Tuesday, November 09, 2004

cosmetic neurology

Cosmetic neurology: Makeovers for brains
By Laura Beil

Knight Ridder News Service

In the future, reality shows may have names such as Extreme Makeover: Brain Edition or Sharp Eye for the Dumb Guy.

At the beginning of each episode, viewers could learn about one hapless soul's lifelong struggles with algebra. By the end, the transformed contestants would be winning chess matches and prancing carefree through fields of daisies.

The idea is not all fantasy. Some neurologists have recently wondered whether their field is the next frontier in elective medicine. The specialty now tries to protect ailing brains from conditions such as Parkinson's disease or migraine headaches. But doctors' efforts may one day extend to improving normal brains.

"This is coming, and we need to know it's coming," says Anjan Chatterjee of the University of Pennsylvania.

There's even a name for the field: cosmetic neurology.

As he envisions it, cosmetic neurology could one day mean not just sharpening intelligence, but also elevating other dictates of the brain - reflexes, attention, mood and memory. Studying for the SAT? Take this drug to retain more of those pesky facts.

Last month in the journal Neurology, Chatterjee pointed out that drugs already exist that may have many of these effects. In one study, for example, emergency-room patients given a memory-altering drug appeared to be spared some symptoms of post-traumatic stress.

Before doctors are caught by surprise, Chatterjee says, they need to be prepared for these conundrums. "What I'm hoping to do with this is get people talking."

They are. Since the journal's publication, he has fielded steady e-mails. Some neurologists say they've already had patients asking about such medications for the mind.

Not all of Chatterjee's colleagues, though, agree that cosmetic neurology is inevitable, even if mind-improving drugs become safe.

Writing in the journal, Richard Dees of the University of Rochester argues that "as neurologists and as citizens, we can collectively control our own destinies, if we choose and if we have the will to act."

Few specialties know the risks of cosmetic expansion as well as plastic surgeons. Before there was Nip/Tuck and Michael Jackson's nose, plastic surgeons were rebuilding war-mangled bodies. As safety improved, so did public demand for cosmetic services. Robert Goldwyn, who has edited the Journal of Plastic and Reconstructive Surgery, has this caution for colleagues who focus on the brain: "The minute technology comes along, it will be used," he says. "If doctors won't do it, other people will do it."

Mental enhancement with drugs is not unethical, says Thomas Murray, president of the Hastings Center, a bioethics institute based in Garrison, N.Y. A cup of coffee heightens alertness beyond a natural state. Few people object to caffeine because it is considered safe.

But other drugs might raise more questions. In his editorial, Chatterjee raised questions about whether cosmetic neurology might lead to coercion in certain professions. If a drug improved the emergency reaction of pilots, would they then be forced to take it? Would you pay more for a flight knowing the pilots took the drug? [philly.com]

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