Here’s a thoroughly modern ethical dilemma to chew over. You go for a job interview but are pipped to the post by another person who seems wholly underwhelming and is less well qualified. The feedback is that she came across as more zappy and focused. Over coffee, she shares that she’s popped a tab of Ritalin before the interview. How does that make you feel?

Or here’s another one. Senior members of the academic department that you work in share their tip for being able to fly over to the US and deliver a lecture the same day while looking fresh and sounding perky.

They regularly take the drug Modafinil to counter jet lag and enhance their cognitive function. You’re not keen, but as a junior member of the team, you want to perform as well as possible. So do you try to get your GP to prescribe some or, like most of your workmates, buy some on line?

These challenges aren’t theoretical but real. Cognitive-enhancing drugs, also known as “smart” drugs are already being used to help people with Alzheimer’s disease, schizophrenia, attention deficit hyperactivity disorder (ADHD) and brain injury. But is there burgeoning use among university students and others wishing to boost their brain power? It is this that’s posing the ethical dilemmas.

Barbara Sahakian, professor of clinical neuropsychology at Cambridge University, described how the smart drugs fit in to our quest to keep our minds functioning longer and better in our ageing population, in a lecture last night at the Royal Institution, organised by Prospect magazine.

The three drugs in common use are methylphenidate (Ritalin), modafinil (Provigil) and atomoxetine (Strattera). All boost neurotransmitter chemicals (noradrenaline, acetylcholine, dopamine) at the junction between nerves to improve transmission or electrical activity.

Even modest improvements in cognitive function can make a big difference to people’s lives. It can make the difference between someone with schizophrenia being able to live independently or not. Or a kid with ADHD being able to stop his impulsive behaviour and stay out of trouble at school. And there are huge financial implications in being able to reduce the cost of long-term care for people with Alzheimer’s if a drug can slow their cognitive decline by even 1%.

Professor Sahakian said that the smart drugs are just one approach to boosting cognitive function. Exercise (three brisk walks a week will do, she said) and learning new things throughout life are most important. And connecting with others, giving of yourself and maintaining your curiosity about life are the other cornerstones of mental wellbeing.

She warns against the potential dangers of people under 20, whose brains are still developing, taking smart drugs like Ritalin unless they have a condition such as ADHD. But an estimated 16-20% of US college students take smart drugs and there is reason to believe its spreading to the UK.

The field of neuroethics is developing to look at challenges posed by advances in the neurosciences. Some arguments for smart drugs include removing disparity in society and boosting performance. In a lengthy operation, it is best to have one surgeon do the whole job and a tab of Modafinil may be better than caffeine which, in high doses, can cause tremor.

The US army is interested in smart drugs to allow troops to complete military operations as quickly as possible. But the potential harms include the fact that we don’t know about long-term effects, especially in developing brains. People may feel coerced into taking them. There’s a potential for abuse and you may get unwanted effects like persistent memories. Is it cheating to take the drugs? Will it turn us into mechanistic beings who don’t feel we’ve earned the right to feel proud of our achievements? Will working hard and being motivated become antiquated concepts? Will we become a homogenous society and will we lose creativity?

The last concern is practical. There is no licence for prescribing smart drugs unless you have a specified condition. No self-respecting GP is likely to prescribe it. And buying drugs online is fraught with dangers. You have to check you have no contraindications, that it won’t interact with any other medication and that what you get in the post is what it says on the box.

First published in UK news paper ‘The Guardian’

http://www.guardian.co.uk

Mark often faced the decision of studying to earn an A or going out to party with his friends.

In the end, Mark, a recent College of Liberal Arts graduate, who asked that his real name not appear in print, never had to make that decision, but he had to break federal law to make the grade.

The answer to Mark’s problem lay in a roommate’s medicine cabinet: Adderall.

“This stuff is all-American. It’s everything we value,” he said. “The side effects are probably limited, it makes us more productive and it’s focused on academics, making us better-functioning members of society.”

Mark isn’t alone. Where students once relied on caffeine, some are now turning to more potent solutions such as Adderall.

University of Minnesota students’ use of the drug as a study aid raises fresh concerns over the safety of nonprescription drug use, but some are questioning the fairness of neuroenhancement in classrooms where the difference between one student’s A and another student’s B may lie in a $5 pill.

A cure for Facebook

Possession of drugs without a prescription is against state and federal law, but at the University, nonprescription use of neuroenhancers lands in a gray area between policies.

Illegal possession of drugs is against the University Student Conduct Code, but neither that code nor the academic misconduct policy specifically addresses neuroenhancing drugs as they affect academic performance.

In the 2009 Minnesota College Student Health Survey, 7 percent of students at nine Minnesota colleges reported that they used prescription drugs without a prescription. The survey did not specify exactly which types of prescription drugs students were using.

In other college polls, as many as a quarter of students have reported using neuroenhancers as a study aid.

Lee Penn, an associate professor of chemistry, said she sees lots of students who have difficulty studying for tests.

Penn recommends that students distance themselves from potential distractions when they are studying. That means no television, no cell phone and, if possible, no computer.

“I think, in general, people who [cram] end up trapping themselves into doing it by flittering away their time by staying on the Internet or Facebooking in an addictive fashion,” Penn said.

And that’s exactly the sort of distraction that Steve, a CLA sophomore, who asked that his last name not appear in print, said Adderall helps him block out.

“When I’m studying without it, I’ll check Facebook and whatnot,” Steve said. “When I’m on it, I don’t even think about anything else. I’m just focused on studying.”

‘A few calls away’

Adderall, Ritalin and Provigil all belong to a class of drugs sometimes called neuroenhancers. They’re often prescribed as a treatment for attention deficit disorder and attention deficit hyperactivity disorder, but they can be a boon in last-minute study sessions and for those who have more work than time.

The drugs haven’t been widely studied in people without ADD/ADHD, but physicians say their addictive potential is high.

Dr. Gary Christenson, director of Mental Health Services at Boynton Health Service, said that element of uncertainty alone should give students pause.

Users sometimes experience jitters, a loss of appetite and increased heart rate. In rare cases, the drugs can cause severe heart conditions and stroke.

Thorough assessments for ADD/ADHD include tests of intelligence, short-term memory and planning. The tests detect over- and under-compensation to eliminate healthy individuals who are simply looking for a prescription.

For physicians, prescribing neuroenhancers means striking a precarious balance between covering all those with ADD/ADHD while limiting the number of people with prescriptions who don’t have the conditions.

“We don’t have X-rays for this,” said Dr. Ken Winters of the University Department of Psychiartry.

But those who want the drug have been known to circumvent the rigorous testing by going to primary care physicians who often don’t have the time or the means to perform the methodical and expensive examination.

“If you say the right symptoms — everyone can figure that out by going on the Internet — you might be able to convince somebody you have a problem,” Winters said. “For ADHD you can do cognitive ability tests that help determine whether somebody really has an attentional problem or not. That probably isn’t done often in a lot of clinics.”

Mark said his roommate was prescribed the drug while in high school “before this Adderall panic.”

That roommate knew exactly what to tell his doctor in order to get a stronger dosage that had a higher street value, Mark said.

“He doesn’t really need them. He can study fine without them.”

Those with prescriptions can become targets for 11th-hour cramming, and there is an expectation that prescriptions will be shared, Mark said.

“It’s kind of like being a freshman in the dorms who has a fake ID. You’re just expected to buy booze for your friends.”

But those who have prescriptions sometimes hide that fact so they aren’t pressured into selling their drugs.

An Institute of Technology junior, who asked that his name not be used, said he hides his Adderall prescription from friends because he doesn’t want to be pressured into selling.

Mark agreed that the precedent for selling can drive some with prescriptions underground.

“If I had a prescription, I would probably keep it on the hush,” he said.

Even if those with prescriptions are hiding that fact, the drug is never more than “a few calls away,” Mark said. “There’s definitely not a problem finding it at all.”

Mark’s friends often asked him why he used the drug instead of planning and studying in advance — instead of “being responsible.”

“We don’t want to,” Mark said. “We want to kick it. We want to chill and then [study] at the last minute because we can.”

Scholastic arms race

All the Adderall users interviewed for this story denied that the drug gave them an edge in the classroom.

They all said Adderall simply allowed them to reach their full potential.

“I’m not relying on it to get through class or anything,” Steve said. “It’s not like you take it and you become smarter.”

Mark praised Adderall for giving him the energy to go through college without sacrificing free time or his social life for grades.

“Adderall was really rad because I could go out and party and have a bunch of fun pretty much every night of the week, and then the day before a test, or the day before a report, I would say, ‘I’m going to take some Adderall and crank it out.’ ”

Christenson said that using the drug without a prescription should raise questions.

“Stimulants give you a better ability to focus, a better ability to concentrate and they’re also energizing, so that would give an advantage to someone who, for all intents and purposes, had the same skills and talents.”

But some students and professors question the absolute fairness of the academic setting.

One College of Design junior who has a prescription for Adderall said the drug “does make things easier” for users, but she said that whether it is fair is irrelevant.

“There are some people that naturally are able to read things, like business textbooks, and focus the whole time,” she said.

“I think [Adderall] levels out the playing ground, because the people that are able to do this stuff aren’t the ones that are trying to take it.”

On the other side of the gradebook, professors said drugs may be a game-changer.

“We shouldn’t be talking about competitive academics, and yet we are because it’s always about the bell curve,” Penn said. “My gut response is that it’s not fair.”

Penn said classes already tilt in favor of students with better education, but the introduction of drugs shreds any possibility of a fair assessment.

“People ought to be bringing a true and faithful representation of how hard they work to the exam situation, and if you take drugs that make it easier to take the test, it’s not a true and faithful representation of who you are.”

From a medical perspective, Winters said Adderall use is morally ambiguous.

“That’s an ethical dilemma, and from a fairness standpoint, one could draw a line in the sand and say, ‘That isn’t acceptable.’ ”

The issue may be akin to a scholastic arms race.

As students resort to more extreme measures, their peers may feel the need to do the same or risk lagging behind, Christenson said.

“Why should someone feel compelled to take a medication and accept the potential risks of any medication that they take just because someone else is doing it?” Christenson said.

First published http://www.mndaily.com

Josh has an exam and, like most of the other boys at his prestigious public school, he’s keen to put his best foot forward. He’s eaten breakfast and dressed smartly, but before he sets off for class, he reaches for a white pill and pops it into his mouth.

He bought 30 of the tablets online for £40 from the U.S., but for all Josh knows they might well have been knocked up in an illegal backstreet ‘pharmacy’ in India.

Still, the drug modafinil – usually used to treat sleeping disorders – has worked before for him and if it works again he is sure to get top marks.

Welcome to the world of ‘smart drugs’, otherwise known as cognitive enhancement pharmaceuticals.

This is a world where pupils as young as 15 self-medicate, participate in illegal online drug trafficking and swap notes on the best pill cocktails for good grades.

Concern over smart drugs has been growing for some time among academics, politicians and pharmacologists, but it has been brought

into sharp focus with the announcement that the former health minister, Lord Darzi of Denham, is heading a study at Imperial College, London, into their effects.

This might seem odd because most of these drugs have been around for decades for the treatment of conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, and have been found to be safe.

But no one has monitored their chaotic use in healthy young people taking inappropriate doses to boost their intellectual prowess.

And some experts believe this kind of use in brains that are still developing could cause addiction and permanent damage.

Josh is an intelligent, articulate 17-year-old, so you wonder why he needs extra help to feel smart. He has been taking modafinil (sold as the prescription-only drugs Provigil, Alertec, Modavigil and Modalert) since he was 16, but has friends who began using smart pharmaceuticals at 15. He lives in London and his parents are lawyers.

‘I read about modafinil in a newspaper and then researched it on the internet and spoke to some of my friends about it,’ he says.

‘It appealed to me as an inexpensive method for highly concentrated revision, for which I would otherwise depend on coffee, tea or Red Bull. Modafinil gives you heightened alertness, stamina and productivity. I find it helpful for focus and memory.

‘I find I can memorise a graph after drawing it once instead of several times. I would say it makes me 40 to 50 per cent more productive in a day, but it does not make me any cleverer.

‘While revising for my last set of exams, I was taking 100mg of modafinil a day for six or seven days a week for three weeks.

‘Around half-term, I stepped it up to 150mg to 200mg a day and in the last two or three weeks up to the exams I took 200mg to 300mg a day and worked 18-hour days.

‘I find you can get by on four to six hours of sleep for up to three weeks and then, at the end, the body needs to rest and catch up. I take a whole day off and sleep for 24 hours.

‘Taking it is no different from having other stimulants such as coffee, ProPlus caffeine tablets or Red Bull. It is no different from taking painkillers for a headache.

‘I use it specifically for exams and will carry on at university. I would recommend it to anyone who is informed about it and knows what they are doing.

‘I haven’t told my parents about using modafinil. They wouldn’t know what it is and they wouldn’t approve of me using it.’

Josh’s use of modafinil is not unusual. A quick scan of student web forums uncovers a world where drug advice is swapped.

The benefits of Ritalin and Adderall, which are meant to be used to treat ADHD, are compared with Provigil, Modalert and a group of drugs called ampakines – prescription pharmaceuticals that are showing promise in the treatment of Alzheimer’s and Parkinson’s.

The problem in telling students not to take them is that tests have shown these drugs can help with focus, memory, concentration and alertness by interacting in different ways with neurotransmitters – chemical messengers – in the brain.

the ADHD treatments contain amphetamines, which can result in addiction, and there are suspicions that sleep disorder treatments such as modafinil could be addictive.

Barbara Sahakian, Professor of Clinical Neuropsychology at Cambridge University, says scientists understand how drugs such as Ritalin work by stimulating levels of the neurotransmitters dopamine and noradrenaline in the brain.

These affect mood, cognition and memory. ‘However, there is an optimal dose for ideal performance,’ she says.

‘Levels beyond that could cause problems with addiction. With modafinil, no one really knows how exactly the drug acts in the brain to boost cognition.’

However, evidence is emerging that modafinil – thought not to be addictive – also affects the levels of dopamine. This is significant because dopamine production can lead to addictive behaviour.

Sometimes referred to as the ‘reward’ drug, dopamine is released during experiences such as the enjoyment of sex, food and drugs. We are programmed to repeat rewarding experiences, a cycle that can result in addiction.

A study published in the Journal of the American Medical Association last year looked at ten healthy men taking modafinil and found it did increase levels of dopamine. The research was conducted by the National Institute on Drug Abuse (Nida) in the U.S.

‘[Modafinil] has the signature that it could potentially be addictive,’ says Nida’s director Dr Nora Volkow.

‘Studies have shown consistently that all of the drugs of abuse . . . have a common effect of increasing dopamine in the nucleus accumbens [area of the brain].

‘That is believed to be crucial for their reinforcing effect and ultimately their underlying potential for producing addiction.’

The jury is still out on whether modafinil is addictive. Scientists regard tests on just ten people as being far from definitive.

Sahakian has called on the Government to hold a public debate on the use of smart drugs.

On the one hand, she feels they could be of real benefit to society if proven to be safe.

On the other, she wonders whether in some dystopian future people will be pressured into taking them to work longer and harder.

Already, there is evidence that students feel pressured into taking smart drugs to compete with highachieving classmates who are using them. And some pushy parents appear to be condoning their use.

One third-year student studying computer science at London Metropolitan University told us that taking modafinil is a ‘lifesaver’ in helping him to complete assignments.

‘I am aware of school children who have taken modafinil. They were aged between 16 and 18,’ he says.

‘Their father [a computer programmer], my friend, used to take it occasionally.

‘The parents had extremely high expectations for their children and they were taking exams.

‘My friend’s daughter was advised to take modafinil by her classmates. Unfortunately, this was a terrible decision.

‘She was taken to hospital after five days of sleep deprivation. She had high blood pressure, was anxious and experienced some kind of hallucinations and psychosis.

‘She was taking extremely high doses of modafinil. I was told she had felt some kind of euphoria and kept taking more and more. It is proof that modafinil can be addictive for some people.’

If Nida in the U.S. is correct and all these drugs affect dopamine levels in some way, then concern is likely to focus on students self-medicating inappropriate dosages and using them over a long time.

Dr Daniel Amen, a psychiatrist and Fellow of the American Psychiatric Association, says that while treating young ADHD patients with carefully controlled doses of Ritalin can improve their lives immeasurably, unmonitored doses taken by healthy youngsters could be damaging.

‘A therapeutic dose arrived at by careful monitoring by a physician might be anywhere from 5mg to 60mg a day,’ he says.

‘We know that can enhance brain function in many people by stimulating levels of dopamine.

‘But where you have some of these students taking concentrations of 100mg to 500mg, that could cause some problems.

‘The extra dopamine produced constricts blood flow to the brain and, over the long term, that could cause permanent damage.

‘The adolescent brain, especially the pre-frontal cortex – the most thoughtful part of the brain  -  is developing rapidly. Anything that disrupts or interferes with this process can cause lasting problems.’

There is debate on student forums over whether using smart drugs amounts to cheating.

Some say it does, while others argue that those who want to ban them should be prepared to give up commonplace stimulants, such as caffeine and nicotine. Even academics are divided.

Dr Anders Sandberg, a philosophy lecturer specialising in bioethics at Oxford University, tried modafinil as part of his research three years ago and now uses it openly.

In common with students who take it, Dr Sandberg is on the legal side of an illegal transaction. Under the 1963 Medicines Act, it is an offence to supply a drug without a prescription, but not to buy one.

‘When I take it, it is like having a little electric motor in the back of my head running through lists of things I need to do,’ he says. ‘Then, instead of putting them off until tomorrow, I go ahead and do them.

‘I use the drugs only occasionally if I have a paper to write or need to fly long distances to attend a conference or deliver a speech. I find that instead of having jet-lag, I can focus on the job at hand.’

But isn’t that sending the wrong message to students?

‘This is something I have spent a lot of time considering, but in general I believe people should have control over their own bodies,’ he says.

‘That right is important, but you need to use it appropriately and that’s why youngsters shouldn’t take responsibility for managing drugs, alcohol or enhancers. ‘These drugs are like step-ladders.

‘If you need them to attain something that would otherwise be out of your reach, then use them. But if you can reach those heights anyway, then you’re just being lazy.’

However, health professionals take a dim view of anyone misusing drugs.

‘Anyone taking prescription drugs without a prescription obtained through a consultation with a health professional is making a big mistake,’ says Neal Patel, a pharmacist and spokesman for the Royal Pharmaceutical Society.

‘It’s dangerous to experiment with medicines and the sideeffects of cognitive enhancement drugs are significant  -  they can cause abdominal pain, nausea, heart problems and changes in blood pressure.

‘These side- effects are dose dependent  -  the more you take, the greater your risk of being affected and seriously harmed.’

Professor Sahakian and Dr Amen say there are other, less risky yet proven remedies for improving brain function: like sleep, exercise and a healthy diet for instance. Apparently, they work.

First published in the Daily Mail

http://www.dailymail.co.uk

Indeed shifting patients from a soon-to-go-off-patent blockbuster, to its tweaked successor is old hat in the pharma biz.

Ever since drugmakers figured out that adding a time-release coating or other slight improvement could earn it a new round of patent protection, they’ve been developing strategies for competing against their own meds.

Raising the price of the old version to get patients to switch to the new brand, hoping they’ll stick when the old one goes generic? Done.

Touting the slight improvement as if it’s a major advance? Also done.

If you’re interested just what Cephalon might bring to its follow-up party, check out its Q2 earnings call. Jim Edwards at BNET Pharma did, and found that it’s eyeing new indications–and a new focus on recently won indications–as a Nuvigil switching strategy. According to the call transcript, it’s also using price breaks: free samples, a seven-days-free coupon, co-pay assistance of up to $50 per scrip. It’s offering deals to insurance plans and managed care companies. All to capture brand business before the wakefulness med Provigil goes off patent, sometime before 2012.

But more about those new indications. At the end of June, Cephalon asked FDA to approve Nuvigil for jet lag disorder. It’s studying Nuvigil as a treatment for sleepy brain-injury patients. It’s plotting two Phase III trials of Nuvigil as an add-on for bipolar depression. It’s enrolling for a IIB study in schizophrenia. And it’s in the early stages of developing Nuvigil as a treatment for chemotherapy-related fatigue.

That’s quite a range of uses. And at least in the case of jet lag disorder, one might argue–as BNET does in relation to Nuvigil’s shift-work fatigue indication–that jet lag is a natural physical response that Type A business travelers hate. And those travelers would be quick to ask for Nuvigil even if their jet lag isn’t extreme enough to be disorderly. That’s all good for Nuvigil sales, of course. And Provigil and Nuvigil together account for half of Cephalon’s recent revenues. Stay tuned.

Looking for generic versions of Provigil/Modafinil? Your quest is over. Buy generic provigil HERE.

http://www.fiercepharma.com

Cephalon conspired with other drug makers to delay generic competition for its blockbuster drug Provigil, pharmacy chains say in a federal antitrust class action.

Rite-Aid, Eckerd, Brooks and CVS Caremark sued Cephalon and generic drug manufacturers Mylan, Barr, Teva, and Ranbaxy Pharmaceuticals, claiming Cephalon bought more time for its “wakefulness promoting agent” by paying more than $200 million to generic manufacturers in four patent settlements.

The pharmacies say that had not Cephalon taken steps to “destroy the market for generic Provigil and the potential benefits to consumers from generic entry,” generic versions of the drug could have been available by January 2006.

Sales for Provigil, Cephalon’s flagship drug, hit nearly $1 billion in 2008. It is prescribed for sleep apnea and narcolepsy, to help people stay awake. It’s become a popular drug on college campuses, where students use it as a high-class form of “speed” to study.

The class action is the latest in a number of similar claims filed in Philadelphia. Since April 2006, other plaintiffs include private health care providers, health care co-operatives, pension funds such as the Pennsylvania Employees Benefit Trust Fund, and the Federal Trade Commission.

The latest class action was filed by Steve Shadowen with Hangley & Aronchick. The pharmacies demand treble damages and an injunction.

Don’t miss out. Buy Generic Provigil HERE

http://www.courthousenews.com

Ritalin is a heavily prescribed (and even more heavily abused) amphetamine based drug normally prescribed in the treatment of ADD/ADHD amongst a great many others.

And whilst I’m no doctor or pharmacist, I have read a great deal into the workings of how it affects the human body, and how it works has no resemblence at all, to how Provigil works.

Whilst Cephalon have been very quiet regarding how Provigil works, its not said to be a big user of “dopamine” receptors in the brain;

The ‘mechanics’ behind giving us a “high”.

Ritalin tweaks these dopamine receptors to such a degree, the consumer can feel jittery when the drug is wearing off, as the body’s dopamine supply is used & exhausted.

Dependence
In people with an addictive personality this can quickly lead to dependence as the user tries to feel better by taking more amphetamine.

But as Provigil pays little or no attention to the dopamine receptors, there are no jitters when the drug wears off, leading to a far more ‘user-friendly’ experience.

For more information, or to ask any questions you may have regarding Provigil/Modafinil, check out the new Facebook group by clicking here .

http://www.provigil-rx.info

The Ultimate Provigil/Modafinil Information Resource – Buy generic provigil today. Order with confidence!!

In the middle of the exam season, the offer of a drug that could improve results might excite students but would be likely to terrify their parents.

Now, a distinguished professor of bioethics says it is time to embrace the possibilities of “brain boosters” – chemical cognitive enhancement. The provocative suggestion comes from John Harris, director of the Institute for Science, Ethics and Innovation at the University of Manchester, and editor-in-chief of the Journal of Medical Ethics.

Ritalin is a stimulant drug, best known as a treatment for hyperactive children. But it has also found a ready black market among students, especially in the US, who are desperate to succeed and are turning to it in preference to the traditional stimulants of coffee and cigarettes. Users say it helps them to focus and concentrate, and this has been confirmed in research studies on adults.

David Green, a student at the University of Harvard, told The Washington Post: “In all honesty, I haven’t written a paper without Ritalin since my junior year in high school.”

Matt, a business finance student at the University of Florida, claimed a similar drug, Adderall, had helped him improve his grades. “It’s a miracle drug,” he told The Boston Globe. “It is unbelievable how my concentration boosts when I use it.”

Some experts have condemned the trend and accused students of gaining an “unfair advantage” by doping, without explaining why it is any more unfair than hiring a private tutor or paying for exam coaching.

Professor Harris says that the arguments against the drugs “have not been persuasive” and that society ought to want enhancement.

“It is not rational to be against human enhancement,” he writes. “Humans are creatures that result from an enhancement process called evolution and moreover are inveterate self improvers in every conceivable way.”

Although no drug can be guaranteed safe and free of all side-effects, Ritalin has been judged safe enough for children with attention deficit hyperactivity disorder (ADHD), and has been widely used to treat them over many years, he says.

The drug is a stimulant which was introduced in 1956 and appears to influence the way the brain filters and responds to stimuli. It increases energy as well as confidence and has been compared to cocaine. Possible side-effects are typical of stimulants and include insomnia, loss of appetite, dizziness and depression on withdrawal.

Other drugs investigated for their mind-enhancing properties include donepezil, a treatment for dementia and modafinil, used in narcolepsy, the condition in which sufferers repeatedly fall asleep.

Both drugs are thought to boost highly skilled performance, where concentration and alertness are prerequisites. One study found commercial pilots who took donepezil for one month performed better than pilots on a placebo when dealing with emergencies on a flight simulator. A study of modafinil found that it boosted the performance of helicopter pilots flying on simulators who had been deprived of sleep.

Writing in the online British Medical Journal, Professor Harris says the use of cognitive enhancing drugs should be seen as a natural extension of the process of education. Drug regulatory agencies should assess the benefits and risks in the same way as they would for any other medical intervention.

“Suppose a university were to set out deliberately to improve the mental capacities of its students. Suppose they further claimed that not only could they achieve this but that their students would be more intelligent and mentally alert than any in history. We might be sceptical but if the claims could be sustained should we be pleased?”

His answer is an unequivocal yes. He concludes that it is unethical to stop healthy people taking Ritalin to enhance their mental performance.

But in total disagreement, Professor Anjan Chatterjee from the University of Pennsylvania argues in the BMJ that there are too many risks. In the US, the drug carries a “black box” warning, the most serious, because of its high potential for abuse, serious adverse risks on the heart and the risk of sudden death.

He adds that there are cognitive trade-offs in taking Ritalin, with a loss of creativity, and points out that “being smarter does not mean being wiser”. He raises the spectre of children at top preparatory schools taking Ritalin in “epidemic proportions” and pilots, police and doctors being pressurised to take it when on-call.

Progress often carries risk, says Professor Harris. The development of “synthetic sunshine” (firelights, lamplight and electric light) could have forced people to work through the night. The answer was not to ban it but to introduce laws to regulate working hours. “The same is or will be true of chemical cognitive enhancers,” he concludes.

A stimulating debate: The pills in question

Ritalin

A stimulant drug introduced in 1956 for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children, it has become increasingly widely used, especially in the US. In recent years, reports have emerged of it being abused by students seeking aids to help them through their exams.

Amphetamines

The stimulant was first synthesised more than a century ago and has been used and abused to boost energy, increase wakefulness and prolong endurance. Its users have been as diverse as long distance lorry drivers wanting to ward off drowsiness and women trying to lose weight. Today it is prescribed for ADHD and narcolepsy, and has been investigated for its role in helping stroke victims re-learn motor skills.

Donepezil

Scientists in aviation medicine and in the military have been examining medicines which might increase alertness and concentration to minimise risk of pilot error and maximise endurance. Donepezil, used to treat of dementia, has been shown to boost the performance of pilots on flight simulators, especially in emergencies.

Modafinil

Modafinil, a drug used to treat the sleep disorder narcolepsy, has also been tested on pilots and other members of the armed forces. While commercial pilots have strict rules governing flying time and rest periods, fighter pilots may be called to action at a moment’s notice. Tests on helicopter pilots flying on simulators who had been deprived of sleep showed the drug boosted performance.

http://www.independent.co.uk

It was originally designed for narcoleptics, but clinical trials stumbled across something odd: if you give it to non-narcoleptics, they become smarter. Their memory and concentration improves considerably, and so does their IQ. There were no known side-effects, except – oh, thank you! – weight loss.

I hunted it down online. A week later, the little white pills arrived in the post. Within a few hours of a 200mg dose, I found myself gliding into a state of long, deep concentration, able to read a book for six or seven hours at a time without looking up. My mood wasn’t any different; I wasn’t high. It was like I had opened a window in my brain and all the stuffy air had seeped out, to be replaced by a calm breeze. On Provigil, I had the most productive month of my life, writing reams of articles. I didn’t notice any side-effects – until the third week.

At any given time, only a small amount of your brainpower is dedicated to the tasks immediately in front of you. The rest is working on other stuff – processing memories, your subconscious, your creative thoughts. But Provigil points all your mental guns forward. It deploys far more of your brainpower on to your direct task.

It’s great at first – but it has a cost. After a while, you realise that your mental life is oddly depleted. Creative thoughts don’t come to you any more. You are running on the imaginative store you built up before Provigil, and whizzing through it efficiently, but you aren’t inventing anything new. That part of your brain is undernourished. You feel fast and flat.

When I stopped taking them, my brain went back to its slower, scrappier state – but my creative impulses came back. I was more spontaneous again. So I have cut a deal with myself. I keep a pack in the bathroom cabinet for the days when I am really knackered and have to be able to work fast and fluently – but I don’t ever take more than one or two a month.

But if I ever had to do exams again, I would take Provigil. And here’s the ethical dilemma. Is this the equivalent of athletes taking steroids? Does it create an unfair pressure for other people to take these drugs – which are still pretty expensive – to keep up with other students and co-workers? Or would we be unfairly holding the human race back by refusing to smarten up?

We can’t escape these dilemmas now. Smart drugs are only going to become more subtle and powerful as money flows in. As Professor Anjan Chatterjee says: “This age of cosmetic neurology is coming, and we need to know it’s coming.” My little pack of Provigil is a challenge to us all.

http://www.independent.co.uk

Question: Why do people feel so crummy when they move across time zones?

Answer: Jet lag. It is a disruption of the circadian rhythms. It happens when the body’s clock and the destination’s clock are out of sync.

Question: Then jet lag is more than a lack of sleep?

Answer: It’s definitely more than a lack of sleep. You can take a flight across the time zones, and even if you sleep you can still experience symptoms of jet lag.

Question: What causes these disruptions in the body’s rhythms?

Answer: Light primarily drives the brain clock. Because the brain’s clock receives light information about the new time zone directly from your eyes, it actually shifts faster than the clocks in the rest of the body. Bodily tissues have their own clocks – liver, kidney, stomach, intestines, etc. Part of jet lag may be a misalignment of the brain’s clock and these peripheral clocks.

Question: What are the symptoms?

Answer: The symptoms are fatigue, insomnia, gastrointestinal upset, headache, trouble focusing and generally feeling “out of whack.”

Question: How long do symptoms last?

Answer: It really varies by individual, but there is a general rule of thumb that you can figure on about a day to shift per every time zone you travel through.

Question: How do people who travel regularly cope with this?

Answer: Really, the people who are successful are those who try to stay in their own time zones behaviorally. If you fly to the West Coast and try to get up early like you’re still on East Coast time, you’ll experience fewer symptoms. The worst is when you are flying to China, which is 13 hours off.

Question: Is jet lag worse going west to east or east to west?

Answer: Most people say going to the east is harder. The reason for that is most people find it harder to get up earlier.

Question: Is there anything you can do to reduce the symptoms of jet lag?

Answer: There is some controversy about that because every person is different. Some people try to preshift to the other time zone. If you are going to be gone for a long time, it makes sense to preshift. If you are on a short trip, it makes sense to stay in the current time zone. Other people try other things: bright lights, pharmaceuticals such as melatonin or Provigil, caffeine or naps. Directly or indirectly, these things are ultimately going to affect the brain’s clock.

Question: What do you advocate?

Answer: I try to stay in my own time zone when traveling within the U.S. My advice is work with your natural rhythm. There’s a second thing I do. If you’re going to travel to Europe, get up, start your sightseeing and engage in vigorous activity. Also, eat multiple small meals throughout the day. I feel less nauseated and more alert.

Question: Do certain kinds of food help?

Answer: There is anecdotal evidence that carbohydrate-rich foods will help, but it may be that they just make your brain feel good. One of the things we need to realize about circadian rhythms is that there is a genetic component to them, and there is a tremendous variability of what will work for each person.

http://www.dallasnews.com

It’s a play right out of the Twitter era and the family medicine cabinet. “Distracted,” at an off-Broadway theater in New York, examines the ever-shortening attention span of modern life – including the moral conundrum of whether a restive 9-year-old should be given pills to alter his mood.

At one point, an actor breaks from character to address the audience directly and advocate the use of Ritalin and Adderall, two over-the-counter stimulants, which, he says, helped him learn his lines.

The aside encapsulates a growing debate in scientific circles and living rooms across America: Should adults be using so-called “brain-boosting” drugs – normally intended to treat serious medical conditions – to improve concentration and performance?

Order generic Provigil/Modafinil (generic name Modalert) with confidence.

College students, of course, have been using stimulants for years: They take modafinil, Adderall, and Ritalin (known on campuses as “vitamin R”) to enhance their memories for exams or to stay up all night and press out a term paper. By one estimate, at least 10 percent of U.S. college students use prescription drugs as study aids.

Now the general adult population is turning to the pills, too, to boost productivity and enhance their mental prowess on the job. Some experts laud the development: They think it’s time to consider making the stimulants legal for brain-boosting functions.

But critics worry it will accelerate a slide toward a drugged society. In an era when people take everything from Viagra to enhance their romance to steroids to enhance their baseball statistics, they argue that the addition of so-called “cognitive enhancement” drugs will only make us more dependent on the pill bottle.

Ultimately, it raises the most fundamental questions about identity and what it means to be human: Are we the sum of our experiences or the sum of our pills? As Carl Elliott writes in his book, “Better than Well: American Medicine Meets the American Dream”: “Today, enhancement technologies are not just instruments for self-improvement, or even self-transformation – they are tools for working on the soul.”

Last summer, Michael Arrington, the founder of the influential technology blog TechCrunch, wrote a post asking, “How many Silicon Valley start-up executives are hopped up on Provigil?” He was referring to the stimulant, which is the brand name for modafinil, that doctors normally prescribe to treat excessive drowsiness associated with narcolepsy and other sleep disorders. “[T]he buzz lately is that it’s the ‘entrepreneur’s drug of choice’ around Silicon Valley,” the post said.

In an online poll in the British science journal Nature last year, answered by 1,400 people in 60 countries, 1 in 5 said they had used drugs for nonmedical reasons “to stimulate their focus, concentration, or memory.” Only about half had a prescription for the drug they were using. A third had bought the drugs over the Internet. And even though about half reported unpleasant side effects, 4 out of 5 “thought that healthy adults should be able to take the drugs if they want to,” Nature reported.

Philip Harvey is one who uses them. A professor of psychiatry and behavioral sciences at Emory University in Atlanta, he regularly flies from Georgia to Europe on business. To prepare for his flight, he takes modafinil. He uses the stimulant to feel alert and rested, despite lost sleep, allowing him to return to his family faster. He has no trouble getting a prescription from his doctor. “From Atlanta, I can get to Europe by 6 a.m. and give a 9 a.m. presentation,” he says. “It lets you go and come back the same day, or go over one day and come back the next.”

Right to choose?

In the current debate over brain boosters, the focal point of much of the discussion has been a commentary in the December issue of Nature. Seven prominent bioethicists noted that the drugs “are ‘disruptive technologies’ that could have a profound effect on human life in the twenty-first century.” While calling for more research to better understand the safety and effectiveness of use in healthy individuals, the piece went on to advocate that “mentally competent adults should be able to engage in cognitive enhancement using drugs.”

In the months since, the paper has met with both hearty approval and deep reservations from scientists and other bioethicists. “Anything that can help our brains deal better with the complex challenges of the twenty-first century is to be not only welcomed but actively sought,” wrote Nick Bostrom, director of the Future of Humanity Institute at the University of Oxford, in a letter to the journal.

The commentary served its purpose to “kick up” a needed discussion, says Henry Greely, a bioethicist and professor of law at Stanford University and one of the coauthors of the Nature commentary. He received far more e-mails about the article than for any other he’s published. The aim, he said, was to argue that “enhancement is not fundamentally a dirty word.”

“I think people should think of [drugs] as just one more of many different ways we try to improve our minds,” Dr. Greely says. “I’m a teacher. I’m in the enhancement business. I’m trying to enhance my students’ brains.”

But others were disappointed with the commentary. “It’s not really a piece of science. It’s an editorial arguing that we should use more drugs,” says George Annas, chairman of the department of Health Law, Bioethics, and Human Rights at Boston University. He wonders why an article taking the other side of the debate didn’t accompany it, and why the authors called for looser strictures on use of the drugs before more is known about them. “The way you make sure they’re not harmful is you do a study before you widely advise people to use them,” he says.

Critics argue more time is needed before the drugs are used as mind enhancers. “The reality [is] that there is very little research to document whether [these drugs] are universally beneficial, whether they could be detrimental, what are the long-term outcomes, what are the side effects,” says Nora Volkow, director of the National Institute on Drug Abuse, a U.S. government agency. “There’s really very, very limited knowledge.”

What troubles Dr. Volkow is how the commentary dismissed the dangers of these drugs, equating taking them with drinking coffee, “which is, to say the least, an irresponsible way to present it and an inaccurate one,” she says.

In March, Volkow published a small preliminary study showing that taking modafinil might be addictive in humans, increasing the levels of dopamine, a neurotransmitter that plays a major role in addiction.

But some worry about other problems. Would workers feel coerced to use enhancement drugs in order to win promotions or even simply to keep their jobs?

“For example, what if hospitals started to demand that medical residents dose up on methylphenidate, a drug used to improve concentration, as a prerequisite for employment?” asks Jacob Appel in an article last year in the Journal of Medical Ethics called “When the boss turns pusher.” Or what if fast-food chains insisted that employees take antidepressants to keep them calm and upbeat?

Employers may face a dilemma. “Denying some individuals the opportunity to enhance in this way clearly undermines their right to do with their bodies as they choose,” he says. “However, to permit some to engage in these enhancements may lead to an inevitable race to the bottom – or top – in which employers and market forces pressure more and more American workers to place their brains at the disposal of their bosses.”

More broadly, some worry that as more brain-enhancing drugs come on the market in the next 10 to 15 years, countries may battle for “neuro competitive advantage” in the workforce. If you’re a 58-year-old person living in Boston who’s competing with a 25-year-old in Mumbai, for instance, you might be tempted to use the drugs – whether or not they’re legal in the U.S., notes Zach Lynch, executive director of the Neurotechnology Industry Organization, a trade group.

Moreover, even if they are illegal, or regulated, enforcing those controls would be difficult. “Living in a global economy, I think it’s going to be very hard to regulate the use of these [drugs] in the future, if they’re safe and effective,” Lynch says.

Brain-boosting drugs are already being considered for another workplace – the military. The Defense Advanced Research Projects Agency is working on “all kinds of drugs to make you stronger, to make you eat less,” says Dr. Annas. “They want soldiers to function for up to five days without sleep. That would certainly require drugs. Whether that would have any long-term consequences, I don’t think anybody knows yet.”

A drug called donepezil, developed to treat Alzheimer’s disease, has been shown to modestly increase memory in healthy people. It may become a Viagra-like hit with baby boomers worried about cognitive decline. Work is also under way to use drugs or other methods to selectively erase memories, something that could be used to ease post-traumatic stress among soldiers returning from war, allowing them to forget what they did on the battlefield. Annas sees problems. “I think we want to have remorse about killing,” he says.

Advocates point out that humans already “enhance” their thinking in a variety of ways, from drinking beverages with caffeine (a known stimulant), to exercising to brighten their mood, to relying on a computer to increase knowledge, to simply getting a good night’s sleep before a big test.

But for some, a caution light goes on when we’re changing the way the brain works, particularly when so little is known about it. “Not only do we not have a model for how our brains do complex tasks, we can’t even imagine one,” Dr. Karl Deisseroth, a neuroscientist at Stanford University, told Wired magazine earlier this year.

Revolution of the brain

At the most fundamental level, the drugs challenge perceptions of who we are. Some people believe the next big scientific revolution will be turning our technological prowess on the world within, notably our brains, rather than the world around us. Neuroscience, which includes the development of brain enhancers, is part of this “revolution.”

In this realm, some experts suggest that using pills to alter thinking or mood comes too close to altering our sense of self. “In seeking by these [biotechnologies] to be better than we are or to like ourselves better than we do, we risk ‘turning into someone else,’ confounding the identity we have acquired through natural gift cultivated by genuinely lived experiences,” wrote Leon Kass in a 2003 report on human enhancement from the President’s Council on Bioethics.

Yet others argue the definition of what is one’s “real” self will be up to the individual – and should be.

“It’s not at all clear that people feel more themselves when they’re unmedicated than when they’re medicated,” says James Hughes, director of the Institute for Ethics and Emerging Technologies in Hartford, Connecticut. “Some people are going to feel more ‘themselves’ when they take the drugs, and some are not going to feel more themselves.”

As drug and biotechnology companies look to expand their products and markets, more possibilities for illicit use may lie ahead. Cephalon Inc. is planning to launch Nuvigil, a longer-lasting version of Provigil, later this year. The company sold nearly US$1 billion of Provigil last year, but the drug is going off patent in 2012. Cephalon says a study shows that Nuvigil works to alleviate jet lag, and it is expected to ask the Food and Drug Administration (FDA) to add jet lag as a new medical condition.

Many argue that more research is needed on existing drugs before we start thinking about new ones. Greely, for one, says we don’t have any “real evidence about the effects, short-term or long-term,” of Adderall and Ritalin, which are both used to treat attention-deficit hyperactivity disorder, on healthy people. As companies seek approval from the FDA for new drugs, if they seem likely to be used for enhancement, “we should require some research on those off-label uses,” he says.

If a drug is truly quite safe, he says, the FDA could make an early decision to permit over-the-counter sales. On the other hand, it also could place tough limits on who could prescribe a particular drug or limit the number of pills per prescription. In the end, if it’s true that we only use a small part of our brain now, people are always going to try to improve on that, Annas says, “and drugs are a way in.”

“But we certainly want to think this through and do careful, controlled studies before we move toward over-the-counter sales.”

http://www.etaiwannews.com

Order generic Provigil/Modafinil (generic name Modalert) with confidence.