Experts Debate Benefits and Risks of Stimulants

Dr. Nick Friedman’s comment below regarding http://www.medscape.com/viewarticle/705057

Experts Debate Benefits and Risks of Stimulants for Healthy People

June 29, 2009 — Two new editorials debate the question of whether healthy people should take stimulants, especially methylphenidate [Ritalin (sic)], to enhance cognitive performance.

John Harris, DPhil, from the school of law at the University of Manchester, in the United Kingdom, argues that it is unethical to stop healthy adults from taking methylphenidate to enhance cognitive performance and asserts that chemical cognitive enhancers should be freely available to those who choose to use them.

Anjan Chatterjee, MD, from the Center for Cognitive Neuroscience at the University of Pennsylvania, in Philadelphia, disagrees, maintaining that making methylphenidate freely available to those who want to enhance performance would cause undue medical risk and that these drugs should be reserved for those who suffer from attention-deficit/hyperactivity disorder (ADHD). The risks of methylphenidate include potential for abuse and dependence and risk for sudden death and serious cardiovascular events, he points out.

Their discussion is published online June 18 in BMJ. [British Medical Journal (sic)]

Risk for Sudden Death  Dr. Harris argues that methylphenidate is safe enough to be used widely in children and adults with ADHD, and its significant advantages for healthy adults include improved executive function, study skills, and the ability to focus. In an interview, he noted that access to methylphenidate could be improved by taking it off prescription or allowing it with a pharmacist consultation.

Methylphenidate’s health risks should be dealt with in the same way as are those of cigarettes; while adults who use the drug should be warned of its potential for abuse and cardiac risks, sale should not be prohibited. “We should not police healthy adults,” he said. “We can issue them a warning as we do on other dangerous products.”  (sic)

Social Coercion? Dr. Chatterjee, however, warns of the public-health risks that could occur should methylphenidate be freely available. He notes that the risks for serious cardiovascular events with methylphenidate are likely to be higher in older people with undetected cardiac disease —  1 group that might be likely to use the drug if it were sold over the counter.

Dr. Chatterjee also argues that the use of methylphenidate might pose another risk for society that is rarely considered in debates about the subject. He notes that enhancing focus with methylphenidate might mean sacrificing creativity. “Most models of creativity suggest that you have to have some down time in order to have the leaps of imagination that end up being creative insights; it requires not being focused,” he said.

Dr. Nick’s comments: This really caught my attention. Ritalin is a speed drug that is used for ADHD individuals. I am in Dr. Chatterjee’s corner with this. The part that is really scary is when Dr. Harris recommended controlling it the way we do with cigarettes: put a warning label on it. That works really well!

How many people are still smoking, getting emphysema, cancer, heart disease, etc.? This is another person with flawed thinking. Yes, we would ALL like to have increased energy both physically and mentally! But doing this through the use of drugs does not work. Every pharmaceutical drug out there, OTC (over the counter) or prescription, has its side effects, some more than others. But they ALL have them. Further, the more readily available this is, the more the real side effects in “healthy” individuals will start appearing

June 29, 2009 — Two new editorials debate the question of whether healthy people should take stimulants, especially methylphenidate [Ritalin (sic)], to enhance cognitive performance.

John Harris, DPhil, from the school of law at the University of Manchester, in the United Kingdom, argues that it is unethical to stop healthy adults from taking methylphenidate to enhance cognitive performance and asserts that chemical cognitive enhancers should be freely available to those who choose to use them.

Anjan Chatterjee, MD, from the Center for Cognitive Neuroscience at the University of Pennsylvania, in Philadelphia, disagrees, maintaining that making methylphenidate freely available to those who want to enhance performance would cause undue medical risk and that these drugs should be reserved for those who suffer from attention-deficit/hyperactivity disorder (ADHD). The risks of methylphenidate include potential for abuse and dependence and risk for sudden death and serious cardiovascular events, he points out. Their discussion is published online June 18 in BMJ. [British Medical Journal (sic)]

Risk for Sudden Death  Dr. Harris argues that methylphenidate is safe enough to be used widely in children and adults with ADHD, and its significant advantages for healthy adults include improved executive function, study skills, and the ability to focus. In an interview, he noted that access to methylphenidate could be improved by taking it off prescription or allowing it with a pharmacist consultation.

Methylphenidate’s health risks should be dealt with in the same way as are those of cigarettes; while adults who use the drug should be warned of its potential for abuse and cardiac risks, sale should not be prohibited. “We should not police healthy adults,” he said. “We can issue them a warning as we do on other dangerous products.”  (sic)

Social Coercion? Dr. Chatterjee, however, warns of the public-health risks that could occur should methylphenidate be freely available. He notes that the risks for serious cardiovascular events with methylphenidate are likely to be higher in older people with undetected cardiac disease —  1 group that might be likely to use the drug if it were sold over the counter.

Dr. Chatterjee also argues that the use of methylphenidate might pose another risk for society that is rarely considered in debates about the subject. He notes that enhancing focus with methylphenidate might mean sacrificing creativity. “Most models of creativity suggest that you have to have some down time in order to have the leaps of imagination that end up being creative insights; it requires not being focused,” he said.

Dr. Nick’s comments: This really caught my attention. Ritalin is a speed drug that is used for ADHD individuals. I am in Dr. Chatterjee’s corner with this. The part that is really scary is when Dr. Harris recommended controlling it the way we do with cigarettes: put a warning label on it. That works really well!

How many people are still smoking, getting emphysema, cancer, heart disease, etc.? This is another person with flawed thinking. Yes, we would ALL like to have increased energy both physically and mentally! But doing this through the use of drugs does not work. Every pharmaceutical drug out there, OTC (over the counter) or prescription, has its side effects, some more than others. But they ALL have them. Further, the more readily available this is, the more the real side effects in “healthy” individuals will start appearing.