Thanks to the Frontal Cortex, I recently stumbled across an article on the online journal n+1 that describes firsthand a new and disturbing trend in higher education, Adderall abuse. Adderall is a mixture of long and short acting amphetamines that keep the mind revved up and the body energized for hours. It appears overachievers at Ivy League Universities are sorely tempted by this as it improves test taking skills, focus, recall, enables all-nighters to work, etc. The one group of students my mind immediately went to was the classic overachiever, the medical student.
I can totally see how this could be very attractive to the cutthroat, straight A student, need the grade to get into medical school crowd. Further, I can’t believe it would stop there. Medical school is intense. The information overload in the first two years is extraordinary. Caffeine is the life blood of medical students in my experience. I am now left wondering how many of them took this a step further. Like Jonah Lehrer, I am starting to feel like the pitcher who never dabbled in HGH.
Being raised in the most conservative of Mormon communities, I have an aversion to even using caffeine to wake up. I don’t believe, as many of my neighbors did, that the Word of wisdom (the section of Mormon scripture that tells us to avoid coffee, tea, alcohol and tobacco) prohibits caffeine. I drink it occasionally, very careful to make sure it is not daily, or that I have any shakiness or headaches. I have been reduced to using it on rounds after receiving feedback that I am too sleepy, and appear uninterested.
I do feel that the general idea of the word of wisdom is to avoid habit forming substances and thus increase our agency and freedom. I do not at all like the idea of chemical dependence. While I am certain that my anxiety would only mushroom out of control with amphetamines, the idea of needing any drug in order to perform causes a visceral reaction in me. This very reaction caused me to short circuit my own residency. This is where it gets tricky. It turned out that at least for a time, I have needed drugs in order to function. I have been on the other side of this and I feel it was appropriate. Granted, it is probably much better done with psychiatric supervision, the line gets rather fuzzy.
In Residency, Adderall could be argued a superior substitute for caffeine. The setup is perfect for amphetamine abuse. We have to work exhausting hours, 30 at a time, 80 a week if the program is on the up and up. Studies have shown residents make more mistakes post call. For this reason, new rules have been in force the past few years for limiting the hours per week or length of a shift to the numbers above. The goal is to cram all the experience and learning possible into 3-5 years and manage a busy hospital service on the side. A few wise physicians have pointed out to me that no one cares what your work hours are once in practice. In all it is a little frightening.
The idea of chemical enhancement is not new. In fact, amphetamines were used with soldiers in World War II. There seems to be a certain streak in society that sees nothing wrong with performance enhancement. I can imagine a scenario where a patient might benefit being operated on by an amphetamized surgeon, for example. I have to believe it would be better than an exhausted surgeon, awoken in the middle of the night. I can see how performance on rounds would be improved, how evaluating physicians would think better of you. I know quite personally how enticing this would be to a struggling resident.
What happens when we allow this? By the n+1 account, students ace the test, but don’t remember anything they wrote. It seems this is a shortcut in the worst possible arena, patient care. What happens if we run out of adderall and can’t perform? What happens when we come down? What happens to all the knowledge or experience we can’t recall without the drug?
I wonder how far certain clandestine research could take this in the future. Will we develop brain enhancers without the drug downside or dependence? Is this a good or a bad thing? Could physicians be required to partake of brain enhancement at some point? I am probably getting a little paranoid here and need to break out the tin foil hat and the Zyprexa. It is just very disturbing to me that the drive to be bigger, faster, and stronger in our society is not limited to sports. In fact it seems much easier to justify when you are doing something that actually benefits society, rather than just entertain it. Where would it end? Where should we draw a line?
Mind, Soul, and Body 
7 comments
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February 27, 2008 at 12:19 pm
LDS Anarchist
I find that habanero tincture works wonders for enhancing brain and body functions, plus it makes you feel sooo good for hours afterward. Granted, it is a bit hot. Even better, though, than habanero tincture, is eating a raw habanero. 15 minutes of pure hell fire, and 5 hours of eternal bliss. What a high that stuff gives you, with no addiction or adverse side effects! I highly recommend it.
February 27, 2008 at 3:08 pm
Lincoln Cannon
If there are no negative effects, individually or communally, there should be no line. To draw such a line is damnation.
February 27, 2008 at 4:34 pm
Mormon Heretic
Very interesting post, and I concur with your opinions. I keep hearing a certain national radio sports talk host say that there are no side effects to HGH, that the elderly should use it, and that it might be a “fountain of youth.” He thinks that everyone should be allowed to take it, and that we will all live much longer.
My first question, “is this a correct assessment of HGH?” And secondly, if there are no side effects, why is Barry Bonds head so large?
February 27, 2008 at 5:25 pm
Doc
LDSA,
Wasn’t there an episode of the Simpsons where Homer ate a habanero and met his native american spirit guide coyote while in a crazy trance?
Ah but Lincoln,
How do you know there are no ill effects unless you test it for it’s intended use on willing subjects, and if the subjects are doctors, how do you know they are not being unduly pressured into such testing by peers or by work demands? What if it works for some but not others? Then, once you have it do you make available to everyone, what about cost? Are the rich the only ones worthy of it, do you do a social calculus or determine the cost benefit ratio to society?
I personally don’t see how a stimulant type medication at least could not have side effects. At the very least we need sleep. We know there are critical if poorly understood processes going on in sleep for mental functioning. Lack of sleep for several days is literally fatal. Another negative effect I forgot to mention, but found in the comments of the Frontal Cortex post, is that while attention and focus are vastly improved people are not able to integrate new information, change attention focus or account for sudden problems or surprises is impaired. You can get blindsided, and creativity suffers. This could be bad in an emergency situation. These things always more complicated than they appear on the surface.
February 27, 2008 at 5:30 pm
Doc
MH,
Thanks for the comment. We know what happens when you get too much HGH because patients with pituitary tumors have shown us. It is called acromegaly, and yes your head gets big. Andre the Giant had this and his heart gave out at a very young age. It is amazing the misinformation that gets passed around when we want something to be a miracle drug. Pretty much all medicines, even vitamins have side effects and toxicity depending on the dose. There is a cost benefit analysis that always has to be done and the answer is not always clear.
February 27, 2008 at 7:52 pm
pistolpete
I used Adderall for a time in an effort to combat Bipolar Disorder. I can see how it could become addictive. I was riding high.
March 6, 2009 at 6:22 pm
Mormon Doctor Mom
I had a father/physician who was in a generation of the wonder-drug diet pill called amphetamines. They handed out samples to the doctors like we get the newest statin. It wasn’t long before my father and all of his doctor buddies were popping them to do those endless hours of call. Then there were those moments when they needed to sleep and barbituates were equally as accessible so the predictable pattern began. My dad was one of the many dependent physicians of that “golden era” of doctors. It was a well-kept secret… but they were everywhere. My father joined the Mormon church much later and the dependent doctor was only a bad memory by the time I was born. Despite that, I was told of the moods swings, the anger problems and the obsession that becomes getting the next pill.
I, for one, live the Word of Wisdom because I know what life would be like without that free agency. The idea that anyone needs these drugs is a sin and a corruption of our profession. When we are tired, we should rest. When we can’t pay attention, we should work harder to develop those skills. We should not drug children and I do not believe in ADD/ADHD meds for 90% of those that receive it! Period.