The complex truth about "smart" drugs

In 'Limitless', a cognitive enhancement pill

enables Bradley Cooper's character to finish

his novel in four days, learn to play the piano

in three and make millions on the stock market

in two weeks.

There is a comprehensive and very thought-provoking article on "smart" cognitive "enhancer" drugs like Ritalin and modafinil in Mosaic Magazine that's well worth your time. The very fact that I am putting "smart" and "enhancer" in quotes tells you where the article's coming from. The problem with these pills is that their lure is seductive, so more often than not we would all like to overstate their promise. It's thus particularly important to take a realistic view of what they can and cannot do.

For those besieged with multitasking today here's a summary of the main points. Alternatively, of course, you could take a smart drug to help you zip through the article...

1. Nobody really knows how smart drugs work, except for a very limited understanding of substances like caffeine and a few brain pathways like those dealing with nicotinic acetylcholine receptors (in fact, nicotine and nicotine-like substances may well be the only true cognitive enhancers). This fact would be consistent with our general lack of understanding regarding neurological drugs.

2. Most important take-home message: These drugs don't really seem to "enhance" function; rather, they simply optimize existing function. An immediate corollary of this fact is that the drugs would show the greatest effect only in cognitively impoverished brains. Thus, the effect may be marginal to zero in normal people. Studies seem to support this contention.

3. There is an ongoing controversy about whether intense focus brought about by these drugs can stifle creativity. Opinion among neuroscientists seems to be divided, although I find myself leaning toward the pessimistic side. 

4. As the article notes, studies seem to support this pessimistic view for now. Smart drugs don't really cause enhancement across the board; rather, they seem to modify performance on very narrowly defined tasks, especially related to attention and memory.

5. Another important take-home message: It's possible that smart drugs actually don't enhance cognitive function all. Instead what they might simply be doing is lowering other barriers necessary for normal cognitive function. Thus, instead of actually enhancing your ability to learn something for instance, they  might simply be getting rid of the lethargy, procrastination and boredom that often keeps us from learning or picking up a book in the first place. 

This to me sounds logical. A good control experiment to run in this case would be a side-by-side comparison of a purported smart drug with another one that's known to only improve peripheral qualities such as alertness or mood.

6. There is legitimate concern that even if these drugs enhance certain functions, they may be affecting other functions in negative ways. More generally, there is legitimate concern that we simply don't know enough about the brain to understand what the side effects of these drugs on other parts of brain function might be.

7. Big Pharma is shying away from smart drug research partly because we don't understand how they work. Of course, the cynic in me says that we can still get away with marketing the hell out of marginally effective supplements like 5-Hour-Energy, but that's a topic for a different post.

8. The societal implications of smart drugs are fascinating and important. If their significant impact is only on cognitively deprived members of society, then we should legitimately ask whether they should be prescribed more to say, poor or homeless people whose "attention reserves" have been unfortunately spent on more pressing basic issues like health or housing. These are the folks who in theory might benefit the most from such medication. Of course, we would then also have to deal with the potential ethical implications of testing these drugs on such people.

9. Bottom line: There will be a market for certain smart drugs in the future. But these drugs will very likely be highly targeted, optimizing only limited functions like short attention spans or rote memorization. Enhancing memory or attention in a consistent manner might be an achievable goal in the short-term future, but enhancing creativity or general IQ might well be impossible. The prospect of a pill that enhances cognitive capabilities across the board might likely remain the stuff of movies like 'Limitless' (which is quite an entertaining movie, by the way).