Drugging brains, young and old

I read two interesting articles today on brain performance-enhancing of one kind or another. Denise Grady of the New York Times contributes a long article about the quest for an Alzheimer's cure:

Answers are urgently needed. Alzheimer's was first recognized 100 years ago, and in all that time science has been completely unable to change the course of the disease. Desperate families spend more than $1 billion a year on drugs approved for Alzheimer's that generally have only small effects, if any, on symptoms. Patients' agitation and hallucinations often drive relatives and nursing homes to resort to additional, powerful drugs approved for other diseases like schizophrenia, drugs that can deepen the oblivion and cause severe side effects like diabetes, stroke and movement disorders.

It's a good article with lots of history about the disease and its social and economic toll. But I found this passage the most significant:

The potential market for prevention and treatment is enormous, and drug companies are eager to exploit it. If a drug could prevent Alzheimer's or just reduce the risk, as statins like Lipitor do for heart disease, half the population over 55 would probably need to take it, Dr. Thies said.
If new drugs do emerge, they will come from studies in patients who already have symptoms, Dr. Thies said. But he said the emphasis would quickly shift to treating people at risk, before symptoms set in. Many researchers doubt that even the best preventive drugs will be able to heal the brains of people who are already demented.
Treating preventively, Dr. Thies said, "will be more satisfying to patients and physicians, and there will be an economic incentive because you'll wind up treating more people."
The only thing that could slow the drive for early treatment, he said, would be serious side effects -- and Dr. Morris, at Washington University, said drugs powerful enough to treat Alzheimer's would probably have strong side effects.

It's interesting to me because of the recent genetic stuff I've been working on. But also in light of this other story in today's LA Times, by writers Karen Kaplan and Denise Gellene:

Drugs to build up that mental muscle
Academics, musicians, even poker champs use pills to sharpen their minds, legally. Labs race to develop even more.

People are already using various psychoactive drugs to get a leg up in whatever mental competitions they pursue. Some of this is no more sophisticated than late-night coffee drinking for the Ritalin generation. But some is more surprising:

"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.
The growth of the brain drugs bears a striking resemblance to the post-World War I evolution of plastic surgery -- developed to rehabilitate badly disfigured soldiers but later embraced by healthy people who wanted larger breasts and fewer wrinkles.
The use of cognitive-enhancing drugs has been well documented among high school and college students. A 2005 survey of more than 10,000 college students found 4% to 7% of them tried ADHD drugs at least once to remain focused on exams or pull all-nighters. At some colleges, more than one-quarter of students surveyed said they had sampled the pills.

The article discusses the "blockbuster drug that labs are racing to develop," a memory pill. Which of course brings us full circle to Alzheimer's treatment.

You may be thinking there is something unnatural about this; maybe even something unfair -- like an athlete using steroids to enhance his performance. But with psychological factors, it is a little more evident that there is a continuum of uses, some of which are pretty clearly acceptable. For example, the performance artists who take a pill to calm their nerves before appearing on stage are literally enhancing their performance, but in a way that is arguably different from their skill as artists.

Likewise, there is a continuum among normal people -- how do we justify allowing Adderall for the student who has trouble taking an eight-hour exam, but denying it to the student who had trouble sleeping before the exam?

Progress on these kinds of drugs will only come with understanding the continuum of psychological and cognitive variation among living people -- along with the causes of that variation, both developmental and genetic. We might like some chemical to increase memory performance. But the brain is a complicated place with countless interactions of different structural and regulatory processes. Maybe some people already have the chemicals that enhance memory, and other people don't, or don't express them in the right places in the right amounts. If so, then Alzheimer's treatment may focus on the metabolic processes of non-Alzheimer's brains, for example.

Plus, as we've learned recently with respect to traumatic stress, it's not always good to remember things well, so there is no reason to assume that the human population has been adapting toward longer or better memory. In general, it's not obvious exactly what memory characteristics have tended to increase fitness recently or during earlier phases of human evolution. Aside from the energy and life history constraints of large brains, we don't know what evolutionary trade-offs exist with respect to memory or other aspects of cognitive function.

Athletes take performance-enhancing drugs for a relatively slight advantage. Pharmaceutical firms are pursuing brain drugs on the expectation that millions of people will take a daily pill for years on end, in order to stave off Alzheimer's. Unshackling the mind power of a large proportion of the older population will no doubt have a tremendous impact on the societies of the future.

Pretty exciting stuff, if only we could figure it out.