So you want to improve your brain’s performance? Heard of nootropics?

What are nootropics?

Nootropics are substances, drugs and supplements that some experts and users believe will enhance cognitive performance in people who take them. The use of substances like Modafinil, a drug that claims to boost memory and alertness, are on the rise with sales of off-label Modafinil increasing fifteen fold over the past several years. These drugs are clearly marketed to a target audience consisting largely of university students and white-collar workers.

In the past few years, the nootropics industry has grown to a value of US $1 billion in the US alone. This could be partly attributed to the portrayal of this technology by the media, including films such as Limitless and Lucy starring influential big name actors such as Bradley Cooper and Scarlett Johansson. Modafinil is one of the most common nootropic drugs sold on the market, (largely illegally). This nootropic is known for its “supposed” ability to induce wakefulness, improve executive function and increase alertness. Let's take a closer look into this technology.

What do the experts think?

One expert who agrees that nootropics work as enhancers is Dr Musgrave of the University of Adelaide. He claims that nootropics work by increasing cognitive performance. Musgrave points to a chess study, where nootropics such as Modafinil, Methylphenidate and Caffeine are verified to enhance chess performance in highly skilled tournament players. The results from this study showed that people who used nootropics would increase their chances of winning by 5%. In order for this to be considered a reliable claim, this statistic would have to be replicated across multiple studies, which it currently isn't.

The efficacy of nootropics is still contested within the scientific community, but it is generally agreed that this emerging technology is in its nascent phase. According to Dr Farah, a cognitive neuroscience researcher at the University of Pennsylvania, the cognitive enhancement (CE) literature may have suffered from publication bias. This means that small studies with positive results were published, while the majority of studies that had inconclusive or negative results were discarded. If this claim is true, then our current understanding nootropics has been compromised.

Ethical concerns?

The implications of a drug that could radically improve your performance by altering the chemistry of your brain have raised some serious ethical concerns including fairness, addiction, safety and personhood.

In a world where nootropics work as claimed, there are many who argue that the use of nootropics in an academic setting would create an uneven playing field, allowing those who can afford the enhancements to outperform those who cannot. Dr Farah, however, disagrees with this idea because disparities already exist in terms of biological and environmental differences between the socioeconomic classes. She and others argue that education is already an unequally distributed cognitive enhancer that is tolerated by society, thus, prohibiting the use of cognitive enhancements on the grounds of unequal distribution would be hypocritical.

Another concern around the use of nootropics like Modafinil is addiction. The question we may want to consider asking ourselves is this: how extensively can we alter our cognitive and mental functioning without irreversibly harming ourselves?

If Dr Musgrave is to be believed, then, "All drugs have side effects". He states that if a healthy individual is considering the use of nootropics in order to pass an exam, or work longer hours, then they should consider that they may experience the side effects of such drugs like diarrhoea, high blood pressure, nausea etc. The nootropic community on Reddit pushes the idea that the only way to attain the ultimate result is by stacking multiple nootropics. This is, however, a dangerous concept. Studies have shown that combining two or more nootropics increases the side effects more than the gains. This is verified by Musgrave, "It is not certain that the effects of two nootropics have a cumulative effect, they may even limit each other". In terms of getting "addicted", Dr Musgrave points out that there is currently no evidence that shows Modafinil to have addictive properties. Whereas Piracetam, a nootropic used for the treatment of age related cognitive impairment, does.

In the meantime, there are unanswered questions about the potential of this technology being weaponized, since they have been used by the military in the past. Additional questions include: "Could employees become coerced to use nootropics to increase the economic output of the company?", "Is using nootropics in the workplace a smart alternative to reducing work hours?"

A common phenomenon in Asian countries is Karoshi, which is "death by overwork". Employers demanding more hours from their employees may push them to develop strokes due to stress, or even have heart attacks. This is still an ongoing issue, and the promise of nootropics may seem tempting to many. Could the future of nootropics be a future of overworking individuals?

In the US in 2017, there were 70,237 drug overdose deaths, and 67.8% of them involved opioids. From 2013 to 2017, synthetic opioids contributed to increases in drug overdose death rates in several states in the U.S, and from 2016 to 2017, synthetic opioid-involved overdose death rates increased by 45.2%.

More than 130 people died every day from opioid-related drug overdoses in 2016 and 2017, according to the US Department of Health & Human Services (HHS).

What started all this though? What were the contributory causes that led to this current crisis? As already mentioned, one of the causes could be attributed to pharmaceutical companies underplaying the risks of addiction to this drug. But wasn't mentioned was that there were medical papers that claimed that addiction to opioids were rare and unimportant. Such papers lacked strong data and were used to justify the use of opioids for the treatment of chronic non-cancer pain. Sounds familiar?

Addiction to drugs is a severe issue. The study of nootropics is still undergoing studies, but is sold nevertheless. This is unfortunate because there are inconsistencies within the cognitive enhancement literature, which have also prevented an agreement within the scientific community on the efficacy of Modafinil as a CE (cognitive enhancer). In addition to that, discussions on the suitability of its off-label are ignored.

Despite the claims of drug manufacturers and studies showing that signs for dependence are little to none, it is important to note that, since nootropics are classified as dietary supplements, the Food and Drug Administration will not regulate manufacturers’ statements about their benefits (as the giant “This product is not intended to diagnose, treat, cure, or prevent any disease” disclaimer on the label indicates). But as history has taught us, they are capable of using their influence to get their way. What should be learned from the history of opioids is to be wary of claims drug companies make on the safety and benefits of their drugs, more so on nootropics.

What happens now?

As we have seen, cognitive enhancement through nootropics is an emerging technology. Its potential and its promises are enticing, however, the undesirable side effects outweigh the gains of power. For as the saying goes: "Health is wealth". Good health is a nice indicator of wealth and well-being. As an emerging technology, it is still retained to be in its infancy. Why rush into it?

Why spend money on drugs that may not even work to boost your performance and mood, when you can take a 30 minute jog to do get just that? There is research that shows the benefits of exercise to mental health. The advantage of this is that it's cost effective and very low in side effects. Among the advantages are: stress relief, increased mental alertness and improvement in mood.

Humans will always retain the capacity to change their brains, we employ this plasticity every day when we practice certain tasks or learn new materials. For normal, healthy brains, taking advantage of this feature allows us to reap many of the benefits of cognitive enhancement without any ethical issues.

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