I seem to be the last person who hasn't yet blogged about the Nature article advocating a more liberal view of the use of drugs for cognitive enhancement. One reason is that there's so much to say here that I'm not sure where to start. Another, though--this is one of inherent issues with a journalist who does a blog on the side--is that this is the rare issue on which I'm a little leery of preempting what a future in-depth story (and I haven't spoken to the authors yet, something I may well do soon).
With that caveat, though, there are a couple of points that struck me. It seems to me that both people who are optimistic about cognitive enhancement and those who are terrified of it try hard to draw a distinction between the "abuse" of drugs like amphetamines (Adderall or Dexedrine) and the use of these drugs or others like Provigil for "cognitive enhancement." The anti-enhancement folks think that anything that's not prescribed to treat some condition recognized by the DSM-IV is abuse, the pro-enhancement folks think that taking drugs to think better rather than just to get high is not abuse. But both seem to work under the assumption that these uses are less dangerous than, say, taking amphetamines for the fun of it.
The problem, it seems to me, is that the dangers of amphetamines do not manifest themselves from occasionally taking them to get high--the use that everyone seems to think is not okay. They come out precisely in the extended and continuous use of drugs for what people think of as cognitive enhancement. There is no question that dextroamphetamine, the best studied of the smart drugs, can in fact make you think faster and potentially even more creatively ... to a point. There are studies on this; there would be more, except the proposition that amphetamines do offer some kinds of enhancement is not really much more controversial than the proposition that beer gets you drunk.
Unfortunately, there's also a lot of evidence that they will drive you crazy. This is something that folks saw in the 1950s, when Benzedrine (a drug closely related to Adderall) was routinely used by intellectuals and artists for cognitive enhancement, which with some regularity ended up sending them to the mental hospital. From the outside, the distinction between "smarter" and "crazy" looks clear. But from the inside it is emphatically not, and this situation is made worse by the fact that while Adderall or Dexedrine might make you "smarter" they invariably make you think that they've made you smarter, adding still another level of complexity to the cognitive enhancement puzzle. You're particularly likely to think that drugs are making you smarter exactly at the point at which they are in fact making you crazy, and in this situation, unfortunately, it is difficult to consult other people for a disinterested perspective. I'll save for another post why I think that it will be very difficult to find a drug that provides the kind of cognitive enhancement that people look for in amphetamines and other drugs without holding out the same very real risks of psychosis.
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