Intended for healthcare professionals

Observations Heads Up

The billion dollar business of being smart

BMJ 2015; 351 doi: (Published 14 September 2015) Cite this as: BMJ 2015;351:h4829
  1. Krishna Chinthapalli, neurology advanced trainee, Royal North Shore Hospital, Sydney, Australia
  1. kchinthapalli{at}

Demand for cognitive enhancement is huge and growing

The prolific French novelist Honore de Balzac wrote for 15 hours a day with the help of his “precious essence.” After a dose, he said, “Ideas march into motion like battalions . . . Memories charge in . . . The cavalry of metaphor deploys with a magnificent gallop; the artillery of logic rushes up.”1 He eventually took it up to 50 times a day. As far as de Balzac was concerned, caffeine was his “smart drug.”

Caffeine is still the drug of choice for many college students in search of the same effects. Most have used coffee, caffeine drinks, or caffeine tablets to help them study.2 In the United States, caffeine is now being supplanted by the prescription stimulants Adderall (amphetamine plus dextroamphetamine), methylphenidate, and modafinil. Some 5-15% of college and university students report taking these stimulants to help academic performance but most do so only occasionally (40% had used them only once or twice).3 Colleges with higher entry criteria have a higher prevalence of stimulant use. In high schools, too, 7% of …

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