Monday, May 31, 2010
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh. You're listening to These Days on KPBS. People have been taking pills to treat physical problems for many years. It's only been in the past 20 years or so that pills and prescriptions for emotional and mental conditions have become widespread. Hyperactive children take pills to improve their focus in schools, adults take pills to correct chemical imbalances that cause depression. Now, it turns out some of those pharmaceuticals and others in the research pipeline can do remarkable things for healthy people. They can increase alertness and focus to such a degree, they are being called ‘smart drugs.’ It's estimated that up to 16% of college students now use some form of smart drug to enhance their performance on tests or interviews. Today, as part of our monthly series on science and ethics, we want to explore the social, medical and ethical implications of the use of smart drugs. And my guests are Dr. George Koob, professor in the Department of Neuropharmacology at the Scripps Research Institute. Dr. Koob, welcome to These Days.
DR. GEORGE KOOB (Professor of Neuropharmacology, Scripps Research Institute): Thank you, Maureen.
CAVANAUGH: And Tricia Bertram Gallant, academic integrity coordinator for UC San Diego. Tricia, good morning.
TRICIA BERTRAM GALLANT (Academic Integrity Coordinator, University of California San Diego): Morning.
CAVANAUGH: So, Dr. Koob, what drugs are people taking to make them smarter?
DR. KOOB: Well, they fall into a number of categories but the ones that are probably most prevalent are the what we call them, the business indirects and pathomimetics, which are drugs like methylphenidate or Ritalin, and this is actually a drug that has a lot of similarities to amphetamines, and there are amphetamines, that’s Adderall, and then there is a new drug, relatively new, called Modafinil, which is Provigil, which is used for treatment of narcolepsy. So these are the drugs that have act – you know, very prominent stimulant-like effects. And so those are the ones that tend to get diverted because actually, these drugs have their best effects in situations of fatigue and exhaustion where people need something to sustain performance and so you don’t see a great benefit in individuals that are well rested, appropriately fed and have good nutrition and are generally good exercise and sleep well. You’re not going to see nearly as dramatic effects of a drug like methylphenidate as you’re going to see in someone who’s exhausted and trying to pull all-nighters to finish term papers before the end of the term or something of that nature.
CAVANAUGH: But to be clear, these are healthy people, these are people who have not been prescribed these drugs.
DR. KOOB: Right.
CAVANAUGH: And, again, Doctor, what is it that they – what kind of benefits do people get or do they think they get from taking these drugs?
DR. KOOB: Well, again, they’re stimulants so they release chemicals in your brain called dopamine and norepinephrine, which facilitate function of a large part of your basal forebrain, notably a area called the frontal cortex, which is involved in executive function and attention. And they also, through their action on dopamine, help focus behavior. So one of the major benefits of methylphenidate is an increased focusing of attention and so instead of being distracted by everything going on, TV or cell phones or text messages or Twittering or whatever, they’re going to, under the influence of methylphenidate, they will focus in on the task at hand and finish the term paper.
CAVANAUGH: And when you talk about drugs like Adderall and Ritalin, they’re usually prescribed for people who have attention deficit disorder. How do they work for those people, the people who’ve actually been prescribed the drugs?
DR. KOOB: Well, exactly the same way. So they, people with attentional deficit hyperactivity disorder, by definition have a problem with focusing of attention so that the purpose of these drugs is to focus their attention, so that’s exactly what they do. But they’ll focus everybody’s attention if you’re distracted because you’re overworked, overtired, strung out, so forth, in those situations. So that’s where it gets into the interesting area. Well, what about air controllers? What about individuals on shift work? What about truck drivers who have to do long hauls? When is it appropriate to prescribe these drugs for healthy individuals but who are under situations where their cognitive performance is taxed?
CAVANAUGH: Along with focus, a lot of people would like to take some sort of medication to improve their memory. Do these drugs improve memory? Or is there something else that people are taking now, some other smart formulation to improve memory?
DR. KOOB: Well, these drugs will help improve some types of memory, mainly probably through the attentional mechanism. Certainly, I think, again, if you’re fatigued, your memory is going to fail. If you’re taking a stimulant like amphetamines orally, it’s going to facilitate your ability to remember things. There are other drugs that have been developed. They’re not nearly as effective, all right. They’re drugs that are used for treatment of Alzheimer’s, which are acetylcholinesterase inhibitors, they boost your brain’s acetylcholine, and they work in Alzheimer’s patients, particularly early stages of Alzheimer’s and have been a great benefit. They can add a year or more of cognitive performance to a subject. But in a normal individual, the effects are very small and there are some significant side effects to those drugs. The same thing happens with some of these new tropics. They’re called n-o-o-t-r-i-t-o-p-i-c-s (sic) [nootropics]. They’ve been around for 50 years. They have very mild effects. I mean, in animal studies and in humans where individuals are compromised then they show effects but in an average person, they’re pretty mild. So, I mean, that’s the holy grail of cognitive enhancement is to find a drug that has minimal side effects but also could improve, you know, memory performance. And it really doesn’t, to my knowledge, exist at this point.
CAVANAUGH: Mark in San Diego is on the line. Hi, Mark. Mark, are you there? Oh, well we’ll go back and maybe Mark’s thinking about it. Tricia, you are the integrity coordinator…
CAVANAUGH: …for UC San Diego. And do you know people taking smart drugs? Is this something that’s come to your attention?
GALLANT: It hasn’t come to my attention yet but it wouldn’t surprise me. Students at UCSD in particular are high-achieving students.
GALLANT: The average GPA of our entering freshmen this year was above 4.0, which means our average entering student is better than perfect. So if they come to university with this notion of being a better than perfect student, they are pretty willing to do what it takes to at least maintain a high GPA, especially because a lot of them want to go on to medical school or other postgraduate schools so, you know, it wouldn’t surprise me. And the quarter system, I think, might enhance that tiredness, the overwork, the all-nighters that have to be pulled when you’re taking a full course load in 10 weeks.
CAVANAUGH: Well, what are you seeing? If you’re not seeing the smart drugs quite yet, what are the things that come to your attention because of that pressure?
GALLANT: Well, and I’m not seeing smart drugs because we wouldn’t know they’re taking them…
GALLANT: …you know, necessarily. It’s not – it’s something that’s done under the radar, so, you know, what I get reported to my office is pretty old-fashioned stuff, stashing notes in the bathroom stall so that you can access them during the exam.
GALLANT: Having cheat sheets in the exam. Talking on, you know, getting answers from the cell phone, to get a bit more technologically advanced. Plagiarism and crazy – but the stories I hear from students, because I see students after they’ve violated the policy, the stories I hear are I was stressed, I didn’t have enough time to it all, it was 3:00 a.m., I was trying to finish a paper, I ended up plagiarizing three of the ten pages. They lose their minds. You know, if you talk to them, it sounds like they’ve just lost all rational decision-making at that moment and they’re focused on the end goal, which is getting the assignment in and hopefully getting an A or a B, at the worst, on the assignment.
CAVANAUGH: Yeah. Well, let me ask you something, in fact, let me ask you both this. Do you think that if, indeed, it came to your – the school’s attention that there was someone who was taking Ritalin and hadn’t been prescribed it in order to enhance focus, would that be an ethics problem, would it be an integrity problem for your office?
GALLANT: It would if they were taking them illegally, right, if it wasn’t prescribed to them, certainly. But our first concern, I think, would be to the health of the student, not only their physical health but their mental health, and getting them in to see counselors. So we probably deal with it more from a health-wellness perspective than a ‘you’ve broken the rules’ type of perspective because there’s, you know, there’s nothing in our rules and our code of conduct that says you can’t take cognitive enhancers. But, of course, if they were taking them illegally, that would be a legal issue but from an ethical perspective, we haven’t crossed that bridge yet.
CAVANAUGH: That’s fascinating. So, Dr. Koob, there’s nothing in the rules or regulations about specifically taking cognitive enhancing drugs. Do you think this should be considered wrong to do? First…
DR. KOOB: Well, that’s a tough – that’s a tough question. I mean, these are drugs that are prescribed to individuals for treatment of attentional deficit hyperactivity disorder so then they’re diverted. So that, in a sense, is illegal. Of course, you know, in our society that’s going to not nearly be considered as strong an indictment as doing crack cocaine. But, in fact, in a sense, on a legal level…
DR. KOOB: …it’s the illegal use of a drug. The – Again, to emphasize what Tricia said, the problem is with the health aspects. These drugs in the psycho-stimulant class, Adderall and methylphenidate have serious side effects or can have serious side effects and in individuals with compromised cardiovascular systems where they have not been checked out by a physician, then there’s a danger. They could have a serious cardiac event. And, in fact, you see this in, you know, the chap in spring training who died from taking one of these weight control medications that turned out to be very similar its effects on the cardiovascular system as these smart drugs. You know, under situations of – in a dance situation where it’s hot and everyone’s exercising extremely by dancing vigorously or in a sporting situation where it suddenly becomes hot and humid, if you don’t know that you have the vulnerability to your cardiovascular system, these drugs can be very dangerous. So that’s probably where the concern comes in. I think as a society we have to make some ethical decisions and that’s what the purpose of some of these discussions are about, well, then if these drugs are going to be used as cognitive enhancers, then there needs to be some rules about who prescribes them. Are health professionals going to get involved? Presumably, yes. And then what do you do – what do you do about the SAT exam?
CAVANAUGH: Umm-hmm. Yes.
DR. KOOB: Are they allowed to take methylphenidate before they take the exam or not? And if one student is allowed to do it, what about the other students?
DR. KOOB: And so you get into these really ethical things that we have not really broached. Except on “Boston Legal,” these are not things that we’ve broached in this country.
CAVANAUGH: And, Tricia, just to round this out, past the idea of the legality of using a prescription drug illegally, kids use caffeine pills and Red Bull…
CAVANAUGH: …before a test to try to get that edge.
CAVANAUGH: Do you think it – this pharmaceutical thing is taking it an extra step?
GALLANT: Yeah, and you’re probably kind of asking the wrong person, too, because I – You know, I was laughing when we were talking earlier about how this doesn’t work on relatively healthy people…
GALLANT: …people who get sleep, people who do exercise, yoga. You know, I was joking when I was telling some friends about coming on here, we were joking about, well, why don’t people just calm down, go to yoga, take a break. And, you know, a lot of the stress we put on ourselves is self-imposed, right. So students don’t have to maintain a perfect GPA in university so the fact that they want to try is not necessary. So this is not a life and death situation like maybe if a pilot has to take it to stay awake because he’s been flying for 24 hours. It, you know, it’s a very different situation. My concern more is the ethics of the – our society that have – or the educational system that have led to this. And if we tread down the road of should we be allowing cognitive enhancers before the SAT or what have you, without considering stepping back and saying why are students feeling like they need to take these? What is it about our system? Does our system give us – create the ends that we want or are we heading down a different path that, yes, we would need cogs for but is that the path we want to be going down? And that, to me, is where I feel like our discussion should be happening.
CAVANAUGH: That’s Tricia Bertram Gallant. She’s academic integrity coordinator for UC San Diego. And my guest also is Dr. George Koob from the Scripps Research Institute. We’re talking about smart drugs. We have to take a short break. You’re listening to These Days on KPBS.
CAVANAUGH: I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. And we are talking about the use of cognitive enhancing drugs, what some people are calling smart drugs, how they affect student performance and whether or not they will be part of our lives in the future. We’re taking your calls at 1-888-895-5727. My guests are Dr. George Koob. He’s professor in the Department of Neuropharmacology at the Scripps Research Institute. And Tricia Bertram Gallant, academic integrity coordinator for UC San Diego. Let’s go right to the phones because there are a lot of people who want to get in on this discussion. Chevone (sp) in San Diego is on the line. Good morning, Chevone.
CHEVONE (Caller, San Diego): Good morning. I just wanted to say that I’m an honors student and I never found a reason to take, quote, smart drugs. I don’t think that it’s necessarily a good thing to pressure ourselves to such a point where we think we have to be perfect. I think it’s just a matter of making sacrifices in our lives in order to refine our concentration naturally and not sacrifice our longterm chemical health in our bodies as well as mental health in our mind, I just don’t – I think that’s very dangerous. And because of that, I wouldn’t agree and I’d actually call those dumb drugs because I just think that people feel they need it because we live in such a competitive society but we really have to be able to choose what we want to do in terms of our priorities and do that in a good way so that we’re not dependent on anything else for our success.
CAVANAUGH: Chevone, thank you very much for that call. Let’s take another call now. Ellen in – at UCSD. Hi, Ellen.
ELLEN (Caller, UCSD): Hi. Can you hear me?
CAVANAUGH: Yes. Certainly can. Hello? Okay, we’ll try back with Ellen in a while. I thought – I was thinking while Chevone was on the phone that, Dr. Koob, her rationale would work except if the person sitting next to you taking the SAT is on one of these cognitive enhancing drugs. That’s really where it comes down to the wire, isn’t it?
GALLANT: Well, George is pointing at me, so… Well, I guess but her point was very good. It’s – The world is competitive but it – you choose what you want to compete in. I was just talking with a group of students in a physics class yesterday about their purpose of being there. If you’re always competing with other people, right, I don’t want to get a good score on the SAT to demonstrate how much I’ve learned and how much knowledge I have, but I want to get it to be better than other people to get that prime spot in Harvard or UCSD or what have you. And the joy in, I think, what our caller was talking about was the joy in trying to master that stuff on your own with your own abilities and with your own ability to function, and being proud of the accomplishments that you make regardless of what the other people around you are doing. Now, is it fair in an SAT type situation? No. But I have my own doubts about the validity and usefulness of SATs anyways, so, you know, that’s why I say we step back again and say, look, is this where we want to be going down? Is SAT really measuring what it is we need in the 21st century when it comes to knowledge and wisdom.
CAVANAUGH: Let’s try to take another call. We’ll go to Matthew in Mira Mesa. Hi, Matthew.
MATTHEW (Caller, Mira Mesa): Hello?
CAVANAUGH: Hi, Matthew?
MATTHEW: Hi, how you doing?
CAVANAUGH: Just great. What’s…
MATTHEW: How can I help you?
CAVANAUGH: No, how can we help you?
MATTHEW: No, I was going to – As a young child, I took Ritalin. And I’m older now, I’m 40, and I do come to find out that as I’ve gotten older, I had gotten to the point where I guess you could say grew out of the Ritalin. But just recently within the last three years I had taken a class and I worked in the electronics high tech area and I found it really hard at times to concentrate, especially on test day. Even though I could fly through this stuff, the problems that I was having were directly related to remembering things and then just being shuffled. And I’m wondering, talking about the Ritalin, of course, if I should be reevaluated again and see if I could take the Ritalin?
CAVANAUGH: Well, thank you, Matthew. Dr. Koob, there is such a thing as adult attention deficit disorder, isn’t there?
DR. KOOB: Oh, absolutely. And, in general, in fact the definition of adult ADHD is that you have to have had ADHD as a child.
CAVANAUGH: I see. I see.
DR. KOOB: So it would be a wise thing to possibly get reevaluated. There are plenty of adults who do find that continuing some mild form of treatment is beneficial in certain situations. There are other drugs that have been used now in adults that are less stimulant-like as well, so atomoxetine, for example, is a newer drug that seems to have some efficacy in adult ADHD, so that’s another thing you might want to check out.
CAVANAUGH: Now when we were talking before, Dr. Koob, about the use of these drugs on healthy people who don’t get prescriptions for them, you said that the – you know, if you’re not stressed out, if you’re not jet lagged, they don’t really have much effect on you. But when we start to get older, in middle age, when it’s harder to, you know, get focused on something, is that the standard that these drugs, instead of students with – is that the time that these drugs might help people who don’t have attention deficit disorder or anything, any diagnosed problem like that?
DR. KOOB: Well, yeah, sure. And that’s, of course, another one of the areas where the ethics are going to have to catch up with the pharmacology. But, again, the problem – one of the problems is going to be in adults who would, say, illicitly use methylphenidate or take their kids’ ADHD medicine occasionally. What about the vulnerability for cardiovascular events and side effects? These are the things that are not being screened or monitored by a health professional. So I think what we, as society, have to decide is the cost benefit of using these drugs in situations where there is no, you know, diagnosed…
DR. KOOB: …disorder and how should they be prescribed and what are the conditions and so forth. And those things can be worked out but I think it should be done with, you know, the contribution of the professionals involved, which would involve everything from medicine to psychiatry to counselors and so forth.
CAVANAUGH: Let’s take another call from – Oh, this is Ben in Poway. Good morning, Ben.
BEN (Caller, Poway): Good morning. When I was a college student, I took some medicines to stay awake and I read but I learned nothing and the next day when it wore off, I was very, very tired. So does one really learn even though one is awake?
CAVANAUGH: Well, either one of you would take that question.
DR. KOOB: Well, yes and no. And, again, you point up an interesting issue with some of these drugs that I wanted to mention and so I thank you for that, which is there’s no free ride when it comes to the chemicals in your brain. So if you take methylphenidate to, let’s say, for example, or better yet amphetamine, you take amphetamine for all-nighters and you careen through getting your term papers in and so forth, at the end of it you are going to crash. There is going to be a period when you’re going to be really tired and wiped out because there is a rebound sleepiness and fatigue and lack of motivation that’s going to follow any extended use of those kind of drugs. As far as why you didn’t remember, it depends on what the drug is. If it was marijuana to keep you going, then you probably wouldn’t have remembered anything that you learned during that period. I would think that with the stimulants you would probably remember. Generally with stimulants, they – you retain the memory of what transpired during the period that you’ve taken it but it very much depends on what the drug was and the circumstances.
GALLANT: Well, and it’s not going to help you perhaps if the test ended up testing you on something different. So the drugs generally improve attention and memory but if the test is on problem solving and critical thinking and it’s really forcing you to apply what you were supposed to memorize, then just taking the drug to improve your memory’s not going to help you on the test.
CAVANAUGH: Another call now, Dakota in San Diego. Good morning, Dakota.
DAKOTA (Caller, San Diego): Hello, how are you?
CAVANAUGH: Just great.
DAKOTA: I just wanted to call in as someone who has, I guess you could say, illegally abused Adderall without being technically diagnosed and I’ve probably used it a couple of times now when I had to cram for an exam or do a long paper. And I found the results extremely pleasing, to the point where it frightened me to not want to use it again. I could see it becoming something that would be really habit-forming. And from my experience being in college and having lots of friends in school, it – I find the Adderall and Ritalin is used everywhere. Everyone I know has – is using it, and to hear Tricia say that it hasn’t really been addressed to her as a problem is kind of surprising because I kind of see Adderall as the steroids…
DAKOTA: …of college. So I’m just kind of wondering, as someone who feels against it, how it’s fair. I feel like I’m at an unfair disadvantage to not be using these kind of super human study drugs that’s kind of raised the bar for the rest of us.
CAVANAUGH: Let me just ask you a question, Dakota. Did you have any side effects?
DAKOTA: Not really. I mean, I took a very, very small amount and I was able to do a lot of work, and I timed it so I was doing it in the morning and wasn’t staying up all night. And, no, actually – I mean, I felt a little bit jittery but for the most part I felt okay about it. And I know lots of people that have wanted Adderall and they’ve just gone to doctors and said, oh, I could get Adderall any time, like even if they don’t technically have the disorder, they – doctors are just giving prescriptions away. It’s almost like they, well, the pharmaceutical companies obviously want to make money so, I mean, we all know how that whole thing works, so it feels like everyone’s a little too eager to medicate. So…
CAVANAUGH: Well, thank you for…
DAKOTA: …I don’t know…
CAVANAUGH: Thank you so much for the call, Dakota. And I’m wondering, Tricia, this is maybe a subculture that hasn’t risen up to your office yet.
GALLANT: Right. Well, we generally know that people keep behaviors that they know aren’t generally acceptable…
GALLANT: …under the radar. And so that tells us something. If people aren’t being open about it, it tells us they know it’s inherently maybe wrong or unethical. What concerns me is, though, that the student population knows about it, as Dakota just mentioned. We all know everybody’s doing it or a lot of people are doing it and so it’s okay to let your friends know, and that’s where we start to realize that there’s a gap between the student subculture and maybe the institutional culture and that’s when we’re going to start to see a lot of trouble because if we turn a blind eye to it and just say it’s not our problem or it hasn’t been reported so we don’t have to deal with it, then we’re probably asking for some bigger, negative effects than if we just start dealing with it now and start having frank, open conversations with students about it.
CAVANAUGH: Since you are the academic integrity…
CAVANAUGH: …coordinator there, if we can just move aside the idea that it is illegal to…
CAVANAUGH: …use a prescription drug if it’s not been prescribed to you or for another reason than for what it’s for.
CAVANAUGH: Do you find that this is an ethical problem that schools are going to have to grapple with?
GALLANT: Definitely, I think so. I mean, Dakota mentioned it, you know, when she’s not taking it she feels like she’s on a – in an – she has an unfair advantage – or, they have an unfair advantage, the people that are taking it in tests and, you know, in other avenues. So that does become an issue although, you know, some might argue that the taking of the drugs levels the playing field so that people who don’t have the natural ability to do it are now leveling the playing field with the people that do have the natural ability.
GALLANT: And so it is – it’s not necessarily – if we take the legal issue out and the fact that doctors are giving it to people who don’t need it and so on, it is a right versus right dilemma. You know, is it right for students to want to better their cognition? Of course. That’s partly why they’re in school. Is it right for us to say, whoa, you know, that’s maybe not the best way to do it and is that the path we want to go down? And so we need to have those kinds of conversations. It sounds like we also may need to do some social norming education. If the perception by – of students is that everybody else is doing it so I’d better do it, too, we better actually find out is everybody else doing it or is it such a small but vocal percentage that are doing it that makes it seem like it’s everybody? And if students knew that other people weren’t doing it, then maybe they wouldn’t do it either.
CAVANAUGH: Let’s take another call right now. Debra is in San Diego. Good morning, Debra. Oh, I’m sorry. Bruce is in the South Bay. Good morning, Bruce.
BRUCE (Caller, South Bay): Yeah, hi, good morning. I’d be interested in the doctor’s opinion. I’m looking at a box of herbal tea by a company called Traditional Medicinals. It’s called Think-O2. It’s kind of nine different herbs, ginko, gotu kola, sage, lemon balm, rosemary and so forth. So I’m wondering, what are some of the options that the doctor and the other guest find commonly acceptable for concentration?
CAVANAUGH: Thank you, Bruce.
DR. KOOB: Well, I use caffeine, so I’ll be very up front about it and glasnost or whatever it is. I – The herbal medications like ginko in large quantities has some beneficial effects. It increases, you know, oxygen utilization in the brain and there’s possibly some mild effects on some of the neurotransmitters we’ve been talking about. A lot of the things in these herbal concoctions, though, unfortunately, are not in large enough quantities to have any major effect. They’re pretty homeopathic. I think you’re probably better off in many cases just having adequate nutrition and good sleep and good exercise and that will go far, you know, far further in maintaining good cognitive performance than some of the herbal preparations. Now, you know, having said that, there are a number of things out there that I know young people take and if you look in them very carefully, you’ll see that most of them have caffeine in them, so…
DR. KOOB: …caffeine is pretty much the common element that provides the stimulant aspect to anything from Red Bull on down. And there are some fairly significant quantities of caffeine in those preparations, and that’s probably why they do have at least the sensation of allaying fatigue and improved performance. And caffeine is a stimulant and it also can have some side effects if you start doing the ten coffee cups a day. But if you’re moderate with its usage, generally, you know, below three cups – coffee cup equivalents a day, it’s generally considered relatively safe. There are some who would argue there are problems there and others who would argue that it’s very beneficial to a number of bodily functions. So that’s my take on some of these things that are out there.
CAVANAUGH: We are talking about smart drugs, the effort to cognitively enhance ourselves by taking all forms of stimulants and so forth but most especially what some would call the misuse of prescription drugs to enhance the cognitive activity for students and sometimes for older people as well. We will continue our discussion when These Days continues in a moment.
CAVANAUGH: I'm Maureen Cavanaugh. You're listening to These Days on KPBS. We’re talking about smart drugs. My guests are Tricia Bertram Gallant, academic integrity coordinator for UC San Diego, and Dr. George Koob, professor in the Department of Neuropharmacology at Scripps Research Institute. And, Tricia, I want to ask you, you know, all this talk about using everything from caffeine to Adderall to try to focus attention on getting the good grade and so forth…
CAVANAUGH: …how has our society’s view changed over time regarding school performance and testing?
GALLANT: Well, it hasn’t really. I mean, we’re still running our educational system as if it was the 18th century, generally speaking. You know, it’s a testing environment. We’re still depending on memorization. You know, we have the internet now. I can look something up in five seconds on my cell phone. So, you know, is memorization really what we should be focusing on in school or should we be focusing on the critical thinking and problem solving so that I know what to do with that information, or if I know if that information’s legitimate? And so that’s part of the problem. Cheating, drug use, we were talking during the break, is endemic to the school system. It’s not a new thing and we shouldn’t fool ourselves by thinking it’s a new thing. However, you know, if we – I think the problem is that we’re not taking a good look at ourselves and saying, again, is this where we want to go? Is this the right educational system for the 21st century, which is much more complex and fast-paced than the 18th century was, and perhaps it’s time to move beyond the blackboard and beyond the memorization tests to new methods and new learning.
CAVANAUGH: Pat in Solana Beach is on the line. Good morning, Pat.
PAT (Caller, Solana Beach): Yes, thank you. Are you there?
CAVANAUGH: Yes, indeed.
PAT: Oh, thank you for taking my call. First, I’d like to applaud the student who called in and explained that she has, indeed, taken Adderall to improve her academic performance. And secondly, to Tricia, yes, it is below the radar screen because the university and all universities, and I’m certainly not singling out UCSD, would like it remain under…
PAT: …the radar screen. But, thirdly, and most importantly, we need to address why. What is the reason why are these students taking Adderall to improve their performance? What is it that they feel they have to do that? Not just have the drugs available—you can always get anything you want, any kind of drug you want—but, like Tricia said, what is the reasoning? Do we need to move away from that, you know, burning the midnight oil, staying up all night because there’s too much workload on the students? And the workload that they’re getting, is it really necessary?
PAT: But just give them what is necessary.
CAVANAUGH: Thank you.
PAT: Thank you.
CAVANAUGH: Thank you, Pat, for that call. I wonder what role the No Child Left Behind Act had on our attitudes about performance?
GALLANT: Oh, you had to go there, didn’t you? Well, it has increased that high stakes environment. There have been numerous reports of not just students cheating but teachers and school administrators and parents cheating to improve, quote, unquote, the performance of their schools because they lose funding if they don’t. So I’ve been told by my students who took a lot of AP classes that they would have—and these were students from different high schools—that they would get a half hour cheat time at the end of every AP exam. So the teacher would say, okay, I’m leaving the room now, go ahead and talk. And that was standard, and, again, they were from different high schools. We’re had reports of teachers giving students the answers during tests, of teachers and administrators changing the scores after the tests had been completed, tons of cases around the United States. So clearly that has accentuated this high stakes environment not just for the students anymore but for the teachers and the administrators as well. I was interviewing, in my research, I was at one elite university, and I was hearing stories about SAT prep classes being given to grade six students. Grade six students being put in SAT prep classes by their parents or whomever to prepare. And now ETS, the testing service, has come up with a ‘are you ready for college’ type of exam that is being given to middle schoolers. Are you ready for college? It’s absolutely insane.
CAVANAUGH: We actually have a middle school – a question about a middle school…
CAVANAUGH: …on the line. Steve in San Diego. Good morning, Steve.
STEVE (Caller, San Diego): Hey, good morning, folks. I wanted to shout out to Dakota for saying what she did, and I didn’t know if you guys picked up really where she left off, which is this is much bigger than I thought. I have a new child who came to live with us. He’s now in the 8th grade. And since I’ve been involved in his school, I found out that this is actually rampant…
STEVE: …in the middle grade, middle school. We have – everyone’s wanting to outperform and going into high school, and where Dr. George has me really alarmed is that the children who are doing this and I really – and I’ve asked them and they said, yeah, they’re doing it—is—are the athletes, the ones that are concerned about not being able to play sports in high school because of their grades so they want to do this to keep their grades – not to get 4.0 but just to stay in sports. And what does that do to cardiovascular when you’re growing and in high school? That really concerns me but I’m seeing an epidemic of this and it’s not smart drugs. I don’t think that we should glorify it with that terminology. So…
CAVANAUGH: Well, thank you.
STEVE: …anyway I…
CAVANAUGH: Thank you very much for that call, Steve. There again, there’s that analogy between steroids and sports and these drugs in academic performance. Is it really the same?
DR. KOOB: Well, there’ve been a number of people who’ve argued no. There’s an article in Nature in 2004 where they’ve argued that that’s not the case. I think there are, as the speaker pointed out, some similarities where they – these things do cross over. And the other side effect of chronic use of stimulant drugs in a paper that just recently came out is that there’s actually over a three-year period of a growth retardation that’s manifest, so one inch a year – one inch over three years and about five pounds in the individuals who started methylphenidate, and these were ADHD treated children. So the drugs can have untoward effects even for individuals who are taking them to try and enhance academic performance, they may be in a sense shooting themselves in the foot by taking a drug that’s actually reducing their growth curve during a critical time point. So these are all the kind of issues that need to be discussed, is what are the effects on the developing brain that doesn’t need the drug? Obviously there are some developing brains that need the drug because they have a disorder. But, in contrast, those that don’t have a disorder, what are their – When I teach students, I mean, if you take a psychotropic drug as a normal individual, the only effects you’re going to see to a large extent are the side effects. So that’s the downside. Not always but to a large extent, the only effects you’re going to see for antidepressants, antipsychotic drugs, and to some extent the stimulant drugs, are the side effects and not so much the beneficial effects.
CAVANAUGH: Let’s take another call. Ellen at UCSD. Hi, Ellen.
ELLEN (Caller, UCSD): Hi. Thank you for taking my call again. My question concerns my mother who has just turned 75, is in great physical condition, does not have Alzheimer’s according to an evaluation but her memory is, you know, progressively being impaired pretty significantly. And it’s causing her a lot of emotional distress. She knows that she’s losing her memory and it’s pretty significant. She doesn’t know where she is in the morning. My dad has to tell her. And I – being that she’s in, you know, hopefully not the last chapter but the last few chapters of her life, I don’t think longterm effects are as much a concern nor the morality or ethics of it, and I’m wondering if you could speak briefly on the possible efficacy of one of these drugs to help her just enjoy the last, I hope, 20, 30 years of her life?
CAVANAUGH: Thank you so much for the call, Ellen. Dr. Koob.
DR. KOOB: Well, again, this is a situation where you should take her to her physician and openly discuss the issue. There are certainly drugs that can be used to help a person in that situation, some of the same drugs that are used for treating Alzheimer’s disease. But, again, you’re going to have to deal with the issue of the side effects and is your 75-year-old mother in the physical condition that would allow her to tolerate some of those effects. And so I would suggest that the place to go is directly to a physician who is – There are a number of physicians in San Diego who specialize in the elderly, in fact, and know a great deal about the elderly. There are clinical psychologists who specialize in the elderly. And these are the individuals that should advise you on those kind of things, and they will.
CAVANAUGH: Dr. Koob, I wonder if we could get right to the heart of the – of this ethical question. If there was a drug developed for memory retention and focus that was safe, had no long or short term side effects, was cheap, available over the counter, what would be wrong for students or adults or anyone taking it for performance enhancement?
DR. KOOB: Well, again, I think this is something Tricia could probably answer better because the issue comes down there then to this ethical concern: Are we changing personality? This is the kind of cosmetic pharmacology issue that comes up, and I don’t have an answer for it. You could argue that it’s definitely beneficial on the – You know, on one hand, you could say this is going to improve our society, improve our functioning enjoying our twilight years in better shape. Or you could argue as it filters down to younger people, well, that’s going to change their personality and maybe it’s going to substitute for the normal mechanisms that we use to increase motivation and excel at our jobs, and without these things – In other words, on the other side you could say, well, they’re crutches and we’re not going to develop the appropriate skills when we need them and, you know, as one person wrote, what are we going to do if the surgeon has to do an emergency operation and he doesn’t have his…
DR. KOOB: …smart drug that day? How can he even do it if he’s so used to performing only under the influence? And that, of course, is a gross exaggeration but those are the two sides of the picture. One would be why not help people live a happier, more fruitful life? The other would be, do we change their personality and somebody – some of us, ultimately, are going to have to discuss these issues and come to some conclusions and some recommendations.
CAVANAUGH: I – And I put the same question to you, can you see a day, Tricia, where it would be okay on a campus to just take some of these drugs?
GALLANT: Oh, I hope not. I mean, I think George just said something that was key, you know, it – what’s wrong with it? You know, do we want to have people happier and more functioning and I think that is why it’s a different conversation between someone who needs it, the 75-year-old mother, and a child. I don’t know that the students that are taking Addy as they call it, or any of the other drugs are happier than students that aren’t. I find generally that we can get that internal motivation, that desire to concentrate and focus when we are doing things that we want to be doing. And I just talk to so many students who are doing things, particular to school or school subjects because that’s what will make them money later or that’s what their parents told them they had to do or they wouldn’t finance their education. And so, of course, if you’re taking chemistry and you don’t – or biology because you’re going to go into med school but you don’t actually love it, you’re going to need drugs to keep going because you’re not motivated internally by the learning or by the subject or by the passion. I’m a little bit of an idealist but I think that, again, we’re going down the wrong road by assuming that taking these drugs for kids is going to make them happier.
CAVANAUGH: And you see it, apparently from all of your answers to my questions, as part of a much larger issue…
CAVANAUGH: …when it comes to the way the schools are just simply teaching and prioritizing these days.
GALLANT: Sure. I mean, isn’t anything like drug use or caffeine use or whatever we’re talking about, they’re all – they’re always symptoms of something else. You know, they’re never problems in and of themselves. And so, you know, and I think it was Ellen – no, it was the caller before that that said, you know, maybe universities don’t want to know students are doing this. And I think there’s a part of that that’s true partly because it’s so overwhelming to think about it. How do we deal with this? Because if the solution is changing the educational system, well, that’s not going to happen, certainly not overnight. So how do we handle it? It is a very complex problem with some serious ethical dimensions to it.
CAVANAUGH: As I was doing research for this, Dr. Koob, I came across a quote from philosopher Francis Fukuyama. He’s written about smart drugs and he says, the purpose of medicine is to heal the sick not turn healthy people into gods.
CAVANAUGH: Would you agree?
DR. KOOB: The purpose of medicine, yes, is to heal the sick. But I think we all, at some level, would aspire to immortality. So I think, you know, those are – that’s a separate – that’s a separate – I would split it into separate issues. I think, you know, medicines are definitely there to heal the sick and, you know, you can turn that on its head and the argument is, well, if the medicine works maybe the person was sick. So there are two twists to that part. In other words, there are plenty of individuals who are not properly diagnosed for ADHD, for bipolar disorder, for depression, that would benefit from being diagnosed. I mean, there was a – just in the news the other day that they think teenagers who are showing certain symptoms that, in general, are considered teenager symptoms, but some of them may actually be an underlying depression and there should be ways to screen for that.
CAVANAUGH: Well, we’ve got to end it there. I want to thank both my guests, Dr. George Koob professor in the Department of Neuropharmacology at the Scripps Research Institute, and Tricia Bertram Gallant, academic integrity coordinator for UC San Diego. Thanks, you both, for coming in today and speaking with us.
GALLANT: Thanks, Maureen.
CAVANAUGH: You’re listening to These Days on KPBS.