GAY AND GRAY: Outing Age
This Week in Elder News: 28 February 2009

Brain-Boosting Drugs for Elders?

category_bug_journal2.gif In an opinion piece in the December 11 issue of the British science journal Nature, seven authors including scientists, ethics experts and the editor-in-chief of the journal, called for the right of all healthy people to use brain-enhancing drugs like Ritalin and Adderall (usually prescribed for attention deficit hyperactive disorder) and Provigil, a sleep disorder drug.

[Because Nature is a subscription-only website, I am relying on an AP story about the article published in The Dana Foundation’s monthly print newspaper, Brain in the News.]

Although it is illegal, American college students have been using these prescription drugs for years to boost their brain power and concentration.

“’We should welcome new methods of improving our brain function,’ and doing it with pills is no more morally objectionable than eating right or getting a good night’s sleep, the authors wrote.”

Personally, I don’t believe pharmaceuticals can be equated, in their moral ordering, with a healthy diet and sleep. An ethicist who is not involved with the Nature group sees this advocacy as nothing more than another avenue to enrich the pharmaceutical companies:

“It’s a nice puff piece,” said Leigh Turner of the University of Minnesota Center for Bioethics, “for selling medications for people who don’t have an illness of any kind.”

Maybe so, although the authors claim no financial ties to drug companies. Nevertheless, I am intrigued, especially for old people.

Perhaps some TGB readers have been mildly disturbed, as I have, by an occasional lag time between conceiving an as-yet unarticulated thought and finding the words for it. This gap is only some number of nanoseconds – like a hiccup of blank space - but it is enough to call attention to itself and I don’t recall it happening until the last few years. Before then, the thought and the words appeared simultaneously – or close enough that I didn’t notice any slippage.

To be clear, this lag time isn’t connected with memory lapses like forgetting where the car keys are or wondering why I opened the refrigerator. In those cases, I forgot something I knew a short time earlier. This new-ish brain phenomenon is about a new idea traveling from thought to language more slowly than in the past.

If that slowdown is a function of an aging brain, it seems to me that brain-boosting drugs, which are good for increasing concentration, would help sharpen elders’ declining cognitive function.

Messing around with the brain in any manner can be dangerous business and the authors are not calling for immediate approval of existing drugs for this off-label use. They are urging research into it and they mention several areas for study: risk of dependency or addiction; policies to guard against coercion to take the drugs and to protect against worsening socio-economic inequality.

That last point is critical unless we are interested in giving a few people an unfair advantage by turning them into a cognitive elite - mental equivalents of A-Rod and Barry Bonds.

Also, although not noted, it would be important to know exactly how the drugs affect what parts of brains and what side-effects there might be – especially in elders. It is known (although not widely enough) that standard dosages of some drugs affect old people differently from mid-age people.

Although no drugs specifically created to enhance brain power yet exist, one bioethicist interviewed for the AP story lauds the authors for making a convincing case that “we ought to be opening this up for public scrutiny and public conversation.” One of the authors told the AP reporter:

“I would be the first in line if safe and effective drugs were developed that trumped caffeine,”

I wouldn’t go that far. Oh - well, maybe I would. Maybe it would depend on whether that lag time is going to expand as I get older. What do you think?

[At The Elder Storytelling Place today, Sydney Halet tells the story of Zayde’s Cat – and in the reading, you’ll learn a little Yiddish too.]

Comments

This is one of those good stories that has a hundred or more different angles to it and no possible resolution. Good mental exercise in itself!

One of my many 'what if's' was...what if Ritalin and similar drugs were found in nature? In some obscure nut or berry? Would we ban them? And if a drug is not being used medically, is it still 'medicine'? (caffeine being one, so why not Ritalin?)

But, back to the question...yes, i would be an early adopter. Standing in line.

Another important thing to consider is drug side effects, effects of long term use, & interaction with other medications. Also I'd like to know what kind of research has been done with Ritalin & Adderall on elders.

And yes, Ronnie I know about that "thought gap," & I know there are others who are with us on this. However, I've learned to adapt & to slow down & focus when I'm using my brain. I guess I'd be happy to pop a pill so this wouldn't happen, but I don't want to risk another pill that may cause a bad side effect. I remember my MIL telling me that it doesn't matter what you do to slow the process, you will still age. :)Dee

The most unthinking pill popper in the world is my 82 year old mother. I have seen her frankly offering my teenage children some of her pain medication when they just bump an elbow against the door. She looks to pills to solve all of her problems and pills now are the cause of many of her problems. She is a walking chemistry experiment that often blows up in various ways.

The water she uses to wash them down is the thing she should increase...but I cannot get her to believe simple water is good and necessary. Why? I guess there are not a dozen commericals on tv every day to tell her so.

Better living through chemicals...what a profoundly stupid idea.

I don't see really see the moral or ethical issue here, other than the usual Big Pharma taking the ball and running off with it, so my concerns would be, is it safe? and is it effective? Both of those questions can be tested to a certain extent on animals (perhaps that is a moral issue), but we won't really know the definitive answers until years down the road of common usage. And given that Big Pharma has a bad habit of hiding unfavourable results, there's the risk that information will not be available as soon as it might be.

My understanding is that there are risks in giving Ritalin to ADHD kids, and that many doctors and parents feel that the benefits outweigh the risks. Will it be the same for elders? [there are risks with caffeine too ;-)]

My position is adults should be able to choose whether or not to take a drug, and should be fully informed of the risks and benefits before they make that decision. For drugs known to have serious mental or physical effects, some degree of supervision by professionals is in order.

Once started you would not be able to stop. Better to age gracefully adapting as we go.

"My once started.." comment may be unclear. I think that once you begin taking the drug you would see the improvement. As time went on you would naturally not want to go back. Then you would not know the extent of the difference - have I gotten worse? Would others notice? This could cause fear and then result in a psychological addiction.

I don't agree with taking these drugs for your brain. Though I will wait to see what reputable research shows. It seems we always look to a pill to cure our ills.

What I have learned from working with people my age or older, and from our own research that will be published in book form later this year as a sort of self help book, is that while the mind, body and spirit do change with age, there are things people can do to keep what they have. In relation to the slow down of information Ronni has referred to in posts, I pulled some information for all of us:
"“There are changes as you age in the connections between brain cells. These connections help facilitate mental processing but slow down with the aging process. As you age, it may seem that your memory is failing when you keep forgetting your keys or what you had for dinner last week or you are searching for a word, and it comes but a little after you think of it. But there are other functions besides memory going on in your brain that may be changing—like your reasoning and processing speed.

Processing speed relates to how fast you can translate information into action. When your processing speed slows down, your reaction times (to jokes, clever word twists, and even changing traffic lights) slow down, too. But you can also train your processing speed to be more efficient by doing various exercises.”

So I don't think a pill is (at least now) the answer.

It's not the thing to do.

All the potential objections brought up are valid: dependency, addiction (physical or psychological), side effects, a halo effect approving use of all drugs for any purpose, coercion, cognitive elite. But from my point of view, the ethical is the most overriding. This is fiddling with our natural progression. Now, I don't ENJOY this natural progression: new pains in my knees and my thumbs, wondering whether this "Why did I open the refrigerator?" is the harbinger of yet worse (and how soon?). But I believe that taking of medicine when there is no illness is going down the wrong path.

Is the use of mind-sharpening drugs for an essentially well person ethical? How about artificially inducing a growth spurt in a child who would otherwise be shorter than their siblings? How about fiddling with embryonic genes to assure that one's yet-to-be-born child is a genius or a gifted athlete. If you see Barry Bonds' and A-Rod's decisions as being ethical (they are informed adults) then so is this. It's all in how you choose to see it.

Incidentally, Dee, I was really pondering, "What is an MIL? Medical Information Liaison?" Then my sweet wife suggested I use Google to find the definition. Oh -- "Mother In Law." Perhaps she'd like "Medical Information Liaison."

As usual, I agree with what Anne says. People should inform themselves and make their own choices. If what they want to take has significant side effects it should be monitored by a health professional. Why are so many people so eager to tell others what to do, when the only person affected is the one taking the pill?

This question is fascinating. I'm one of the most drug-free persons around, always resisting taking any medicine -- except that I'm completely dependent on maintaining a considerable level of caffeine in my system just to stay even. This has no bad effects that I'm aware of.

So I guess I'm already doing this, on the cheap. And have been doing this all my life.

Is it a good thing? Don't know. There was a smart running doctor during the first running boom who described his running as "an experiment of one." That's what we do when we don't have broader data.

I would rather not take any more medicine than I already do. However, I need something to help me with the "lag time" between thoughts and words. I get very nervous when the words don't come which I am sure makes things worse. I would be interested to know if anyone has suggestions or tricks they use to help the situation.

Having a gap between thought and speech can be a positive thing. I'm one who has had my foot in my mouth back when my thought and speech were simultaneous. Now I'm more likely to refrain from saying something that I would regret.

Experiencing this gradual decrease in mental acuity, especially the increasing length of the thought-gap, concerned me enough that I told my doctor about it at my last physical exam.

Fortunately he is well-versed in geriatric medicine and, after a thorough physical exam and detailed questioning, his diagnosis was that I was experiencing the effects of normal aging.

He explained that, since we are all unique, this process progresses at different rates for each individual. Not only that, but high-functioning individuals (those who are involved in complex types of thinking) are more sensitive to changes in their cognitive processes and are apt to notice these changes much sooner than those who are less cerebral. For the high-functioning people, this sensitivity makes the apparent decreases in cognitive abilities seem greater than they actually are.

If these decreases in cognition do reach a point where they interfere with the patient's ability to function normally, it is not uncommon for a physician to prescribe medication of the types mentioned in the article. In many cases, these medications do help the patients and result in a significant improvement in their quality of life.

I think maybe Anne named the elephant in the room when she stated, "My position is adults should be able to choose whether or not to take a drug, and should be fully informed of the risks and benefits before they make that decision." The seed of this conversation before we even talk about each individual case and how one uses these "aids”, is how enabled are we going to be in regards to information (side effects, commitment to quality of life, dependency on the improvements, etc) These are all questions one needs to answer for themselves and can only be answered if we've seen fit to make sure we have all the information we need to make that decision. At our age, we may be too entrenched in the mainstream of a lifetime of lifestyle choices to have a great deal of options about what we can decide but we can leave a legacy of suggesting our children make better lifestyle decisions when they are young and by seeing to it that pharmaceutical corporations do not dictate policy on the use of these medications and/or supplements. We can make informed choices only when accurate information regarding side effects and possible lifestyle complications is a natural part of the conversation.

Thank you, Ronni, for always keeping these important conversations going.

My son began taking Ritalin as an adult. He believes he has adult ADD, and though he passed through school w/out that diagnosis, ADD would explain some of his academic difficulties. I believe we missed this with him because he had no behavior problems, and because I didn't want to have him offically diagnosed and "labeled."

What he tells me, as a mental health professional, is that his medicine helps him be patient with his clients. He also believes it helps him concentrate.

A truly beneficent side effect is the decrease in appetite he experiences. He looks better than he has in years.

I want this medicine for me! I could always stand to be more patient--and less fat. (I am extremely impatient, actually.) Since my son and I are in many ways alike, I think probably I could benefit from this medicine.

But I'm not going to my doc for this. What I want is not at this point ethical to ask for. Or is it? According to the cited article, perhaps it would be.

More to the point, I find it fascinating that impatience and impulsiveness might be tied somehow to appetite.

I am rather cynical about most psychiatric drugs. Each one is the new miracle that will transform lives. Then, as it goes generic, its dangerous side effects and ineffectiveness are discovered just as the new miracle drug bursts on the scene. Psychotropic drugs are now regularly prescribed for children, even though no research has been done on their use on children. I would be horrified if the same pervasive brain drugging extended to healthy adults.

Research is indicating that atypical anti-psychotics, widely used in nursing homes to sedate agitated dementia sufferers, hasten their deaths. The FDA regularly approves psych drugs on the basis of short-term studies; then the drugs are prescribed indefinitely.

Caffeine is already generic and has a rather lengthy track record.

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