Friday, June 26, 2009

Should Ritalin Be Used by the Healthy?

The British Medical Journal has an interesting two part debate on the question of whether methylphenidate (i.e., Ritalin) should be acceptable for use among healthy students and adults. The non-medical usage rates of this and other types of ADHD medications are high, and indeed it is the only class of prescription drugs for which there are more non-medical users than medical ones. So, whichever side you stand on this debate, it is a difficult topic to ignore.

The "Yes" side, written by John Harris, makes the argument that boosting cognitive abilities is something we should be celebrating. The "study steroid" analogy to sports fails in that education is not a zero sum game. To the extent that a more knowledgeable populace will make society better in some objective way, then improving information storage and cognitive load capacity has definite benefits. And if society does not improve as students learn more, then remind me again why we are subsidizing higher ed?

The "No" side, written by Anjan Charterjee, attacks the positive argument from a number of angles, including fears of diminished creativity, socioeconomic inequity, and possible serious cardiovascular adverse events as a result of intake. The inequity claim is not just a postulation. Students whose family income is above $250,000 are three times more likely to have used prescription stimulants non-medically in the past year than students whose family income is less than $50,000, a larger effect than that seen in other drug use (from a 2007 study, see here). Although the drugs themselves are sometimes free, the inequity may be present because social networks are likely to be divided at least loosely along socioeconomic lines, and social networks are how one hears about and begins to use the drugs non-medically. However, this inequity is similar to the phenomenon in which richer students are more likely to be classified with learning disabilities and get extra time on exams because their parents were rich enough to pay for the tests. And nobody seems to care about that very much.

The "No" side author also makes the tired argument that perhaps more intelligence would be bad for the world, on the basis that "very smart people generating complicated models to distribute financial risk" was a contributing factor to our current economic woes. This is totally unsubstantiated and indeed much of the data points in the opposite direction. More intelligent people are less likely to fall victim to a hodgepodge of cognitive biases (see here), and a more educated and intelligent populace predicts a greater rule of law, a higher political freedom, and an increased GDP in that country (see here).

Despite the benefits, I still fall somewhere on the "No" side of the debate. I think there should be more and better data on the topic before any further steps are taken. For example, almost all of the cognitive research done has been on Ritalin even though Adderall is now just as prevalent. Additionally, the risk of psychological dependence has been basically ignored in college aged adults. Anecdotally, some of my classmates have noted that they "can't study" without the drug or that "it's not worth it"--see here for one of the many examples of this on the internet. Perhaps I am overly risk averse but to me these risks outweigh the potential benefits, both on a personal level and in my opinion about what should be done about society at large.

If you enjoyed this post, perhaps you will enjoy my longer essay on the topic, which you can find here. I discuss the research into neural mechanisms of ADHD drugs, the history and current attitudes about the risk of psychological dependence, and make some propositions about the present with an eye towards the future.