Caffeine 2.0: Cosmetic neurology
Last week, we talked a bit about neurostimulants, and in particular caffeine. In this week’s episode of BrainWaves, we take it to the next level and discuss the “cosmetic” uses of neurostimulants and other psychoactive substances. For more on the topic, and a world renown expert in this particular field, Dr. Anjan Chatterjee tells me more.
What is “cosmetic neurology”? Sounds like concierge medicine, but really it’s far from that…and much more interesting. In Dr. Chatterjee’s seminal paper, published in Neurology in 2004, he describes cosmetic neurology as the pharmacologic augmentation of the nervous system to make brains better. While many people think of medicine as the practice of making sick people healthy, cosmetic neurology refers to the practice of making normal brains better. And this may sound utopian or fanciful, but really we’ve been doing this for a while now. The use of caffeine is just one example–and for all the incredible reasons we discussed last week (improving attention, facilitating learning, increasing strength and endurance among athletes, etc.).
But it’s more complicated than that. In 2002, as an example, a trial was conducted among Navy SEALs in which trainees were randomized to caffeine or placebo. The outcome results were obvious. As you would expect, SEALs who received caffeine performed better on cognitive assessments testing psychomotor vigilance—which is defined as the ability to recognize and respond to rare but critical stimuli. Caffeine also improved reaction time and memory without adverse consequences or impairment in marksmanship—a military task that can be affected by the tremor induced by caffeine. And even waaaay before 2002, pilots and other military personnel had been receiving stimulants (basically “PRN”). These “go pills” kept pilots awake on long missions and may have even improved the survival of pilots and ground troops when inattention and lethargy could lead to capture or death.
Ok, that’s awesome. But does that make “cosmetic neurology” ethical? This is an extremely murky issue, and one in which Dr. Chatterjee explains very well in his book, Neuroethics in Practice . Basically there are 4 major ethical dilemmas to implementing this type of practice:
- Safety. Do the risks of pharmacologic side effects, drug interactions, addictive potential, and long-term consequences outweigh the benefits of psychopharmacologic agents?
- Character. Does the use of these drugs alter our personality and behaviors such that we are no longer ourselves?
- Distributive justice. Will these mind enhancers, which presumably cost money, be available only to those with money, thereby widening the gap between classes in society?
- Coercion. Knowing that these substances may improve performance, could they be forced into certain occupational domains like pilots and military personnel? And where does this stop? Could lawyers, doctors, chefs, and bus drivers also be mandated to use these drugs?
Perhaps one of the most controversial moments of the use of “go pills” in the military is the Tarnac Farm Incident. It took place in 2002 during the War in Afghanistan where 2 American F-16 pilots were returning from a 10-hour night patrol mission. The pilots, Majors Harry Schmidt and William Umbach, of the US Air National Guard, descended upon a ground-based combat zone where Schmidt voiced concern that this force was attempting surface-to-air fire against the two pilots. This area near Kandahar, Afghanistan was known to have been occupied by Taliban forces recently, and the pilots had been briefed on this matter before their mission. Despite warnings from Umbach that the forces may have been “friendlies,” Schmidt felt he and Major Umbach were being fired upon and responded using lethal force. It was only seconds later that both pilots were informed that these ground troops were Canadians, and that they had been authorized to conduct a live-fire exercise in that area. Four were killed, and 8 were wounded in the friendly fire incident. In an official press briefing, Lieutenant General Michael Delong did not make any mention of stimulant use when outlining the root causes of the incident, although it was highly suspected.
Since then, the military has seen several ups and downs in the approval/disapproval of these drugs. The debate for these and other non-pharmacologic interventions is ongoing, and there is no doubt that this kind of dilemma—improving the alertness of people whose fatigue could result in lives lost—might spill into other occupational disciplines (Dr. Chatterjee’s concern with coercion). In Dr. Chatterjee’s 2004 paper, he poses the question, “Would you want resident [physicians] to take medications after nights on call that would make them less likely to make mistakes in caring for patients because of sleep deprivation?” If I were a patient, and if I knew that I had a 5% greater chance of surviving hospitalization if my doctor was taking a “go pill”, OF COURSE I WOULD WANT THEM TAKING GO PILLS! But if my daughter were getting B’s on her biology homework, and I knew that giving her caffeine would turn them into A’s, would I necessarily ask her to drink coffee in the morning? Honestly, I don’t really know. These are really interesting questions, and I don’t think I’ll ever know the best answer. But I’m glad you’re thinking about them too.
You can learn more about everything we discussed today in Dr. Chatterjee’s two books, Neuroethics in Practice (which specifically addresses cosmetic neurology), and The Aesthetic Brain. Definitely good reads. And just think, if you read them with an espresso in hand, maybe you’ll learn something.
The content in this episode was vetted and approved by Anjan Chatterjee.
- Chatterjee A. Cosmetic neurology: The controversy over enhancing movement, mentation, and mood. Neurology. 2004;63:968-974
- Lieberman HR, Tharion WJ, Shukitt-Hale B, Speckman KL, Tulley R. Effects of caffeine, sleep loss, and stress on cognitive performance and mood during u.S. Navy seal training. Sea-air-land. Psychopharmacology. 2002;164:250-261