Cosmetic Neurology: Brain-Boosting Drugs

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by: Roger Dooley

the next big frontier in pharmaceutical marketing? Blockbuster drugs
seem harder to develop these days, and it’s getting more difficult to
sell minor tweaks to old products as major breakthroughs. It’s even
getting more challenging to talk to physicians, as many of the old
ploys to get face time (expensive meals, honoraria, etc.) are being
These days, it seems, pharma companies have been reduced to trying
to convince consumers they suffer from obscure maladies like “restless
leg syndrome.” The Holy Grail of new products would be a drug that
could be used by anyone, and that is so attractive that consumers will
flock to their physicians to demand it. Could that drug be a cognitive
enhancer? Enter the brave new world of cosmetic neurology…

the potential side effects, academics, classical musicians, corporate
executives, students and even professional poker players have embraced
the drugs to clarify their minds, improve their concentration or
control their emotions.

“There isn’t any question about it —
they made me a much better player,” said Paul Phillips, 35, who
credited the attention deficit drug Adderall and the narcolepsy pill
Provigil with helping him earn more than $2.3 million as a poker
player. [From the Los Angeles Times, Drugs to build up that mental muscle by Karen Kaplan and Denise Gellene]

appeal of cognitive enhancers is that just about anyone could justify
taking them. Who wouldn’t benefit from being sharper and more focused
on the job or while studying? Who wouldn’t like better memory? The
authors of the LA Times article point out that, unlike the steroid
uproar in sports, there has been little objection to the use of brain
enhancers. You might not want your home run champion to be juiced, but
if you were headed into surgery, wouldn’t you want your surgeon to be
focused, alert, and free from hand tremors?

Musicians have a
reputation for being relaxed about drugs, but in this case it’s not
brain-fried rock stars popping the pills but otherwise staid classical

In the world of classical music, beta
blockers such as Inderal have become nearly as commonplace as
metronomes. The drugs block adrenaline receptors in the heart and blood
vessels, helping to control arrhythmias and high blood pressure. They
also block adrenaline receptors in the brain.

“You still have
adrenaline flowing in your body, but you don’t feel that adrenaline
rush so you’re not distracted by your own nervousness,” said Dr. Bernd
F. Remler, a neurologist at the Medical College of Wisconsin in

As many as three quarters of musicians
may use beta blockers, at least occasionally, according to one veteran
symphony player quoted in the article.

Classical musicians
aren’t quite mainstream, but there’s plenty of evidence that cognitive
enhancers are being used by students to improve their study skills. The
pressure to excel felt by many students isn’t dissimilar to that
experienced by their athletic counterparts.

In addition to
Adderall, Provigil, and Inderal, ADHD remedies like Ritalin and
Alzheimer’s drug Aricept may also have cognitive enhancement potential.
In all cases, boosting the brains of healthy people isn’t one of the
FDA-approved uses, although physicians in the U.S. have always had the
freedom to prescribe drugs at their discretion.

A slightly more scholarly look at the search for cognitive enhancement drugs can be found in The Quest for a Smart Pill, a chapter in the Scientific American book, The Best of The Brain.

true “smart pill” could be the biggest new drug introduction ever. If
shown to be safe and effective, and if approved by the FDA for
cognitive enhancement (which would allow full-bore marketing for that
purpose), watch out. To use a movie analogy, if Viagra was Star Wars, this new drug will be Titanic.

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