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The Case for Performance-Enhancing Drugs

The Olympics saw only one doping (and one pot!) bust. Opposition to chemical boosting remains high, but the inevitable trend will end in an embrace—oddly, led by "smart drugs."

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Brain doping: a genius idea? photo via

By Maia Szalavitz

08/08/12

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Anyone familiar with addiction is likely to be wary of brain-boosting drugs: we all know how chemicals that once seemed the answer to all our woes can become instead our biggest problem. But those of us who have also benefited from antidepressants and other mood-altering prescription drugs know, too, that the right drug in the right situation can be positively transformative—and that simply deciding that “all drugs are bad” can be counterproductive. 

As technology advances, we’re increasingly faced with new drug issues that force us to examine and re-examine our values and our chemically malleable selves. With each Olympic games, we face new types of doping and tricky issues like why high-altitude training, which boosts levels of red blood cells just like “blood doping” does, is acceptable, but using drugs to achieve the same result is not. (In the 2012 games, two athletes have so far been banned: a race-walker for the blood booster erythropoietin, a common doping drug; and a judo fighter for marijuana, which no one would call “performance enhancing,” in sports at least.) 

The camp that supports removing the ban on safe doping in sports does so based on several claims. These include: that they maintain a level playing field because all athletes have equal access to the boosters, that permitting enhancers would allow it to be monitored for safety and that certain performance-enhancing drugs, like steroids, blood boosters and growth hormones, mimick the body's natural processes.

Is implanting a gene already found in athletes who came by it naturally “cheating”?

Soon, undoubtedly, too, someone will select an embryo for in vitro fertilization (IVF) that has genes linked with athletic prowess. That seems less natural than allowing talent to emerge through training, but nonetheless doesn’t involve truly artificial manipulation like genetic engineering or cloning.

In the not-too-distant future, we’ll likely also have to ask: is implanting a gene already found in athletes who came by it naturally “cheating”—and if so, why is it OK for those born with that advantage to use it but not OK for others to acquire it? After all, simply taking steroids or “smart drugs” doesn’t guarantee performance: if you sit on the couch and don’t train or study, you’re not going to have the skill or knowledge it takes to compete and the same is true for genetic endowments. (So-called smart drugs may enhance cognition, memory, wakefulness and other brain functions.)

Already, our attitudes around performance-enhancing drugs are highly dependent on context. For example, a recent study found that college men judge a hypothetical sprinter who wins a race because he takes steroids more harshly than they do a student who uses a friend’s Ritalin to boost his exam performance. The rationale? Sports are a zero-sum game: if I win, you lose. But my high test scores in class don’t necessarily influence yours: we can both do well even if a curve is applied.

When it comes to consideration of widespread use of drugs that improve mental clarity, it can be quite difficult, in fact, to make a rational case against them, provided that the side effects aren’t dire. For example, who wouldn’t want scientists to find a cure for cancer more quickly or for policy makers to become smarter to find better solutions to social problems? 

Of course, this immediately becomes a question of values: would a “smart drug” also produce smarter criminals—or would it make them less impulsive and thereby more likely to choose the straight and narrow? We want our friends to become smarter, but not necessarily those with whom we disagree. 

The best case against smart drugs involves fear of pressure to use them “because everyone else is”—but again, if the benefits outweigh the risks, why would this be bad? Alternatively, there are worries about the poor being left behind as the rich, who can afford to buy cognitive enhancers, gain ever greater advantages for themselves and their children. However, we certainly don’t deny the rich every other advantage for this reason.

The questions become even thornier when we consider drugs that might, say, vaccinate against addiction or aggression or envy. Would our kids lose some of their free will if we vaccinated them so that smoking would never bring pleasure and cocaine would carry no kick? If we had an anti-violence drug, would we even use it for fear that it would neutralize our animal flight-or-fight response enabling chemically unenhanced enemies to take advantage of us?

The ability to regulate ourselves with drugs produces multiple conundrums because altering the defaults on the way we make choices inevitably changes who we are. This is why addiction itself is so frightening: although we’re already limited in controlling “what we want to want,” addiction insidiously places one desire above all others. But if a drug allowed us to choose what we want to be passionate about, how would we even know what that should be?

Existing “smart drugs” like Ritalin and amphetamines are marred both by their addiction potential and by the fact that their effects aren’t especially large and only enhance certain types of learning. Indeed, some research suggests that they actually impair the performance of those who are most intelligent, working best on B and C students, not those already getting As.

Oddly, the same drug may help people with ADHD less likely to yield to unwise impulses, while making those who are addicted to it more likely to make ill-advised choices. Both phenomena seem to reflect the idea that there’s a “sweet spot” in the brain’s dopamine system: run it too low and attention and memory may be impaired, but elevating it too high also causes problems.

We tolerate greater drugs risks in the quest for knowledge and personal growth than for pleasure.

But if effective drugs are developed that fight the ordinary cognitive decline that can come with aging—not just frank disease states like Alzheimer’s— they may well improve intelligence generally and it would be nearly impossible to prevent “off label” enhancement use. Indeed, we’re already far more lenient with drugs we see as productivity tools than we are with those we see as offering unearned pleasure. While some doctors will freely admit to prescribing Ritalin, Provigil and amphetamines to buoy up busy executives, they would be targeted for prosecution if they confessed prescribing Valium or opioids for mere relaxation.

The idea of cognitive enhancement allows us to consider drug policy issues afresh and to examine the often hidden-values questions in arguments that are framed as being simply about risks. We tolerate far greater risks in the quest for knowledge and what we view as personal growth than we do in the quest for pleasure. This is why dangerous expeditions like mountain climbing that are far riskier than most drugs are not seen as simply selfish indulgences. It’s also why many people see psychedelic drugs as being wrongly classed among drugs thought simply as "meaningless" pleasures.

Pharma will not shy away from cognitive enhancers if it can market them as fighting aging—and if we allow plastic surgery, it becomes bizarre to ban improving the mind as well. The chemicals that can change us may be sitting on lab shelves right now: those of us who know both the highs and the lows of pharmaceutical experience need to think hard about how the world can best deal with them to maximize the benefits and minimize the unintended negative consequences.

Maia Szalavitz is a columnist at The Fix. She is also a health reporter at Time magazine online, and co-author, with Bruce Perry, of Born for Love: Why Empathy Is Essential—and Endangered (Morrow, 2010), and author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006). 

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