Brain-boosting "cosmetic neurology" on the horizon

By Laura Beil
The Dallas Morning News

DALLAS — In the future, reality shows may have names such as "Extreme Makeover: Brain Edition" or "Sharp Eye for the Dumb Guy."

At the beginning of each episode, viewers could learn about one hapless soul's lifelong struggles with algebra and another's desire to stop being a worrywart. By the end of the hour, the transformed contestants would be winning chess matches and prancing carefree through fields of daisies. Don't check the TV listings yet, but the idea is not all fantasy.

Some neurologists recently have wondered whether their field is the next frontier in elective medicine. The specialty now tries to protect ailing brains from conditions such as Parkinson's disease or migraine headaches. But doctors' efforts one day may extend to normal brains.

"This is coming, and we need to know it's coming," said Dr. Anjan Chatterjee of the University of Pennsylvania.

There's even a name for the field: cosmetic neurology.

Other improvements

As he envisions it, cosmetic neurology one day could mean not only sharpening intelligence, but also elevating other dictates of the brain — reflexes, attention, mood and memory. Studying for the SAT? Take this drug to retain more of those pesky facts. About to report for duty at the fire station? These pills will improve your reflexes. Here's the 800 number. Ask your doctor.

These are not only theoretical musings. Last month in the journal Neurology, Chatterjee noted that some current drugs already may have many of these effects. In one study, for example, emergency-room patients given a memory-altering drug appeared to be spared some symptoms of post-traumatic stress. Another small study of pilots in flight simulators suggested that those taking medications for Alzheimer's disease performed better, particularly under emergency conditions.

Chatterjee reserves opinion but says the idea speaks to the basic purpose of medical practice.

"I'm not arguing that this is a bad thing, and I'm not arguing it's a good thing." Before doctors are caught by surprise, he said, they need to be prepared. "What I'm hoping to do with this is get people talking."

They are. Since the journal's publication, he has fielded steady e-mails. Some neurologists say they already have had patients asking about such medications for the mind.

Medical gatekeepers

Not all of Chatterjee's colleagues, though, agree that cosmetic neurology is inevitable, even if mind-improving drugs become safe and available. "There are certainly pressures that are going to push us that way," said Dr. Richard Dees of the University of Rochester. Doctors have the power, however, to shape the future of their profession regardless.

Writing in the journal, Dees argues "as neurologists and as citizens, we can collectively control our own destinies, if we choose and if we have the will to act."

Another of his colleagues has a different take. Dr. Stephen Hauser of the University of California, San Francisco, wrote that "advances in neuroscience carry with them the likelihood, intended or otherwise, of medical applications that go well beyond the traditional goals to prevent, diagnose and treat disease."

Few specialties know this as well as plastic surgeons. Before there was "Nip/Tuck" and Michael Jackson's nose, plastic surgeons were rebuilding war-mangled bodies. As safety improved and public demand for cosmetic surgery grew, so did the number of cosmetic surgeons.

"You've always had a dilemma and a schism," said Dr. Robert Goldwyn, who has edited the Journal of Plastic and Reconstructive Surgery, the field's premier journal, for more than two decades. In fact, some plastic surgeons now wonder whether their profession — under financial and public pressures — leans too far toward cosmetic surgery. And he has words of caution for colleagues who concentrate on the brain: "The minute technology comes along, it will be used," he said. "If doctors won't do it, other people will do it."

There are other instances of doctor-provided enhancements beyond plastic surgery, said Thomas Murray, president of The Hastings Center, a Garrison, N.Y.-based bioethics research institute. Synthetic growth hormone was developed to help children with severe hormone deficiencies. But some parents have asked doctors to give it because their children simply are at the low end of the normal-height bell curve. In response, endocrinologists have tried to develop strict guidelines for its use.

"The thing about surgical enhancement is we think we can more or less understand the risks," Murray said. "With drugs it gets more complicated."

Looking ahead

Mental enhancement with drugs is not itself unethical, he said — a cup of coffee, after all, heightens alertness beyond a natural state. Few people object to caffeine, however, because it is considered safe, is inexpensive and is available to almost everyone.

But other drugs might not be so clear. "There are major safety concerns," Murray said. For example, a person's personality is a blend of all traits, yet no one knows whether a drug that distorts one mental function would diminish another.

In his editorial, Chatterjee also raised questions about whether cosmetic neurology might lead to coercion in certain professions. If a drug improved the emergency reaction of pilots, would they then be forced to take it? Would you pay more for a flight knowing the pilots took the drug?

These and other questions are those that neurologists should be asking themselves now, Murray said, before advances take them by surprise. The growth-hormone story, he said, demonstrates that physicians can set standards, regardless of where public momentum pushes them.