Pill wars: debate heats up over 'brain booster' drugs.

Philip Harvey is one who uses them. A professor of psychiatry and behavioral sciences at Emory University in Atlanta, he regularly flies from Georgia to Europe on business. To prepare for his flight, he takes modafinil. He uses the stimulant to feel alert and rested, despite lost sleep, allowing him to return to his family faster. He has no trouble getting a prescription from his doctor. "From Atlanta, I can get to Europe by 6 a.m. and give a 9 a.m. presentation," he says. "It lets you go and come back the same day, or go over one day and come back the next."

In the current debate over brain boosters, the focal point of much of the discussion has been a commentary in the December issue of Nature. Seven prominent bioethicists noted that the drugs "are 'disruptive technologies' that could have a profound effect on human life in the twenty-first century." While calling for more research to better understand the safety and effectiveness of use in healthy individuals, the piece went on to advocate that "mentally competent adults should be able to engage in cognitive enhancement using drugs."

In the months since, the paper has met with both hearty approval and deep reservations from scientists and other bioethicists. "Anything that can help our brains deal better with the complex challenges of the twenty-first century is to be not only welcomed but actively sought," wrote Nick Bostrom, director of the Future of Humanity Institute at the University of Oxford, in a letter to the journal.

The commentary served its purpose to "kick up" a needed discussion, says Henry Greely, a bioethicist and professor of law at Stanford University and one of the coauthors of the Nature commentary. He received far more e-mails about the article than for any other he's published. The aim, he said, was to argue that "enhancement is not fundamentally a dirty word."

"I think people should think of [drugs] as just one more of many different ways we try to improve our minds," Dr. Greely says. "I'm a teacher. I'm in the enhancement business. I'm trying to enhance my students' brains."

But others were disappointed with the commentary. "It's not really a piece of science. It's an editorial arguing that we should use more drugs," says George Annas, chairman of the department of Health Law, Bioethics, and Human Rights at Boston University. He wonders why an article taking the other side of the debate didn't accompany it, and why the authors called for looser strictures on use of the drugs before more is known about them. "The way you make sure they're not harmful is you do a study before you widely advise people to use them," he says.

Critics argue more time is needed with the petri dishes and field testing before the drugs are used as mind enhancers. "The reality [is] that there is very little research to document whether [these drugs] are universally beneficial, whether they could be detrimental, what are the long-term outcomes, what are the side effects," says Nora Volkow, director of the National Institute on Drug Abuse, a US government agency. "There's really very, very limited knowledge."

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