Blue Sphere Health

Posts Tagged ‘lifestyle drugs’

What Links Cognitive Enhancement and Erectile Dysfunction?

Now that I’ve caught your interest, I will answer the question and explain the odd title for this post.  The link between these two conditions is not medical – before anyone sues me – but is in how people obtain and use prescription drugs. For the uninitiated, cognitive enhancers are drugs that make us think better or improve our concentration and attention span.  Many of us use one of them every day – caffeine.  However, there are now stronger, prescription medications available and their increasingly widespread use raises some interesting ethical questions as well as worries over supply chain security and counterfeiting. I’ll tackle the ethical issues first. The use of cognitive enhancers in people with impaired function (due to conditions such as Alzheimer’s, schizophrenia, ADHD etc) is relatively uncontroversial.  If drugs enhance the patient’s cognition, their lives will probably be improved.  In recent years the logic has been extended – surely making healthy people smarter is a good thing?  Recently I attended a fascinating and very well-balanced lecture by Professor Barbara Sahakian of the University of Cambridge on the use of cognitive enhancing drugs in healthy people – an area that is known as “cosmetic neurology”.  College students regularly take Modafinil, Adderall etc to enable them to work harder, complete a bigger workload, or just compete against their peers.  Controlled studies in experimental systems do seem to show reproducible advantages for subjects taking the drugs versus those taking a placebo.  University students are independent and have choices, but there is even debate about whether cognitive enhancing drugs should be given to normal schoolchildren to make them “cleverer”.  In discussion afterwards, with an audience of doctors and medical students, I had several people compare the use of these drugs to other ways that parents try to ensure that their kids get ahead – providing a good diet or paying for a good school. In my personal opinion, giving a prescription medication to a perfectly healthy child so that they get better grades is wrong.  Kids look to their parents for guidance and to do the right thing by them.  Others will disagree, but I think there is a difference between gradual and reversible acts such as attention to diet, insistence on a homework regime etc, and using prescription drugs.  Modern medicine has performed miracles, but feeding our kids drugs when they are healthy is not the way I want society to go and I don’t see how it squares with the Hippocratic Oath.  Furthermore, if we allow unregulated use of these drugs, eventually the majority of people will be taking them and the relative advantage they confer disappears.  The playing field re-levels itself, so there will be a search for yet stronger alternatives. This is an ethical minefield and I leave the detail to others (such as the Neuroethics Society) to thrash out. My professional concern is that all lifestyle drugs are an open invitation to counterfeiters.  Pfizer’s long battle with fake little blue pills is a case in point.  Most of those students who use Modafinil probably get it from the internet.  There is little evidence for the specific prevalence of counterfeits in this class of drug, but I am willing to guarantee that much of the time they are taking poor quality, sub-dose and possibly contaminated material. Studies show that over 50% of drugs bought from internet pharmacies are fake.  If the placebo-controlled experiments on human volunteers,  quoted above, were repeated with internet-bought drug (instead of pristine drug straight from the manufacturer), I bet the enhancement effect would be a lot less. The more widespread the use of cognitive enhancement drugs becomes, the bigger the market for fakes.  Perhaps the answer is to de-regulate, and allow good quality drugs to be supplied to those who want them?  That doesn’t usually work either, because many people will still seek lower prices and greater convenience online and expose themselves to the danger of counterfeits. There is no easy answer, but we need to decide whether these are medicines to treat disease or lifestyle enhancing supplements.  If the former, then we need to restrict the clinical indications for which they can be licensed and clamp down on off-label use and counterfeits.  If we take the latter road of de-regulation, then we should be aware of what we are getting into – the answer to the title question is going to be counterfeit drugs. Photo: Okko Pyykko from flickr
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Pharmaceutical Anti-Counterfeiting

Combating the Real Danger from Fake Drugs has become a must-have primer on anti-counterfeiting and is widely used by drug companies, regulators and others. The book covers the legal, strategic and political issues as well as the technical counter-measures such as process control, digital serialisation and physical security.

Pharmaceutical Anti-Counterfeiting book