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Living for the instant brain fix

 By Dr. William Goldberg and Mark Leyner

Is it just us, or does it seem like everyone is either searching for that little something to get a competitive edge or simply struggling to keep up?

Americans are 24-7-365. We are both guilty of swilling espresso as we burn the candle at both ends to finish our new book.  But that doesn't disturb us nearly as much as the overwhelming amount of highly caffeinated "energy" products being marketed to help stimulate our competitive kids. Snack food maker Mars has even released a new "Snickers Charged," so even candy can now give you an extra nudge.

The pharmaceutical industry is, of course, lurking right there with a whole slew of cognitive enhancers to push our bodies and brains to their max.

As a society, we tend to reflexively deride and often morally condemn the instant fix (while at the same time scrambling for it). But what about drugs that can instantly improve your cognitive functioning? Not good, right? They're unfair – like steroids for the brain.  Until you consider the pilot who's flying your plane for the next 10 hours or the neurosurgeon operating on your mom. Maybe a hit of Provigil doesn't sound like such a bad idea. 

There's nothing earth-shattering or radical about the idea of "cognitive enhancers." Caffeine and nicotine are two old-school boosters. Many studies have proven that both help maintain attention, heighten alertness and, of course, keep people awake. Research has also shown that caffeine possesses cognition-enhancing properties that can enhance higher cognitive functions like short- and long-term memory and perceptual sensitivity.

But a java jolt isn't enough for those seeking the the new "smart drugs" or "nootropics," many of which were originally developed to treat neurological or mental disorders such as Parkinson's disease.

"Two of the drugs which are now being used as cognitive enhancers, donepezil and tacrine were originally approved in the United States for treatment of Alzheimer's . A study published in the journal Neurology found that commercial pilots who took 5 milligrams of donepezil for one month performed better than pilots on a placebo when asked to fly a Cessna 172 on a flight simulator. There was a significant difference between the groups in the effectiveness with which they dealt with emergencies.

"Then there's Ritalin, the drug of choice on college campuses for sleep-deprived students struggling to pull all-nighters, complete term papers, even boost concentration during exams.
Drugs like Ritalin and Adderall are commonly prescribed to treat attention deficit hyperactivity disorder (ADHD). At recommended doses, these medications can accelerate the central nervous system, heightening concentration and alertness.

"But as a "smart drug," Ritalin may not be quite so smart. Never mind the fact that sharing prescription medicine is a felony drug offens in most states – taking excessively high doses of Ritalin can increase the risk for neurological and heart-related symptoms.

The current superstar of prescription stimulants is Provigil (Modafinil), first approved as a treatment for narcolepsy. A secondary indication was to treat something called Shift Work Sleep Disorder (SWSD), a sleep disorder that affects people who frequently work schedules that resist the body's natural Circadian rhythm, such as night shifts or rotating shifts. We both know doctors who regularly use Provigil.

Provigil can keep a person awake and alert for 90 hours straight, with none of the jitteriness, impaired concentration, "rebound effect," or risk of addiction associated with amphetamines or even coffee.

Not surprisingly, Provigil is reportedly popular with the U.S. Air Force, and has been used more than 150 times this year by bomber crews to ward off fatigue on missions of more than 12 hours.

Barbara Sahakian, professor of neuropsychology at the University of Cambridge, who has conducted extensive research on Provigil has found that it results in greater concentration, faster learning and increased mental agility. "It may be the first real smart drug," she has said. "A lot of people will probably take [it]. I suspect they do already."

Provigil seems to safely bolster alertness for days at a time with few side effects, but its long-term effects have not been sufficiently studied to completely rule out all potential problems. 

A couple of final points. We're both fathers. When conversations turn to cognitive enhancers, the issue of "fairness" invariably comes up. For instance, do you want your kid taking the SATs and competing with a bunch of other kids who are tweaking on Provigil? Hopefully, we will have instilled in them an awareness of the profound difference between the ability to perform well on standardized tests and the capacity for intellectual discovery, innovation and creativity, and humane conduct.

But we may be in the minority. The "customized" man is looming and there may be little we can do about it.