03 December 2012

Looking For an Edge

Adderall, the NFL and why cognitive enhancement will mean the end of sports doping sanctimony


Let’s start with a mental exercise. Suppose you’re a corporate lawyer. And suppose you’re preparing for a major trial. The case is vast, complex and hangs on a series of arcane technicalities; it’s your job to master the material and persuade a jury in court. The other side has attorneys, too, some of the nation’s best. Winning would be a major victory for your firm. Defeat would ensure that you don’t make partner. An office colleague confides in you: She has been taking a pill. The pill makes her sharper, more focused, able to work 20-hour days without wearing down. She needs less sleep. Her memory is better. She reaches into her purse, offers you a medicine bottle. The trial starts in one week.

Do you take the pills?

If you do, is it somehow unethical?

Now, replace major trial with football game. Swap corporate lawyer for quarterback. Exchange persuade a jury for make the playoffs, other side for division rival and nation’s best for league-leading defense.

Now, do you take the pills?

If you do, is it somehow unethical?

Here’s the thing: This isn’t a mental exercise. Not entirely. Last week, USA TODAY Sports reported that the drug Adderall -- a prescription psychostimulant used to treat attention deficit hyperactivity disorder (ADHD) -- is widely used in both the National Football League and Major League Baseball. One of the reasons? According to the article, Adderall acts as a powerful stimulant, one that can boost the alertness and energy levels of athletes seeking competitive edges.

I can’t say this news surprises me.

Seven years ago, I wrote a story about the dawning age of cognitive enhancement -- an era coming in scientific fits and starts, to be sure, but coming nonetheless -- and how it likely will affect sports. At the time, I asked chess champion Susan Polgar about the International Chess Federation’s decision to adopt the World Anti-Doping Agency’s universal drug code, a policy shift that ultimately resulted in her providing officials with a urine sample following a four-medal performance at major tournament held in Spain.

"I have no idea what they were really testing for,” she told me. “Even if a drug makes you bigger and stronger, it won't help you think better. You need logic, planning, concentration. To my knowledge, there is no drug that would help us play better chess."

That’s no longer the case. When ingested by otherwise healthy individuals, Adderall and the ADHD drug Ritalin can enhance focus, concentration and memory, as well as allowing users to work longer hours with less fatigue. The narcolepsy medication modafinil can produce similar effects. Other drugs in development -- mostly for Alzheimer’s and dementia -- may have off-label memory benefits. None of these pills will make you smarter, just as steroids won’t help you hit a Stephen Strasburg fastball. But they will help you study more effectively, the same way ‘roids will help you hit a Strasburg fastball farther. And that means that cognitive enhancers -- brain steroids, if you will -- could help you play better chess. Or superior poker. Or give you a boost in any activity that requires mental as well as physical performance.

Like, for instance, memorizing offensive game plans and opposing defensive schemes as a quarterback.

Or dealing with exhaustion and jet lag as a globe-hopping professional tennis player.

Or designing game plans and defensive schemes as an up-’til-4 a.m., day-starts-at-5:30 a.m. football coach.

As I said, I’m not surprised by the Adderall news. To the contrary, I’m surprised that the number of positive tests and (perhaps) dubious medical use exemptions isn’t higher. (Start testing coaches and front office employees, and I’m sure the number would be higher still.) More to the point, I won’t be surprised when cognitive enhancement -- slowly but inevitably -- drives a stake through the heart of society’s sanctimonious, morally-panicked attitude toward the use of performance-enhancing drugs in sports.

Let me explain.

Currently, it’s easy to pooh-pooh athletes taking steroids, human growth hormone, whatever pharmacia-approved bovine-bulking chemicals Barry Bonds (allegedly) favored. Not simply because the practice sounds gross -- let us never forget that MRI scans of Roger Clemens buttocks abscesses were entered into the same historical Congressional record that contains the Watergate hearings -- or because there are real and legitimate (if poorly understood) health risks involved.

No, the primary reason it’s easy to feel holier than Raffy’s wagging finger is that juicing doesn’t affect the rest of us. Not in any significant way. The vast majority of people outside major, for-profit athletics -- excluding, perhaps, the annoying type-A triathlete guy in your office with the $5,000 bicycle -- aren’t looking for a competitive physical edge. Particularly not one, like steroids, that produces serious side effects while still requiring you to spend tons of time sweating in a gym. (Never mind our ever-expanding waistlines and national obesity statistics; we’re the nation that has spilled more ink on the death of the Twinkie than death by extra-judicial presidential kill lists. You think working out harder is a major public priority?) In America, unless you’re an athlete, pro wrestler or Hollywood actor trying to land an action movie role, your general yokedness does not influence your earning potential; nobody else has taut, veiny, slightly creepy skin in the game.

Cognitive enhancement is different.

Cramming for a law school exam? Up against a hellacious programming deadline? Doing the work of three salespeople because of office layoffs, and worrying you’re next on the chopping block? Don’t sweat it. Someday soon, pills will make all of the preceding much more manageable. Easier. And lots of people -- students, knowledge economy professionals, strivers and go-getters in every field -- will take full advantage.

Actually, this already is happening.

This summer, a New York Times article about the widespread use of drugs such as Adderall by high school students seeking academic advantage quoted a New York City psychologist who said “it’s throughout all the private schools here. It’s not as if there is one school where this is the culture. This is the culture.” According to research cited in a 2009 New Yorker article, 4.1 percent of American college undergraduates used prescription stimulants for off-label uses in 2004, with usage rates on individual campuses as high as 35 percent. The most frequent users? White males at highly competitive Northeastern schools.

The article also reported that:

* Two academic researchers reported in the scientific journal Nature that a number of their colleagues -- that is, professors -- were also using drugs like Adderall and modafinil for cognitive self-enhancement;

* In an informal poll of 1,400 readers conducted by the same journal, one in five respondents said they were taking cognitive-enhancing drugs, while a majority of respondents said that healthy adults should be allowed to take brain boosters for nonmedical reasons;

* An advice column in Wired magazine featured a question from a reader worried about “a rising star at the firm” who was “using unprescribed modafinil to work crazy hours. Our boss has started getting on my case for not being as productive.”

Therein lies the real rub: You may not want to juice your brain. But what happens when the person in the next cubicle does, and both of you are competing for the same promotion? What happens as the economy continues to sag and pill-enhanced productivity could mean the difference between working and unemployment? American-style capitalism means an endless arms race of constant economic competition; if someone else finds a way to build a better mental mousetrap, you had better follow suit. Or else. For now, cognitive enhancement remains a choice -- but if the drugs get better and more commonplace, it likely will become a requirement, because doped-up production will become the performance baseline. The new normal.

In other words, society finally will catch up to the sports world.

In May, Sports Illustrated’s Tom Verducci wrote about four pitchers who were teammates on a Florida minor league baseball squad in 1994 -- all right-handed, roughly the same age, throwing with similar, unremarkable velocity. One of the pitchers, Dan Naulty, took steroids, gained 50 pounds and made it to the majors, his once-pedestrian fastball reaching the mid-90s. Over a four-year span, he earned $759,000. He won a World Series ring with the New York Yankees. The other three pitchers chose not to dope. They did not make it to the majors. They earned substantially less. There were no rings.

When it comes to cognitive enhancement, the rest of us may end up facing the same choice. The same consequences, too.

Of course, it’s possible that society will react to brain doping the same way it has responded to physical performance-enhancing drugs. With restrictive laws, Congressional hearings, a moral panic. I suspect that won’t be the case. There’s too much pent-up demand for a mental edge, and too much potential profit for the pharmaceutical-industrial complex to ignore. Think high school students scratching and clawing to get into colleges; college students battling to get into law and medical school; Silicon Valley entrepreneurs and innovators racing to create the next Facebook; journalists worried about getting scooped in the 24/7 news cycle; Wall Street bankers trying to ascend to -- or not fall out of -- the One Percent; soldiers and intelligence officers on hellacious overseas counterterrorism deployments; aging Baby Boomers who can’t stand forgetting where they put their car keys. We are all Dan Naulty, even if we don’t realize it yet, and I doubt many of us will Just Say No when presented with a potentially life-changing pill.

Especially not when the drugs, you know, work.

Donepzil, an Alzheimer's drug, has been shown to increase the concentration and alertness of healthy pilots in a flight simulator and to improve certain types of memory. According to the New Yorker article, other studies have found that modafinil helped healthy, non-sleep-deprived young males perform better on a series of cognitive tests involving memory, visual pattern recognition and spatial-planning and that a different type of drug intended to stem memory loss in Alzheimer’s patients “unequivocally” improved short-term memory in healthy users. In addition to the “cream” and the “clear,” BALCO mastermind Victor Conte gave modafinil to sprinter Kelli White and other athletes; former professional poker player Paul Phillips told the New Yorker that taking Adderall and modafinil helped him stay focused and alert at multi-day tournaments, helping him win $1.6 million in a six-month span, more than he had won in four previous years of playing.

A writer I know -- perhaps ironically, he’s an expert on PED use in sports -- once took modafinil while scrambling to finish a book. He did so as something of an experiment. And also, perhaps, out of necessity. He remained awake for 39 consecutive hours. He did not feel tired. And that wasn’t the only benefit.

“You feel like you could run a little faster,” he told me a few years ago. “Colors seem brighter. It turns a switch in your brain. Athletes I’ve talked to that have used it say it’s like having a good day. Puts you in the zone.”

Indeed. As a nation, we already spend at least $1 billion annually on dietary supplements claiming to boost brain power. When actual, honest-to-goodness, peer-reviewed pharmaceuticals become more readily available, is there any chance we’ll scale back, buy less of something that could make people smarter, more successful, more productive, more self-actualized? Could we even do so in good conscience? Years ago, I put the former question to bioethicist Paul Root Wolpe. “If and when these drugs have a real effect on normal people, they are going to put Viagra to shame,” he told me. “Look at the market for Prozac, for Ritalin. Americans take psychopharmaceuticals at a greater rate than any other country.”

Reconsider sports. If and when most of us are juicing our brains -- either out of want or need -- are we simultaneously going to keep telling athletes that they can’t juice their bodies? Someday, I think, we’ll look back on what we’ve dubbed the Steroid Era and wonder what the fuss was about. Because the Steroid Era won’t be a standalone, sports-specific era at all. It will be more like the beginning of things, the dawn of a brave new world. Or maybe the same old world we’ve always lived in, just with better pharmacological tools.

Years ago, I asked chess champion Polgar if she had ever considered taking any substances to enhance her performance. She laughed.

"I don't really drink coffee religiously like some chess players," she said.

Read the original article at Sports on Earth