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Socratic Seminar Guide: Nootropics (Memory enhancing drugs)
1) When should people be allowed to use nootropic drugs?
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2) Should students be allowed to take nootropics, if they are safe and effective?
Should they be required?
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3) What kind of society would likely result if most people took nootropics?
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4) Thorough this seminar, we learned the following three things…..
Article 1
Source: New York Times
Date: July 29 2003
Race Is On for a Pill to Save the Memory
By DAVID TULLER
They are called smart pills or brain boosters or, to use the preferred pharmaceutical term,
cognitive enhancers.
But whatever the name given to compounds created to prevent or treat memory loss, drug
companies and supplement producers - eager to meet the demands of a rapidly growing
market 0 are scrambling to exploit what they view as an enormous medical and economic
opportunity.
Three drugs being prescribed for Alzheimer's disease - donepezil (Aricept), galantamine
(Reminyl) and rivastigmine (Exelon) - have been shown to delay somewhat the loss of
mental abilities in people with the illness. So has the drug memantine, which has been used
for years in Europe but has not been approved in the United States. Some experts also say
that performing mental exercises and adding fish oil to the diet can delay memory decline.
Pharmaceutical companies are investigating dozens of other compounds to see whether
they can help people who have memory difficulties but have not progressed to Alzheimer's.
Some researchers hope that drugs will eventually prevent the deficits that even healthy
elderly people experience.
Much of the excitement among pharmaceutical companies, which have dozens of drugs in
development, stems from advances in clarifying some of the brain processes and
biochemical pathways that can hinder or help memory storage and retrieval, said Dr. Paul
R. Solomon, a professor of psychology at Williams College.
"The basic research into the causes of memory disorders is going very rapidly," said Dr.
Solomon, who is also co-director of the Memory Clinic at the Southwestern Vermont Medical
Center in Bennington.
But it will probably be at least five years before any of those drugs meet the standards for
approval by the Food and Drug Administration, researchers said.
Clearly, the market for memory enhancers is growing with the aging of the population.
Dr. Steven T. DeKosky, a professor of neurology and psychiatry at the University of
Pittsburgh School of Medicine, says he has noticed a marked increase in anxiety among
baby boomers, who are watching their parents descend into Alzheimer's and hoping that
new medicines will help them avoid the same fate.
"People in their 40's and 50's are saying: `How can you help my mother? And, by the way,
how can I avoid this?' " Dr. DeKosky said. "Ten years ago, people wanted to know how
frequently they should have their blood pressure checked and what sorts of food they
should eat. Nobody ever asked what they should be doing to prevent themselves from
getting a late-life dementia."
Even among those who are already suffering memory loss, Alzheimer's is far from the only
source. An estimated four million Americans have it, but millions more suffer from other
disorders that can lead to dementia, including Parkinson's disease, multiple sclerosis,
stroke, head trauma and schizophrenia.
Experts estimate that an additional four million people have a syndrome called mild
cognitive impairment, which may progress to Alzheimer's. People with the impairment can
function on their own but have gaps in their memories.
Economic imperatives are also driving the search for new and better treatments for memory
disorders.
The current cost of Alzheimer's alone runs $100 billion or more, said Dr. William Thies, vice
president for medical and scientific affairs of the Alzheimer's Association, a research and
support group.
If no new medications for memory disorders are found, Dr. Thies added, the number of
Alzheimer's patients could quadruple by midcentury.
"That's going to bankrupt our health care system," he said. "So there's a need to find a way
to short-circuit that impending disaster."
Except for extreme cases like advanced Alzheimer's, memory disorders do not generally
disrupt what is often called procedural memory, the ability to perform basic tasks or motor
skills like riding a bicycle or getting dressed.
Far more vulnerable is episodic memory, the ability to recall specific information about
people, dates and events. Many of the new compounds being scrutinized seek to improve
the way recent memories are stored, transformed into long-term memories and brought
back into consciousness when needed.
Drugs approved specifically for Alzheimer's are being tested in patients who have mild
cognitive impairment. But the medications can have side effects like nausea and diarrhea.
So researchers are looking ahead to the second generation of memory enhancers, some of
them now in clinical trials.
Some of the drug companies most involved in the search are small enterprises, focused on
specific pathways or aspects of brain biochemistry. Memory Pharmaceuticals in Montvale,
N.J., is developing compounds that maintain brain levels of a substance called cyclic AMP,
which transmits intracellular signals and has been shown in mice to play a role in memory
formation and retrieval.
Another company, Cortex Pharmaceuticals in Irvine, Calif., has two drugs in clinical trials
that bind themselves to sites on nerve cells called AMPA receptors. The receptors respond to
signals between cells carried by the neurotransmitter glutamate, and the drugs, called
ampakines, are intended to enhance the strength of the incoming signal.
"It's like an amplifier to a stereo set, and you can turn up the volume of brain activity quite
a bit by using these compounds," said Dr. Roger Stoll, president, chief executive and
chairman of Cortex.
Despite optimism among neuroscientists about eventual success, few expect memory
enhancers to be a panacea. Many researchers acknowledge that even if they find effective
treatments, there is no guarantee that the drugs will do anything for people who age
normally.
There is even less optimism that these drugs will boost the brain power of younger people
hoping to master a foreign language or excel on a calculus examination.
Although some drugs have clearly enhanced the ability of animals to learn and perform
routine tasks, that does not necessarily mean the same medications will help people
remember names and faces, said Dr. Rodney Pearlman, president and chief executive of
Saegis Pharmaceuticals in Half Moon Bay, Calif.
"It isn't clear that animals use the same kinds of memories that humans do," said Dr.
Pearlman, whose company is developing several memory enhancers. "A mouse doesn't have
to remember a PIN number to get along during the day."
Article 2
Revving up the brain
By Julie Deardorff (c) Chicago Tribune, March 7, 2004
The controversial prescription drug Ritalin, best known as a treatment for children diagnosed with
attention deficit disorder, has been co-opted by a new population: healthy people trying to boost their
mental performance.
The phenomenon, which has been increasingly documented by university researchers during the last five
years--and fueled by anecdotal evidence from pediatricians, guidance counselors and heads of test
preparation programs--is more than a fad. In some circles, Ritalin is known as a "cognitive performance
enhancer," or the academic equivalent to doping in sports.
College students, who once relied on caffeine, cigarettes and diet pills to get through exams, call Ritalin a
"study aid" and use the stimulant to stay wired for all-nighters. Pressured high schoolers take Ritalin for
sharper focus and concentration before major tests like the spring's college entrance exams.
Adults sample their child's medication to see whether popping an occasional pill might help meet work
deadlines and improve productivity. Or, in bizarre cases, they steal it. Last month an elementary school
custodian in Indiana admitted that she had swiped Ritalin from the school's nursing office, hoping it would
improve her cleaning performance.
The potential promise and perils of so-called "smart pills" such as Ritalin and other advancements in the
pipeline, including memory-enhancing drugs developed for Alzheimer's patients, have spawned a new
area of concern, debate and inquiry called "neuroethics."
One view is that accelerated learning or memory improvements, designed for medical purposes but
adopted by the public, could greatly benefit society. But in addition to safety issues, "moral questions of
fairness and choice are raised when students use stimulants to do better academically," said pediatrician
Lawrence Diller of the University of California at San Francisco, author of "Running on Ritalin" and
"Should I Medicate My Child?"
"In sports we value not only the home-run record but the effort involved in reaching that goal. Taking a
performance-enhancing pill cheapens that sense of effort," Diller said.
In addition, the fact that some athletes use drugs invariably pressures others to do the same to keep
pace.
"Is it any different if scholars are popping pills instead of athletes?" Diller asked.
During the next decade, perfectly healthy individuals will increasingly use drugs that improve how the
brain functions, according to experts in neuroscience, bioethics, health policy and education who met in
New York City last year to discuss the social ramifications of cognitive enhancement. The results of the
meeting--including guidelines on how to handle the complex issues related to revving up the brain--are
expected to be published in a scientific journal in the next two months.
"Unprecedented moral issues surround the impact that neurotechnology may have on the very definition
of human nature--on our capacity to reason efficiently and solve problems and to have emotions, selfconcept and unique cognitive style," conference co-chair Judy Illes of Stanford wrote in a meeting
overview. "How we envision this future must be the focus of continuing conversations."
Ritalin, the brand name for methylphenidate, is the most popular example in the debate, because it
already is widely available and shows signs of affecting those who have been diagnosed with attention
deficit and those who are "normal."
Streamlining brain function
A stimulant, it works by increasing levels of dopamine in certain parts of the brain. Dopamine is a
neurotransmitter that controls movement, attention and other functions, helping the brain work more
efficiently, said Dr. Dana Brazdziunas, director of behavioral and developmental pediatrics at the Ronald
McDonald Children's Hospital of Loyola University Medical Center.
A stimulant like Ritalin can also affect some of the other neurotransmitters in the brain such as
norepinephrine.
Four to 6 percent of Americans have attention deficit disorder, according to the Attention Deficit Disorder
Association. For some underperforming children, Ritalin and a similar drug called Adderall can increase
attention span to help them reach a "normal" functioning level.
Some experts have said that if used properly, the effects can be as dramatic as finding the right pair of
eyeglasses for nearsightedness.
Ritalin, however, is considered a universal enhancer. If a child not struggling with ADD takes Ritalin in a
pill form, he might feel he has an above-average attention span.
"It's related to the pressure students feel to do well at classes," said Katie Finn, 20, a junior at the
University of Iowa, who knew of peers in high school who would fake attention deficit for a prescription of
Ritalin. "It's a study enhancer, and people take it with the goal of being more focused."
Finn said she has been tempted to try it herself, but so far she hasn't.
"At times I feel distracted and would love to be focused, but my fear is the risk associated with it," she
said.
Though relatively safe if taken as prescribed, Ritalin does not work for everyone and has high abuse
potential. If it is snorted or injected rather than taken orally, it can produce a euphoric high. Adderall
produces a more potent buzz, experts say.
Side effects include an inflated sense of accomplishment, insomnia, loss of appetite, nausea, vomiting
and headaches.
Overdosing can cause tremors, hallucinations and seizures. Inappropriate doses actually can
overstimulate the body, making concentration quite difficult and resulting in feelings of agitation, rather
than focus and calm.
Experts disagree on the cognitive effects. Some say ingesting a high dose of Ritalin at 10 p.m. can keep
a person awake all night, but there is no evidence Ritalin can help on tests. In fact, sleep deprivation that
accompanies Ritalin abuse can make matters worse.
"It increases your vigilance when things are boring and hard, but it doesn't make you any smarter, more
creative or more organized," said Mina Dulcan, head of child and adolescent psychiatry at Children's
Memorial Hospital. "If you're an airport screener with thousands of bags and you have to watch closely to
catch one thing, it might help. But for most people, attention isn't what limits your knowledge. It's creativity
and organization."
Flunks as a test strategy
Dulcan said the stimulant is extraordinarily safe but a lousy test-taking strategy.
"You don't know what dose is right. Too much might result in a headache or stomachache, make the
student overfocused or too vigilant, so they can't shift attention," she said. "It's not a magic smartness
pill."
In today's frenetic world, however, an increased attention span could be an advantage, even if it's only
psychological. With increased pressure to achieve, students and parents have found Ritalin keeps them
going a little more, said Paul McHugh, a professor of psychiatry at Johns Hopkins University.
"It probably doesn't raise their ultimate IQ, but it pushes them along a little faster," said McHugh, a
member of the President's Council on Bioethics, which has debated the issue at length. "Since we're a
time-determined society--you have to clear this hurdle at a certain age--it could allow kids to speed up
learning on algebra, geometry and history,
giving them a little advantage."
Safety and efficacy aside, cognitive enhancers are rife with other ethical issues. Most people consider it
akin to corking a bat, including the U.S. Chess Federation, which agreed to begin drug testing for
caffeine, amphetamines and Ritalin in 1991, saying the substances could provide an unfair advantage.
In addition, using pills to treat or enhance natural conditions, such as attention span, shyness or memory,
can shift the definition of "normal" and risk medicalizing regular human behavior, said Illes, a senior
research scholar at the Stanford Center for Biomedical Ethics and Department of Radiology.
If only the wealthy have access, the effects have the potential to change the fabric of society, Illes said.
Of even greater concern to Illes are potential coercive uses, especially with a long history of steroid abuse
in athletics. "If we can improve cognition and control fluctuations of mood, should all school bus drivers be
required to take the drug so attention and alertness is at a maximum?" she asked.
"We're talking about the brain, as opposed to eyeglasses or a prosthetic device for an amputated limb,"
she said. "We're talking about the definition of personhood and privacy at a different level than ever
before."