After completing this module, you should be able to simply yet effectively
1.) Teach the fundamentals of neurophysiology and neuropharmacology
2.) Lead a discussion on enhancement - what it is, why it is difficult to define, and why it is an important area of study
3.) Present the ethical questions raised by Ritalin and Adderall non-prescription use in order to stimulate discussion in the classroom

Curriculum Integration Ideas
This brief may be used in life science classes during units for topics including:
1.) Human neuroscience
2.) Public policy discussions on medical regulation and physician practices

2.  How the Brain Works

The human brain is a miraculous organ.  Without even realizing it, your brain is allowing you to regulate your breathing, control your heart rate, hear and talk in the classroom, control your movements, and think all at the same time!  The nervous system is made up of billions of individual nerve cells that form a system of connections from your head all the way to your toes.  These nerves are unique compared to other cells in your body since they can send electrochemical signals.  For example, if you step on a pin with your toe, a nerve cell in your toe will feel pain and send a signal up to your spinal cord to move your leg off of the pin and maintain your balance so you do not fall.  At the same time, a signal will travel up your spinal cord to your brain so that you know what is happening and can say "Ouch!"  Please view this slideshow  for further information about the components of the nervous system.

These signals travel both electrically within the nerve cell and then through chemicals called neurotransmitters between the nerve cells.  It is this pattern of neurotransmitters that a nerve cell releases that medicines affect.  Medicines such as Ritalin and Adderall are normally prescribed to patients with Attention Hyperactivity Deficit Disorder (ADHD), a condition in which they find it difficult to concentrate, in order to boost their attention span.  Studies have found that these medicines affect the pattern of neurotransmitters in the prefrontal cortex (PFC).  The PFC is an area of the brain that controls attention, decision-making, and impulse control.

3. A Closer Look - Ritalin and Adderall
Each day, millions of people in America drink coffee, tea, or soda for the caffeine jolt to stay energized and focused.  Thousands of these people are now turning to Ritalin or Adderall since it has stronger effects on the PFC and can therefore improve concentration and minimize fatigue much more so than caffeine.  These drugs are being obtained by people without the diagnosis of ADHD and sold on the black market.  In fact, some college campuses report that 3% of their students have abused these prescription stimulants.

So if the medicine increases your ability to study or do well at your job, then what is the problem?  Well, first, its illegal to take the medicine without having a prescription from your doctor.  Secondly, Ritalin and Adderall are not without their own health risks.  Side effects include difficulty sleeping, seizures, high blood pressure, loss of appetite, depression, and many others.

4.  What Are Some Of The Ethical Issues Raised?

There is a wide variety of ethical issues that have been raised by the widespread non-prescription use of Ritalin and Adderall.  Some of these are:

Cognitive Enhancement
Enhancement was defined by the President's Council on Bioethics as the "use of biotechnical power to alter, by direct intervention, not disease processes but the ‘normal' workings of the human body and psyche, to augment or improve their native capacities and performances."  So if medicine is used to treat disease, it is therapy; if not, it is enhancement.  An example is erythropoeitin.  This medicine increases red blood cells and is used by doctors in patients with kidney disease.  However, many athletes have been accused of using it ("blood doping") to increase performance.  The first, is therapy.  The second, enhancement.  So is the non-prescription use of Ritalin and Adderall cognitive enhancement?  On one hand, it is not being used for its intended purposes of treating ADHD, but instead to increase concentration.  But on the other hand, millions of people use caffeine for the same purpose.  So just how far are we willing to go in calling things enhancement?

Off-Label Prescribing
Another problematic area is just how these medicines are being obtained.  The legal use of Ritalin and Adderall requires a prescription from your physician for the treatment of ADHD or other health conditions.  Off-label usage means that a physician prescribes you a medicine for something other than the use for which it was approved by the FDA - in this case, to increase concentration even if you don't have ADHD.  If you were a physician, Would you give out a prescription for Ritalin to a high school that has a big paper due in a week?  Is it wrong for people to sell their pills on the black market?  Do the pharmaceutical companies that make Ritalin and Adderall have a responsibility to strengthen safeguards so that their medicine is not used for off-label uses or sold to others?

Unfair Advantage
Since Ritalin and Adderall help increase concentration and decrease fatigue, students are able to study longer and more effectively.  Is this cheating compared to those students that study without this kind of pharmaceutical aid?  Since the drug is being sold, perhaps poorer students are unable to afford the pills - is this fair to these students?  But then again, is it cheating to drink a cup of coffee or is this somehow different?

5.  Review Questions
1.     Explain some of the key components of the human nervous system
2.     Discuss how messages move through the nervous system and how Ritalin and Adderall affect this process
3.     Identify three ethical issues raised by the non-prescription use of Ritalin and Adderall and discuss your stance on each of these issues
4.     What is enhancement?  Is enhancement always bad?  Discuss other technologies that could be considered enhancements.
5.     Discuss some other unfair advantages that exist in the classroom.

References
1.     Fact Sheet on ADHD
2.     Fact Sheet on Stimulant ADHD Medications
3.     President's Council on Bioethics, Beyond Therapy:  Bioetechnology and the Pursuit of Happiness
4.     American Academy of Neurology
5.     Science Daily, How Ritalin Works in The Brain

Multimedia
How The Brain Works