“Doc, I Need a Smart Pill”—Requests for Neurologic Enhancement

Abstract

CLINICAL CASE "Doc, I Need a Smart Pill"-Requests for Neurologic Enhancement Commentary by Dan Larriviere, MD, JD Dr. Warren, the only neurologist in a hardscrabble town of 7,000 residents, looked at his new patient and chewed his lip. They were sitting in a small examining room at Dr. Warren's clinic. The patient, Mr. Conway, was a soft-spoken 28-year-old unemployed sales clerk who had just explained the reason for his visit: recently laid off, and with no other job prospects in sight, he wanted to attend graduate school. This would require him to take the Graduate Record Examination (GRE), but Mr. Conway said he would have "extreme difficulty" remaining focused for the full 4hour length of the exam. He wanted Dr. Warren to prescribe something to help him stay focused and think better."Just temporarily, Dr. Warren," the polite Mr. Conway said. "Just so I can do my best on the exam." Dr. Warren had listened to his patient's story with great sympathy. Mr. Conway needed a scholarship to attend graduate school, and a low score on the test would spoil his chances. Based on a growing literature, modafinil might help Mr. Conway focus during the long test. Dr. Warren had explained to Mr. Conway that, because he did not have symptoms of attention deficit disorder (ADD) or other neurological problems, prescribing a cognitive-enhancement drug would be hard to justify.