Tulsa World - August 12, 2004
Drugs Could Help Healthy People Boost Brainpower
You can rub Rogaine into your scalp to try to regain the hairline of your youth.
You can inject Botox into your forehead to smooth time's inroads, at least
temporarily. And, some scientists predict, you'll eventually be able to
pop a pill to freshen up the inside of your head, as well.
Thanks to recent strides in understanding how the brain works, it's only
a matter of time before medications specifically designed to improve mental
ability, or cognition, hit the market.
"The hallmark of these drugs is they don't create more memory,"
says John Tallman, CEO of Helicon Therapeutics of Farmingdale, N.Y., which
plans to begin testing its most promising brain drug in humans later this
year. "What these drugs really do is enhance the conversion process
of short-term to long-term memories."
Besides Helicon (for the mountain in Greek mythology where Apollo played
with the Muses), companies with such evocative names as Sention (apparently
a play on sentient, which means conscious or aware) and Memory Pharmaceuticals
are focusing on medications to treat patients whose brains are impaired
by disease or injury.
But the real market for such drugs might be healthy people who would
simply like to be a little quicker on the uptake.
Americans already spend $1 billion a year on dietary supplements claiming
to boost brainpower, even though there's little evidence that they work,
notes an article in the May issue of Nature Reviews Neuroscience. From
vitamin B12 to ginkgo biloba to "BrainQUICKEN" capsules -- "used
by top students at every Ivy League institution," according to the
product's Web site -- health-food stores and the Internet are rife with
products promising to enhance memory and learning.
Once the Food and Drug Administration allows a drug on the market to
treat, say, Alzheimer's disease, doctors could prescribe it "off-
label" for any purpose they like, including sharpening healthy minds
dulled by age or fatigue. And Internet shoppers would have their pick
of Web sites selling the drugs without even requiring a prescription.
To an extent, it's already happening. Though it's not clear how widespread
the practice is, high school and college students who don't have attention
deficit-hyperactivity disorder are taking Ritalin to help cram for exams.
Scientists have been known to pop Provigil, approved only to treat narcolepsy,
to increase alertness before speaking at professional meetings.
"People are already using a wide range of medical drugs to improve
their own performance," says Sention CEO Randall Carpenter, citing
Viagra's popularity with men who don't have erectile dysfunction as one
example. "It's almost impossible to stop people if they want to do
that."
On its Web site, Memory Pharmaceuticals of Montvale, N.J., acknowledges
that the potential market for its compounds, one of which is being tested
in humans, might extend far beyond patients with Alzheimer's and other
memory-robbing ailments. Though 37 million people worldwide have Alzheimer's
disease, the company says, more than 180 million -- or half of all people
over 65 -- are experiencing "age-associated cognitive decline."
"This decline is not clearly linked to a definable disease condition
and may be a 'normal' part of the process," the company says on its
Web site.
Memory Pharmaceuticals raised $35.4 million in its initial public offering
this year. President and chief science officer Axel Unterbeck says the
medical need alone "would be worth the entire investment" in
developing drugs to improve cognition. But he acknowledges that healthy
people will seek them out. "This indeed will be a very interesting
trend to look at," he says.
Tallman says older people are "very, very concerned about their
memories, because their memories are what make them human. No honest person
would ever say to you, 'I would never take the drugs.' "
Still, there's no guarantee drugs that work in people impaired by disease
also would benefit healthy people who would simply like to recall names
more quickly.
For example, first-generation Alzheimer's drugs Cognex and Arricept block
the breakdown of acetylcholine, one type of neurotransmitter, a substance
that enables nerve cells to communicate with each other. Alzheimer's patients'
have a shortage of acetylcholine, but people with normal brains do not,
so it's not clear what effect the drugs would have on them, says Steven
Rose, a director of the Brain and Behavioural Research Group at the Open
University in England.
And even if such drugs did enhance cognition in average individuals,
Tallman says, "highly functioning people would have probably limited
benefit."
Duke University researchers have found that the nicotine patch, approved
only to help smokers break the habit, boosts brain function in people
with mild to moderate Alzheimer's disease and adults with ADHD and schizophrenia.
But earlier tests in healthy volunteers found only a modest effect, says
Edward Levin, a professor in Duke's psychiatry and behavioral science
department.
Even in Alzheimer's patients, Levin cautions, the nicotine patch's benefits
aren't worth the risks. Side effects include an elevated heart rate and
blood pressure, sleep disturbances, nausea and dizziness.
The nicotine patch points out another obstacle toward developing "smart
drugs" for normal brains. "It has to be as safe as water,"
Carpenter says. "That's a very daunting task that few people want
to try to accomplish."
"The issue is: How do you specifically alter such a complex organ
as the brain without affecting anything else?" asks biologist Robert
Gerlai, a memory researcher at the University of Hawaii. "The brain
doesn't just work on learning and memory. It has all kinds of other functions."
Just who should get a boost?
James McGaugh, director of the Center for the Neurobiology of Learning
and Memory at the University of California-Irvine, bristles at the notion
of people with normal brains taking medication to boost brainpower. After
all, he says, no one regards the slowing down of the body with age as
a medical condition.
"Does Michael Jordan have age-related physical impairment?"
McGaugh asks. Just as Jordan may not be as agile on the basketball court
as he used to be, McGaugh says, there's strong evidence that memory processing
slows with age. Any middle-aged person who has grasped for a word or a
name can vouch for that. But "it's only critical if you want to appear
on "Jeopardy!," McGaugh says.
Things get even more complicated if one considers the possibility of
enhancing memory and learning in young people, McGaugh says.
For example, he says, if doctors took such a drug throughout their training,
would they be required to continue taking it as a condition of their license
to practice medicine? And what about children? McGaugh asks. "Are
you going to put the pill in their lunchbox when they go off to school?"
And, he asks, what if you can't afford to?
Nature Reviews Neuroscience published an article about the ethics of
enhancing mental performance. The authors, a panel of neuroscientists
and ethicists, suggest that "when we improve our productivity by
taking a pill, we might also be undermining the value and dignity of hard
work, medicalizing human effort" and labeling a normal attention
span abnormal.
But researcher Mark Bear, a Massachusetts Institute of Technology neuroscientist,
says it's unlikely that brain-boosting drugs will have much effect on
young, healthy individuals whose brains have not yet begun to slow down.
"I think it's pretty clear in animal studies that treatments that
will enhance memory in aged rats often will fail in young rats,"
says Bear, co-founder of Sention, a Providence, R.I., company that is
testing two experimental drugs for Alzheimer's and other memory- robbing
ailments in volunteers.
To Bear, taking a drug to counteract aging's effect on the brain isn't
much different from wearing bifocals to compensate for aging vision.
Or maybe "smart drugs" are more analogous to Botox than to
bifocals, another example of "the baby-boom generation wanting to
maintain a youthful quality of life right into old age," says Bear,
who, at 46, falls smack-dab in the middle of the boomer generation. "We
really are not accepting age gracefully."
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