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TERRY GROSS, host:

This is FRESH AIR. Im Terry Gross.

It just keeps getting harder to keep up with the amount of information that we have to absorb and produce. Caffeinated coffee is a popular pick-me-up, but lately a growing number of students and working people have been using prescription drugs to help stimulate their focus and concentration, drugs that werent intended to do this and that arent prescribed for this purpose, drugs that are prescribed for attention deficit hyperactivity disorder, narcolepsy and Alzheimer's disease.

Their off-label use as neuroenhancers raises many ethical, as well as medical, questions. My guest, Margaret Talbot, examines those questions in her article, "Brain Gain," published in the current edition of The New Yorker. Talbot is a staff writer for the magazine.

She says people who take neuroenhancing drugs are using them like steroids for the brain, hoping for a brain boost, a cognitive edge. Margaret Talbot, welcome to FRESH AIR.

One neurologist who you spoke to coined the term "cosmetic neurology," using drugs developed for serious mental deficits to improve ordinary cognitive function, an interesting term. What are some of the drugs that fit in this category, and what are they typically prescribed for?

Ms.�MARGARET TALBOT (Staff Writer, The New Yorker): Yes, I love that term, and I think its quite descriptive of the phenomenon. The main drugs I would say that are being used this way now are the drugs Adderall and Ritalin, which are stimulants that are used widely to treat ADHD in children and adults.

GROSS: Which is attention deficit hyperactivity disorder.

Ms.�TALBOT: Exactly. And the other one is a newer drug that I think perhaps fewer people may have heard of. The brand name is Provigil; the generic is Modafinil. And its a drug that was developed to treat the sleeping disorder narcolepsy and came out with approval for that use in 1998.

The stipulated uses have expanded a bit. So now it can, its stated on the label, be used for the kind of excessive daytime sleepiness that might be associated with shift work, people who work nights, or sleep apnea.

But off-label and kind of ad hoc, people have been taking it to improve their focus, promote wakefulness, and they think give them an edge, a mental edge.

GROSS: Apparently, a lot of students on college campuses are using these neuroenhancers now. You spoke to somebody who's used a lot of them who didn't want his real name used, but tell us what he had to tell you about how he used them and how he thought they helped him.

Ms.�TALBOT: Yes. Well, this was a student who had graduated from Harvard recently. In the piece, I call him Alex. He had been one of these really busy, kind of overcommitted people. He had a lot of extracurriculars. He ran a big student organization. He wrote a lot of research papers, about 12 a semester, and he wanted to have some fun, as well.

He told me, you know, he didnt want to completely miss out on his youth. So he felt that basically he had this impossible life. He was so overscheduled, and yet he didnt want to give any of it up, and he wanted to get good grades, and so he started taking Adderall.

He got a doctor to prescribe it for him. He was familiar with the symptoms of ADHD because he had a brother who had been diagnosed with it, and he basically would take it pretty regularly, but in order to power through the papers he had to write, go to all the meetings he wanted to go to and do as well as he thought he should be doing in college without giving anything up.

GROSS: Now, I mean college students for years have drunk cups and cups and cups of coffee or taken caffeine pills like No-Doz. Whats the difference between taking these, you know, new drugs like Ritalin versus taking either, you know, old-school amphetamines or, you know, caffeine?

Ms.�TALBOT: I think whats different about this is - first of all, they are prescription medications that people are taking often without a doctors prescription or approval.

Oftentimes on college campuses, people are getting friends who have prescriptions because they have a diagnosis of ADHD to sell them the drugs or give them the drugs. So theyre taking them without a doctors supervision, and thats significant because I think people - a lot of college students in particular, tend to think of these drugs are really benign because theyve grown up with so many people who had the ADHD diagnosis, so many schoolmates who were taking the drugs that they tend to think of them as not something you need to worry about really.

But they do have side effects, and particularly if you are taking them without knowledge of somebody who knows your medical history, because theyre stimulants, they have the kinds of effects you might guess stimulants would have, the kind of unwanted effects as well as the kind of desired effects: difficulty going to sleep when you want to go to sleep, loss of appetite, headaches, sometimes unexpected spikes in blood pressure.

I think for older people especially, they can also carry a risk of various cardiac problems. And also, they carry a risk of dependence, as well, according to the FDA labeling on them.

GROSS: Do we know what Ritalin or Provigil, two of the drugs that are being used now as neuroenhancers, what they do to the brain to increase the focus or give you more mental energy?

Ms.�TALBOT: Its interesting. Provigil, which they call an atypical stimulant, they really dont understand the mechanism by which it works. It may increase dopamine levels. It may have a number of effects, sort of global effects on the brain that we dont really understand.

A little bit more is known about the mechanisms of the stimulants that have been around longer, like Adderall and Ritalin, but I think that a lot of neurologists will tell you we dont really know the long-term impacts of some of these drugs. And interestingly, some of the neurologists I talked to said, you know, there are physical side effects to be concerned about, but you could also talk about cognitive side effects.

Usually, you dont improve one aspect of thinking without taking some kind of potential toll on another. So there are a couple of researchers, for example I talked to at U Penn - Anjan Chatterjee and Martha Farah - who are looking at what impact these drugs might have on creativity, creative thinking.

They seem to, in laboratory tests, help on tasks that require focus, that require really bearing down on something, and in certain kinds of tests like remembering a string of numbers forwards and backwards and that kind of thing, they do show a real benefit. But would that kind of focus actually have a dampening effect on creativity?

I think all of us have had the experience of getting a great idea when were not, in fact, hyper-focused on something but when were out, you know, walking the dog or in the shower, and so that kind of thinking doesnt seem to be aided by these new cognitive enhancers.

GROSS: Well, we mentioned that a lot of students, college students, are using these drugs to help them focus on their work, their term papers. Theres other people who you talked to who have found it useful in what theyre doing, for instance a champion poker player.

Ms.�TALBOT: Thats right, yes. His name is Paul Phillips, and I came across him because hes actually written about the benefits he thought he got from taking Provigil before he went out on the World Poker Tournament circuit, and he feels that it really helped him to focus and to take in a lot of information about the other players without feeling overwhelmed or overstimulated, and he really felt that it increased his earnings.

GROSS: You know, although neuroenhancers have been called, like, brain steroids, and compared to what steroids do for athletes, they are not banned, for instance, from poker competitions.

Ms.�TALBOT: Thats right. Theyre not banned, and so anybody can take them, and I think people are fairly open about taking them in those situations. And you know, many people say they are akin to steroids, and you know, thats another issue, whether - an ethical issue thats raised by these, I think, which is whether they constitute a form of cheating.

I think on college campuses, where you do hear a lot about these drugs, there is some discussion, especially among students and especially among students who arent taking them, about whether this is fair. You know, if you are going into an exam - because for example, the student that I spoke to, one of the kinds of purposes he used it for was, you know, before he went in to take an exam, he would pop an Adderall.

So I think some students wonder, well is that really fair if other people arent getting that advantage, and should you have to report that youre taking the drug?

GROSS: And I should say, particular if youre being graded on a curve.

Ms.�TALBOT: Particularly if youre being graded on a curve. Now, its a little hard to imagine how that would work. I cant imagine really, you know, some of our students in our finer institutions having to pee into a cup before theyre given their blue books, but you know, I think it is a legitimate question to raise.

GROSS: Now another use that you mention in your article is that you say the Air Force distributes one of these neuroenhancers, Modafinil, to pilots on long missions.

Ms.�TALBOT: Thats right. The Department of Defense actually in general was one of the first kind of entities in society to take an interest in Modafinil when it became available and started testing it on pilots who go on long missions and funded a lot of the early research on it.

And now the Air Force makes Modafinil available to them, and that raises an interesting question, I think, which is will this be something that employers will be inclined to hand out? It may be tempting for employers in the future.

GROSS: To suggest that perhaps your performance will be enhanced with these drugs.

Ms.�TALBOT: Exactly, exactly, and that you will be able to be much more productive and working long hours. I mean after all, thats kind of a direction were going in in society anyway.

GROSS: In a way, your employer doesnt even need to encourage you if youre competing with other people in the workplace for a promotion or just to keep your job. You might feel the need to do that to keep or to get a competitive edge.

Ms.�TALBOT: Well thats right. I think thats actually a real issue because there are subtle forms of coercion that I think we all feel. Actually, when the scientific journal Nature did an informal poll of its readers last year, asking whether they took drugs like this at grant times or under deadline pressure and so on - most of the readers were presumably scientists or academics - they got 1,400 responses, and one out of five of the people said that they did take the drugs like Provigil and Adderall and Ritalin for sort of "cosmetic neurology" purposes, if you will, and interesting, a third of the people who were polled said that if they knew that parents at their childrens school were giving their children these drugs not for a medical diagnosis but just to give them an extra edge, that these people would feel also pressured to give their own kids, even though they didnt really believe in it. And a third of the people who responded to this poll said that they would feel that kind of pressure.

And then there is just the more - the feeling that I get as I was reporting this story, for example. I would mention, you know, to colleagues that I was doing it, and kind of a surprising, you know, number of people said oh yeah. Ive taken Provigil, I take it for deadlines. And then I, you know - I dont actually use these drugs, but part of me was thinking gosh, am I - is this why this person is so much more productive? Is this why, you know, Im so behind on my deadlines? And you do feel that maybe youre not quite keeping up, and I think theres a lot of that pressure in our society today anyway to work longer hours and be more productive, and this is just another agent in that trend, I think, thats important to look at.

GROSS: My guest is Margaret Talbot. Shes a staff writer for The New Yorker, and in the current edition, she has an article called "Brain Gain: The Underground World of Neuroenhancing Drugs." And well talk more about these drugs after we take a short break. This is FRESH AIR.

(Soundbite of music)

GROSS: If youre just joining us, were talking about new neuroenhancing drugs. These are drugs that were created for other purposes, like attention deficit hyperactivity disorder, drugs like Ritalin and Adderall that are now being used by a lot of people to increase their focus and productivity, either students or people on the job, pilots, things along those lines.

And my guest, Margaret Talbot, is the author of the piece "Brain Gain: The Underground World of Neuroenhancing Drugs," which is published in the current edition of The New Yorker. Weve talked about why some people feel that they benefit from taking these neuroenhancing drugs, but from the research youve done, do they have, like, an equal benefit for everyone, or are only certain people more likely to feel a benefit from drugs like this?

Ms.�TALBOT: Individually, I think some people probably, you know, get some placebo effect if they believe in this strongly. Also, in the research thats been done, and there is some data on these drugs in healthy, you know, non-mentally-impaired people, where people are given a dose of, say, Provigil and then asked to perform certain kinds of laboratory tasks that test focus and memory, and in general they do show an improvement, not across the board, but they show an improvement for most tasks in the studies that have been done.

However, they seem to show, interestingly, that they help people more who are kind of in the middle range of intellectual ability than people are at the higher range, which is kind of surprising, I think.

It seems like you might expect it to make smart people smarter, and I think what it seems to suggest is maybe theres kind of a ceiling. If you do quite well at a given memory test, say, already, theres only so much room for improvement, and that may have some real-world applications, too, that these drugs may help people go from kind of the mid-range or high mid-range a little higher in their capacity to do various kinds of jobs and not really help people at the highest end.

GROSS: Now, youve talked about some of the drugs that are being used as neuroenhancers to increase focus and productivity, and theres another class of drugs that are being used or look like they might be on the verge of being used this way, and these are drugs that were originally created for things like Alzheimer's disease, for memory impairment. Can you talk about those drugs?

Ms.�TALBOT: Yeah, I mean, I think that one of the things thats interesting about this is this kind of neuro-pharmaceutical area is really booming because we have an aging population and people who are working longer or want to be able to work longer, and we also have, obviously, the Alzheimer's problem and the memory impairments that come with that.

So there are a number of drugs in development that work on various receptors in the brain, many of them with the aim of treating Alzheimer's patients, some with the aim of treating other kinds of cognitive impairments that are associated with mental illnesses like schizophrenia.

Thats the purpose of these drugs. You know, some of them eventually may also trickle down into the kind of uses Im talking about here, where people are getting a hold of them one way or another and taking them to give themselves a cognitive boost when they dont have a recognized impairment or diagnosis. And some of them, eventually, the uses may be expanded for them, too, and what we consider to be an acceptable cognitive decline may also change, you know.

The kind of memory loss that a lot of people accept, mild memory loss that a lot of people accept with middle age now, people may no longer feel is acceptable and may be willing to take a drug that helps with that in the future. So I think that may be a direction were moving in.

GROSS: One person who you quote in your article who supports the use of these neuroenhancers says, why would you want an upward limit on the intellectual capabilities of a human being? And you know, thats a pretty convincing way of putting it.

On the other hand, one of the things I worry about is that if theres this cosmetic neurology that starts happening, it risks creating a new normal in the way that cosmetic surgery creates a new normal.

Suddenly, like, theres so many people who never have wrinkles. So its no longer normal to have wrinkles as you get older. Its normal to be wrinkle-free in a lot of circles, and you know, if you dont do that, youre the one who looks abnormal.

(Soundbite of laughter)

Ms.�TALBOT: Right. I think that the argument you cite by the person who says why would you want an upper limit on, you know, intellectual capabilities is something to keep in mind, and I think youre hearing it, including from scientists and neurologists who work in this area, and you know, their argument is well, this even has some trickle-down benefits for society if people who are very smart and are working on cures for diseases and so on, if they are smarter and more productive, then that will benefit all of us.

The British Medical Association came out with a report where, among other arguments, they made that argument. They said, you know, generally making people smarter is considered a good thing. So you know, why would we not want that?

Theres also, I guess, the social-inequality argument, which is that this is the kind of thing, like so many benefits, that accrue to people at the upper ends of the economic ladder. You know, that this is - the kind of people who will get access to these drugs, who will have the savvy to go to a doctor and describe the kind of symptoms that would get them a prescription - who will know about them, whose parents will know about them - are also the kind of people who already, you know, are getting extra help in the form of SAT tutoring or whatever it is and who already are going to the best schools or whose parents can afford to send them to the best schools. So that it - you know, theres an argument that it could compound social inequalities that are already at least somewhat concerned about.

GROSS: One study that you cite in your New Yorker article says that its predominately white males going to Northeast colleges who are members of fraternities who use these neuroenhancing drugs. Whats the interpretation of that?

Ms.�TALBOT: Well, the authors of the study are fairly careful not to extrapolate too much from it, but I think its an interesting, suggestive finding.

You know, you can imagine that college campuses that are more competitive and have, you know, higher standards to get in, and where people feel a fair amount of academic pressure to keep up, you know, would be more likely to be laboratories of this kind of experimentation.

I mean on this point, Im just guessing, but fraternities I would imagine would be places where people could trade them amongst themselves with greater ease. One of the things that was interesting to me is trying to look a little bit at how people get these drugs on campus, and there are these Web sites called BoredAt, where students who are in their libraries at their various institutions and ostensibly studying are sort of sending notes to one another on this computer board. And a lot of them - I mean, its quite common to find on there queries about buying or selling or trading Adderall and Ritalin. And some of the universities where I looked at these sites were some of the leading Ivy League institutions.

And so I think that academic pressure and academic competitiveness is one of the forces contributing to the use of these drugs.

GROSS: Margaret Talbot, thank you so much for talking with us.

Ms.�TALBOT: Thank you.

GROSS: Margaret Talbot is a staff writer for The New Yorker. Her article, "Brain Gain: The Underground World of Neuroenhancing Drugs," is published in the current edition. Im Terry Gross, and this is FRESH AIR.

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