Why not use pills to get smarter? This was the topic of an extraordinarily engaging event entitled ‘Smart Pills, anyone?’ that took place on the evening of Monday 18th March at the Cambridge Science Festival 2013. The event was organized by the Naked Scientists (delivery partner of the Wellcome Trust-funded Smarter UK project) and the University of Cambridge Behavioural and Clinical Neuroscience Institute (BCNI), and was supported by the Wellcome Trust, the British Association for Psychopharmacology and the University of Cambridge. Fully booked and attended by more than 150 people, mostly college students, ‘Smart Pills, anyone?’ was chaired by Alok Jha (science correspondent at The Guardian) and included presentations by a panel composed of Professor Barbara Sahakian (Department of Psychiatry and the MRC/Wellcome Trust BCNI University of Cambridge, and current President of the British Association for Psychopharmacology), Dr. Hannah Critchlow (Naked Scientists) and Ben Johnston (Graphic Science and lead of the Smarter UK project). The evening also included a highly articulate debate on the use of cognitive enhancers by GSCE/A Level students from local schools.
The event started with the host’s greeting, followed by a role-play by the Naked Scientists. Hannah Critchlow and Sarah Castor Perry theatrically jumped straight into the play, with the backdrop of bemused-looking scientists and students on the panel. The session was opened in a rather unexpected way to a quite bamboozled audience: An advertisement agency has been commissioned for setting up a global marketing strategy for smart pills. Describing the pros and cons of this strategy, they discussed the main medical and ethical issues about using ‘smarts pills’ over the counter: is enhancing your performance during exams ethical while other students do not? Should these pills be restricted to selected groups of patients (those with cognitive problems) or professionals (e.g. surgeons, pilots)? What about the short, and long term safety issues? And, if it works, when would you stop using it? Could they become addictive?
Ben Johnston from the Bristol based Graphic Science, presented the Wellcome Trust funded Smarter UK, a project for discussing the use of these drugs among college students. So far, more than12,000 college students have attended their workshops all over the country. He stressed the importance of engaging in discussion at schools and the positive outcomes of these sessions.
Prof Sahakian delighted the audience with the science behind the smart pills. Expert on studying cognition in both healthy people and those suffering with mental health disorders, Prof. Sahakian is also a world expert on studying the effects of these pills (methylphenidate, atomoxetine, and modafinil) in human cognition and an avid discussant about the ethical dilemmas involved. Her talk cited the astonishing figure: 90% of modafinil, one of the most successful ‘smarts pills’, is sold off-label. Evidence for the efficacy of these pills on working memory tasks (those brain actions involved in the intellectual performance) were presented, but also the physical and psychological risks and the ethical dilemmas, as she has also extensively discussed in her two books. Her book out in April, ‘Bad Moves. How decision-making goes wrong and the ethics of smart drugs’, is based on previous University of Cambridge Science Festival lectures and recent research as well as its implications for society.
These three presentations set perfectly the scene for the life discussion, facilitated by Dr. Hannah Critchlow. Limelight was on the local GSCE/’A’ levels students: Natasha, Jon, James and Kalpesh, from the Nene Park Academy (Peterborough); Jessica, Bethany, James, Julia, from the Manor School (Arbury, Cambridge) and Hugo, James, Jimmy and Alex from the Simon Balle School (Hertfordshire). These students passionately defended the use, the caution stand-by and the totally against attitude, respectively, towards the use of the smart pills. The debate was engaging and posed several unsolved questions: what is the difference between these drugs and ‘common’ enhancers such as caffeine? What is the risk for the developing brain? And what about the cost? Would they only be affordable to some people and therefore increase the social gap and lead to an unfair society? Of course, Cambridge students claimed that more research is needed (Cambridgeans looking for research funds from young ages!). The debate concluded with the question of fairness again: These drugs are designed for people suffering with mental health disorders (i.e. attention deficit hyperactivity disorder) to catch up with ‘normal’ attention. If they are taken by other people for enhancing their performance, then will those suffering with ADHD will be able to catch up? The suggestion of doubling the dose for the ADHD group was the cheeky conclusion to the debate.
To finalize the evening, Alok Jha chaired the open questions to the panelists. The audience posed a series of questions: if you take the ‘smart drug’, then who passes the exam, you or the drug? Prof. Sahakian reminded that it is just an enhancer, and that you still need to study! What is the impact on creativity? Would these drugs improve previous functions or just unleash a new part of the brain? Dr. Hannah Critchlow highlighted that we are in a ‘24/7’ society now, and the pressure for performance and outcomes increases gradually; whereas Prof. Sahakian mentioned that these drugs increase cognitive flexibility, which correlated with creativity. The unresolved question about securing the best performance for those in special jobs closed the debate, with the dramatic example of night bus drivers.
The audience’s perceptions about the Smart Drugs were asked before and after the event. Answering the questions with a hand held device, about 40% would use smart pills if they were safe, whereas a consistent third of the audience would never use them. The majority objected to their use by college students, as long-term side effects are still unknown. However, the great majority agreed that the use of these drugs would be the norm in the future, although it is unclear when.
Smart pills are a hidden reality and an ethical and medical conundrum that merits such debates and discussion and many more in the future.