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?