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HEAD TO HEAD: John Harris Is it acceptable for people to take methylphenidate to enhance performance? Yes BMJ 2009; 338: b1955 [Full text]

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Body and mind enhancement: not (anymore) a medical issue

Arnaud Chiolero   (25 June 2009)

over the counter amphetamines

Ann M Blatt   (26 June 2009)

Methylphenidate Mirage

SAMIRAN ADHIKARI   (8 July 2009)

Body and mind enhancement: not (anymore) a medical issue 25 June 2009
Arnaud Chiolero, Epidemiologist Montreal, Qc, Canada, H2H 1X1 Send response to journal: Re: Body and mind enhancement: not (anymore) a medical issue	To the Editor, One critical point may have been missed in the fascinating debate regarding the acceptability of methylphenidate to enhance cognitive performance [1, 2]: beside prescription, this is not (anymore) a medical issue. Authors rightly argued that the limit between medical and non-medical body and mind enhancement methods is arbitrary. It is also vanishing. Actually, one should first admit that many stakeholders (e.g., pharmaceutical industry selling such drugs, but also any industry who wants to increase productivity of their employees or schools who want to improve the average grades of their pupils) are involved and that professional vested in public health or medical domains do not hold the keys of the debate. Second, acceptability of tools to enhance body and mind functions reflect social and cultural trends and values. In the futurist society described in 1932 by Aldous Huxley in Brave New World [3], the fashionable drug “soma” is used to relieve individuals of the burden of existence, to enhance pleasure, and to favor social contact and, eventually, sexual promiscuity. And the numerous reasons to take soma are consistent with the dominant values of this Brave New World: soma has “all the advantages of Christianity and alcohol; none of their defects”; it “raise[s] a quite impenetrable wall between the actual universe and [the] mind” and “instead of feeling miserable, you'd be jolly. So jolly.“ [3] Methylphenidate may not help feel jolly but better matches with the current aspirations of many societies in which individual performance is highly valued. Arnaud Chiolero MD MSc, epidemiologist, Montreal References 1. Harris J. Is it acceptable for people to take methylphenidate to enhance performance? Yes. BMJ 2009; 338:b1955. 2. Chatterjee A. Is it acceptable for people to take methylphenidate to enhance performance? No. BMJ.; 338:b1956. 3. Aldous Huxley. Brave New World. 1932. Full text available online: www.huxley.net (accessed 25 June 2009). Competing interests: None declared
over the counter amphetamines 26 June 2009
Ann M Blatt, retired Valinhos, SP 13277220 Send response to journal: Re: over the counter amphetamines	My husband, who is Argentinian, reminds me that amphetamines were sold freely over the counter in Argentina in the sixties and many students used them as did many other people without apparent problem. Ann Blatt, MRCPsych (retired) Competing interests: None declared
Methylphenidate Mirage 8 July 2009
SAMIRAN ADHIKARI, Medical Advisor, Doctor SUN Pharmaceutical Industries Limited, ACME Plaza, Andheri Kurla Road, Andheri East, Mumbai 400072, Send response to journal: Re: Methylphenidate Mirage	Healthy mind requires formidable challenges to overcome the apparent difficulty and we can utilize untapped abilities and skill to overcome the mental challenges. Thus are endowed with skill without the potentially dangerous and unpredictable outcome of an untested chemical solution of a human problem. Stimulant and many psychotropic drugs are known for their variable effects. The same drug is having different and opposing effect over a period of time on our body and mind. For example, cocaine increases libido over short-term use but the same is not true during chronic use. The same amount of alcohol is not able to produce the same effect on mood and behavior over chronic use. Therefore, our dependence on chemical agents to improve our cognitive edge is not backed by solid examples. Furthermore, available evidences are not strong enough to suggest the possible benefit over a period of time. Another important point is that use of methylphenidate will be covered with a pseudo comfort of taking a magic pill. This is dangerous, as we will deny ourselves from a second wind or the enormous capacity of our mind to adapt to challenges. Therefore, there will be a temporary boosting of mood and cognition only to be covered by a complacent attitude and its consequences. Therefore, methylphenidate magic is just a mirage for our magnificent mind. Yours sincerely, Dr. Samiran Adhikari Competing interests: None declared