What’s the wisest approach to ‘smart pills’?

The CBS program “Limitless” is one of the hottest crime dramas on American television right now. Based on a movie of the same name, the series dramatizes what happens when the main character takes a pill that gives him access to every neuron in his brain. This allows him to recall every memory he has ever formed and temporarily makes him the smartest man in the world.

Although the magical drug that Brian Finch takes is fictional, “smart pills” of a less spectacular variety are real. Cognition-enhancing stimulants such as Ritalin and Adderall are prescribed to help students who have attention deficit hyperactivity disorder and trouble focusing on their assignments. And for at least a decade, young professionals — seeking an edge in their competitive workplaces — have been using those same drugs to make their minds work a bit better. Sometimes they have prescriptions from a doctor.


Inderal and other beta blockers — mainstays of hypertension treatment — have the additional benefit of taking the edge off stage jitters when used in low doses. And drugs that keep tired people alert, notably Provigil, have long been used by military personnel on long missions.

There’s no doubt that these and other smart pills are being used, legally or otherwise, by people who have no approved medical need to take them. That raises questions, both medical and ethical, about the risks associated with using medications in such a way.

“Victoria,” a pharmacist working near Atlanta, knows the rules about using unauthorized pharmaceuticals. But she admits to taking the stimulant Adderall to get through back-to-back 14-hour shifts, saying the pressures of her job demand it. In fact, she says she believes she has a moral obligation to stay on her toes at all times in such a high-stakes job, and that not taking Adderall would do a disservice to her patients. She asked that no part of her real name be used for this article.

“To be competitive in markets today, you have to be able to do what you need to do,” she said. “I mean, job-wise, I’ve been doing this for five years. They can get somebody who’s younger or who can do it more” if an employee can’t keep up, she said. So she uses Adderall.

Considering the risk

Dr. Randall Tackett, a pharmacy professor at the University of Georgia, feels the risks and potential side effects make the misuse of prescription unjustified.

“The real issue that you worry about with these drugs, when you’re not really treating a disease state, is that every drug you take basically carries a risk with it,” Tackett said. “Any time that you are taking a drug, one of the things that a doctor should be doing is determining whether the benefits of the drug outweigh the disease. And if you don’t have a disease, then you may possibly be taking a risk with these drugs.”

Adderall pills
Adderall pills

This point comes through even on “Limitless.” The hero of the TV drama must take a second drug to counteract the potentially deadly side effects associated with his epic smart pills.

The bottom line is, “There is no such thing as any substance without a side effect,” said Tackett.

And he added, “No one should be taking any of these prescription drugs without the supervision of a physician.”

Still, others have expressed the view that if we can enhance our brains and bodies, we should go for it. Medical ethicist Arthur L. Caplan, head of New York University’s Division of Medical Ethics, supported the use of cognition-enhancing pharmaceuticals in an article published in the September 2003 issue of Scientific American. At the time, the idea of using these drugs to enhance normal cognition, not just treat disease, was new.

“As long as the drugs are safe,” said Caplan in an interview, “I don’t see any problem in trying to enhance your attention, or get rid of bad moods, or try to figure ways that you might be able to react more quickly in a crisis.”

Caplan said that he didn’t think there was one set of rules for soldiers and a different set for stockbrokers. Drugs that improve performance might just be another tool in one’s cognitive-enhancing arsenal, he said.

“If you can stay awake and fly longer missions, if you can react more quickly to something you see, I don’t think anybody would argue we shouldn’t do that with soldiers. And similarly, I think as long as there aren’t these side effect issues, I see some of the cognitive-enhancing drugs as somewhat akin to using a calculator or a computer to enhance your cognition,” Caplan said.

Caplan was straightforward about who would benefit and who would not.

“Some people say, ‘Well, that’s just not fair!’ ” he said. “ ‘Poor people don’t get the same advantage: They can’t find the drugs.’ I think that’s true: it isn’t fair. But I don’t think a lack of fairness will stop people from trying to get an edge.”

 The old-fashioned way

UGA pharmacy professor Merrill Norton says people who can’t get the prescription drugs through proper channels, or can’t afford to buy them on the street, often try a cheap alternative. They head for the store to load up on energy drinks. Because these high-caffeine products are sold everywhere with no restrictions, people assume they’re harmless.

[youtube]https://www.youtube.com/watch?v=HqvsSfsWVDQ[/youtube]“I don’t really criticize the public for what they do with the consumption,” said Norton. “Because they think, ‘Well, they’re next to the Cokes and they’re the same as coffee.’ And we treat those things as being very safe. It’s the amount that they consume.”

Norton cautions against consuming more than 400 milligrams of caffeine per day, the equivalent of two 1.9-oz. shot drinks made by 5-hour ENERGY.

When it comes to taking smart pills, Norton agrees with Tackett and rejects the more freewheeling approach of Caplan.

“As far as ethics? No. It’s not ethical; it’s actually illegal,” Norton said of taking such a pill without a medical justification. “It’s not something that you want to do, especially when it comes to self-medication.”

Regardless of whether unsupervised use of smart pills is safe or ethical, they’re probably here to stay.

“We live in a chemical culture,” Norton said, “so people use just about anything to make their performance better.”

Sandra L. McGill is a graduate student majoring in Health and Medical Journalism at the University of Georgia. When not writing, she enjoys producing art of the photographic, paint, and vocal variety.