Smart drugs and smarter airline bosses

Since I posted last week, I have been to London to interview Sandra Bullock - funnier than I thought she would be - and to the South of France for a very serious interview on a very serious subject (it would be flippant to insert the relevant smiley/unsmiley faces here).
So it's fitting that two pieces I have published in newspapers today display the eclectic range of subjects I write on.

The first is on the abuse/use of cognitive-enhancing drugs by students in the Irish Independent...
http://www.independent.ie/lifestyle/are-smart-drugs-cheating-our-students-out-of-their-future-1808926.html

The second is a piece I wrote at 7am this morning for today's edition of the Evening Herald on Ryanair's delightful proposal to rip out some of the seats on their planes in favour of stools. Charming man, that Michael O'Leary...
http://www.herald.ie/opinion/comment/if-oleary-could-hed-make-us-flap-our-arms-1809445.html

ARE SMART DRUGS A CHEAT?
Tuesday July 07 2009

By Jeremy Laurance and Susan Daly

Certain households -- those containing exam-sitting students -- may have noticed a peak in their consumption of coffee last month. Caffeine-loaded energy drinks have long been stimulants of choice for students struggling to burn the midnight oil.

But what if students began to turn to more serious stimulants to enhance their performance at the end of term?

Ritalin is a stimulant drug, best known as a treatment for hyperactive children. But it has also found a ready black market among students, especially in the US, who are desperate to succeed. Users say it helps them to focus and concentrate, and this has been confirmed in research studies on adults.

David Green, a student at the University of Harvard, told The Washington Post: "In all honesty, I haven't written a paper without Ritalin since my junior year in high school."

Matt, a business finance student at the University of Florida, claimed a similar drug, Adderall, had helped him improve his grades. "It's a miracle drug," he told The Boston Globe. "It is unbelievable how my concentration boosts when I use it."

Dr David McGrath, of Trinity College Dublin's Student Health department, says that student-health services in Ireland are aware of the problem.

"It is rarely an issue with Irish students at the moment in our experience," he says, "but we frequently find students from abroad using it as a cognitive-enhancing drug."

These students have often originally been prescribed the likes of Ritalin for a diagnosis of a genuine disorder such as ADHD -- but then they don't necessarily take it in the way it was prescribed to them. "Some will only use it when they want to cram before an exam," says Dr McGrath.

Student health medics try to keep an eye on this abuse of such stimulants -- "that would be a lot of our workload at the start of the year, trying to determine that those who come to us needing these drugs prescribed have been diagnosed by a consultant psychologist" -- as drugs like Ritalin are subject to stringent controls.

"You can't just walk into a pharmacy and buy these. We don't issue them for people who say, 'Oh I tried my friend's Ritalin and it worked for me'. These drugs should never be opened up willy nilly to people over the counter, because they have side-effects and can interact with other medicines, even herbal remedies. They are as strongly controlled as morphine -- and with good reason," says Dr McGrath.

Of course, the internet is a potential source of drugs. "I would imagine that there is no drug that you can't type in the name and find online," says Dr McGrath, "but the drugs you receive in the post might not be the drugs that they are marketed as."

Still, there are no specific regulations governing the use of chemical cognitive-enhancing. Is it really cheating? Some experts have condemned the trend and accused students of gaining an "unfair advantage" by doping, without explaining why it is any more unfair than hiring a private tutor or paying for exam coaching.

John Harris, director of the Institute for Science, Ethics and Innovation at the University of Manchester, and editor-in-chief of the Journal of Medical Ethics, has made the provocative suggestion that it is time to embrace the possibilities of "brain boosters".

Professor Harris says that the arguments against the drugs "have not been persuasive" and that society ought to want enhancement.

"It is not rational to be against human enhancement," he writes. "Humans are creatures that result from an enhancement process called evolution and moreover are inveterate self-improvers in every conceivable way."

Although no drug can be guaranteed safe and free of all side-effects, Ritalin has been judged safe enough for children with attention deficit hyperactivity disorder (ADHD), and has been widely used to treat them over many years, he says.

The drug is a stimulant which was introduced in 1956 and appears to influence the way the brain filters and responds to stimuli.

It increases energy as well as confidence and has been compared to cocaine.

Possible side-effects are typical of stimulants and include insomnia, loss of appetite, dizziness and depression on withdrawal.

Kieran Fitzpatrick is Welfare Officer with the Union of Students in Ireland. He says the USI would definitely not advocate the use of medication to sharpen brains at exam time.

"It is medication, it has side effects, there can be increased heart rate," he says. "And what happens after the exams are over? Do people develop a bit of dependence, do they go through the trauma of withdrawal?"

The ethics of the debate over whether 'smart' drugs are cheating is less important than initiating research into how their misuse can "tamper with the human body", Fitzpatrick believes.

Writing in the online British Medical Journal, Professor Harris says the use of cognitive enhancing drugs should be seen as a natural extension of the process of education.

Drug regulatory agencies should assess the benefits and risks in the same way as they would for any other medical intervention.

"Suppose a university were to set out deliberately to improve the mental capacities of its students.

'Suppose they further claimed that not only could they achieve this but that their students would be more intelligent and mentally alert than any in history.

"We might be sceptical but if the claims could be sustained should we be pleased?"

His answer is an unequivocal yes. He concludes that it is unethical to stop healthy people taking Ritalin to enhance their mental performance.

But in total disagreement, Professor Anjan Chatterjee from the University of Pennsylvania argues in the BMJ that there are too many risks.

In the US, the drug carries a "black box" warning, the most serious, because of its high potential for abuse, serious adverse risks on the heart and the risk of sudden death.

He adds that there are cognitive trade-offs in taking Ritalin, with a loss of creativity, and points out that "being smarter does not mean being wiser".

He raises the spectre of children at top preparatory schools taking Ritalin in "epidemic proportions" and pilots, police and doctors being pressurised to take it when on-call.

Professor Bert Gordijn, chair of Dublin City University's Ethics Institute, similarly argues that there is a concern that if certain groups start to use 'smart' drugs to get an edge, then there might be societal pressure for everyone to use them.

"What seems abnormal today could become normal tomorrow," says Prof Gordijn. "We are talking about medicalisation here."

There isn't any empirical research in Ireland on the use of enhancement technologies, but Prof Gordijn believes that there is a general tendency globally for them.

"While medicine has focused on curing disease, now it's coming up with improving on the traits of normal people.

"You see this with the rise in cosmetic surgery, or in the endeavours in sporting medicine which are more about enhancing performance than curing disease."

Progress often carries risk, says Professor Harris. The development of "synthetic sunshine" (firelights, lamplight and electric light) could have forced people to work through the night.

The answer was not to ban it but to introduce laws to regulate working hours.

"The same is or will be true of chemical cognitive enhancers," he concludes.



IF O'LEARY COULD HE'D MAKE US FLAP OUR ARMS...
By Susan Daly

Tuesday July 07 2009

Are you right there, Michael? Just when you thought Ryanair had removed all the frills it possibly could, it changes the definition of the things we should consider little extras. You know, crazy luxuries like seats and such.

The latest missive from the low-fares, who-cares airline outlines plans to perch passengers on stools so more cargo -- sorry, humans -- can be squeezed on a flight. It's the equivalent of that schoolboy prank of pulling the seat out from under you when you're not looking.

Michael O'Leary has already put the call in to Boeing to find out if his evil genius can be accommodated. He is taking as his model the Chinese airline Spring, which introduced stools to increase its passenger load by 50pc and cut costs by 20pc.

Enterprise and communism make for uneasy bedfellows, but you can see how it might be inspiring for O'Leary. Ryanair would refer to passengers by number rather than by name if they thought it might cut down on the paperwork.

It is entirely possible that this is another flier from O'Leary, the CEO of an airline that ran a competition for new money-generating ideas. The winner: to charge customers for using the onboard toilets. It has yet to come to pass, but O'Leary managed to keep his poker face long enough for the publicity fires to be stoked.

Stunts

Publicity stunts are a huge part of Ryanair's advertising -- Michael O'Leary is a rare breed of millionaire who is happy to dress up as a priest or a giant mobile phone in the pursuit of the next shekel. But what if this latest wheeze is true? Would you take a stool to save even more money on a flight already discounted to peanuts? The truth -- which O'Leary has built his business on -- is many of us probably would.

We have surprised ourselves by how much we can get used to. Remember the public outrage when O'Leary announced he would be charging for a cup of tea or coffee? The Liveline phones were hopping red-hot for days.

No matter how we grumbled, we kept booking with O'Leary's dastardly empire because the fares kept plummeting. The real test of O'Leary's success was when other airlines, emboldened by his brazenness, followed suit.

That is why it didn't seem at all unfeasible when the story about Ryanair's latest plan began to emerge. Initially, it was reported that passengers might be asked to stand at the back of the plane in exchange for the lowest of low fares. I guess that wouldn't go down well with the air safety people.

I'm just wondering where this will all end. They might consider getting rid of those big, expensive planes -- if birds can fly, surely we lazy passengers can grow some wings. Stop moaning, people, it's progress.