A basic fear in today's competitive society is not measuring up. "Brain Gain," Margaret Talbot's insightful and troubling article in The New Yorker in April 2009, opened the way to broader public discussion about the pros and cons of "neuroenhancement," the use and misuse of prescription stimulants by those seeking better mental cognition to offset worries about falling behind or otherwise falling short. (1) According to Peter D. Kramer, the prominent psychiatrist and author of Listening to Prozac, the term "encompasses a set of medical interventions in which the goal is not to cure illness but rather to alter normal traits and abilities." (2) That would be altering for the better, Kramer hopes, because the drugs carry a long list of side effects. Indeed, despite its upbeat title, Talbot's article also came with a darker subtitle, "The Underground World of 'Neuroenhancing' Drugs," as if questioning whether the term is accurate or misleading.
Talbot's article covered the widespread off-label abuse of Adderall, Ritalin, and Provigil by often panicky college students seeking a cognitive advantage. (Off-label abuse means taking medications, like Adderall, commonly prescribed to those with attention-deficit hyperactivity disorder, for conditions not approved by the Food and Drug Administration.) Abusers typically get their hands on the pills through friends' prescriptions and online pharmacies with lax requirements and poor safety regulations. Talbot referenced surveys calculating that 6.9 percent of students in U.S. universities have used prescription stimulants to try to overcome academic performance anxieties or being bested by their peers, with the greatest frequency at highly competitive schools. (3)
The article also quoted prominent scholars at Stanford, Harvard, and Penn arguing that concerns are overstated because "cognitive enhancement has much to offer individuals and society, and a proper societal response will involve making enhancements available while managing their risks." (4) Talbot's piece further referenced the British Medical Association (BMA) arguing in one upbeat 2007 discussion paper, "Boosting Your Brainpower," "Universal access to enhancing interventions would bring up the base-line of cognitive ability, which is generally seen to be a good thing" (5) and, thus nothing to be worried about.
Increasing cognitive ability is of course a good thing, and there are many ways to achieve it, including through education. But to what extent can chemically-raised expectations about academic performance be said to be a real or lasting improvement? And what might the BMA be missing about unanticipated medical risks? (Adderall is comprised of mixed amphetamine salts whose side effects include loss of appetite, headaches, extreme fatigue, fever, heartburn, and cardiac arrhythmia.)
Talbot led off by interviewing a recent Harvard graduate dubbed "Alex," a history major who daily took Adderall off-label, without a medical or psychiatric diagnosis, in hopes of ramping up his output as he juggled an ever-greater number of extracurricular activities. These included running a student organization, a task sometimes eating up 40 hours per week, as well as bouts of weekend partying. A rebalancing of priorities was doubtless in order. "Since, in essence, this life was impossible," Talbot comments, "Alex began taking Adderall to make it possible."
Like many of the thousands of students across American campuses who routinely take medications off-label, Alex wanted to accomplish more than time and body permitted. As he put it, summing up the rationale of taking the drug off-label, "it's often people--mainly guys--who are looking in some way to compensate for activities that are detrimental to their performance."
But female students do this too. The British Guardian newspaper published an April article, "Are 'Smart Drugs' Safe for Students?" that featured, among other bright students, Lucy, a postgraduate at Cambridge, who uses the drugs "less from a lack of diligence than an excess of it. …