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

Adults are taking stimulants like Ritalin and Adderall, normally used to treat serious medical conditions, to boost their concentration and job performance. Critics ask: Is it making Americans too dependent on their medicine cabinets?

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Advocates point out that humans already "enhance" their thinking in a variety of ways, from drinking beverages with caffeine (a known stimulant), to exercising to brighten their mood, to relying on a computer to increase knowledge, to simply getting a good night's sleep before a big test.

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But for some, a caution light goes on when we're changing the way the brain works, particularly when so little is known about it. "Not only do we not have a model for how our brains do complex tasks, we can't even imagine one," Dr. Karl Deisseroth, a neuroscientist at Stanford University, told Wired magazine earlier this year.

AT THE MOST FUNDAMENTAL LEVEL, the drugs challenge perceptions of who we are. Some people believe the next big scientific revolution will be turning our technological prowess on the world within, notably our brains, rather than the world around us. Neuroscience, which includes the development of brain enhancers, is part of this "revolution."

In this realm, some experts suggest that using pills to alter thinking or mood comes too close to altering our sense of self. "In seeking by these [biotechnologies] to be better than we are or to like ourselves better than we do, we risk 'turning into someone else,' confounding the identity we have acquired through natural gift cultivated by genuinely lived experiences," wrote Leon Kass in a 2003 report on human enhancement from the President's Council on Bioethics.

Yet others argue the definition of what is one's "real" self will be up to the individual – and should be.

"It's not at all clear that people feel more themselves when they're unmedicated than when they're medicated," says James Hughes, director of the Institute for Ethics and Emerging Technologies in Hartford, Conn. "Some people are going to feel more 'themselves' when they take the drugs, and some are not going to feel more themselves."

As drug and biotechnology companies look to expand their products and markets, more possibilities for illicit use may lie ahead. Cephalon Inc. is planning to launch Nuvigil, a longer-lasting version of Provigil, later this year. The company sold nearly $1 billion of Provigil last year, but the drug is going off patent in 2012. Cephalon says a study shows that Nuvigil works to alleviate jet lag, and it is expected to ask the Food and Drug Administration (FDA) to add jet lag as a new medical condition.

Many argue that more research is needed on existing drugs before we start thinking about new ones. Greely, for one, says we don't have any "real evidence about the effects, short-term or long-term," of Adderall and Ritalin, which are both used to treat attention-deficit hyperactivity disorder, on healthy people. As companies seek approval from the FDA for new drugs, if they seem likely to be used for enhancement, "we should require some research on those off-label uses," he says.

If a drug is truly quite safe, he says, the FDA could make an early decision to permit over-the-counter sales. On the other hand, it also could place tough limits on who could prescribe a particular drug or limit the number of pills per prescription.

In the end, if it's true that we only use a small part of our brain now, people are always going to try to improve on that, Annas says, "and drugs are a way in."

"But we certainly want to think this through and do careful, controlled studies before we move toward over-the-counter sales."

Sarah More McCann contributed to this story.

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