This is your brain on performance enhancing drugs

Perhaps the top science journal in the world - Nature - reported today on epidemic-like levels of cognitive performance enhancing drug abuse by top academic scientists.

why they began the survey

The survey was triggered by a Commentary by behavioural neuroscientists Barbara Sahakian and Sharon Morein-Zamir of the University of Cambridge, UK, who had surveyed their colleagues on the use of drugs that purportedly enhance focus and attention (Nature 450, 1157–1159 ; 2007). In the article, the two scientists asked readers whether they would consider “boosting their brain power” with drugs. Spurred by the tremendous response, Nature ran its own informal survey. 1,400 people from 60 countries responded to the online poll.

They looked at illegally obtained (no prescription) use of three drugs: methylphenidate (Ritalin), a stimulant normally used to treat attention-deficit hyperactivity disorder but well-known on college campuses as a ’study aid’; modafinil (Provigil), prescribed to treat sleep disorders but also used off-label to combat general fatigue or overcome jet lag; and beta blockers, drugs prescribed for cardiac arrhythmia that also have an anti-anxiety effect.”

One in five respondents said they had used drugs for non-medical reasons to stimulate their focus, concentration or memory. Use did not differ greatly across age-groups

Favorite drugs of the performance enhancing professor:

For those who choose to use, methylphenidate was the most popular: 62% of users reported taking it. 44% reported taking modafinil, and 15% said they had taken beta blockers such as propanolol, revealing an overlap between drugs. 80 respondents specified other drugs that they were taking. The most common of these was adderall, an amphetamine similar to methylphenidate. But there were also reports of centrophenoxine, piractem, dexedrine and various alternative medicines such as ginkgo and omega-3 fatty acids.

As I have srtten many times before. Prepare for the upcoming epidemic of performance enhancing drug abuse. I predict these drugs will be used at rates surpassing any other illegal drug in history. They have minimal side-effects and are becomming increasing viewed on college campuses as nothing more than a no-doze.

Read my previous posts on this topic here:

1. New Drugs Enhance Performance, Eliminate Need to Sleep
2. New Generation of Performance Enhancing Drugs
3. How far would you enhance your body for performance?

Would you use it? My history of working to the limit. I was in an accelerated 6-year combined college and medical school program. Balancing the advantage of being accepted to medical school while still in high school was taking full years of college courses ever summer to catch up on the skipped time. At one point I had medical school 8-5 followed by college classes from 6-10. All was manageable until med school finals hit the same week as college midterms. I remember giving up sleep and filling 2-liter soda bottles with iced coffee to get through the day. We moved onto iced coffee in Captain Crunch next. I stopped at this point (actually at two of these bottles a day= 3000 mg caffeine). I knew others who went the route of amphetamines no-doze and pizza. While an intern my worst shift ever in the hospital was 7AM Friday until 4PM monday= 81 hours. By sunday night I was unwell to say the least. Will drugs help this? I have a good friend who is a leading academic physician. He is a brilliant physician, professor and inventor. He could not believe I had not taken modenifil and raved about how well it worked for him.

Apparently other experts agree with me:

“Neuroscientist Anjan Chatterjee of the University of Pennsylvania in Philadelphia predicts a rise in the use of these drugs and other neuroenhancing products and procedures as they become available (A. Chatterjee Cam. Q. Healthc. Ethics 16, 129–137; 2007). Like the rise in cosmetic surgery, use of cognitive enhancers is likely to increase as bioethical and psychological concerns are overcome and as the products gain cultural acceptance. One difference, Chatterjee says, is that use of cognitive enhancers doesn’t rely on training of medical specialists such as surgeons. Internet availability will also greatly accelerate use, he says.”

There has been a flurry of debate in the military, industrial, and privacy sectors on “smartdust” and the concept of “souveillance” - but no one has yet realized this technology is poised to springboard into medicine and transform medical diagnostics.  Here I wanted to give you an overview of what this idea is and why you should keep your eye on it. 

First the general concept background:

“Smartdust” refers to micro devices (called motes) which are detection microchips each potentially the size of a speck of dust.  These grains of sand however can automatically self-network.  So far people have conceived of these low-power distributed sensing networks as having functions for climate control systems, entertainment devices and especially for big brother type surveillance systems.  

Wikipedia wrote “the smartdust concept was introduced by Kristofer S. J. Pister (University of California) in 2001 , though similar ideas existed in science fiction before then. A recent review discusses various techniques to take smartdust in sensor networks beyond millimeter dimensions to the micrometre level.  A typical application scenario is scattering a hundred of these sensors around a building or around a hospital to monitor temperature or humidity, track patient movements, or inform of disasters, such as earthquakes. In the military, they can perform as a remote sensor chip to track enemy movements, detect poisonous gas or radioactivity. The ease and low cost of such applications have raised privacy concerns.”  Beyond web 2.0 vast networks of these real time sensors are once possible technology leap of the yet inknown web 3.0.

General concept - What is Souveillance?:  is a term from Steve Mann that refers to “bottom up” surveillance using smart dust as opposed to “top down” big brother networks looking at us little people.  Here instead activities are recorded from the “perspective of a participant in the activity, typically by way of small portable or wearable recording devices that often stream continuous live video to the Internet.”  Remember the impact of the Rodney King video and of all the user generated video content on the web.  Now fast forward to a world where a large segment or even a majority of the populice had real time streaming video devices on all the time (no we are not going to discuss the porn angle on this).   This has also been called “inverse surveillance”.

Privacy advocates have been debating the merits or horrors of this type of sensor technology.   I serve on the Scientific Advisory Board of the Lifeboat Foundation which is dedicated to protecting us from future technological threats through advocacy research and education.  They have been having a heated debate on the “paradox of smart dust: we may not live without the greater security provided by smart dust, but many think they could not live with smart dust impinging on our privacy.’  

Medical Implications:  I have a vision that once this type of low power networked microsensor technology exists it will logically lead to medical sensor technology.  Potential uses I see include:

1. mass screening for infectious disease or bioterror agents.  Subjects walking into screening areas could be checked for signature molecules associated with infectious agents.  Just as we have metal detectors and now have molecular signature detectors (the litle wipe test for explosives at the airport) we will have such biological screening techology.
2. The next step will be similar screening for disease states.  Metabolomics is one such technology. Metabolomics is the study of the small-molecule metabolite byproducts left behind from cellular processes.  In simple terms it’s like examining poop.  The concept is that by measuring the collection of all the byproducts of the cells metabolism you can get a snapshot of the physiology of a cell or organism that translates to health.  One such sensor is being developed as a breath sensor for disease.  This could lead to Star Trek like medical sensors. 
3. Similarly, such technology will lead to individual genetic screening for disease risk using chips that interact with the tiny bits of DNA we shed every time we touch something. Companies commercializing this approach also already exist and have products. 
4. Taking a clue from smart dust we will then inject such sensors into our bodies where thy could circulate in the bloodstream or sit in the abdminal cavity silently sensing for disease, infectious agents, or the DNA or signature molecules of a cancer cell.  Alternative chips could exist that sit and slowly release drugs when such cell reappear once a patient is diagnosed.

I will be writing more about the details of these concepts and devices being developed in future posts now that I have introducted the concepts.  Let me know what you think! 

NatureNews has just reported on a new drug that plugs calcium leaks in muscles and boosts stamina (in mice).  I have previously written of the next wave of what I call “designer drug abuse” coming- performance enhancing drugs.  The first batch are called eugeroics and offers improved memory, mood enhancement, improved alertness and cognitive powers without any of the nasty side effects and mass murder of speed and crank.  This new class is a physical performance enhancer.   You can read my thoughts on how far people will go in the future to enhance their bodies here.  If you think plastic surgery is the rage of body enhancement - wait until we get performance and congnitive enhancing bionics, drugs, and implants!

Nature writes of the published in the online edition of the Proceedings of the National Academy of Sciences today (Bellinger, A. M. et al. Proc. Natl Acad. Sci. USA 105, 2198-2202 (2008).

Researchers have shown how intense exercise can damage muscles, and developed a drug that can hinder the effect in mice. Mice on a taxing work-out schedule were stronger and had more endurance when given the drug.

The drug, called S107, prevents calcium from leaking into muscle cells. Calcium causes muscles to contract, but calcium leaks can reduce the force of contraction and activate an enzyme that chews up muscle protein.

They go on to say that “leaky calcium channels have been associated with the fatigue and soreness that follows intense, sustained exertion, such as running a marathon or long-distance cycling. This weakness can last for days or weeks, and is not the same as the brief discomfort that follows a typical work-out.”

As expected there is a start-up ARMGO Pharma, that plans to develop S107 and others like it for clinical use in patients with chronic tiredness from disease.

Nature hits upon the potential for abuse just as I predicted.  “Don Catlin, director of the Olympic Laboratory drug-testing centre at the University of California, Los Angeles, says that a drug such as S107 could also become prime fodder for athletes looking to improve their stamina.

I myself had dinner with the former chief medical director of the olympic committee (the guy in charge of thesting if the women really are women and vice versa).  He told me he is very concerned about athletes and students using performance enhancing drugs.  Imagine a high school athlete or student offered a pill that could makethem run faster or longer or increase memory without adverse effects.  How many do you think would take them.  I recall his worry- your child saying daddy I want to be a track star- can you amputate my legs so I can get the new bionic ones. 

Everyone is jumping on the natural product and herbal bandwagon.  What many don’t know is that all-natural is often far from all-safe.  Almost all of these producs remain highly unregulated and untested in their claims (therefore the need for the blanket disclaimers that the products are not intended to diagnose of treat any condition). 

One of the problems with herbals is the huge rate of contamination with other ingredients.  This may be inadvertant such as mercury in fish oil capsules, heavy metals in herbs, or intentional such as the well-reported spiking of herbal viagra with real drug viagra. 

I know a manufacturer of herbal supplements.  He used to sell electronics but now sells herbal supplements.  I think it’s a more lucrative business.

Today the FDA issues a warning out arsenic contamination in mineral water.  Just realize that when these contaminations occur in herbal supplements it is often buyer beware before its discovered.  Low level contamination often is never discovered.

FDA Warns Again About Arsenic in Mineral Water  - Five Brands Recalled Within Last Month

The Food and Drug Administration (FDA) is re-issuing its warning to consumers not to drink “Jermuk” brand mineral water due to the risk of exposure to arsenic, a toxic substance and a known cause of cancer in humans. The agency is providing this information again to consumers due to an expansion of the recall initiated by the products’ importers and distributors. “Jermuk” water is imported from Armenia and distributed under different labels in California. Five brands of these products have been recalled since March 7

The good news is you probably won’t die

Although arsenic is a well known human poison, there is little chance that someone would become seriously ill after consuming the recalled products over a brief period of time (days to weeks). However, it is likely that the person would experience nausea, abdominal pain and possibly vomiting, which are indicators of arsenic toxicity.

FDA has sampled the contents of 500 milliliter (mL) green glass and/or plastic bottles of all of these brands and found they contained 454-674 micrograms of arsenic per liter of water. FDA’s standard of quality for bottled water allows no more than 10 micrograms per liter.

UPDATE:  wow two recalls in one day of natural health products!

Another fDA recall is in effect this time for some vitamins.  Unfortunately, the manufacturer faled to fully list the ingredients onthe label.  As I said it happens all the time.  This one had fish products but never listed them posing a severe allergic reaction risk for some.

FiberChoice Plus Multivitamins Issues Allergy Alert Fish Allergen Not Declared on Label

FiberChoice® fiber supplement is recalling the newest variant of FiberChoice® plus Multivitamins fiber supplement. This recall affects 90 count (16oz.) plastic bottles. 

This recall was initiated after we discovered fish gelatin, a known allergen, contained in one of the raw materials of the product, which was not declared on the product label for the multivitamins being recalled. The fish gelatin consists of the following species of fish: cod, pollock, hake, cusk, haddock, redfish, sole, and flounder.

Beppe in NYC

Now I have seen it all.  Old school med-industy came to NYC a-courtin’ new school med-bloggers last night.  I was invited to a dinner at Beppe a well ranked (not bad in Zagat - menu here) Italian restaurant near Grammercy Park by the Corporate Communication Folks at Johnson & Johnson.

The big pharma folks are exploring the blogosphere and testing the waters before they tread deeply.  Their goal was to explore the medical blogging environment and garner information to help them decide how to get involved. 

In attendance were a cadre of marketing and corporate communication execs from J&J (Heidi Youngkin (executive director/global marketing group), David Swearingen (vp corp comm), Mark Monseau (director of media relations), Jeffrey Leebaw, Ray Jordan (vp public affairs), Rob Halper (director of corporate TV) and others whose cards did not make my pocket.  They brought Adriana Lukas of mediainfluencer and bigblogcompany along with them from across the pond (UK)to try to stir-up the waters.  Nothing like having a new media marketer sitting next to an ex-official FDA marketer for fun dinner talk. 

On the medblogging side was (along with myself) Jim from BrandWeekNRX, Bob and Peter from Drugwonks and CPMI, Fard from Envisioning 2.0 and , Ed Silverman  from Pharmalot , and a highlight for me - a chance to meet my electronic pals from medgadget and blogborygmi Gene Ostrovsky and Nick Genes (of Grand Rounds Fame). 

L to R Gene Me and Nick!-

guess who works in the ER, who is a computer programmer, and who came from a full day of patient office hours?

The conversations focused on how industry could partner with bloggers, should they give emplyees free-reign to blog about their work (sure the attorney with NDA in hand will love that), and how the public is using inernet and blog med info.  Personally, I spoke about what I see in patient disease chats and discussion forums.  There is so much great information but so much disinformation and inaccuracies.  I volunteer my time to answer medical questions on forums like these such as ATIME.  I believe industry can play a role to foster moderation of information (think Citizendium to Wikipedia).  A bit of industry support could help get a panel of docs pharmacists nurses etc time to respond to the mass of information requests and provide an objective commentary (when requested).  Real partnerships between industry and patient groups could be fostered on education and not just financing. 

I also enjoyed picking Peter Pitts (former FDA’s “chief messaging officer,” serving under Commissioner Mark B. McClellan) brain about 1) why the FDA and legislature is not tackling the herbal and alternative medicine horrors MD’s are seeing (ie who’s getting the payoff) and 2) if FDA does not think herbals are drugs to be regulated why they think sperm, eggs, and embryos are (but that the subject of a whole series of posts to come…)

UPDATE- wow some people are actually blogging about the dinner and who did or did not get invited.  You can see the Post on Rost’s whistleblower site and my comments back here

Grand Rounds 3.25 is up over at Scienceroll.  A gret blog I have mentioned before it is run by Bertalan Meskó, a Hungarian Medical Student wit a passion for genetics.  Definitely worth checking out there are about 60 posts but excellently organized in categories to make the reading clear and quick.  A nice variety.

I am honored that he chose two submissions from docinthemachine (one I submitted and one submitted by somemone else!).  There are links to my posts on :

docinthemachine’s first podcast on the coming technological revolution in surgery (in a new web 2.0 section of grand rounds )and also on new regulations to spread information and increase post marketing surveillance of drugs from the FDA

this stuff makes crank look like candy

Gizmag reports on the further evolution of no-sleep performance enhancing drugs.

The original version of these substances was the “time-shifting” drug, Modafinil that enables you to stay awake for 40+ hours with close to full mental capacity and with few side effects. (produced by Cephalon as PROVIGIL®, MODIODAL® in France and VIGIL® in Germany, for excessive sleepiness associated with narcolepsy and for “shift work sleep disorder” - hear that you medical interns?- web site advertises free 7 day trial supply).  

This is precisely the substance the the former chief medical director of the olympic committee spoke to me of.  He asked - once this stuff hits the street don’t you think a majority of college students would use it to perform better on exams?   The military sure thinks its a god idea for soldiers and pilots.  You can read my thoughts on how far people will go in the future to enhance their bodies here.  If you think plastic surgery is the rage of body enhancement - wait until we get performance enhancing bionics and cognitive enhancing drugs and implants!

The drug is a eugeroic and offers improved memory, mood enhancement, improved alertness and cognitive powers without any of the nasty side effects and mass murder of speed and crank.

What’s a Eugeroic you ask?  - Literally the term means “Good Arousal” .  They are a class of novel stimulants that produce long-lasting mental arousal. They are unique in producing hypervigilence and alertness without peripheral effects or addidition of usual stimulants.  Strangely, they have minimal effect on sleep structure, and do not cause rebound hypersomnolence (crashing).

You might also be interested in Ampakines are similar but also cause memory enhancement (just a bit of abuse potential there).  One of these - a drug code-named CX717 from Cortex - reportedly enabled sleep deprived rhesus monkeys to outperform rested normal monkeys on memory tasks. 

Under carefully controlled conditions and constant medical monitoring, the monkeys were individually sleep-deprived for 30-36 hours and re-tested at that time. When monkeys are sleep deprived their performance accuracy is reduced by 15-25%, and their reaction times slow by at least 50%. A dose of 0.8 mg/kg of CX717 completely reversed the performance deficits associated with sleep-deprivation. In addition, specific brain EEG changes that occur after sleep deprivation were returned to the non-sleep-deprived state in the CX717 group, but not in the control group. Thus, CX717 counteracted the effects of periods of prolonged sleep deprivation when given immediately before testing  

Not surprisingly, DARPA had a hand in these experiments.

Man, I remember as an intern a 43 hour shift I once did (Friday AM straight to Monday afternoon).  By Sunday I was practically hallucinating, everthing was in slow motion , and there was a constant sound of running water…  I predict these drugs have an abuse potential greater than any drug since alcohol.

I hear there is a new super eugeroic called armodafinil coming down the pike with even more potent effects.

Gizmag reports of a new dental drug resevoir devivery system.  Interesting.

a dental prosthesis capable of releasing accurate dosages into the mucous membranes in the mouth. As it can administer accurate micro amounts over continuous periods, the prosthesis overcomes the peak concentrations that occur with taking pills and even offers the ability to monitor and maintain consistent blood levels of any drug. What makes the Intellidrug prosthesis unique is that, unlike existing drug prostheses and implants, it is small enough to fit into two artificial molars. Inside the patient’s mouth, it is readily accessible and can easily be maintained and refilled. The dental prosthesis consists of a drug-filled reservoir, a valve, two sensors and several electronic components,” explains Dr. Oliver Scholz of the Fraunhofer Institute for Biomedical Engineering IBMT in St. Ingbert, where the sensors and electronics were developed.

“Saliva enters the reservoir via a membrane, dissolves part of the solid drug and flows through a small duct into the mouth cavity, where it is absorbed by the mucous membranes in the patient’s cheeks.”

The duct is fitted with two sensors that monitor the amount of medicine being released into the body. One is a flow sensor that measures the volume of liquid entering the mouth via the duct, while the other measures the concentration of the agent contained in the liquid. Based on the measurement results, the electronic circuit either opens or closes a valve at the end of the duct to control the dosage. If the agent has been used up, the electronic system alerts the patient via a remote control, which was also developed at the IBMT. This control permits wireless operation of Intellidrug, and can be used by the patient or doctor to set the dosage required.

The patient has to have the agent refilled every few weeks. This could be done using a deposit system whereby the patient swaps the empty prosthesis for a newly refilled one. At the same time, the battery could be replaced and the device could be serviced

The “serviced every 2 weeks part is not going to fly IMHO.