Suppose your child was about to sit an important exam and you were offered a drug that would boost his powers of thinking and concentration.

What's more, you were told it was medically approved and had few sideeffects. Would you allow him to take it?
'No way,' might be your first response. But suppose you learned that other children sitting the exam were already taking the drug to help with their revision.

What's more, their parents were raving about the positive effects. These are just some of the hard questions you might be faced with very soon thanks to the development of socalled 'smart drugs'.

These are drugs that have been developed to help people with conditions such as dementia and ADHD but have been found to improve memory and thinking in healthy people as well.

They generally work by increasing levels of certain brain chemicals.

The drug Ritalin, for instance, boosts a hormone called noradrenaline.

This helps hyperactive children to focus on one thing at a time - but when used in otherwise healthy adults it makes them feel more alert and full of energy

 

Only last summer there were reports that British parents were buying Ritalin on the internet for their healthy children to boost exam results. As many as 10 per cent of students at American universities are thought to be using Ritalin and Adderall (another ADHD drug) to improve their performance.

And it's not just students who are getting chemical help. Another prescription drug, Provigil, is widely used by businessmen and other professionals to overcome the effects of jet-lag by making them feel focused and alert even when they haven't slept. Users also report their performance improves as well. The drug is officially licensed to treat narcolepsy.

Last week, a Cambridge psychology professor wrote an article in the science journal Nature, calling for a debate on the use of these 'cognitive-enhancing' drugs. 'We've done informal research that shows not only students, but also senior academics, are using smart drugs to improve their performance,' says the author and professor of clinical neuropsychology, Barbara Sahakian.

'I was offered Provigil by a colleague to help me give a presentation after an eight-hour flight, and some of my fellow academics use it regularly.' She believes that as both education and business become more competitive, demand for these drugs will increase, fuelled by easy availability over the internet. A pack of Provigil can be bought online for £64.

'As a society, we need to have a debate about how we want to control the use of these drugs,' says Prof Sahakian. 'Do we want to accept them and have them handed out at the university pharmacy, or are they a form of cheating? Should there be random drug-testing of students before they sit exams?'

By contrast, one of the world's leading experts on the way the brain works is not concerned about these developments.

Professor Michael Gazzaniga, president of the Cognitive Neuroscience Institute in America, said recently: 'People have all sorts of natural advantages - some are cleverer, stronger or more beautiful than others. If we can boost our abilities to make up for the ones Mother Nature didn't give us, what is wrong with that?'

Certainly, the wider market for safe and effective smart drugs could be huge. By 2012, an estimated 41 per cent of the UK population (23.8 million people) will be over 50 - the age when memory and mental ability begin to decline. Should they be allowed to pop a pill to help them think more clearly?

Unlike Professor Gazzaniga, some of the experts developing these drugs are unhappy about their use by healthy people. There are also concerns about potential side-effects and the ease with which these prescription-only drugs can be bought over the internet.

The active ingredient in Adderall and Ritalin is amphetamine - this was first manufactured in 1887 (indeed, it's just one of the smart drugs that isn't actually 'new') and was used by soldiers to stay awake. Women have also long used it for dieting.

Its potential side-effects include heart attacks, blurred vision, pain, numbness and seizures - and studies of its smart drug capabilities show it's not actually much more effective in boosting concentration than a strong coffee. Another of the 'older' smart drugs is Aricept (also known as donepezil), used for Alzheimer's patients.

A study a few years ago found it improved the memory of fighter pilots learning new moves on a flight simulator. At the time, Professor Gazzaniga enthused: 'I believe that donepezil could become the Ritalin for college students.'

What this ignored is the long list of unpleasant side-effects associated with the drug, such as generalised pain, dizziness, nausea and vomiting. In fact, all the existing smart drugs come with some pretty nasty side-effects.

Even Provigil, which is known to have the mildest side-effects, may result in headache, nausea, nervousness, rhinitis (inflammation of the nose lining), diarrhoea and back pain.

What's more, there is some evidence that Ritalin may affect the development of young brains. (A more positive, if bizarre side-effect is that the concentrated attention produced by Adderall and Ritalin has been turned to housework; universities in the American report that students' apartments have never been cleaner.)

However, enthusiasts claim that these drugs are just the beginning. They are the pharmaceutical equivalent of the Wright brothers' bi-plane, forerunner of today's supersonic jets. The era of 'cosmetic pharmaco-neurology' is on its way, when our growing knowledge of genetics and biochemistry will allow scientists to sculpt all sorts of human behaviours, from faithfulness in marriage to emotional stability, with greater safety than current smart drugs.

Much hope is being put in a new class of drug called ampakines, which seem to be able to improve alertness without the jitteriness that comes with caffeine or drugs such as Adderall.

A study of one of these compounds - known as CX717 - was done two years ago at the University of Surrey. When it was given to 16 healthy young men who'd been deprived of sleep, it improved their memory, attention, alertness and problem-solving ability.

Ampakines boost the amount of a brain chemical - glutamate - which is involved in creating memories. 'We all have the same computer,' says Gary Lynch, a neuroscientist at the University of California, Irvine, who invented the drugs. "But some of us are running with different voltage levels. Ampakines boost the voltage."

He believes that if his drugs prove to be safe, the social implications could be astounding. "At the moment, people accept their place in the intellectual hierarchy," he says. "What happens when it becomes possible for them to change?"

Of the drugs available at the moment, the one that comes closest to the ideal of the smart drug is Provigil.

It certainly seems effective in keeping you awake and functioning better; although it does have some side-effects (such as headaches, diarrhoea, and insomnia), many people seem to feel the benefits outweigh them.

Indeed, some people may be prepared to tolerate quite a lot of discomfort as long as the drug is effective.

One student, when asked about the possible dangers of Ritalin, replied: 'It's medicine that parents give their eightyearolds. It's brand-name stuff. How bad can it be? Sure, there are problems with weight loss, sleep loss, the jitters and throwing up, but it works.'

Even so, using Provigil to play with your sleep patterns may not be a good idea. "We don't know the long-term effects of using drugs to stay awake longer," says Professor Jim Horne, of the Sleep Research Centre at Loughborough University.

"What we do know is that there are powerful mechanisms for sleep and no

natural ways to override them, so it's potentially a dangerous thing to do." All of the many other drugs in the pipeline have had impressive results in animals, but that doesn't necessarily mean they are going to work in humans. What's more, there are warning signals from the animal world that indicate some of the things that could go wrong.

Mice whose brains have been boosted with smart drugs are certainly better learners, but some are also more sensitive to pain. Higher doses of ampakines are more effective at strengthening memories, but in one set of studies, the animals on high doses were also more likely to suffer from seizures.

Then there is the issue of giving drugs to people who are otherwise healthy. Another scientist researching the pharmaceutical holy grail of a safe and effective memory-booster is Nobel Prize-winner Professor Eric Kandel of Columbia.

His work on sea slugs found that a protein called CREB was crucial for memory formation, and he's now involved in trials of a series of CREB-boosting drugs to help people with the memory loss caused by disorders such as dementia and Parkinson's disease.

He is horrified by the idea that such drugs should be used by healthy students to boost exam scores. "It's awful," he said. "They are designed for people with serious problems who really need help. The idea that character and intelligence is to be judged by a small improvement in an exam result is absurd."

Another intellectual heavyweight who is doubtful about smart drugs is Professor Howard Gardner, a psychologist at Harvard University. He developed the theory of multiple intelligences - the idea that intelligence isn't just about being academically clever.

Instead, he says, there are at least seven different types of intelligence, such as being musical, using your hands and being alert to other people's emotional states.

"We have no idea what these drugs do to these other forms of intelligence," he says. "In human terms they are just as important." So who should be allowed these drugs, and who should not? "Ultimately that's a question for society," says Professor Derk- Jan Dijk, the director of the Surrey Sleep Research Centre.

"But it seems inconsistent to allow the drug to combat the drowsiness caused by a night shift at the petrol station but forbid it to a sculptor who stayed up all night finishing a piece."

It is precisely because there is this huge range of opinions about smart drugs that Prof Sahakian believes it is vital to have a proper debate.

£People raise their eyebrows at the idea of academics using drugs to improve their performance," she says, "but if there were safe drugs that improved concentration and planning-many might think it would be OK if they were used by the likes of air-traffic controllers, surgeons or soldiers."

The authorities, meanwhile, are unable to address this issue. The UK drugs watchdog, the Medicines and Healthcare Products Regulatory Agency, only licenses drugs to treat medical conditions.

It also has no control over drugs bought through the internet but advises against it. "If people self-prescribe in this way they could damage their health," said a spokesperson.

Cephalon, which makes Provigil, declined to comment directly on its widespread unapproved use. A spokesperson said: "Our company is exclusively engaged in activities which relate, in compliance with the rules and regulations of the pharmaceutical industry, to the officially approved indications which are excessive daytime sleepiness, mainly narcolepsy."