Medication Nation

Too fat, too thin, too sad, too happy...Whatever the problem Biotech is developing a vaccine or a pill to cure us. Mark White examines the consequences of a world where all our worries can be medicated away

It may be known as 'retail therapy', but the next edition of the American Psychiatric Association will recognise being a shopaholic as a clinical disorder. At Stanford University, trials held on the SSRI anti-depressant Citalopram concluded that the drug was a 'safe and effective treatment for Compulsive Shopping Disorder'.

The rise of compulsive spending mirrors the obesity time bomb slowly detonating in the richest countries of the world, according to psychologists. A recent study found that women in their twenties had gained an average of five kilograms in the last seven years.

In the last six months clinics to treat internet addiction have opened in the US and China. Meanwhile, a Scottish teenager was treated recently by an alcohol trust for addiction to electronic messaging. He spent £4,500 on texting in a year, and quit his job after he was found to have sent 8,000 emails in one month. That's 400 a day, or about one a minute, every minute of the working day.

It's kind of comforting when you get [a message],' he told the BBC. 'I like it, it's like a game of ping-pong, as you send one and get one back.'

So many new addictions, but the old ones remain. The hardcore smokers can't ditch their coffin nails. Alcoholics young and old litter streets and hospitals, and there's scarcely a pub toilet left in the land without a residue of cocaine smeared across the nearest flat surface. It's enough to make you stay in bed and stare at the ceiling, mind racing about climate change, that lifestyle you can't quite afford, and the next big terrorist attack.

Mind racing... a Buddhist would tell you how to cure that by meditating on the impermanence of existence - and that the racing mind is the result of man's failure to achieve Enlightenment. But Big Pharma has a better idea: in the first week of May a $60 million advertising campaign began in the States for Lunesta, an insomnia drug to cure... a racing mind. All you need is a prescription and a glass of water.

Swiss biotech company Cytos has 25 research programs underway, including its Immunodrug^TM nicotine vaccine CYT002-NicQb, along with vaccines for chronic diseases including obesity, hypertension, allergy, psoriasis and rheumatoid arthritis. The company was granted a US patent in early 2005 for vaccines against different drugs of abuse, and hopes to release its nicotine vaccine in 2010. The vaccine antibodies prevent dopamine, the chemical that leads to a feeling of pleasure, from flooding the brain. They have a half-life of 50 to 100 days, meaning the response could be a boosted by a further injection. The rewards are huge: Decision Resources estimated the 'stop smoking' market in America alone will be $1.5bn by 2007, and as China and India become richer, with more people smoking, eventually more people will want to stop smoking too.

Cystos' obesity vaccine works on a similar principle with an antibody against ghrelin, a small protein that regulates appetite. If you inject extra ghrelin into people it makes them hungrier. Fat people who lose weight develop extra ghrelin, leading to yo-yo dieting. The theory is that by stopping the uptake of ghrelin it will be easier to stick to a diet. Cytos is to be running trials with 112 obese volunteers on a six month treatment of the vaccine or a placebo, and at the same time counselling them about healthy eating and encouraging exercise. While obesity is a leading cause of preventable death in rich countries, it is also, in every sense, a growing problem, with rich nations becoming fatter and fatter, and less and less happy about it. A successful vaccine would be worth billions.

The military are in on the act, naturally, sponsoring research into drugs that will keep their soldiers awake without the jittery, glittery rush of adrenaline that follows amphetamine use. And then there are mood-enhancing drugs to combat the rise of depression, a disorder that the World Health Organisation estimates will be the biggest health problem in the industrialised world by 2020.

'Tomorrow's biotechnology offers us the chance to enrich our emotional, intellectual and, yes, spiritual capacities,' says David Pearce, a leading transhumanist philosopher (transhumanists favour using science and technology to overcome human limitations). I think there's an overriding moral urgency to eradicating suffering. This ethical goal eclipses everything else.'

Zack Lynch, a leading expert on the biotech industry and publisher of several blogs and neurotechnological market reports, dismisses concerns about side effects: 'Future neurotechnologies will have the capacity to extend all aspects of what makes us human, from self-centredness to radical empathy.' Eradicate suffering? Making people less self-centred?

Radical empathy? Sounds great. So why does the idea of pills that will eradicate angst give so many people, well, angst?

If people were satisfied they wouldn't need to try to improve themselves. But our societies are based on the concept of endless growth, so they rely on us never being satisfied. Alexis de Tocqueville made this observation in his 1848 classic Democracy in America. 'In America I saw the freest and most enlightened men, placed in circumstances the happiest to be found in the world; yet it seemed to me as if a cloud habitually hung on their brow, and 1 thought them serious and almost sad even in their pleasures.' Maybe it's the price you pay for living in a society based round not happiness per se, but its pursuit.

The notion of 'progress' has brought a million fresh hells trailing in its wake. As Lynch notes in an entry on his Corante blog from December 19, 2003: 'Our extensive global connectedness has created new problems for modern humans. While many people question the uneven distribution of power that exists in today's world, others are disillusioned by the happiness that wealth was supposed to bring. In every culture, feelings of uncertainty, depression, anger and resentment have surfaced on a vast scale.'

For Lynch the solution is an extension of modernity, or our systems of control over the physical environment, inwards to our mental environment: 'We now need new tools to address the mental stress that arises from living in a highly connected urbanised world... new tools [that] represent our best hope in a world seemingly out of control.' Those tools are new drugs that, for him, are a means towards sharing our emotions to create a more empathetic society.

There is an alternative view, explored by philosopher Carl Elliott in his essay Pursued by happiness and beaten senseless: Prozac and the American Dream, that looks at alienation in societies - the 'mismatch between the way you are living a life and the structure of meaning that tells you how to live a life... it makes some sense (though one could contest this) to say that sometimes a person should be alienated - that given certain circumstances, alienation is the proper response. Some external circumstances call for alienation.' He gives the example of Sisyphus pushing the boulder up the mountain. He may be happier on Prozac and his psychic well-being would be improved. But his predicament is not just a matter of the wellbeing of his mental health, but how he is living his life. If someone's life is making them sick, then you can make them well by cither changing how they live their life or by making them fit in with what made them sick in the first place. It is, of course, a lot easier to give someone a pill and hope they'll adapt to their circumstances, just like housewives in the 1950s popped a Valium, cleaned the house, cooked dinner, and waited for their husband to come home from a hard day at the office.

Better than well

Not that the meticulous unravelling of human biology stops there. The real kicker is the class of experimental drugs developed by Cortex Pharmaceuticals, known as ampakines, that boost the levels of glutamate in the brain - a neurotransmitter implicated in the consolidation of memory. The drug's obvious therapeutic use is to treat people with Alzheimer's or dementia, but why stop there? A report in New Scientist earlier this year described the effects of the Cortex Pharmaceuticals ampakine CX717 on 16 healthy male volunteers at the University of Surrrey who were kept awake all night and then put through tests. Even the smallest doses of the drug improved their performance, and the more they took the more alert they became and the better their cognitive performance. The ampakine users remained alert and with none of the jitters associated with caffeine or amphetamines.

Psychologist Peter Kramer was one of the first professionals to discuss the implications of drugs that could 'change' personalities in his 1993 book Listening to Prozac. He became interested after prescribing Prozac to patients and seer radical shifts in how they interacted with the world. Some said they had become the person they always wanted to be. Others felt that Prozac had robbed them a deeply valued sense of self. If the drug could cause such a shift in identity to people who needed therapy, said Kramer, what could it do as an enhancement to people who were basically fine? Could it make them 'better than well'?

This notion of being better than well causes unease in western societies, particularly ones with Protestant roots where the notion of getting something nothing is thought to be a sin. It's being called 'cosmetic neurology', a phrase coined by Dr Anjan Chatterjee, fromt University of Pennsylvania, in a paper the September 2004 issue of Neurology. He argues from the slippery slope, saying that: yes, we are getting a boost without doing the work, but we already live in homes with central heating; yes, such drugs could change people's personalities, but steroids and mind-altering drugs do that already; yes, the rich will have better access to such drugs than the poor, but we already accept huge inequalities in society; and yes, I government, religions and journalists will urge restraint, but they are likely to be | overwhelmed by a 'relatively unrestrained [market' and the military.

Patients, he says, will demand the right of access to a drug designed to raise their baseline level of happiness. 'If social pressures encourage wide use of medications to improve quality of life, then pharmaceutical companies stand to make substantial profits and they are likely to encourage such pressures,' he says,'... it does not take much imagination to see how advertisements for better brains would affect an insecure public. Gingko Biloba, despite its minimal effects on cognition, is a billion dollar industry.'

There's certainly money to be made, as the following comments on neuroinvestment.com about Cortex's ICX717 show: 'Given that schizophrenia is the most clinically advanced program, we believe that this particular indication would be the most valuable in a licensing deal... Cortex plus Organon's schizophrenia rights (throwing in depression as a sweetener) would look great in a Big Pharma's Christmas stocking.'

David Pearce poses a thorny question by email: 'Should people be compelled stay the way they are? After all, the reason we're so discontented a lot of the time is because of the legacy of our evolutionary past - making their vehicles discontented helped our genes to leave more copies of themselves in the ancestral environment. Potentially, the new drug therapies and genetic interventions will be 'empowering' in the best sense of the term. A lot of people today just feel imprisoned in brains, bodies and personalities they didn't choose and aren't happy with at all...'

This brings two competing notions of happiness to a head: Eastern, which comes from accepting each moment as being neither good nor bad, but just as something that is, and the Western one, the pinnacle of consumerism and materialism, that of having your desires satisfied. I asked Pearce if he thought it was good for people to have their needs met at all times, and he replied that if those needs don't adversely affect the wellbeing of others, then yes.

The comment reminded me of a quote in Elliott's essay from Walker Percy's Signposts in a Strange Land. Writing of a Geriatrics Rehabilitation Unit where old folks grow inexplicably sad despite having all their needs met, he says: 'Though they may live in the pleasantest Senior Settlements where their every need is filled, every recreation provided, every sort of hobby encouraged, nevertheless many grow despondent in their happiness, sit slack and empty-eyed at shuffleboard and ceramic oven. Fishing poles fall from tanned and healthy hands. Golf clubs rust. Reader's Digests go unread. Many old folk pine away and even die from unknown causes like a voodoo curse.'

All technologies have mission creep and unintended consequences. Chatterjee dismisses concern about drug safety with the blithe phrase 'in general, newer medications will continue to be safer', despite little evidence to that end - and recent evidence with fen-phen, Vioxx and' the hiding of negative SSRI drug data by Big Pharma pointing in the other direction. The debate is framed in such a way as to make cosmetic neurology sound like an extension of evolution, when it's about as natural as a GM tomato containing a fish gene. This kind of technological arrogance is what's dooming the ecosphere, not saving it. 'I'm not prepared to say they can't be a good thing,' wrote Elliott, by email. 'They may well be. But I guess my feeling is that while the benefits are obvious, the possible drawbacks are not, and need to be thought about more carefully. There are also a lot of people out there with a financial interest in hyping the benefits and downplaying the risks.'

Take enhanced memory. Sounds great. We've all seen elderly relatives get lost in a fog of misfiring neurons, and it can be incredibly sad. But whether you believe in an intelligent designer or your starting point as the Big Bang, something has led the human brain to its present state of nature.

'We understand little about the design constraints that were being satisfied in the process of creating a modern human brain,' says Martha Farah, from the Centre for Cognitive Neuroscience at the University of Pennsylvania. 'Therefore we do not know which "limitations" are there for a good reason... normal forgetting rates seem to be optimal for information retrieval You could, in effect, remember too much: the hair colour of the person who sat in front of you in the cinema, the smell as you passed the bakery on your way to work, what you had for dinner every night of the last year - memory after memory too readily accessible.

A class of drugs used to treat Parkinson's disease gained the nickname 'the Las Vegas pill' after it was found to turn a small but significant number of its patients into compulsive gamblers - ironically by stimulating the dopamine-producing area of the brain that the addiction drugs are aimed at quietening down. The Doogie mice are another case in point. These smart rodents were genetically engineered to have enhanced memory and learning skills. They were better at recognising and locating objects and remembering painful experiences - but when pain was induced it lasted longer. They found it hurt to be made smart.

There's a wider point at stake here: if nature is something worthy of respect, then why not human nature? Our belief that we are set apart from the world has led us to treat our environment as a plaything for the fulfillment of our desires, though we forget that the demands of our egos are never-ending and monstrous. Can we ever be too happy? Too rich? Too thin? Too satisfied?

Zack Lynch believes that humans are social animals wired for social acceptance. 'I see no indication that the majority of individuals will not choose to enhance aspects of themselves to make them more giving, caring and empathetic towards each other and the rest of the biosphere,' he writes, by email, choosing not to highlight the increasingly aggressive, competitive economic and social world that we are building for ourselves and future generations. Millions of people already alter their reality by taking mood-altering drugs like ecstasy, or sink a bottle of wine, or hammer a bong, and there's little evidence of an upsurge in love.

Rats exposed to cocaine will keep on self-administering the drug, to keep the pleasurable chemicals swirling around their brains, no matter what happens. That wiring for social acceptance is being rewired for social status, and you can see the results just by looking around you. Futurist Ray Kurzweil has named 2045 as the point at which humans reach Singularity, the moment when the barrier between our minds and computers disappears and the non-biological portion of our intelligence predominates.

And then? Author Michel Houellebecq, when not scandalising the French establishment, keeps returning to issues of identity and humanity. He did it in The Elementary Particles, and in his next book The Possibility of an Island he describes a cult that thinks of genetic engineering as a path to immortality. The main character's girlfriend explains: 'What we're trying to create is an artificial humanity, a frivolous one, that will never again be capable of seriousness or humour, that will spend its life in an ever more desperate quest for fun and sex - a generation of absolute kids.'

Pearce believes that drugs that make us happier will rip up most of philosophy: just think, no more Nietzsche or Camus. 'Most of the philosophical tradition is based on grief and suffering. The same is true of traditional "great" literature too,' he wrote. I asked him if he thought art needed suffering to be created, and he wrote back with a link to a book called Touched with Fire: Manic-Depressive Illness and the Artistic Temperament. It contains Lord Byron's famous quote: 'We of the craft are all crazy.'

Houellebecq's main character knows where the world is headed: 'Nothing was left now of those literary and artistic works that humanity had been so proud of; the themes that gave rise to them had lost all relevance, their emotional power had evaporated.' So, what an improvement the post-human will be. We will feed our desires and remove all the insecurities and blunt edges and pain and art, and as the sky boils and the ice caps melt and the fish all die and the land is fouled and the bombs keep exploding we will, at least, have a smile on our faces and a happy feeling in our hearts.

Mark White is a freelance journalist

HOME
The Good Drug Guide
mental health in the third millennium

Search
biopsychiatry.com

Refs
Drug Companies
Superhappiness?
Online Pharmacies
The End Of Suffering?
The Abolitionist Project
Feeling Groovy, Forever
Health, Wealth and Happiness
The Futile Pusuit of Happiness?
Depression and Antidepressants
Big Pharma and Madison Avenue
World Transhumanist Association
Happiness: A Buddhist Perspective