“The good-grade pill”

The problem of competitive use of stimulants isn’t much like the problem of taking drugs to feel good. Current drug-policy categories don’t have much to offer in thinking about the problem, and the coming problem of true cognitive enhancers.

The New York Times reports on the widespread use of prescription stimulants as study aids among students competing to get into top colleges. These kids aren’t partying: they’re working. And unlike the false impression of improved performance that alcohol gives, the improved performance from the amphetamine-type stimulants is perfectly genuine. But that doesn’t mean the kids – and the adults who do the same thing anren’t getting hurt.

Using stimulants doesn’t create energy; it just borrows it, at a ruinous rate of interest. Sometimes – in military settings, for one obvious example – the short-term gains cover the longer-term costs. But it’s a tricky business, and of course one long-term effect of stimulant abuse is impaired judgment, especially about drug-taking.

It’s a pure case of the Schelling “hockey helmet” problem: what Robert Frank calls a “smart-for-one-dumb-for-all” situation. The number of spots at Swarthmore doesn’t go up; all the students can do is jockey for position. They’d be better off, as a group, if no one was using, but any individual who doesn’t use finds himself at a competitive disadvantage. And of course the rat race continues thoughout a career in any of the professions, the stakes rising with increasing income inequality.

The problem will only get more complex as pharmaceutical technology develops. The current stimulants are sometimes called “steroids for the brain,” but the analogy isn’t precise; the anabolic steroids build lasting strength rather than merely boosting immediate performance. But scientists are working right now on genuine cognitive enhancers: drugs that will stimulate the growth of brain cells. The advantage they confer will be genuine, but it would be insanely optimistic to imagine that messing with brain chemistry won’t have bad side-effects, or that all of those side-effects, over many years of use, will be detected in routine clinical trials lasting a few months.

The use of amphetamine-type stimulants by those who don’t have attention-deficit disorders (or the much less common narcolepsy) is almost certainly a bad deal socially. That’s much less obvious about the use of true cognitive enhancers, once they have been developed; there might be not much social benefit in improving the IQs of all our litigators – after all, someone is going to win the case, and someone is going to lose it, no matter how smart the lawyers are – but improving the IQs of all of our scientists (or policy analysts, for that matter) might pay big dividends.

One thing, however, is clear: our existing ways of thinking about “drug abuse” and dealing with it through lawmaking, enforcement, and persuasion, have very little relevance to the problems posed by the stimulants and the cognitive enhancers. Their abuse is not like the abuse of recreational drugs; the risks and the motivations of the users are different. Neither enforcement and prevention messages is likely to do much good, but the smart-for-one-dumb-for-all structure of the problem makes a laisser-faire clearly inappropriate.

So it would be a mistake to treat this an an opportunity to open one more front in the drug wars, and an equal mistake to simply allow unrestricted competitive use of stimulants. As Lincoln said about the Civil War, “As our case is new, so we must think anew, and act anew. We must disenthrall ourselves.”

Right now, I don’t see much disenthrallment on the horizon.

Methinks They Doth Protest Not Enough: Were All Parents Truly Fooled by Baby Einstein?

The wildly popular videos/DVDs known as Baby Einstein were pitched by their manufacturer as a learning tool for infants, and were even endorsed in the State of the Union address by President George W. Bush.

But as I wrote about at the time, there was no basis at all for the claim that watching these videos made infants learn anything.

An advocacy group successfully sued the manufacturer, Walt Disney Corporation, forcing it to agree to take back Baby Einstein videos for the original purchase price. Up to 4 videos/DVDs could be returned to the manufacturer for a refund of about $65, regardless of their condition or whether the owner had a receipt.

There are few things that make Americans angrier than the thought that their children have been exploited or harmed by a big corporation. One might expect therefore that millions of outraged parents would have flooded Disney with old Baby Einstein videos both to pocket the $65 and to teach Disney a lesson.

Yet 6 months after this rebate program ended (and from what the Internet Wayback machine tells me, also during it) Ebay is carrying countless used Baby Einstein DVDs/videos selling for as little as two bucks. Why didn’t the people who unloaded these videos take the bigger payout and express their righteous outrage at the same time? Continue reading “Methinks They Doth Protest Not Enough: Were All Parents Truly Fooled by Baby Einstein?”

tDCS: a potential mass-market cognitive enhancer?

Can low-amperage current delivered through electrodes taped to the skull improve cognitive performance, at least temporarily, in healthy people and stroke and dementia sufferers alike? So it would appear.

This week’s New Scientist reports (behind a reasonably low subscription wall) that Eric Wasserman at the National Institute of Neurological Diseases and Stroke (among several other scientists) has demonstrate that a technique called transcranial direct current stimulation (tDCS) &#8212 essentially, running a current of 1-2 milliamps between a pair of electrodes taped to the skull &#8212 can increase neuronal firing rates and produce observable and slightly durable (in the hours range) improvements in cognitive performance in both healthy volunteers and stroke and dementia patients. The effect can be targeted at any part of the cerebral cortex by moving the electrodes.

The treatment is painless, and in fact only marginally noticeable. The requisite device is cheap, low-tech, and potentially portable, running off a 9V battery. Indeed Wasserman is quoted as claiming that “Anyone with the know-how could go to an electronics store, buy the components, and build one.”

The open &#8212 and central &#8212 research question is whether the brain builds up a tolerance, so the stimulation stops working. (The researchers claim confidence that the treatment is safe, which is puzzling if they don’t know whether it builds tolerance. Perhaps they merely mean that it’s safe for the small number of applications they’ve tried on each patient so far.)

From a clinical standpoint, this sounds like a potential breakthrough. But the big market for such devices is probably among healthy people who want a cognitive boost, even temporarily. (How much would a wannabe doctor pay to have his Broca’s area stimulated just before taking the MCAT?)

Whether the technology is electricity, magnetism, chemistry, or sensory stimulation, we’re going to learn, sooner rather than later, how to make people smarter, at least temporarily and with respect to some subset of congitive tasks. What’s scary is how unprepared our regulatory mechanisms seem to be to deal with the tricky set of questions involved. (Chemicals are much more tightly regulated than the other technologies, for no especially good reason other than history.)

The hard problems will come up around techniques that give a cognitive boost, but with undesirable side-effects, and in particular long-run health consequences. The competitive pressure to use those techniques among those competing for elite positions will be intense. The massive cheating, arbitrary rules, and moralistic posturing around “sports doping” doesn’t give me much confidence that we’re going to handle this one properly.

Is test-doping cheating?

Yes. It reduces the validity of the test, and puts test-takers at risk of developing substance abuse.

My email inbox has been full of arguments about my post calling the practice of taking stimulants to improve one’s scores on the SAT and LSAT (and presumably the MCAT and GMAT) “dishonest” and likening it to doping in sports competition. The objections fell into two categories: some asking why doping was cheating, and others arguing that “life isn’t a sporting event” and that the category therefore wasn’t applicable.

Second things first: No, life isn’t a sporting event. But test-taking is part of a competitive process where the (astonishingly valuable) prizes are the small number of places at the top colleges and professional schools. (Arguably, where you go to college, within the range likely to be relevant here, matters more socially than it does professionally. But where you go to law school or business school matters enormously. Moreover, with more and more places using scholarship awards to compete for top students, there are immediate financial advantages to scoring better than your competitors.)

In any competitive process, an advantage for one competitor is a disadvantage for others. So the question is what counts as an “unfair” advantage. The answer isn’t obvious.

In general, though, we expect people to obey the law. Breaking the law for competitive advantage seems to me to fit pretty squarely into the category of cheating.

But why, one might ask, should there be such a law? Using a stimulant once or a few times isn’t harmful. If some students want to obtain a competitive edge by studying, others by popping Ritalin, and still others by catching a good night’s sleep before the test, why shouldn’t the rules allow any or all of those strategies?

The simple answer is that the tests are supposed to measure aptitute for learning, and more generally aptitude for performing intellectually demanding tasks. That’s why the schools value the results. So the test results ought, ideally, to reflect something about the normal performance of the test-takers. Taking stimulants is a self-limiting process; you’re not creating mental energy out of nowhere, but merely borrowing it fairly stiff rates of interest. People can’t be stimulated all the time. So unstimulated performance is a better measure of average performance than is stimulated performance.

Finding the potential law student (for example) who responds most postively to psychostimulants, or tolerates the greatest dose of stimulant without becoming manic or compulsive, or who is most adept at figuring out what dose of stimulant will produce optimal performance on the LSAT, doesn’t have much to do with finding the potential law student most likely to have a good career in law school and as a lawyer. Therefore, the rules of the LSAT should forbid drug-taking as a test adjunct, as the criminal law already does.

If drug-assisted test-taking were legal, and if (as seems likely) the drugs can produce big gains for many students, then every student who really wants to compete will have to do the work of figuring out whether stimulents help him or her, which stimulant is optimal, and how much to use. Some of them are likely to find the stimulant experience rewarding, or discover that they work much better stimulated than not. All of those people will be at risk of developing stimulant abuse or dependency, which is a really bad risk to be at. Lots of methamphetamine addicts started out taking the drug to work, not to party. (I know one guy whose mind will never be the same after the methamphetamine habit he developed while using meth to write his Ph.D. thesis about drug abuse.)

To sum up: Allowing stimulant use in the context of competitive test-taking means, virtually, requiring it of those who want to win the competition. And requiring stimulant use is likely to have some bad results in the future lives of test-takers, in addition to reducing the validity of the tests as predictors of academic and professional performance. Since taking stimulants to boost test scores is illegal, and since making it legal would have bad results, I think it’s fair to call taking stimulants for that purpose “cheating,” and I’m disappointed that today’s test-takers by and large either don’t agree or don’t care. (Two emails informed me that test-doping is now very widespread and barely covert.)

In this respect, test-doping differs from the use of drugs producing long-acting cognitive enhancement. If I can make myself lastingly smarter or less forgetful by taking a pill, that’s no different from an employer’s point of view than if I can do the same thing with good eating or reading habits. The problem there is that the first generation of drugs is likely to have side-effects, and certain to have an unknown long-run side-effect profile. But once again taking those drugs is going to become virtually mandatory for those who are playing the winner-take-all games in the professions and in academia.

There’s probably not much we can do about that.

Even the test-doping problem may be virtually intractable. With millions of prescriptions out there, the milder stimulants are easy to get. ETS and its competitors could start requiring chemical tests, as the sports authorities do, but they’re going to confront the fact that some students have legitimate prescriptions for stimulants to treat ADHD or nacolepsy. Moreover, since the ADHD diagnosis is particularly hard to specify, it won’t be hard for aggressive and well-connected students to find a physician willing to write a prescription in time for the LSAT. The Americans with Disabilities Act would (or at least I hope it would) make it impossible for the test companies to put asterisks next to the test scores of students with prescriptions.

One option would be to take the time pressure off the tests, which would substantially — though not by any means completely — eliminate the stimulant advantage. Another would be for the schools to mount their own tests (perhaps on line), as a supplement to the uniform tests, reducing the gains to be made from doping for a single test that covers all schools.

I don’t have a clear idea about what to do. I am, however, pretty clear that there is a problem.

You knew this was coming

No surprise here: stimulants improve your score on standardized tests. Kids taking the SATs and the LSATs have started to figure that out.

The front page of today’s Wall Street Journal reports a trend toward the use of prescription stimulants to improve scores on standardized tests such as the SAT and LSAT. Given the stakes, and the easy availability of stimulants due to the upsurge in diagnosis and treatment of attention deficits, this is hardly a surprise.

Once the trend is established, it becomes self-reinforcing. If one’s competitors are doping, not doping means losing out. (The story itself is therefore part of the trend; as an editor, I might have thought twice about running it.)

Some of the details are fascinating. I especially liked the kid who, in the scientific spirit, took practice exams in both stimulated and non-stimulated states before concluding that the stimulants really helped. Note that such an approach also avoids some of the dangers of competing for real in a completely novel state; another student reports having been caught by one of the side-effects of stimulant use, spending the entire exam period fascinated with the texture of the pencil and the paper.

What’s depressing is that no one interviewed — neither students nor parents — said that using drugs to get an edge on an exam was effective but illegal and dishonest; one student reported doubts, but the others had found ways to put their consciences to sleep.

The Educational Testing Service is clueless as usual, expressing the pious hope that students won’t do what they need to do to succeed in the set of tasks that ETS has made the gateway to professional-class success but having nothing else to offer.

Fortunately, unlike sports doping, which needs to be done persistently in ways that are bad for the organism, taking a few doses of stimulant isn’t going to do anyone much harm, except for those who either like the effects and start taking stimulants for pleasure or those who start to use stimulants on a regular basis to get studying or work done. They’re at risk for developing substance abuse, and long-term high-dose stimulant consumption can get pretty hideous.

Stimulant use to cheat on exams is just the first hint of a much larger problem. Cognitive enhancers are coming to the marketplace. They’re likely to have some bad side effects. If you’re dealing with someone whose alternative is dementia, the side effects are worth putting up with. But in a competitive world, we’re going to need rules about their use among healthy folks. So far, no one that I’ve seen has even started to think about that problem.