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.

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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’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?

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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.”

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So, he took Adderall – something he’d never done before – and suddenly the impossible was possible. With sleep the last thing on his mind, he cranked out paper after paper (three in all) and even made it to class on time. He didn’t get outstanding grades on the Adderall-fueled assignments, but he certainly passed.

All in all, he would probably tell you the $5 for a pill and increased heart rate were worth it.

Welcome to the world of neuroenhancers. On a college campus, just about everyone knows someone who has used neuroenhancers – usually Adderall, Ritalin or their amphetamine-based cousins – to get work done or study long hours they never could have managed otherwise. Meant to treat attention deficit disorders, the drugs are illegal without a prescription. But that doesn’t stop the thousands of high-functioning and “success”-obsessed students who feel a need to be just a bit higher-functioning. An April article in The New Yorker that examined the use and effects of these drugs dubbed them the drug of this generation’s choice, like psychedelics in the ’60s, heroin in the ’70s and cocaine in the ’80s. It cited a 2005 report by a professor at the University of Michigan’s Substance Abuse Research Center, which found that in the previous year 4.1 percent of American undergraduates had taken “prescription stimulants for off-label use.” At one school, the number was 25 percent. Here at the University, Adderall is apparently “bigger than weed” in the residence halls, one student who was quoted in the Emerald said.

Is anyone surprised? Parents increasingly are bent on giving their children every possible edge, enrolling them in enough extracurricular activities to impress even the most exclusive prep schools. In college they must create a portfolio that outshines thousands of others in order just to enter the efficiency-obsessed, always-connected work force, where the daily grind certainly isn’t any less grinding. If you could pop a prescription pill that would give you an extra 12 hours to build your resumé or make a 24-credit term feasible, why wouldn’t you?

Some argue against the “recreational” use of drugs designed to treat physical or psychological conditions. But to call this increased use of neuroenhancers recreational is inaccurate. My friend didn’t have any fun, but rather experienced, as the New Yorker article called it, “a pinched, unromantic, grindingly efficient form of productivity.” In an always faster-paced world that offers more mindless distractions than ever (how long has it been since your last Tweet?), this productivity is becoming a necessity. It’s not about fun, it’s about work.

Then again, many who talk about their use of the drugs say neuroenhancers aren’t miracle workers. “I don’t think people who take Adderall are aiming to be the top person in the class. At the most basic level, they aim to do better than they would have otherwise,” said a recent Harvard graduate in the New Yorker article, who took Adderall regularly to keep up in school.

Yet some information paints a different picture. The journal Psychopharmacology wrote about a 2002 study on modafinil, another neuroenhancer, and said the results suggested that “modafinil offers significant potential as a cognitive enhancer.” Nature, another scientific journal, published a commentary in December that suggested society should cautiously “respond to the growing demand for cognitive enhancement.”

We don’t need to encourage Americans to work even harder than they do, and the idea of an entire generation using amphetamines to succeed makes me more than a little nervous. But, in a competitive field, if suddenly half your competitors are better equipped to do their job and you don’t want to be left behind, what are you supposed to do? If enough people use neuroenhancers, society’s expectations will raise to the level of what the drugs make possible; everyone else will be faced with the choice: compete or not.

The same commentary in Nature argued that we must reject “the idea that ‘enhancement’ is a dirty word.” Most people are afraid to talk about taking neuroenhancers, partly for legal reasons, but largely because they don’t want to be seen as drug users or people who can’t function without help from a substance. But it’s hypocritical for there to be a stigma around using these drugs: People wouldn’t use them, or at least not to the degree that they do, if they weren’t more or less forced to.

I’m not advocating using neuroenhancers. I strongly feel that my body and brain should be good enough the way they are, as long as I take care of them. But I also recognize that I could get more work done if I did use neuroenhancers. And, because it’s highly unlikely our society will stop valuing rock-hard work and superhuman efficiency anytime soon, this is a trend I’m not sure there’s any point in fighting against.

http://media.www.dailyemerald.com

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Modafinil/Modapro user experience

I’m a 52 year old, work full time, married etc. I’m also studying for a degree part-time, so obviously many late nights. I was interested in Modafinil for obvious reasons – anything that may help me through my final dissertation year would be great and the alleged cognitive boosting effects would be welcome.
I ordered 90x 100mg Modapro, (generic provigil AKA Modalert). No problems, they arrived about a month ago.

The first day I took 300mg in three doses, morning afternoon and late evening. I immediately noticed a raised level of attention, a little bit of a cranked feeling you would get from a very small amount of amphetamine, but this started to wear off by the next day. Although I felt more alert, at the same time my head felt like cotton wool. Not good.

The following day I decided to take 50mg in the morning and 50mg in the afternoon. I continued like this for several days. By the next day I felt fine, no side effects – in fact I didn’t notice anything at all.

The following week I increased the dose to 200mg a day, split am and pm. This I feel does the trick. For me, the effects of this drug are very subtle. Do not expect a dramatic change to how you feel. Also, and I know this will vary from person to person, but there is no way Modapro will keep you awake like stimulants. I can still catnap in the afternoons BUT I often prefer to switch on my computer and get on with some work. I may still feel a bit sleepy but I’m capable of focussing on work more easily.

Occasionaly I will take an extra 100mg between 10-11pm if working on a project. Before taking Modapro I would usually get up at about 8:00am and go to bed between 1-2am. Nothing has changed and I sleep normally, no weird dreams or anything.

On the cognitive enhancement side, well this is tricky because if you took a magic pill to boost your IQ, you probably wouldn’t feen any different. You would need to go through various tests to confirm this. I can’t answer this. Subjectively, all I can tell you is that I feel that I may be performing a little better than normal, compared to where I was, doing my degree last year. I also feel slightly more animated when in discussion but of course this could be coincidence or placebo effect.

There have been a couple of mornings where I’ve forgotten to take my tablet. On those days I felt noticeably sleepy, not terribly so but enough to make me realise that I’d forgotten the morning dose. This could be the rebound of not taking the dose or perhaps this is how I would have normally felt that day without modapro at all. Who knows?

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WABDA, backed by the Federal National Institute of Health (NIH), spoke of impending drug tests for researchers’ use of brain boosters like Provigil and Ritalin. The news spread like wildfire in academic circles, and many scientists – some of whom I know – traded nervous glances over the press release. Was this for real?

They should have checked their calenders. WABDA (a pun on the real-life WADA) was an April Fools brainchild of UC Davis biologist Jonathan Eisen, who coordinated the prank with a number of friends and even set up a website for the organization. While the news was fake, it struck a very real nerve. The viral spread of the prank revealed an actual anxiety should the NIH start collecting urine samples. Ten days later, an informal survey in Nature showed why.

Of 1,427 people working at scientific institutions in over 60 countries, about 20% of the respondents admitted to using brain-enhancing drugs for non-medical purposes.

The most popular drug was Ritalin, a drug that treats ADHD, with 62% of users. The second most popular was Provigil, a drug to improve awakeness in narcoleptics; 44% of users take it. 15% of users admitted to using beta-blockers, drugs designed for cardiac arrhythmias which have an anti-anxiety effect.

Most respondants reported that they used the drugs to improve their concentration, memory and focus. Others pointed to treating jet-lag, partying, housecleaning, and a wide variety of other purposes.

Surprise, surprise. Drugs and science have a long history together.

Kary Mullis won the Nobel Prize for his invention of Polymerase Chain Reaction (PCR), the laboratory foundation of modern genetics. He later divulged to Albert Hofmann, the late Swiss chemist who first synthesized LSD, that the drug helped him to develop the technique.

Similar rumors surround Francis Crick’s realization about the double-helix structure of DNA (another “eureka” of Nobel Prize fame).

Should we be outraged? After all, Barry Bonds made headlines worldwide when it was revealed that he took performance-enhancing drugs. The Tour de France is plagued by accusations of drug use, and fans are justifiably angry when tests return positive.

How is mental exercise any different? Why should some scientists have a chemical edge over others?

For one thing, as much as it might resemble one, science is not a competition sport.

The logic behind anti-doping regulations in sports makes perfect sense; one athlete with a chemical advantage ruins the idea of fair competition, which is the foundation of sports in general. Watching Michael Jordan dunk is less impressive if we know he was just injected with testosterone.

Science, on the other hand, is fundamentally a quest for knowledge of the world we live in.  If a scientist can unveil new revelations about our world, is that knowledge less true because chemicals influenced the discovery?

Even in competive testing – the SAT or GRE, for example – the lines get blurry.

I can personally attest to gulping a big, fat cup of coffee before every major examination of my life; is this so different from pharmaceutical enhancements?

Where can we draw the line? The essential difficulty here is that any “baseline level of performance” – from which drug use is a supposed departure – is an imaginary concept. Our bodies are built differently, and have different baseline performances (mental and otherwise).

Drugs like Adderall help those with ADHD to function at a higher level than their personal baseline (diagnosed as a subnormal capacity for attention).  Does Adderall bring them back up to average? Slightly above or below average?  What is an average attention span, anyway?

This is not to suggest that these drugs don’t help millions to function in the world – they do. But the field of psychology is notoriously plagued by the difficulties of diagnosis, simply because pathologies aren’t as clear as black and white. They occur in many shades of grey, and defining “normal” (and basing diagnoses on it) is both a difficult and a political act.

The first step to a responsible consideration of brain boosters is to consider the vague definition of drugs themselves.

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Caffeine, the most widely used drug on the planet, is socially accepted as a “fair” mental performance enhancer.

Prescription drugs, to many, still fall within the paradigm of medical science as cures to pathologies.  But – as the numbers show – a growing number of scientists feel differently, and use the drugs to boost their healthy brains. They’re not the only ones.

If trends today are any indication, our species’ course is one that increasingly blends our biological bodies with our technologies.

Prosthetics are happily invited to restore functionality to lost limbs. Vaccines and antibiotics allow us to hack our immune system to keep us healthier. Hell, we wear clothes!

Today, brain boosters are eyed suspiciously outside of their medical context. Maybe (just maybe) our grandkids will think differently. Not to mention faster, more clearly, and with a great attention span.

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