DRUGGING UP TO PLAY?

28 December 2007

Increasing use of concentration-sharpening meds


The use of drugs by professional poker players, academics, classical musicians, corporate executives and students to clarify minds, improve concentration or control emotions was explored in an article in the Los Angeles Times this week.

"There isn't any question about it; they made me a much better [poker] player," Paul Phillips (35) told the authors, crediting the attention-deficit drug Adderall and the narcolepsy pill Provigil with helping him earn more than $2.3 million as a poker player.

The medicine cabinet of so-called cognitive enhancers includes Ritalin, commonly given to children for attention deficit hyperactivity disorder (ADHD), and beta blockers, such as the heart drug Inderal. Researchers have been investigating the drug Aricept, which is normally used to slow the decline of Alzheimer's patients.

The drugs haven't been tested extensively in healthy people, but their physiological effects in the brain are well understood.

The authors of the LA Times piece say these are all just precursors to the real blockbuster drug that research laboratories are racing to develop - a memory enhancing pill. "Whatever company comes out with the first memory pill is going to put Viagra to shame," said University of Pennsylvania bioethicist Paul Root Wolpe.

Unlike the anabolic steroids, human growth hormone and blood-oxygen boosters that plague athletic competitions, the brain drugs haven't provoked similar outrage. People who take them said the drugs aren't giving them an unfair advantage but merely allow them to make the most of their hard-earned skills.

But cosmetic neurology, as some call it, has risks. Ritalin, Adderall and other ADHD drugs can cause headaches, insomnia and a loss of appetite. Provigil can make users nervous or anxious and bring on headaches, while beta blockers can cause drowsiness, fatigue and wheezing.

No one has conducted thorough studies about how brain-boosting drugs would affect healthy people after weeks or months of continual use.And there are no rules to prevent overachievers from using legally prescribed drugs to operate at peak mental performance.

The use of cognitive-enhancing drugs has been well-documented among high-school and college students. A 2005 survey of more than 10 000 college students found 4 percent to 7 percent of them tried ADHD drugs at least once to remain focused on exams or pull all-nighters. At some colleges, more than one-quarter of students surveyed said they had sampled the pills.

The ubiquitous mental stimulant is coffee, and a morning jolt is sufficient for many. But as scientists were developing drugs to treat serious brain disorders, they found more potent substances.

Sharon Morein-Zamir, a psychologist at the University of Cambridge in England who writes about the ethics of brain enhancement, said her interest in the medications was largely academic. But when someone she knew who had been taking Provigil for a neurological condition offered her some pills, Morein-Zamir's curiosity was piqued.

"I knew the literature and wondered what it felt like," she said.

The drug helped her focus as she worked at her computer for hours. But she wondered if it was a placebo effect. "Maybe I would have gotten it done anyway," said Morein-Zamir.

In the world of classical music, beta blockers such as Inderal have become nearly as commonplace as metronomes. The drugs block adrenaline receptors in the heart and blood vessels, helping to control arrhythmias and high blood pressure. They also block adrenaline receptors in the brain.

"You still have adrenaline flowing in your body, but you don't feel that adrenaline rush so you're not distracted by your own nervousness," said Dr. Bernd Remler, a neurologist at the Medical College of Wisconsin in Milwaukee.

That's why Sarah Tuck, 41, a flutist with the San Diego Symphony, takes them to stave off the jitters that musicians refer to as "rubber fingers." A survey she conducted a decade ago revealed that one-quarter of flautists used the pills before some or all of their performances or in high-pressure situations such as auditions.

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