Performance Doping in Academia, Take 2

December 19, 2007

A recent commentary in Nature by Barbara Sahakian and Sharon Morein-Zamir discusses the ethical questions arising from the use of cognitive enhancing drugs to improve intellectual function in “normal” people. This follows a prior piece in Nature arguing that science-enhancing drugs may not be just acceptable but indeed laudable, which I covered previously. A couple of blogs are already on it, including Adventures in Ethics and Science (natch), Retrospectacle and Action Potential. [Update: 12/21/07: More from the Silverback , Corpus Callosum and Munger.] Commentary on the first two Borg blogs is already quite brisk. People seem to love discussing brain doping!

I’ll start with a disclaimer. I was holding off on this topic a little and I realize in part because of the conflict issues. Yet I’ve commented at AinE&S and Retrospectacle so that sort of pre-empts things and despite the direction my comments are going to go, some disclosure seems relevant. First, a minor issue, I am passing acquainted with one of the authors of the Nature commentary. Second, I have done some work that might be viewed as contributing to the “cognitive enhancer” literature. Not much, but my professional interests (for which I get paid, naturally) touch on this area of science. Third, I have consulted informally and formally (meaning I got paid) for BigPharma research units interested in developing cognitive enhancing drugs, broadly writ. Consider yourself warned.

We can rapidly dismiss what I see as the non-controversial aspects of the commentary. That is, the straw question raised, “Should adults with severe memory and concentration problems from neuropsychiatric diseases be given cognitive-enhancing drugs?“. The answer is simple, of course they should. Sahakian can perhaps be excused given that this is her life’s work. Further refinement to ask if cognitive enhancers should be used in children and adolescents is obviously just as absurd if we frame it as “Should appropriate, effective and safe medications be used to treat children and adolescents for medical indications?”. Duh, of course they should. Even if they do have side-effects. Take growth “stunting”, a serious theoretical concern with long-term stimulant treatment. Evidence to date suggests that maybe an inch or two lower adult height results (for Ritalin, see this, this, this, this). Take a side-effect like that and, rather than screaming “aaaauuughh, side effect!” ask which is better- a couple of inches shorter or a failed primary school experience? Which is more important for your child? As with much of modern medicine it is a question of tradeoffs. What positive clinical effects are more important than what set of side-effects. I fail to see the ethical implications.

Still, I will admit that the most interesting thing about fixing disorders with drugs is indeed the question of “side-effects” and “safety”. Interesting, primarily because our science to detect lasting toxic effects of acute and chronic drug exposure is not so hot. We’re trying, believe me. I find it a fascinating issue, myself. And even though I currently focus on so-called recreationally abused drugs, it is hairsplitting in the extreme to suggest that the issues at hand are conceptually distinct. The details, sure. But if someone takes amphetamine to get “high” or takes an amphetamine (Adderall is good old amphetamine, don’t let the “mixed amphetamine salts” crap lead you astray) to treat Attention Deficit/Hyperactivity Disorder or takes amphetamine (say, diverted Adderall) to improve academic performance, well, we still want to know the same things. “How much is too much?” to broadly generalize the essential scientific question. Still this issue has nothing to do with ethics. And I might mention, neither does the debate over how accurately we may be able to categorize individuals into ordered/disordered groups when it comes to mental disorders. This is important, yes, but it isn’t an ethical problem, these are empirical questions to be answered by your faithful servants, tax-payer funded scientists.

People such as Janet and Shelley seem to be under the impression that safety is relevant to the ethical considerations of using cognitive enhancers in “normal” people. Although when pressed Shelley and Janet each back up to suggest that safety and side effects are at least relevant to personal choice, if not the ethics per se. They each also seem to be under the impression (as do many of their commenters) that there is much more known, scientifically, about the “safety” and “side-effects” of our well accepted cognitive enhancers caffeine and nicotine than other compounds. To some extent, especially from the standpoint of broad spectrum use in human populations and the conclusions that might be drawn regarding very gross, population-level measures of side effects. On the other hand, because some legal compounds are so accepted, I’d argue that we know more specific scientific information about potentially brain-modifying effects of, say, amphetamine than we do about caffeine. Replace “neurotoxicity” with “cognitive” or other key word in those PubMed searches and you’ll find similar results. That is, commonly used, legal and accepted “safe” drugs are frequently less studied with modern techniques than one might otherwise wish because legal is sometimes equated with “uninteresting”. Despite a fairly significant caffeine addiction (disclaimer!) I really have little perspective on lasting detrimental cognitive effects. Compare this with what is known about lasting effects of alcohol and you’ll see how much we really don’t know. An absence of studies does not necessarily mean that caffeine is perfectly benign.

The original commentary then asks, in essence if it is “cheating” for otherwise normal people to use cognitive enhancers. The central consideration is that we’ve already crossed that Rubicon. Caffeine and nicotine being the primary examples. It is completely acceptable, particularly in the case of caffeine, to brag on use of this stimulant to confer unnatural and unfair advantage over the competition in academic performance. From undergrad, to grad to professordom. Any argument that tries to overlook or minimize this reality is completely bogus. “I wrote my last grant on Modafinil”, “I wrote my last grant at the local coffeeshop” and “I wrote my last grant on Adderall” should have precisely the same ethical implications. The legal status, common acceptance, route of administration of the compound, specificity of the compound, etc have nothing to do with the ethical question of “cheating” by taking a cognitive enhancing compound.

Finally we get to the “raising the bar” complaint mentioned in the Nature piece. This is also one of the primary arguments against sports doping and it is frequently cast in terms of one’s offspring. “If sports doping is permitted, this will mean that anyone who wants to play will be forced to take these drugs. Do you want your kid taking this stuff?” This always rings a bit hollow to me and particularly so in the case of putative cognitive-doping. In case it is news to anyone, the pinnacles of performance one reaches are related not just to some “natural” ability but also to choices made and actions taken in the pursuit of a given goal. If an athlete is totally coddled by their parents, allowed to focus almost exclusively on their cycling for example, nobody thinks this is “unfair” to the poor kid who has to work summer and school year jobs. Neither is it “unfair” that this coddled kid beats that kid who just refuses to train. “Oh”, you say, ” but the drugs are bad for your health”. Yes, and so is training on the bike for a Cat 1 or, particularly, a professional level of performance. Sure, the cardiac benefits might outweigh the risk of road rash, clavicle breaks, death-by-redneck-truck, etc but it isn’t risk free. The “raising the bar” critique for cognitive performance is no different.

  • Is it fair that Professor Smith uses an alarm clock to get up one hour earlier than you do?
  • Is it fair that Professor Jones has a doting spouse that takes on all the household and childcare responsibilities?
  • Is it fair that Professor Brown is unmarried, unattached and just plain works like a dog around the clock?
  • Is it fair that Professor Doe never exercises and eats crappy takeout food to maximize the hours at work?

All of these lifestyle choices might be viewed as entailing some degree of health, social or psychological risk in the pursuit of career performance might they not? Would you ever suggest these people were unethical or “cheating”? What difference does it make if Professor Armstrong chooses to use cognitive enhancing drugs?

13 Responses to “Performance Doping in Academia, Take 2”

  1. physioprof Says:

    The ethical issues only become interesting if a drug can actually enhance performance in normal individuals.

    I have seen evidence that use of various stimulants can enhance the performance of both regular and naive users in certain very contrived and constrained cognitive tasks. However, I have seen no evidence at all that any drugs can actually improve cognitive performance on real tasks that matter (here, in the context of acadmic science, but analogously in any other field of intellectual pursuit): designing an experiment, writing a grant, delivering a seminar, etc, let alone at long-term goals like obtaining a Ph.D., getting an academic position, getting tenure, etc.

    Until there is evidence that any of that stuff can be enhanced, the ethical dimension is completely uninteresting.

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  2. drugmonkey Says:

    You must not be a coffee drinker PP!

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  3. physioprof Says:

    Total wuss. I can’t believe he didn’t drink the damn thing.

    BTW, having patronized many Starbucks in Manhattan, I can tell you that this guy pissed off a lot of people in line behind them. I have seen people literally scream at the person at the head of the line if they hesitate for even a microsecond before placing their order: “You’ve been standing in line for five minutes!! Why the hell didn’t you decide what you wanted then!!??!?”

    And even those who aren’t saying this, are definitely thinking it. It ain’t [city which shall remain slightly obscure-ed].

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  4. Bikemonkey Says:

    “I have seen no evidence at all that any drugs can actually improve cognitive performance on real tasks that matter … having patronized many Starbucks in Manhattan, I can tell you…”

    Okay, then, what do you purchase on your many visits to $tarbucks?

    If the caffeinated products, why do you buy them?

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  5. physioprof Says:

    I buy them for the buzz, not because I think that chronic caffeine use makes me a more successful scientist.

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  6. writedit Says:

    Commentary on “Professor’s Little Helper” in this week’s issue of The Chronicle of Higher Education.

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  7. bikemonkey Says:

    And a bit of quote-mining on the Chronicle Site is here.

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  8. philprof Says:

    i have to agree with physioprof. if you can’t think well, coffee won’t make you a better thinker. just as it won’t make anyone a better basketball player (i am pretty sure all the coffee/ritalin/whatever enhancing drug in the world wouldn’t make me better at that!).

    having said that, it would keep me more alert for longer, which *might* mean that i would think (read, write, be in lab, practice) longer, which in turn could improve my work, or at least make me actually do it, however badly. but it could just as well make me more interested in doing something else instead, because i would be too wired to focus.

    one of my friends in graduate school was an avid coffee drinker. he frequently even slept in his TA office in the department, so as to work longer hours. he eventually dropped out of the program.

    in sum, if you have some capacity and, importantly, interest, in a particular activity, anything that keeps you awake and alert will help you in the pursuit of that activity. but it won’t create the capacity and much less the interest that keeps you at it for years on end.

    assuming that all professors have both things going on for them, is it unethical that some take mind-boosting drugs of any sort? we surely assume that athletes have both things going for them, and we want them to win “naturally”. should we want, say, our assistant profs to earn tenure “naturally” as well? that seems fair, on first thought. note, however, that the ethical and the legal may come apart here, for various reasons (the unfeasibility of regulation, for one). in the case of the athlete, it is a legal matter and a financial matter and, given the high visibility of many athletes, a matter of their serving as an example to others. in the case of the professor who takes a drug, i would say it is, at least in part, a moral choice made, but perhaps one closer to acts such as lying, when the foreseeable consequences do not involve, say, the lives of others. it is not a legal matter. besides, we as a society may stand to gain from the professor who would rather spend his or her time among books or lab rats or looking at the stars. their gain is not personal (although there may be personal gain involved if they get tenure, for instance). perhaps that is partly why there is a reluctance to regulate in these cases. professors are not drinking too much coffee or taking drugs so that they can party all night or win millions playing baseball, but so that they can formulate theories to explain the world in which we live. personally, i care too much for my health to trust most pills, and i avoid taking them. if they take away what little capacity to think i might have, then i would be in serious trouble, for that is how i make my living–then, indeed, tenure would be quite a challenge.

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  9. bikemonkey Says:

    philprof,

    With respect to your “maybe it would help a little” tone, what sort of reason is the magnitude of effect for judging ethics? Sure, a cup of coffee is not going to turn average post-doc into genius Nobel laureate. Sure. But as with sports doping this seriously misses the point. we’re talking when you have a very elite, high-performing, highly selected sample with little variance, effects of small magnitude have a HUGE effect on outcome. point being that assume (native) “capacity and interest” are similar and that drugs are taken to give an edge.

    And “gain is not personal”. Are you kidding? Or are you just assuming it is not possible for any drug to give enough of an academic-performance edge to make the difference between hire/not hire and between promote/deny tenure? If so I think you seriously lack imagination and insight into the effect that 10%, heck even 5% greater productivity might have, applied week-in, week-out, on career.

    I think you have a cartoon version of sports doping, apparently thinking that is limited to superstars like Bonds. The more in depth thought behind sports doping is rather the effect from bottom up, not just at the top. That your Single-A baller will feel that he “has” to take a bunch of roids to have any shot at all at a career. The cyclist who just wants to stay on as a domestique (euro) or get a pro ride at all (e.g., us domestic pros). Motivation to dope is not equivalent to motivation to be a super-star, some just want to make a living.

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  10. […] nothing on, the whole thing ruled by an inflationary ethos of fame.  When young professors jones for Adderall just like their students, maybe it’s time for a chill pill.  Part of me is agreeable to such […]

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  11. Shaun Says:

    FACE IT.

    Caffeine is a drug. It’s a DRUG.

    I know this because I’ve gone back and forth between using it to make better test grades. It’s just not right. There is NO DOUBT that it makes a huge effect on the outcome. FACE IT. If you are using caffeine to do better on test grades, you are doping at your friend’s expenses. I should NOT have to ingest a drug in order to keep up with my stimulant-using friends. Especially one that causes irritability towards everyone (whereas now I can concentrate my current irritability towards a single subject, caffeine causes an uncontrollable irritability that rubs off on people)

    This is just a genuine feeling. It is important to express something if you feel it is the right thing to do. It is hard to take a stand against such a strong crowd, but there are also those that stand up against alcohol abuse and the such. It’s just a larger percentage is all this is.

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