Suicide bombing is now a disturbingly common tactic for extremists, which makes it hard to comprehend the scale of shock, terror and confusion among the first US sailors to face the kamikaze pilots of the Japanese in the Second World War. An enemy who was willing to die to kill you, a pilot who did not fly his plane to attack with a speed and approach that allowed him to pull up and live to fight another day, was a new weapon and one almost impossible to stop.
What made the kamikaze pilots willing to die? Much has been made of their devotion to the divine Emperor, and the cultural shame of surrender to the Japanese soldier. With the ring of superior US forces closing on the home islands, the kamikaze squadrons were a final fling, a heroic sacrifice made by brave idealists who hated the enemy more than they loved their own lives. They were noble patriots who served a greater power. Less known is they were dosed up on methamphetamine. Kamikaze pilots sometimes had to fly for hours to reach the target and needed to be kept mentally alert, and the long-lasting euphoria of the drug high, their commanders assumed, would make them less likely to change their mind.
In the 1940s, Japan was heavily into methamphetamine (meth). A Japanese chemist called Ogata Akira first synthesized the drug in 1919 as a psychiatric medicine also given to people with lethargy and depression. When war came, the Japanese military government thought it might help keep its soldiers and workers mentally alert. It ordered a massive and rapid increase in production of the drug and made it available in a convenient tablet called Hiropon. May not cause drowsiness. Use of heavy machinery was actively encouraged, as the government advertised its not-so-secret weapon.
‘For night work and other times demanding mental alertness. For overexertion. The most powerful new amphetamine on the market! – Hiropon tablets’.
Sanctioned use of meth as a cognitive enhancer in Japan continued after the war, when pharmaceutical companies promoted the tablets to tired workers, war veterans and those struggling to cope with the social change demanded by the horrors of Hiroshima and Nagasaki and Japan’s 1945 surrender. But as reports of addiction and crime linked to the drug grew, official attitudes hardened. In 1951, meth was designated a medicine and most casual use was banned.
One group proved more reluctant than most to give up their easy route to mental alertness. High school students cramming for university entrance tests and university students preparing for their own exams continued to buy the drug on the black market. The situation became so serious that in 1954 the vice-minister of education pleaded with the heads of all universities and schools to do more to stamp out what the Japanese government now called drug abuse. These students were some of the first to use what we now call smart drugs. And, sixty years on, their use is far from stamped out. If anything, smart drugs have never been so popular.
In the autumn of 2014, UK officials raided a lock-up garage in the Midlands brewery town of Burton and came away with what they described as their biggest single seizure of smart drugs. More than 20,000 pills were found and over a dozen different types of drug. Britain was put on alert after a tip-off from Norwegian customs, which had already intercepted and confiscated several packages.
Announcing the UK haul, Alastair Jeffrey, head of enforcement at the Medicines and Healthcare Products Regulatory Agency, told journalists: ‘This is a recent and very worrying trend. The idea that people are willing to put their overall health at risk in order to attempt to get an intellectual edge over others is deeply troubling’. And highly lucrative: the MHRA said the stash had a sale value of about £200,000, bought cheap from drug manufacturers overseas and marketed to students.
Despite the renewed attention from the authorities, smart drugs have continued to arrive in Britain. I know this because some of them arrived at my house. A few months after the Burton raid, they landed in an anonymous brown envelope on my doormat. The pills I had bought online were modafinil. Those who sell the pills promise it will deliver massively increased cognitive abilities.
Like other cognitive enhancement techniques, modafinil was first introduced as a medical treatment. The drug emerged in France in the 1970s as part of research to develop safer alternatives to stimulants like amphetamines, which were used to treat sleep disorders including narcolepsy but carried side effects. As modafinil was increasingly prescribed, doctors started to wonder if the wakefulness and alertness the drug promoted could help tackle fatigue and related symptoms of other conditions. They began to give it out for off-label – not officially sanctioned – use in multiple sclerosis, myotonic dystrophy and more. And as well as increasing wakefulness, scientists started to look at improvements in cognitive function.
In recent years, the off-label use of modafinil has exploded. In medicine, it is being investigated as a replacement for amphetamine-like stimulants in a range of other problems, including treatment-resistant depression and attention deficit hyperactivity disorder (ADHD). Outside medicine, the armed forces of various nations have given it to their infantry and air crews. It’s believed to be so prevalent and potent that in 2015 the World Bridge Federation started to test players at international tournaments for the drug, which it considers a banned stimulant. So did organizers of the ESL One Cologne professional video games tournament. And then there are the students. It’s hard to find reliable numbers but some surveys suggest as many as a quarter of UK undergraduates have taken modafinil or similar to help their work. A fifth of surgeons say they have taken it, and a similar number of professional scientists.
Availability and legal status of smart drugs differs across the world. In Columbia, modafinil is available over the counter in pharmacies. In Russia possession is illegal. In Britain it’s a prescription-only drug, so legal to possess, but illegal to sell and supply. Is it OK to receive a couple of dozen sent through the post from India? Let’s call that a grey area.
Online sales of modafinil and other smart drugs are booming, but buyers beware – there are more than legal risks to consider. As the MHRA says: ‘A huge number of medicines bought online are counterfeit, substandard or adulterated. There is no guarantee the product you are receiving isn’t laced with any number of other dangerous substances.’
The counterfeit medicine market is huge and regularly kills people, from heart patients in Pakistan to those taking tainted steroids and blood thinners in the US. More likely, the drugs simply don’t work. Counterfeit modafinil is often little more than caffeine tablets. So I wanted to verify my online smart drugs were genuine. But, as it turns out, it’s a lot easier and cheaper to buy medicines online than it is to check if they are legitimate.
The brown envelope they were posted in was stamped with the name and address of a company in the Fort area of Mumbai. The same name and address was on the white sticker on the back, which was the customs declaration. Under ‘Quantity and detailed description of contents (e.g. two men’s cotton shirts)’ was printed ‘Sample Harmless Medicine’. A tick box indicated the medicine was sent as a gift. (Good job it was harmless, then.) Brief Googling identified the Mumbai firm as a travel agent that offered honeymoons and tour packages. Not a promising start.
Inside the envelope were blister packs of pills, stamped with Modvigil – a brand name for modafinil – and the name and address of two more Mumbai firms. Both called themselves pharmaceutical companies and more searches on the internet suggested both seemed to check out as outfits that, if they wished, had the knowledge and facilities to knock out a decent batch of modafinil.
Each blister pack was stamped with a batch number, their claimed date of production (January 2015) and expiry date (December 2017). To most buyers, I suspect, that would seem pretty convincing. But the proof of the pudding of course is in the eating, and I wasn’t ready to eat one of these little white discs just yet.
Whether pills bought over the internet are genuine is one of the most common questions on the dozens of websites dedicated to discussions of smart drugs. For modafinil, there isn’t an easy way to check. Dropping them in vinegar and looking for bubbles was suggested by some web-users, but it didn’t add up as a way to detect the drug given the range of possible additives in there. Genuine modafinil, plenty of users pointed out, would make my wee smell foul, but that didn’t sound scientific.
I needed professional help, but the professionals seemed unwilling to offer any. I asked big contract testing labs who said they didn’t deal with individuals. I thought about rebranding myself as a honeymoon tour company that sent gifts of harmless medicines halfway across the world, but decided it would be simpler to ask friendly chemists who worked in universities. They would be interested in the result as well, I reasoned. Although there were plenty of warnings from academics about students risking their health taking unchecked imported drugs, nobody I could find had actually, well, checked them.
At first my emails were politely rebuffed, passed to colleagues or simply ignored. ‘An interesting question but not one I can help with,’ said a typical reply. Then after a couple of months of discussions I finally got a bite: an enterprising university department that sold time on its equipment to top up its research funds was willing to perform some simple tests. But before the deal was sealed, I had to convince the university press officer that, no, I wasn’t writing an exposé on the use of such drugs among her students. And I had to give the department a blank cheque. They would spend as little as possible, they promised. And I had to send them my Indian modafinil. Technically, I suppose, if the modafinil was real, this made me an illegal supplier. Not that I expected the university scientists, after all this, to eat it.
For £230 I got an hour or so from a skilled technician who put my claimed modafinil in a mass spectrometer and subjected it to single-crystal X-ray diffraction. The results showed it was ‘beyond doubt’ genuine, they said. And they found enough of the drug in one of the tablets to confirm it wasn’t cut or laced with anything else. The pills, as far as science could tell, were legitimate. The university now turned illegal supplier and returned the rest of the pills to me. They dropped back onto the mat.
I took my first modafinil pill at eight in the morning. I sent in some cereal and toast first and then swallowed the little white cross-headed lozenge with plenty of water. Two hours later I was sat in my usual coffee shop, writing on my laptop (working on this book), waiting to feel different. I had tried to avoid reading too much about other people’s modafinil experiences because I didn’t want to seed ideas but I did read that it can take a couple of hours for the effects to kick in. And then they can last for sixteen hours plus. I didn’t fancy being awake much past midnight, but I didn’t want to get up and have breakfast any earlier.
Having said that, I did feel different: capital letters different. I felt good, like I was concentrating on the words I wrote in a more deliberate way. I felt a connection to the writing and the screen of my laptop. The music (Christmas songs on strict rotation), other people and the kids running around were less of a distraction. I was thinking these sentences as fast as I could tap them out. I came to this coffee shop because they offered free refills. But after thirty minutes my first cup lay pushed to one side, barely sipped and cold.
Was I making this sensation up, imagining it? Was this just a placebo effect, the power of suggestion? Did it even matter? I had taken a drug supposed to sharpen my senses and release my cognition, and my senses felt sharp and my cognition free. I felt like I wanted to keep typing. So I did. I could FOCUS and I felt MOTIVATED.
In previous days two hours of book writing was about enough for one sitting. I would kid myself I was still making progress beyond that, but my attention would wander and the writing slow. That wasn’t happening that day. Several hours in and I was still alert. The screen seemed bigger and more welcoming. I felt like I was leaning in, the words as they presented themselves seemed to be close and moving smoothly and quickly. This was terrific. If it was a placebo effect then bring it on.
If pilots fly helicopters and fighter aircraft on these drugs then I’m not sure if that’s a good idea. Alongside the welcome sharpening of my senses I felt impulsive and my fingers were twitching when they weren’t striking the keys. I stroked my unshaven chin a lot. I didn’t think I would like to drive. I hadn’t spoken or stood for two hours. I felt like I didn’t want to. My head felt like it was where it was all happening.
I took the modafinil on a Tuesday because I usually play squash on Tuesday nights and I usually lose. I play against my friend Mike and have done for years. If you’ve never played squash then I recommend the book Saturday by Ian McEwan for a first-class description.
It’s an intense, committed sport and, unlike tennis, you compete for territory and court position directly with your opponent. It’s personal. You feel the court shake as they run past you. Mike and I push each other out of the way as we go to hit the ball.
One reason why Mike usually wins is because of something sports psychologists call TCUP. Thinking Clearly Under Pressure. Hot, bothered and frustrated, I lose concentration and start to slash at the ball and play shots I know immediately are wrong. I make mental mistakes. More importantly, I make more mental mistakes than Mike does. The other reason is motivation. He hates to lose more than I love to win. I would happily lose 3:2 in a tightly fought match rather than crush him 3:0. He wouldn’t. (He would also point out, fairly, I am not in a position to judge, having never crushed him 3:0.) Modafinil should help me cut out the mental mistakes, which is why it is banned in competitive sport.
Technically, tonight I will be a drugs cheat, a doper, a fraud who will devalue the honest spirit and purity of sportsmanship. But I am willing to sacrifice my sporting soul for scientific enquiry. If modafinil gives me the extra mental edge I need to beat Mike at squash then it really is a smart drug. And I might take another one on Friday. I’m supposed to be playing golf with Jim.
That evening I returned home to the familiar feeling of defeat. Bugger. I’d lost. Again. And yet . . . For a while I was brilliant. I made correct decisions. I felt focused. I felt GOOD. I’d done nothing special, just put the ball in the right places, down the line and tight to the wall, resisting the ambitious and letting him make the mistakes. I won the first game.
In the second game I played one of the best shots of my life. Not that Mike noticed, or anyone watching would have been impressed. He hit a weak service return, high on the front wall and the ball came looping towards me. I set up to pounce and to smash it low into the front right corner. It’s a tricky shot to get right – hit the ball too hard in squash and it just bounces further away from the wall and makes it easier for the opponent. Hit the jaws, where the front and the side wall meet, and it squirms back towards the middle where he can put it away. It’s a shot I typically mess up, but I felt like I should try it anyway.
Except this time I didn’t. I saw the future and I changed it. I thought clearly under pressure and chose a different, safer shot. Instead of angling the ball down from above my head I shifted the head of the racket and pushed it through the ball, which went up, not down, and arced high over my left shoulder and dropped into the left-hand back corner. Mike was as surprised as me. Anticipating the smash he had darted forwards and could only watch, wrong-footed, as the ball drifted beyond his reach. I won the second game. As Mike, exasperated, reached for his water bottle he muttered to himself and then yelled a single word in anger – ‘CONCENTRATE’. I allowed myself a little smile.
I won the first three points of game three. Incredible. I had won the odd match against Mike, but never 3:0. What a result that would be. What a story. What a METAPHOR. I felt like Malcolm Gladwell, the Canadian journalist who writes bestselling books about simple solutions to complicated problems. What an opening scene to my book this would be. People wouldn’t believe me of course, so I would have to ask Mike to send an email confirming what had happened and how amazed he had been at my cool, clinical, focused play that night. Then I could publish it as a footnote. No, an appendix.
‘6:3’.
What?
‘The score. It’s 6:3 to me,’ said Mike as he served. I tried a clever return, playing it off the side wall to die in the front corner. Risky but he would never expect it. The ball hit the line. Out.
‘7:3’.
Whatever I had, the mental boost of a banned stimulant, the confidence of the placebo effect or just the increased concentration from thinking so much about the mental side of the game, it had gone. The bad old me returned to court. The TCUP well and truly dropped. Mike won the next three games and the match. He won and I lost 3:2 in a thriller, so I suppose we both got what we wanted.
Those first two games were so strange, Mike said to me in the pub later. I just couldn’t get going and I kept making the wrong decisions. You didn’t seem to make any mistakes. I nearly told him the truth but I chose a different, safer shot and stuffed a chip into my mouth instead. Next Tuesday, I thought, I would take the modafinil an hour later.
Don’t judge me. Between 1984 and 2004, many of us could have been drug cheats. Included on the WADA list of banned stimulants then was caffeine, and two Olympic athletes were even caught and punished for using it. The Mongolian judo star Bakaava Buidaa was stripped of the silver medal he won at the Munich games in 1972 for excessive caffeine intake, and Australian modern pentath-lete Alex Watson was thrown out of the 1988 event in Seoul. (He later cleared his name and competed in Barcelona in 1992.)
Recreational use of caffeine – the odd cup of coffee – was ok, but once levels rose above a certain threshold, sporting officials assumed someone was trying to gain an unfair advantage. The cut-off point was high, but it wasn’t that high. About six cups of strong coffee could put someone in the danger zone.
Caffeine has been used for centuries to keep people alert. The writers Voltaire and Balzac are said to have drunk dozens of cups of coffee a day. In my university days in the 1990s, caffeine came in concentrated tablets, but they were pretty weak: each contained 50mg of caffeine, about half of a strong cup of coffee. Students today can call on much bigger guns, and caffeine tablets with 200mg are available. (In Germany they are classified as a controlled medicine for fatigue and called, really, Coffeinum.)
Doctors recommend a maximum of about 400mg caffeine a day (less than the 500-odd found in the largest cup of Starbucks) but they occasionally meet people who have taken much more. A forty-two-year-old in Ohio swallowed 120 caffeine tablets (each 200mg) in a suicide attempt. He survived, but only after four days of uncontrollable vomiting and diarrhoea and slipping in and out of consciousness. He had a record 24g (24,000mg) caffeine in his system.
The best guess of scientists is, when it comes to restoring alertness, modafinil packs more of a punch per mg than caffeine. About 400mg of modafinil does the same job as 600mg of caffeine. That would make my pill with its 200mg of modafinil about the same as necking three cups of strong black coffee at once, or taking six Pro Plus.
There is an important difference though. While caffeine is classed as a mild cognitive enhancer, and has been shown to sharpen reaction times, it has almost all its impact on making tired people feel normal, rather than making normal people feel super. Nicotine does the same. Modafinil is different. While coffee can help tired people feel more alert, modafinil seems to stop them feeling tired in the first place. It’s not just about bringing people back to normal; it seems to have the ability to take them beyond.
The effects of smart drugs are often hyped and exaggerated. But solid evidence suggests modafinil has a positive and significant effect on cognition. It’s been shown to improve the performance of healthy volunteers in several tasks – recalling a series of numbers, decision making, problem-solving and spatial planning among them. In August 2015, scientists at Harvard and Oxford universities pooled and analysed all of the most reliable experiments and concluded modafinil is the world’s first safe and effective smart drug.
By safe, they mean in the short-term. Nobody knows what the long-term effects might be, partly because scientists haven’t tracked chronic modafinil use, and partly because they are not sure how the drug works, or indeed what it does in the human brain. It’s notoriously hard to track the actions of medicines inside the brain because, unlike the other organs, it’s difficult to tell much about what goes on in the brain from conventional tests like blood samples. The brain is bathed in its own syrupy fluid, which is installed in a separate circulatory system to the main blood supply and kept isolated by the blood-brain barrier.
The only real way to directly check on levels of chemicals and drugs and how they might change in this cerebrospinal fluid is to hack into the plumbing lower down the body, and these lumbar punctures (spinal taps) are risky and so are never done lightly. That rules them out for research studies on how well smart drugs can make university students recall strings of numbers.
From experiments with animals and cell cultures, and from studying brain scans, neuroscientists think modafinil probably changes the activity of neurotransmitters, which help direct brain activity by helping the separate neurons communicate. Specifically, modafinil seems to affect the catecholamine system, which produces and releases the neurotransmitters dopamine and norepinephrine. This might concentrate activity in parts of the frontal cortex involved in higher mental function, while inhibiting it in neighbouring regions, so reducing competition for the needed cognitive resource. (That is certainly how it feels – modafinil helps keep the brain on the task at hand and immune from distraction.)
Some scientists are sceptical that modafinil makes the cognitive gears turn faster. It might simply increase attention and motivation. Having taken the drug I can see their point. I could probably attribute many of the effects I felt to heightened motivation, or at least a greatly reduced desire to go and do something else instead.
But if what we want to measure as intelligence is the output of someone’s brain, rather than the internal workings, then isn’t the point moot? As we discussed earlier, we don’t take nerves or a lack of confidence into account when we mark IQ tests or exams. And couldn’t those have as big a (negative) impact on someone’s scores as increased motivation could see them improve?
Although modafinil is widely regarded as safe, some people do seem to react badly to it. Particularly worrying for me, before I took the drug, I found reports that two patients with OCD – people who had been treated successfully and had in effect beaten the condition into remission for at least a year – dramatically relapsed when they took modafinil. The psychiatrists couldn’t be sure what was going on; maybe it caused a part of their brains involved with obsessions to flare up again.
And in 2015, psychiatrists in Turkey reported a patient prescribed modafinil for excessive sleepiness – she felt like she had to go back to bed for an hour or two each afternoon – developed hypersexuality. She still wanted to go to bed each day, just not to sleep. Married with two children, the forty-five-year-old found her massively increased sexual desire a problem. So did her husband, who was seventy-five.
Modafinil, I can report, did not have either of these effects on me.
Beyond modafanil, there are other medicines that healthy people use to increase their cognitive performance, and more are on the way. Medical amphetamines including Benzedrine have been on the market for decades (and were given to RAF pilots in the 1940s) while newer drugs, such as the Alzheimer’s treatment donepezil, are being developed to address the looming crisis in dementia. Among the most common of the so-called study drugs is Ritalin, prescribed (many say over-prescribed) for children and others diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). It helps them focus and stay alert. As such, it too is banned in competitive sport. It’s outlawed in major league baseball in the United States unless a baseball player has been diagnosed with ADHD, in which case he is granted a therapeutic exemption. The result is an epidemic of ADHD among baseball players, who have a diagnosis rate for the condition twice as high as the rest of the population.
Cognitive enhancers are popular among amateur athletes too. An anonymous survey of almost 3,000 competitors at triathlon events in Germany found 13 per cent admitted to physical doping in the previous twelve months, while 15 per cent said they had experimented with cognitive doping. (Because of the legal status of caffeine tablets in the country, those counted.)
It’s not just the athletes themselves who see the appeal of smart drugs. A 2016 editorial in the British Journal of Sports Medicine argued team managers and coaches, who are increasingly expected to rely on complex statistics and make rapid decisions based on large amounts of information, could benefit from brain doping and, as this would give their teams an unfair advantage, these non-playing staff should be drug tested too.
Smart drugs are actually pretty dumb. They saturate the brain with active ingredients and hope that some manage to find a suitable target. It’s impossible to use them to target a specific brain region and so a specific function – say memory or problem-solving. To do that, we need to zoom in a little, to break down the whole brain into its constituent parts and then identify the bits we are most interested in, those that control and produce intelligence.
That can’t be done with drugs. It takes a more focused and hands-on approach. And, in the search for the secrets of intelligence, this is a common strategy. In fact, intelligence researchers have been encouraging a hands-on approach for an awfully long time.