blog.bioethics.net

What Your Children at Columbia University are Thinking About

Christina Persaud and Yang Liu are pretending to study bioethics at Columbia. But we know what they are really doing. Reading blogs. And thinking about drugs for their brains. This is what happens when you send your kids to the Ivies, especially when they take bioethics classes from folks like this. Anyway they seem nice enough, even if they're doped up on nootropics, and here's their guest post:

There’s now a better way to boost your brain power. Just pop a nootropic.

They sound just like those Gingko Biloba tablets from your local GNC. Unlike memory-enhancing fads of decades past, however, nootropics (or “smart pills”) are being developed by some of the world’s top neuroscientists and pharmaceutical companies to alleviate the effects of Alzheimer’s and other neurological disorders. These drugs are born out of an increasingly intimate understanding of the molecular basis of learning and memory.

As with anything done in the brain, the use of nootropics carries profound social implications complicated by their potentially glorifying effects in reasonably functioning adults. Derived from the Greek words noos (mind) and tropos (bend), nootropics could enhance performance on cognitively demanding tasks and improve recall of long term memories. Despite the potential misuse of these drugs (which presents ethical issues similar to those chilling the development of genetic engineering and cloning alike), development is in full swing with several different drugs parading through human clinical trials as we speak. Nevertheless, these drugs could deteriorate the social infrastructure that has crowned us- human beings -the winners in the contemporary game of “survival of the fittest.”

A large proponent of these pharmacological innovations is Eric Kandel, 2000 Nobel Prize Winner and professor at Columbia University. He has investigated the role of CREB protein in long term memory formation and consolidation. His company, Memory Pharmaceuticals, has developed a whole line of drugs that allegedly enhance memory by inhibiting phosphodiesterase (PDE). Blocking the signaling cascade of PDE prolongs the presence of CREB and increases CREB’s concentration in the cell. The more CREB present, the faster memory is consolidated into long term storage.

Just across the Hudson, Tim Tully of Cold Spring Harbor Laboratory – who discovered CREB’s importance in short term memory - is working with CREB enhancers for Helicon Therapeutics. Most recently, Sam Deadwyler of Wake Forest University has demonstrated the effectiveness of CX717 in improving the performance of sleep deprived non-human primates in battery tests to beyond non-sleep deprivation levels. Cortex Pharmaceuticals, the company behind the drug, is currently evaluating the alertness and cognitive performance of sleep deprived participants using CX717 in a ‘simulated night work environment.’

mThere are many drugs currently in human clinical trials; some of them are quite encouraging. Kandel believes that “the progress in Alzheimer’s disease has been terrific, so I think that there will be some immediate effect. We're going to have drugs that improve (non-Alzheimer’s) age related memory loss within about ten years…” MEM 1414-developed by Memory Pharmaceuticals-is presently undergoing Phase III clinical trials and presents no drastic side effects. Tully is experiencing similar success in his most recent Phase I clinical trial. CX717 may very well replace modafinil as the ‘alertness pill’ de rigueur for military pilots. With so much invested in memory enhancement research, the answer to the major question remains elusive: should these drugs be marketed to healthy individuals just looking to score a few extra points? The social implications of mass consumption must be vigorously discussed.

It is common knowledge that some college students depend on hyperactivity and wakefulness drugs (like Adderall and Modafinil, respectively) to maximize their productivity. With a few extra hours to cram for those exams, students can receive the grades they need to achieve professional success. You would logically assume that swallowing a ‘smart pill’ would eliminate the need for that extra time, or enable them to allocate it to sleeping and socializing. ‘Smart pills’ will consequently boost intelligence and lower stress, so everyone wins…right? Not so fast. Consider this situation from another angle: everyone may lose in the long run. Memory enhancing drugs could unnecessarily exacerbate the heavy competition we are currently dealing with. For starters, medical school admissions are notoriously cut-throat, but the odds may be impossible – even with a 40 MCAT – if applicants start using nootropics. Premeds take note: Organic Chemistry will be a breeze, but you’ll never get ahead of the curve.

Naturally, the applicants for a single matriculation year would not be the only ones popping the pills. Nootropics will undoubtedly work their way into the freshman general chemistry course, perhaps even into high school and middle school classrooms. If accepted into the mainstream, parents could dispense ‘smart pills’ to their children with their breakfast or nighttime snack. They will then head off to school with the increased mental capacity to rapidly acquire both new skills and a sense of entitlement. How so? Not only will schoolchildren of the near future dream of becoming physicians, lawyers, engineers, or world leaders; they will consider other career options to be ‘beneath them’ because of their stellar qualifications. A world where everyone is intellectually capable of pursuing the same occupation appears positive in theory, but at the risk of sounding elitist, who would occupy those less glamorous but essential positions? Even Will Hunting, as content as he was being a janitor, ultimately decided that cleaning the floors at MIT was not the optimal use of his intelligence.

There is a simple, yet unfortunate, solution to that dilemma: recruit everyone not using the memory enhancing drugs. “But that’s silly”, you say. “If these smart pills are in the mainstream, as you mentioned before, wouldn’t everyone be taking them? Who wouldn’t want to use them?” The reality is that most lack the luxury of choice. Since nootropics will not be classified as over-the-counter medications any time soon, most people will have to rely on doctor’s orders and insurance to obtain them. This poses a list of problems. For starters, insurance companies may deem these pills as an unnecessary expense (or, as Anjan Chatterjee coins it, ‘cosmetic neurology’) and refuse to cover them. Moreover, even if they subsidize part of the prescription cost, over 46 million uninsured Americans are still left out of the loop. Obviously, this figure does not take into account the millions of undocumented immigrant workers across the country, and we must not neglect the billions abroad still struggling for the bare necessities. What we could indirectly experience from the popularization of ‘smart drugs’ is further class stratification, and more egregiously, the erosion of social mobility.

Even if smart pills become a ‘free for all’, even if the limitations of natural intelligence are demoted from facts to theories, other groups may still protest the use of these drugs. As evident from the heated debates over designing babies with selective genetic traits, there is a strong contingent urging scientists to uphold the laws of nature. It believes that tampering with these laws will disturb an equilibrium that has made human beings so powerful. For instance, few disagree with the idea that our success as a species rests highly on our dedication to nurturing and educating progeny. We have heard countless times from parents and mentors that working hard and learning from our mistakes are two requisite steps for success. This idea is engrained into religious thought as well; Hindus and Buddhists-among many others-believe that the means are just as important, or perhaps more important, than the ends in terms of gaining knowledge.

Now what if someone could bypass enlightenment? What if knowledge came so effortlessly that the ideas of wisdom-from-experience and hard work breeding success became obsolete (or, at least underappreciated). Just as some children born into wealth hold less value for money than lower-income children, who treasure each well-earned dollar they earn maneuvering themselves up the ladder of society, children living in a world where high intellectual capacity is commonplace will likely undervalue education and ambition. Even the most complex ideas from the most eminent scholars will potentially lie within the limits of their creative capacity. Perhaps biographies similar to those of Barack Obama, Oprah Winfrey or Bill Clinton will soon fail to tug at the heartstrings and arouse that zealous internal drive to “prove oneself”, regardless of the obstacles and circumstances they encountered. In short, the stocks of education and ambition will plummet, for knowledge and ability will be at the whims of over-the-counter pills.

“Now hold on a minute. Didn’t you just imply that nootropics will increase someone’s drive to learn and succeed because the heated competition?” This hypothesis is still valid, but in order to accept it, we must assume that our ignorance is infinite. On the other hand, let’s propose that there is a finite amount of knowledge to be discovered. If smart pills are consumed by the masses, this means that everyone could theoretically know everything about anything. Referring to the earlier situation, if everyone already possesses the mental capacity and dexterity to become a physician, what would be inherently special about being a physician? Why should people put themselves through unnecessary struggle if everything could potentially be figured out, and more significantly, if their work will not garner any praise? The late 19th century philosopher Friedrich Nietzsche believed that people’s own perceptions of self must be realized and acknowledged by others for them to be legitimate. If we lose the drive to ameliorate the things lowering our quality of life because acting on this drive says nothing about who we are to the world, we may very well slow the momentum that has made our species successful in the battle for survival. In layman’s terms, we’ll all become lazy.

Since so much scientific inquiry remains before we will realize the true effects of these drugs,
many opt out of the ethical speculation game altogether. Despite their promising results, the scientists behind nootropics try to remain grounded. Kandel states: “Smart drugs have a definite indication for people who have a problem with memory, though they don’t have an indication for improving the memory of people who are functioning reasonably.” Tully expands on this idea, claiming that the issue is not memory of intelligence, but merely information processing. “The drugs we know about simply improve the efficiency of memory storage. As far as we know, they do not improve ‘information processing,’ which might be a less loaded phrase to describe to "intelligence.’” Additionally, since it is not clear what type of information is actually processed (i.e. distracting peripheral information, such as random conversation among strangers, or useful semantic or episodic information), Tully opines, “the net effect of such drugs may, in the end, be negative. We simply won't know the answer without proper, careful clinical assessment.” And that is one answer a smart pill cannot illuminate for us.

Now back to class kids.