear points were created by accident, and then spread because the hunters who used them proved to be better hunters, even if they didn’t know why. Cultural evolution can be rapid and it can help human beings adapt to their environment, but it needn’t be intended or progressive.

Nor can culture be disentangled from biology. Our very synapses are shaped by experience and education from before birth to the time of death. The brain of a monk does not resemble the brain of a soldier or a taxicab driver. An impulse to swoon in distress or erupt in anger may be innate, but Victorian women were quicker to faint at the sight of blood and Southern men are faster to react to slights than women or men in many other places. These predispositions can be passed on from generation to generation without any alteration in anyone’s genes, and yet they are readily seen as aspects of our nature. In a way, they are. “Culture is wired in the brain,” Smail writes, and “cultural practices can have profound neurophysiological consequences.”

But what practices? Ever since the invention of agriculture, Smail claims, we have seen “an ever greater concentration of mood-altering mechanisms.” Some of these mechanisms Smail refers to as “teletropic”: they work primarily to affect the moods of others, stimulating a wash of neurochemicals at a distance. A baby cries and arouses its mother’s instinct to care; a priest intones a Mass and relieves parishioners of stress hormones. The modern era, however, belongs to what Smail calls “autotropic” devices, devices that alter our own moods. In modern Europe, coffee from the Arabian peninsula became a stimulant to “mind, body, conversation and creativity” for the rich and the mercantile. The cultivation of sugar on Caribbean slave plantations made cheap rum freely available, further inebriating the working classes. Individuals became ever more expert at changing their own chemistry, sometimes just for the pleasure of modulating one set of sensations into another. But ingesting substances was only the beginning. The same era saw the rise of novels and erotica, shopping and salons. Books are also autotropic devices, regulating attention and mood; indeed, in the 18th century, their impact was often likened to a fever, jeopardizing readers’ purchase on reality and their physical strength. In the age of Enlightenment, man overthrew kings and subjected himself to mild and intermittently pleasurable addictions.

Of course, there was more to the Enlightenment than that. It’s not clear how a neurohistorian of the future would treat attitudes and beliefs alongside cravings and moods. Nor does Smail directly address the larger implications of what has been called “the psychoactive revolution.” What happens when we learn not just how to alter our moods but also to identify the chemical and electrical constituents of our experiences while we are having them? Is there a price to pay when we make the care of the brain a pre-eminent virtue? Three decades ago, in his influential study “Tastes of Paradise,” Wolfgang Schivelbusch argued that “the brain is the part of the human body of greatest concern to bourgeois civilization.” Coffee and tobacco, which spread through Europe in the 17th century, helped this reorientation, Schivelbusch said: “Coffee functioned positively, arousing and nourishing the brain. Tobacco functioned negatively, calming the rest of the body ... as was necessary for mental, i.e., sedentary, activity.”

Smail focuses more attention on the “pursuit of psychotropy” than on its consequences. Still, an intelligent disquiet runs through these pages. As we “grow numb to the mechanisms that stimulate our moods and feelings on a daily basis,” we ceaselessly shift from one device to another. The prospects for human foresight and self-knowledge would seem dim. In the 1860s, Walter Pater wrote that “art comes to you proposing frankly to give nothing but the highest quality to your moments as they pass, and simply for those moments’ sake.” Has art become superfluous? Smail suggests we are all the choreographers of our own chemical dance, enjoying the “spikes” and “dips” as they follow one another, and simply for their own sake.

Alexander Star is senior editor of The New York Times Magazine.