Note: this post also ran today in Xconomy.
I remember seeing an episode of Desperate Housewives during the show’s first season called Running to Stand Still. In the episode, Lynette, working mom of many, takes her kid’s ADD medicine in order to be supermom and create costumes for the school play while balancing all of her other tasks. It was a classic self-prescribed “off label use” for a drug intended for a serious medical condition but used instead to improve a desired skill to improve performance.
I don’t know why that particular episode stuck with me; I think it was because I could relate to that feeling of wanting a magic pill to make me perform better as a working mom, a job whose description always includes being overwhelmed by more tasks than you can handle, amplified by guilt. How tempting it is to think that a pill, even one with potentially serious side effects, can solve a short-term problem and make you look like a champion.
That TV show episode came back to me this week when I read an article about scientists exploring the use of Valproic acid, a drug normally used to treat bipolar disorder, to train adult singers to have perfect pitch. Takao Hensch, professor of molecular and cellular biology at Harvard, is exploring this off-label application of Valproic acid, which apparently “restores the plasticity of the brain to a juvenile state” and thus reopens the mind to learning musical pitch the way you would as a child, when it is far easier to acquire that particular skill. Given the mechanism of action—basically turning back time on the brain–it is also thought that this drug might help adults learn foreign languages with ease, the way you can as a kid.
What a conundrum. This is yet another example of the search for the pharmaceutical magic bullet, albeit with a particularly specific application. Is it a good thing or a menace? Yet another example of old fashioned American laziness or a miracle of science?
Scientists are constantly searching for drugs that are essentially a quick fix to long-term problems that could, if desired, be solved without drugs, such as weight loss and Type II diabetes. It’s a different category, in my own mind anyway, from so-called “lifestyle drugs” that address problems that might not otherwise be solved through extra personal effort, such as acne, erectile dysfunction and baldness. It’s one thing to search for drugs to solve problems that are not exactly life-threatening; it’s another thing altogether to search for drugs to solve problems that aren’t even problems, but instead to convey personal advantage, akin to steroid use in sports. We are basically talking here about drugs for superpowers, or at least optimal human powers.
If you take a gander through the list of potential side effects that accompany use of FDA-approved Valproic acid, such as catastrophic liver, kidney or pancreas failure, birth defects and Parkinsons-like symptoms to name a few, you gotta wonder what kind of drive would lead a person to make this choice between perfect pitch and failing organs vs. good health but a risk of hearing Randy Jackson say “you’re a little pitchy dawg.” Through the miracle of modern medicine we can create a whole generation of incredible singers with perfect pitch and a lifetime ticket for kidney dialysis. Given the popularity of American Idol and The Voice and all the other singing reality shows, I can almost understand the appeal.
Of course, we have seen athletes make this Sophie’s-like choice again and again as they accrue steroid-induced super powers and testicular shrinkage, impotence and roid rage vs. trying harder but still being number 2. Our American culture, which glorifies the best and dismisses the great, puts incredible pressure on people to make very unhealthful choices.
In the article about the perfect pitch drug there was an exchange between the scientist and the journalist about other ways Valproic acid could help people recover and leverage their young brains to learn new skills. Here is how the scientist responds:
There are a number of examples of critical-period type development, language being one of the most obvious ones. So the idea here was, could we come up with a way that would reopen plasticity, [and] paired with the appropriate training, allow adult brains to become young again?
I think we are getting closer to this day [of the drug becoming common for use of learning new languages], because we are able to understand at greater cellular detail how the brain changes throughout development. But I should caution that critical periods have evolved for a reason, and it is a process that one probably would not want to tamper with carelessly.
If we’ve shaped our identities through development, through a critical period, and have matched our brain to the environment in which we were raised —acquiring language, culture, identity — then if we were to erase that by reopening the critical period, we run quite a risk as well.
In other words, while the drug could help us think, learn, remember as if we were kids, it might literally change our personalities and rewrite our personal history. Yikes. I mean, there are some people who would be massively improved by a personality do-over, and I know several of them. But that is still a pretty high risk proposition, as you might come back as an even bigger jerk instead of as Mother Theresa or Albert Einstein. And furthermore, you could end up with a bunch of adults running around at work acting like hormone-crazed clueless teenagers. Oh wait, that already happens.
The whole topic begs the question about where to draw the line in pharmaceutical R&D, but the quick fix thing is very tempting and makes a lot of people downplay the risk. I have to admit I would think long and hard about taking a drug that made me instantly better at math, even if the side effect was to make me even shorter than I already am. I know plenty of people who would consider a drug to make them instantly better writers or dancers, although the latter can be pretty easily approximated by adult beverages and some Motown.
Would it be worth it to take a pill to immediately improve one’s ability to produce superior venture returns even if it made you lose a vital organ? I know plenty of people who would probably think so; and then they would fund startups to grow replacement organs. As long as the organs grow faster than the IRR, you’re golden.
Part of why this fascinates me so much is because it is an example of consumer behavioral economics in action. We spend a lot of time in healthcare trying to change consumer behavior to get them to eat better and exercise and all that, but it is rarely motivating and it rarely works. Would it be worth it to motivate people with pharmaceuticals that promise near perfection? I wonder if that would increase or decrease medical costs and if medication compliance would be higher than its current lousy <50% if the prize were perfect pitch or some other perceived high value skill that wasn’t medical in nature. Would people agree to religiously take a side-effect-laden pill to treat disease if it could also help them better their careers or attract a hotter spouse or convey hipness at SXSW when it is otherwise elusive?
Motivation is such a complex concept in humans, being personal in a way that makes generalized population-based health interventions pretty ineffective. What we know is that most people are motivated by money and sex or love (or both when they achieve nirvana). Others are motivated by achievement (perfect pitch) or that good feeling you get when you do something charitable. Yet others are motivated by the perfect chocolate chip cookie or a fabulous pair of Manolo Blahniks (in case you’re wondering, I’m in the third category).
I wonder if there is a way to marry the ingenuity of the biotech industry to capitalize on real human motivation to get people to help themselves without resorting to health-compromising medicines. Perhaps what we need is the perfect placebo paired with the world’s greatest marketing plan—the kind that gets people to trade real money for bitcoin. Pharma companies are used to spending $1 billion to bring a product to market, but you could probably spend nothing on R&D and less than half a billion to develop the perfect direct-to-consumer marketing and motivation plan.
I can see it now: a magic “pill” made of Jelly Bellies, which can already taste like anything you want (how do they get that buttered popcorn flavor?), but instead market them as giving the patient whatever skill they want, Wizard of Oz style. You want to be brave? Boom. Here you go, as long as you eat the bravery-inducing black jelly belly every day and do 50 situps. Need a heart? Knock back the red jelly belly that makes you more loving but is only activated by a mile-long walk. You can make people believe and do almost anything if they want it enough, so maybe it could work, although the theme song in the commercial might be just a touch off key.