by Alison Hayward, M.D., Sarah M. Lawrence, and Bill Johnson, D.D.S.
SDN Staff Writers
Amanda (not her real name) is a second year health professional student at a major
state-funded research institution. Like most students admitted to medical, dental or pharmacy school, Amanda was a top student at her undergraduate institution, used to earning high marks with minimal study time. In professional school, Amanda finds her old study habits put to the test. The material is not difficult, she reports, but the volume of information she’s required to process, coupled with the fast-paced schedule and demands of clinical activities, makes achieving at the level she’s accustomed to a major challenge.
Several of Amanda’s classmates have told her about a “study drug” that allows them to stay awake for days at a time and study for extended periods without rest. The drug, they said, improved their focus and concentration and makes it easier to plow through the mountains of information presented in their classes. One of them offered Amanda a little peach colored tablet, and she accepted but didn’t take it. Worried about the side effects, she placed the tablet on her bookcase and looked at it with curiosity from time to time. Finally, faced with an exam and a paper due and not enough hours in the day, Amanda decided to try the study drug. Immediately she noticed a difference. “I felt great,” she told us. “I was able to stay up all night and finish my work and I didn’t even need to sleep before the exam. It WAS a miracle drug.”
Smart Study Aid or Unfair Advantage?
Like steroids in baseball or track, the use of medication to enhance students’ ability to study is controversial. The most commonly abused stimulant medications among college students are amphetamines and related compounds like methylphenidate. Students obtain these medications by legal prescription through a diagnosis of ADHD, from classmates or by buying them illegally. The ethics of using these medications in this manner are controversial. Students who lack a valid medical diagnosis often use stimulant medications to put in extended study hours and reduce their need to sleep, to facilitate preparing for exams or writing papers. Many students consider this just a part of “getting ahead,” while others liken it to any other form of cheating and point to the perceived unfair advantage drug-taking students may have over peers who lack access to or are unwilling to take medication to help them study.
Stimulant Use and Abuse
The first drug used to treat ADHD was methylphenidate (Ritalin), patented in the 1950s for depression, narcolepsy and fatigue. It then began to be used as a treatment for ‘minimal brain dysfunction,’ as ADHD was known at the time. Ritalin’s popularity exploded with the acceptance of ADHD as a clinical entity, and it is now the most commonly prescribed drug for ADHD in the USA. Methylphenidate is available in numerous preparations, including a transdermal patch and extended release formulations such as Concerta. Ritalin is a CNS stimulant, thought to activate the frontal lobes of the brain by binding to dopamine and norepinephrine receptors.
Other, similar drugs used to treat ADHD include mixed amphetamine salts (Adderall) and dextroamphetamine (Dexedrine), which is one of the components of Adderall. Like Ritalin, these medications all have typical amphetamine side effects like decreased appetite, insomnia, and dry mouth. Dexedrine, the oldest patented amphetamine drug, has been used for its weight loss properties in extreme cases of resistant obesity. All are Schedule II, the most restricted classification for a drug considered to have a legitimate medical use, due to the potential for abuse and addiction. They are close relatives of methamphetamine, an illegal substance that has spawned an epidemic of ‘meth labs’ across the country in recent years.
ADHD: A Difficult Diagnosis
There are several challenging and controversial aspects about the diagnosis of ADHD. The Diagnostic & Statistical Manual of Mental Disorders (DSM), the gold standard for psychiatric diagnoses, identifies 22 diagnostic criteria for ADHD, with characteristics broken into three areas: inattention, hyperactivity, and impulsivity. According to the DSM, a diagnosis of ADHD may be rendered if the patient has six characteristics in either the inattention category or the combined categories of hyperactivity and impulsivity. These criteria must have been present for six months or more and be “disruptive or inappropriate for [the patient's] developmental level.” Critics of the process for diagnosing ADHD claim that the determination of whether a patient’s behavior is “disruptive or inappropriate” is too subjective and vague. The diagnostic and ethical challenge,then, lies in the determination of what constitutes “significant impairment.”
One obvious quandary is the diagnosis of ADHD in the pre-professional or professional health care student population. This demographic is already typically comprised of high achievers and perfectionists. Such individuals often feel pressure to use stimulants to keep up with their peers, whether or not they would be able to achieve a ‘normal’ level of function without the stimulants. For these individuals, the issue is a Machiavellian ethical dilemma — do the ends of successfully pursuing and/or practicing a career in health care justify the means that may be required to achieve them? In debates on the SDN Forums, many decry this type of use of stimulants, which seems to be rampant, and compare it to the use of steroids by professional athletes. Even more disapprove of illegal use of stimulants without a prescription.
Stimulating the Ethical Debate
Widespread abuse of drugs like Adderall and Ritalin on college campuses, however, is well-documented in the literature. One annual government study on the use of Ritalin by college students in 2003 concluded that 5% had used Ritalin without a prescription in the previous year, and broader studies have shown up to 35% prevalence of stimulant abuse, misuse, or illicit sales on undergraduate campuses. Anecdotally, the use of stimulants as “academic steroids” amongst health professions students appears to be similarly frequent.
As the number of patients taking stimulant medications continues to grow, so will the number and complexity of the ethical questions surrounding their use. Such publications as the British Medical Association’s 2007 discussion paper, on the ethical merits and challenges of “cognitive enhancement,” suggest the medical community has begun turning its attention to the matter. In the meantime, the use of stimulants by health students remains a matter of significant controversy.
References
http://www.pittsburghlive.com/x/pittsburghtrib/s_265518.html
http://www.higheredcenter.org/pubs/factsheets/ritalin.html
http://www.bma.org.uk/ap.nsf/attachmentsbytitle/pdfcognitiveenhancement2007/$file/boosting_brainpower.pdf
Enhancement is present in all fields as long as people can get away with it.
Medicine is no different. The volume of information has forced some of my old colleagues probably to explore helper pills. Drug abuse is probably much more prevalent amongst professionals than known to the public. It’s sad since I don’t think these folks are druggies who are using them as an excuse, but more so trying to master too much material without realizing its not possible.
It’s what happens when there is too much to know and the public expects you to have it your fingertips. The only solution is to stop medical advancements.
Simply stated Drugs are chemical tools and can improve or restore function. If amphetamines enhance ones ability to concentrate and perform with minimal side effects…what’s the problem. There is no controversy on the use of caffeine by medical professionals. Therefore maybe it’s more of an issue of accessibility.
I agree with Jason and Gary…Patients expect physicians to perform miracles on a daily basis. So much is expected of them that many leave the field to pursue other careers as I have witnessed. While I hear and understand the comparison to performance enhancement in sports, the same does not apply to those individuals LEGALLY prescribed this medication. Patients who are diagnosed with impairments such as ADD/ADHD are expected to excel to the same level as those without an impairment, thus the use of these drugs. How is this an advantage when the prescription was given to treat an impairment? These people are already at a disadvantage and the LEGAL use of these drugs is to help them restore capabilities comparable to ‘normal’ people.
Also, while these drugs work great, aren’t patients requiring them still at a disadvantage? They have to take medication daily just to compare to those without an issue.
Eric,
The article is about students WITHOUT ADHD taking the meds for concentration!!
Anonymous,
Thank you for your very brief comment. However, I am offering my opinion on the ethical debate which is pointed out in the article with which you refer. I am merely sparking the debate while extending my two cents much like Gary and Jason.
I wonder…why are these students turning to the amphetamines instead of higher doses of caffeine? What’s the incentive there?
In response to the article itself,
My observations of ADHD and it’s treatment lead me to believe that these medications DO NOT increase concentration in people without ADHD whom take these medications. In these individuals, the medication merely acts as an energy boost to help them stay up later to study, while pervasively experiencing varying side effects which can be quite unpleasant. This seems fair to me as any student with or without ADHD has access to coffee and the like in order to stay up through the night. So what advantage do they receive over others? I am not a practicing physician, yet, but I have experience with children and college age students with and without ADHD whom take or have previously taken these medications. As being among those in competition for Healthcare Professions, I do not feel threatened or disadvantaged in any way.
Just offering my opinion.
As a 4th year medical student with ADD, it is extremely frustrating when student without this disability starts using it to garner an advantage vis-a-vis their classmates. It further brings suspicion and doubt on those of us who really have ADD. There are enough people who doubt the diagnosis in medical students to start with because we are high functioning and not the classic presentation of the poor academic performer overall. This is not a drug of abuse for us.
For those of you who think the workload and volume is bad for you, imagine how bad it is for those of us who really have ADD. We take stimulants be it Adderall or Ritalin to keep up with the “normal” population. These medications do not enable us to out perform our peers. They simply enhance our ability to process and recall information and bring it to the level of our classmates. It does not enable us to stay up all hours of the day and night like it might for those people without ADD. However, staying up all night and memorizing information can be an advantage for some at least in the short term.
I can see the good and the bad found in these medications. I have never been diagnosed with ADD/ADHD; however, I am nearly positive that according to DSM standards I could easily gain a diagnosis (If I so wished). I had never taken any sort of stimulant, except caffeine, throughout my undergraduate education. I am very inattentive, and extremely easily distracted. Also, I was told by my highschool counselor that I should speak to a physician about ADHD. After spending several years away from academics I was able return to school and do well in my studies, but it required extra effort. Attending lectures is even difficult for me due to level of distraction. I am extremely self motivated, and have done well with self study. However now I am concerned about the requirements of medical school.
Just last year my wife was diagnosed with ADD as an additional diagnosis/treatment option for chronic pain. She was prescribed Adderall. On a few occasions I took relatively small doses of the amphetamine and I was amazed. Never before I had the energy, concentration, or drive that I felt.
However I also know the other side of the drug. I have a sibling who has been hooked on methamphetamines, as well as having seen several of my friends and family shrivel away to a desperate and addicted state while taking these powerful chemicals. Knowing the dangerous power of these drugs I know that I would never wish to begin a regimen; however having felt the affects of them I can see their intrigue to a competitive student.
Taking a study drug is no more illegal than taking caffeine. Those who can afford to do more, get more. This is far from cheating, which is getting what you didn’t work for.
Taking a study drug, while unhealthy and risky, should neither be considered illegal nor unethical. Or it’d be akin to saying studying for extra hours is somewhat unfair. How a person stays up has always been private business and varies person to person.
Debating whether drugs are fair is to debate whether we should compete at all. As if people who can’t afford books should complain they can’t have knowledge and learning.
Mira,
Taking a pill compares to drinking 5 cups of coffee or more, without the caffeine jitters. The pill allows a person to sit for hours without the need to eat, sleep or take a break. They also last a lot longer than coffee, and the crash isn’t as bad. Besides have you tried pulling all nighters on Coffee? It’s really hard and almost painful at times on amphetamines it’s easy and almost enjoyable. Also what would you rather do? drink 5 cups of coffee or swallow one pill.
I totally think taking amphetamines is just like taking steroids or Erythropoietin to help you preform better. But I also believe that if caffeine is available without a prescription why can’t amphetamines be as well. The same side effects can be achieved with high doses of caffeine as they can be with amphetamines. Also if you don’t feel like drinking gallons of coffee, caffeine pills are sold over the counter at all pharmacies. I say either make it all legal or all illegal. Have available info on side effects and the dangers of the drugs and let the people decide. Besides doesn’t the patient already decide what treatment he/she wants and if they want to be treated at all?
As with any drug intake, the side effects of Ritalin can be fairly unpleasant and dangerous. This idea that taking these drugs has very imperceptible side effects that some of the commenters and the article itself have mentioned are ridiculous. The takers of Ritalin can crash after the drug wears off, and the possibility of addiction to the drug do not make taking such drugs a safe alternative. Furthermore, the long term side effects of these drugs are not at all comparable to the “5 cups of coffee” that some have equated it to. The cited sources provide more information on “side effects” of the drug, and I think that it is important to consider the strains that the body is put under by these drugs.
I am disheartened to see future medical professionals using drugs and even simply brushing off the consequences just so they can stay with the pack. That is just ridiculous. The problem is the bad study habits and the lack of time management that need to be addressed. Everyone has a difficult time in medical schools: that’s how these institutions are run. It is ridiculous to complain about the difficult conditions and use that as a reason to use drugs. If I were an administrator and found out that my students were using Ritalin to stay with the pack, I would quickly expel them from my institution. We are supposed to be professionals: doctors-to-be taking drugs will soon become doctors taking drugs and this will undoubtedly affect patient safety.
As much as medical schools test knowledge, they test stamina as well. This is important because doctors–most doctors–require high levels of both stamina and knowledge to safely work on their patients. So if students are taking drugs to excel in medical school, then they aren’t really giving their medical schools the “real them” to test and analyze. Now, if these students were planning on taking these drugs for the rest of their lives, that would be a different story. However, I doubt they are. And, to be honest, if I was in surgery, I’d be sure to pick a surgeono who hadn’t relied on drugs to perform well. And if I found a surgeon who currently depended on them, then I’d avoid them like the plague.
Basically, if you use drugs in school, then you aren’t giving your school an accurate measure of how you’ll perform in the real world. That isn’t only unfair, it’s dangerous.
Ali hit the nail on the head. The problem is “bad study habits.” It’s evident in the article as well- someone who gets high grades by minimal effort in undergrad expects the same thing to happen in medical school. Old habits die hard, and new ones are born in return. Good students don’t need any stimulants. The secret is hard work.
If everyone starts taking these drugs to work harder, and the curve keeps getting messed up, the one honest kid who is working within his means in a non-psychotic way is going to get his behind handed to him on test day.
Substances like adderal and ritalin need to be tested for. They are controlled substances for a reason. We should not speaking for these substances or else they will become the norm for individuals who dont need them but use them as uppers.
The use of these substances among those w/o ADHD or ADD is complete B.S!!
I went to a private university in Cali and a bunch of the students there used it because they spent so much time partying and drinking they needed a way to catch up on their studies. Adderall means great grades and a smaller waistline; what isn’t there to love about it? You don’t honestly think after spending all that money to attend a top school people are just going to flunk out?
Oh, and it is soooooooo easy to get Adderall. You guys are competing with machines. I haven’t heard of anything negative from anyone I know who has taken it, but it would just be my luck if I did take any. It is tempting though. Maybe there is some natural herbal equivalent to Adderall.
You guys are so conservative, loosen up. The drugs are fine, they become a problem when they are abused. And yes people will abuse these drugs and ofcourse the drug will abuse them. This is with any drug though, not just ADHD drugs. Reeellllaxxx. If these medications help one study better, get better grades, perform a better surgery, etc who cares, let them. When done RESPONSIBLY they are FINE. The people who abuse them will abuse other things down the road and get themselves in trouble as well. So many people are hypocrits too, for instance adderall is more safe then alcohol which everyone seems to chug down on the weekends. Alcohol (that drug, yes) kills more than any of the Adderalls/Ritalins. Smoking? Dr. Amen in his book “Change Your Brain Change Your Life” says smoking is worse than taking adderall!
We’re living in a dog eat dog world, if you aren’t doing everything you can to get ahead you get left behind. Ya snooze ya lose. Just do these things responsibily and you’re fine mmmkay?
After reading arguments for and against these study aids, it is easy to see why some people are so strongly against and so strongly in favor of these drugs. Becoming a doctor is certainly not an easy career choice and there is an endless stream of stress to deal with. Different students respond to stress differently and I do not want to judge people who are different than me. Personally, I have never used all-nighters, caffeine, or ADHD drugs to deal with school. As a result, I do not have to deal with side effects such as fatigue and possible addiction. I choose to sacrifice in other areas of my life so that I have enough time during the day to study and then get a good night’s sleep before tackling a big exam.
I pay a price for that choice and people who use drugs pay a price for their choice. We are just dealing with a different set of consequences.
I do not feel threatened by other students who use enhancement measures because I am in competition with myself, not them. I learned a long time ago that measuring your success in any field against the success of those around you will always leave you feeling inadequate and disappointed. The rest of the world might want to throw us all in a curve and rank us, but in the end only I know if I am trying my hardest.
I’m human and sure, it feels great to be number one. It also feels bad to be at the bottom of the pit. But failure is part of life and if I flunk out of school because I won’t take drugs, then maybe I wasn’t good enough to make it as a doctor in the first place. To me, that just means that I was chasing the wrong dream in the first place and I am grateful for the reality check.
Here is another question to consider: A patient has the choice of seeing two doctors, one who was #1 in his or her class with the help of drugs and another doctor who was in the middle of the pack and made it without enhancing drugs. Who will they pick? We are becoming doctors to help other people and it is significant to consider how they view physicians who have/have not used these drugs.
So my personal choice is no drugs but I would pick the doctor who can fix me, regardless of how they got through school.
Students who use performance enhancing drugs with out a script to “help” them study are weak minded.
Johnny: I wasn’t necessarily thinking coffee, but of caffeine pills and energy drinks (including yerba mate). Personally, I can’t stand coffee.
I’ve also taken Adderall before, after being diagnosed with ADD (a diagnosis I now think was incorrect). I would rather drink a diet Rockstar than take it. I found the speed-up effect of Adderall disconcerting. It bothered my family and my lover and didn’t help my concentration beyond the first dose.
It’s true, I’ve never pulled an all-nighter. But I’ve also never experienced a caffeine crash, even when I was drinking two diet rockstars a day. Go figure.
But that must be a personal thing — obviously, that’s not the case for others.
I do think it’s cheating to use a medication to get ahead. I also agree with medstud, it puts a bad light on people who really do have ADD/ADHD. and I agree that the medication usage can be to compensate for bad study habits. But I imagine that it’d be really hard to regulate this kind of thing, unless one wants to drug test the entire school regularly…
If the only way to succeed in medical school was by using Adderall, then I’m sorry, but I wouldn’t become a doctor. I personally don’t think that future medical professionals should have such loose ethics that they take these medications without being diagnosed with the disease they’re intended for. It doesn’t say, “use Adderall for ADD and oh, if you partied too late and need help studying.” That’s ridiculous. And I hope you’re able to swallow that big spoon of irony when you’re pissed off at your patients for taking extra drugs for whatever they feel they like, and not what you’ve prescribed them for.
Also, if I found out that my med school classmates were above me & on a drug like Adderall, I wouldn’t even take that seriously. To me, you’re only competition if you are getting through it without artificial enhancement. You wouldn’t even count in my world.
If it really comes down to med students needing artificial enhancements to get through school, then we have a totally screwed up system, and something needs to change because that’s NOT okay.
I just worry about the long term effects. It is all fun and games until someone is addicted. I am not sure I want to go to a doctor who can only function as a pill popper. Not to mention the effects addition has on someone’s life and family.
It seems that most people here are viewing stimulant use as giving added ability to people, achieving results that are virtually impossible otherwise, as would be the case with steroids. From what I understand, it’s quite the opposite with stimulants though. Stimulants only eliminate disabilities such as inability to focus and fatigue. You achieve no greater results than you would if you were well rested and healthy, working at peak performance. You do not have a smarter or better brain than you had without stimulants. You just have your brain at its best.
I fail to see where this is giving one person an advantage over another. Most people are not able to devote all their resources to school, and it is completely unfair to expect them too. People should be able to have social lives, work a job to pay for school, participate in sports or exercise, or be able to deal with family matters. Such activities though make it impossible for your brain to be in the best condition possible, as would be the case if you had nothing to worry about other than school, and few people have that luxury. All sorts of things can come up, giving someone less time than they need for school and to keep themselves in mental shape, and stimulants may be the only option for that person to be able to perform their best.
I really think it’s no different than someone using painkillers to deal with pain and be able to function properly. They could have been injured from being reckless, they could have a medical condition, or they could have been in an accident. Whatever the reason may be, some more easy to sympathize with than others, they are all legitimate uses of that substance.
Neither stimulants nor painkillers are enhancers, they just help reduce disadvantages, whether they were self inflicted or not. I think it is selfish to criticize others on their use of stimulants, arising from feeling threatened at the possibility of increased competition from others being able to perform at the highest level they can. Those already working at the highest level they can, who wouldn’t benefit from stimulants, are afraid they wouldn’t be able to keep up with others at their highest level.
Personally, I love competition, and I wouldn’t feel like I’ve accomplished very much if I hadn’t competed with my peers at their highest level of performance. There is no better way to succeed than when you do so when everyone is at their best. Those who criticize such stimulant use may not have the confidence in their ability to succeed under such circumstances, but I am confident in my abilities and look forward to competing with those at or very near their best.
I see this as an issue not of advantage, but of the illegal use of drugs just like cocaine or marijuana. It doesn’t matter whether the drug actually helps them, but it does shed a negative light on the ethics of these future health professionals. If they are illegally taking prescription drugs now, what is to stop them from illegally obtaining narcotic pain killers later in their career to feed an addiction? The reason why these drugs require a prescription is because they can be abused just like any street drug. There has been a slanted view of prescription drug abuse because its a substance that’s legal in some limited circumstances, but without the prescription of a doctor it is just as illegal as any other drug that one could obtain on the street. No matter the circumstances, I would never use a drug unless prescribed because it can be dangerous.
I’m with the last guy. 3 reasons you shouldnt:
1. You wouldnt prescribe adderal or any other stimulant to a patient looking for a “study tool”…or at least I hope you wouldnt.
2. These are controlled substances so they are, BY LAW, deemed to be more addictive and ILLEGAL to use. This makes them different than caffeine, tobacco and alcohol.
3. ADDICTIVE.
This is complete b.s. There needs to be mandatory drug testing for these substances in professional schools. Sadly, it has come down to this. The AAMC needs to be more active in condemning this nonsense. It is a threat to our entire profession.
And one more thing, these diagnosis need to be made more carefully. There are too many docs out there who are willing to dish out a diagnosis like ADD or ADHD after 5 mins with a patient and prescribe them Adderal, Ritalin, Straterra etc. These actions need to be monitored by the DEA and AMA.
This site sums it up:
http://thelastpsychiatrist.com/2007/08/how_to_take_ritalin_correctly.html
I smoke rocks.
Chuck Norris: are you serious about stimulants being more addictive than tobacco? You can become addicted to these stimulant drugs, but
just because the government considers tobacco legal doesn’t mean that it is less addictive.
Don’t tell me that you think tobacco is also less dangerous than marijuana.
As for stimulants, I could see why they would be considered illegal, but they should prioritize on handling more dangerous drugs such as cocaine and heroin FIRST rather than wasting resources and money on small-time prescription dealers.
Using these stimulants work on improving memory and recollection of material, but one will have to pay the price of possible long term effects with their heart and brain. There are ethical and health issues involved, and it is up to the individual to make his or her decision.
As for drug tests, that would go totally against personal privacy. I hope our schools/country don’t become more and more fascist to be up in everyone’s business (not to mention the amount of money that would be required to conduct regulation and hundreds of thousands of drug tests).
There’s no easy way out.
Stimulant meds really should not be called “Academic Steroids”. They won’t make you any smarter.
Anabolic steroids of course make you stronger, faster and better at sports.
They are safe when used properly. The military uses them for long missions.
Want a stimulant that will keep you awake without the razor focus of amphetamine or methlyphenidate? Try Provigil.
And folks, stimulants aren’t just for students anymore….
http://blog.wired.com/wiredscience/2008/04/20-of-scientist.html
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steroids don’t make you any stronger they just let you work out harder… just like amphetamines allow you to study harder to become smarter
Just keep in mind in few years you might read this:
…According to a new research conducted by Dr.Ritalin, some psychotropic drugs such as aderall, ritalin were found to cause a memory loss as a long term side effect….
What would you do then Dr. I forgot all what I learned thanks to ritalin
In an ideal world it shouldn’t happen, but considering the rigors one must endure while completing graduate/medical school, it should only be a surprise that it doesn’t happen more often. People don’t start in grad school either…some start in H.S. and undergrad, sadly enough.
I don’t think the rigors will change, so students will continue to look for ways to get ahead….welcome to life.
Is it cheating to gain an advantage over other students by paying a tutor to sit long hours with you and help you learn everything that you need to know?
Bigchoader haha, yeah, everyone who is wealthy is cheating! Private tutors isn’t fair to others, they also have more time to study because they don’t have to work for money, etc, it’s all cheating! But seriousely, the bottom line is if you use these stimulants just do so responsibly and don’t abuse them. Period.
Being in medical school, I would say about 30% of our class is using some form of stimulant mentioned in the article. It is not because they have a disorder, but because they wish to accel over those in the class. There is a difference in being able to recall information for a patient compared to random facts for an exam. I do not believe these types of medications are useful in the real world for physicians…you have the ability to cross reference information to be sure you have the correct prescription or diagnosis for your patient, whereas taking an exam for medical school you have to pull facts randomly from your head. I have never taken a supplement like this, and honestly hate the fact that people are scoring higher than me simply due to taking a medication. To me I think if you can’t handle the material in medical school, maybe you shouldn’t be there honestly. There are different stressed related to the health field, and ritalin won’t help with them all. I mean, I want to be a baseball player, but taking steroids to up my game because I just can’t handle the performance needed doesn’t make it ok, right?
Some of you do need to give it a rest, because this isn’t going away no mater how much you bitch and moan. Fact is these people still have to study, the pill doesn’t make them smarter it facilitates studying. No one is out right cheating here. I am caffeine sensitive so I can’t drink coffee to make me stay up later and help me study longer. Since I can’t drink coffee to stay up later to study should every other student stop drinking it? People are just using what works for them.
I am at a top 5 medical school and a number of my fellow medical students use stimulants to study and as “personality” enhancers. I didn’t mind this “advantage” at first because I can just study and do well, but then I realized how clinical years on the wards are much like a beauty pageant. Many, many an “H” has been won with baked goods, jokes, backrubs, and after-hour bar-hopping. In reality it probably unfair but its not worth fighting. These are the same kids who can call in favors or their physician parents or relatives network and secure top residency spots. So its no-win anyway.
Interesting that few here look at this growing issue as a reflection of the institutions? inadequacy to address the varying special needs of the students. Why is that fixed?
Why are these curriculums, timelines, and teaching styles so standardized, beyond the obvious? Why are support services for medical students with trouble grasping the material more limited than high schools or even some progressive corporations?
Why are so many of you convinced that knowledge, however you come by it, will make you a better doctor, when Americans are begging for doctors with greater emotional intelligence? What does it really take to heal?
That old myth of doctor as omnipotent one, ultimate bad-ass know-it-all on no-sleep, is what drives this diatribe of drugs (its helps me to best my best) vs. no drugs (I sacrifice thru it so I’m the best), and leaves many doctors with true psych issues alienated and isolated amongst the community of nerds and over-achievers. (if there wasn’t something out of balance, you?d be known as achievers.)
I want more of us to make it through this intact and healthy on the phys/emo/SOCIAL/spirit level. So the level of stimulant-usage is rising, what is this really communicating to us about where we need to go as a medical community?
If you’re stupid enough to load yourself up with prescription drugs (or better yet, some drug you’re not even sure of… real smart), be my guest. Competitive edge, my ass. ANYONE can ace medical school through hard work and organization.
Nuisance comments. How many people drop out of medical school, due to the fact that they are not able to accomplish the necessitating task of studying? If Adam wants to be Eve, let him be. If someone wants to risk his/her health inorder to achieve his/her ultimate goal, without affecting the interest of society; then what is our dear problem? please kindly leave the drug heads alone.
Are the side effects of these drugs as innocuous as this article seems to suggest? I’d be okay with enduring dry mouth and reduced apetite in exchange for the pursuit of omniscience.
Hmmm… something to look into…
If people who “have ADD/ADHD” need it to perform with those who aren’t diagnosed traditionally, they are still taking it, regardless. Its enhancing their natural ability. So if everybody who wishes to enhance their natural ability takes it, what’s wrong with that? I mean both parties are taking it, and if one still remains on top, who cares? That’s like. Its the same as it would be without the drug. Except less frustrations. Saying “normal” people or whatever shouldn’t take it is like preferential treatment. Not equality. People are different. Equal isn’t making sure everybody is the same. Equal is equal opportunities. And again, equal opportunity is NOT allowing one party to have something the other can’t. If you can achieve something higher with the drug, and somebody else can achieve something even higher, then why not? I’d rather have the doctor that takes Adderall and is achieving the highest than the doctor that takes Adderall and achieves normal. And if it were just the latter and a regular guy without Adderall, I surely would pick it without, because he achieves it without. NATURALLY more ability, per say. BUT, imagine what he is like WITH Adderall, or whatever you will.
Hey guys,
So I want to start using some kind of stimulants to get more time to study. I’m getting really tired on these rotations. Do you guys recommend any stimulants over another?
How does Adderal compare to Ritalin, Straterra or Concerta? Does one have less side effects than the others?
Just wanted to know. I’d greatly appreciate any advise you could give me.
Also, how many days can you take this stuff before you crash? Can you sleep after taking this stuff?
I used tenuate to overcome a 20-pound fat gain for two months.It worked but then I had a hard two-week withdrawal period and it took nearly three months after the cessation to get back to normal-state-of-mind.Be very careful with these drugs or you may miss a term or other.
Haha, any of you guys want to be featured in my new documentary…
“Med School Junkies”
Maybe med school administrations should just start doing random drug tests for the drugs. Anyone who tests positive without a prescription gets expelled. How about that?
I don’t suppose anyone came to the conclusion that this means they’re pushing students too hard, eh?
The only people who get through the program I’m in either use stimulants or have no social life whatsoever. There is no other way. This is just the natural outcome of students being expected to memorize everything. The choice we’re being given is use drugs or fail.
If you wanted free time you should’ve been a third grade teacher.
An impaired physician is simply that, an impaired physician. I work my ass off everyday and do it without drugs. This shit will catch up to you.
You will get psychosis… and basically feel wireded out on those meds jus’ like cocaine…
There aren’t “ADD people” and “normal people.” There’s just a bell curve of everyone, most of whom have okay attention spans, a few of whom have excellent attention spans, and a few of whom have terrible attention spans. The problem is that among every group of people, a bell curve like that is going to form – and if the ones at the low end take meds, then the average ones become the new low ones who feel like they need meds, and so on until EVERYONE has to take med to keep from being left behind.
I think that many should consider the fact that there are a number of students that experience attention deficit as a result of hormonal imbalances, trauma, etc. I am one of them. I struggle often with it. However, I am a very strong and driven individual with a heart of gold. I am a pre med student and intend to excel as a physician. If the drugs are so controversial, then perhaps they should be taken off of the market for everyone. Personally, I consider myself at a tremendous disadvantage, as the side effects of the medication are unfavorable. Long term use can really take a toll on one’s body, even when taken as prescribed. Taking them intermittently can also be extremely hard on the body and one’s routine as well, causing fatigue, mood swings, etc. Abuse of the drugs, on the other hand, are something to be concerned about. However, this leads to a negative stereotype of those with ADD/HD. Any medical professional with such a narrow mind to follow this should, perhaps, focus on a different career path, as it contradicts their so called integrity.
Here’s my diagnosis: Med school is hard. Some people prefer things easy to hard.
Des – It is bad form to describe one’s self as having a heart of gold.
This article blows me away. I will graduate in December and can’t fathom how anybody can come up with so many left brain excuses to use drugs. People wonder why teenagers are abusing prescription pills like they are. I feel bad for these students that will have adrenal glands that are shot, a brain that can rationalize any unethical/illegal behavior, and a body that will not be able to adapt as it was designed. Look into natural methods of focus enhancement and energy production, such as aerobic exercise, getting a full, uninterrupted nights sleep, and improving your posture. Drugs don’t improve function, they just cover up symptoms.
Seriously, you guys on drugs need to quit med schl. Then the bell curves will drop and med school wouldnt be so insane.
Or would it? You get enough driven/ego hungry ppl together and it is bound to be a boiling pot.
or maybe we should all jump into the boiling pot and drown together. hold hands everyone. The attendings can scream at us until we drown.
I think a lot of us are forgetting the issue of personal responsibility for our actions and trying so hard to force the current med students into the light of moral and ethical accountability.
Drugs, in whatever form you use them, will produce side effects. Sometimes these effects are harmful, and can be a hindrance to normal daily life.
Future Doctors are capable, intelligent, and are currently frontiersman towards the advent of a medical golden age. If we are realistically going to sit here and banter, on the most basic level, moderation of future doctor’s basal health and intake of drugs, we must be ready for due apologies. Commenting on doctor’s personal lives and health habits….what an insult.
ADD/ADHD is a made up disease and creates an unfair advantage to those who are “diagnosed” with it and prescribed amphetamines. If you have the “disease” or not, amphetamines give one a clear advantage over their peers. My thought is to ban amphetamines completly and those of you that have ADD/ADHD can rely on therapy and other treatments.
Med school is hard, but you shouldn’t have to resort to taking drugs illegally. You guys equate using drugs like Ritalin to using caffeine because they both make you more alert and stay awake. Then you must also think its ok to use coke too since its a stimulant. You guys are stupid panzies that shouldnt be in med school with your mentallity, just suck it up and study.
I had to go to rehab for an addiction to Adderall, an ADD drug that I was prescribed. It DID give me an advantage, even though I considered myself (as did my doctor) to have ADD. After three years of sobriety, I have had to retrain my thinking to study normally. It can be done, but it was the hardest thing I’ve ever had to do. If anyone is struggling with this (as I know there are many; four people I was in rehab with were in there for an addiction to these study medications) please just suck it up and ask for help. Just do it and don’t be scared that you will never be productive again, get good grades, or be social. I am living proof. I’m now in my first year of medical school….it was hard work, but I did it naturally. For that I am proud.
The problem that I have is with the opinion that these drugs are miracle drugs, and i have the same problem with steroids. I have no problem with the use of either as long as it isn’t against the rules. Now by rules I don’t mean the laws, but the governing bodies. Whether it be schools that don’t want their students using any stimulants, or sports leagues that don’t want steroid use.
Neither will do a damn thing by themselves. Only accompanied by hard work and eating right will steroids cause muscle growth. Only with studying long hours will adderal help you succeed in med school. They are not means to an end, but a small piece of a puzzle that includes all sorts of habits to achieve a final result.
And I don’t care if my doctor did or didn’t take drugs to learn the massive amount of material in med school, as long as he remembers it!
Being a person who is prescribed Adderal and diagnosed with ADD, it’s really hard to describe how it feels. The priorities are still in order as well as the motivation, but to read a page of material 3 times and not being able to focus and remember the material goes beyond frustrating.
These aren’t just miracle drugs that will improve performance no matter what, they just helps you focus on your main priority. I’m sure you all know that the effects aren’t all positive. When i take it i basically trade in my regular personality and reduce my eating and sleeping so i can perform regularly. People who say this is just a miracle drug that creates inequality aren’t really taking in the whole picture.
I think this argument has an underlying fact about medicine. In the time I spent with doctors, I found two kinds of physicians. There are the ones that treat the symptoms, and the ones that treat the underlying problem. I believe both can provide some relief, however only one path leads to a cure and complete health.
I really feel like both solutions have advantages, but as doctors we should seek the ultimate cure. Is it ok to leave diabetics with only insulin, or people who have AIDs to their unending anti-viral medications? We should be shooting for the win.
The fatige and competition of med school wont go away after your classes, this is the life we are all choosing. So all we really have to decide is the kind of doctors we want to be. The “doctor” who opts for the quick fix, and quicker gratification; or the person who defeats illness and dedicates everything to the perfection of his or her craft.
Thank you Anonymous! Finally someone with some wisdom and scruples!
I just have one thing to say after reading these comments: I thought health care in America was bad as it is–literally a 5 minute diagnosis (with a Nurse Practitioner more often than not) after waiting an hour and a half past your scheduled appointment, all the while watching the “drug pushers” wheel their suitcases of samples in and out of the office, shmoozing all the while. Well I guess the “me” generation isn’t going away. “God” help us all!
Oh, and one last thing…
Ryan said, “but to read a page of material 3 times and not being able to focus and remember the material goes beyond frustrating.”
Yes it is…damn maddening at times. Does this mean I have ADD? I mean c’mon everybody, with the level of sensory input that is considered normal today, not to mention the million “things to do” we are supposed to keep track of, is it any wonder that we have a hard time staying focused? Our level of tolerance has become so low.
Anyway, my point is that if you have to read a textbook page 3 times for it to sink in, then set aside the time to do it and count yourself lucky you’re not having to read it in braille or somethiing.
Seriously. I feel ya’ man, but that’s life.
Anonymous: “My thought is to ban amphetamines completly and those of you that have ADD/ADHD can rely on therapy and other treatments.”
The most obvious problem with this is a combination of the high response rate (in properly diagnosed cases) that comes with stimulant use, as well as the lower response rate for alternative methods.
It must be nice to have a god complex. Adderall is also used in conjunction with severe depression to help offset the sedating affects of antipsychotics like seroquel, in addition to providing or re-establishing a level of concentration that proves effective.
there may be some abuse but mental illness is not imaginary for anyone other than the lucky few who have the luxury of never experiencing it.
Having ADD is not simply not being able to concentrate, its racing thoughts, an inability to focus on anything and resulting in hightened anxiety. In its adult form it can result in an inability to react to situations appropriately and can contribute to increasing issolation and depression.
I find it highly unusual that noone thought to make commentary on that.
There will always be patterns of abuse in everything, from sugar, to cheese to drugs, to exercise to sex. However we can’t start pointing fingers at legitimatly ill people and force them to “prove” their illness. The DSMV is constantly changing and rarely if EVER does someone fit into one category fully, there are always variances, we need to take that into account before weighing judgement.
so, what kind of doctor would i prefer? a doctor who looks at my needs holistically and doesn’t think soley in black and white. I don’t care if my doctor is bipolar, or suffers from mental illness in fact i would PREFER a doctor who had those qualities as they would be the most tolerant to understanding nuances the “normal” herd miss.
mental illness is by no means a disadvantage, it makes you work twice as hard, and it gives you a distinct way of looking at a situation from the other side. It should be embraced as a diversity and not shunned.
that means taking everything into account.
someone should seriously try understanding medical anthropology nuances. Its apalling that doctors are so narrow minded. This must change.
I appreciate Christina’s comment. I was officially diagnosed with ADHD in middle school and LD (learning disability) recently, but was tested for LD and ADHD much earlier on. At those earlier times my parents refused to accept the existence of ADHD or that I had any sort of LD. Nonetheless, I struggled in school while all my teachers and my parents would tell me I could do much better and that I wasn’t trying hard enough. Obviously they all saw my potential, and recognized there was something preventing me from achieving it. I can tell you it wasn’t from a lack of trying.
After starting meds in high school I continued to struggle in school despite the fact I was receiving special tutoring. I felt like I tried harder than anyone else and yet kept being told I wasn’t trying hard enough. I was depressed, anxious and contemplating not going to college.
After years of struggle and bad psychiatrists I found my way during college. I am now a premed post-bac student, pursuing a career as a psychiatrist and I hope to help others from going through what I went through. I don’t think I could do it without stimulants…but I also could not have done it without A LOT of hard work, study skills tutoring and help from others.
Nonetheless I know the cons of depending on such a powerful medication to achieve your goals. It messes with your own self-confidence (i.e. is it me who got the A+ or the drug?), as well as the side-effects (i.e. anxiety and depression). You also face a lot of discrimination by people who doubt the existence of ADHD and think drugs are an easy way out…it basically minimizes and mocks all the suffering people who really need the medication have to face.
I believe there are right and wrong ways of using a tool such as stimulants, and that people who use it the wrong way will ultimately suffer consequences. Nonetheless, it’s their body and their life. For those who use stimulants the right way (i.e. prescribed by a doctor, monitored by a doctor, self-informed about risks/alternatives) I would encourage them to not listen to anyone else but yourself and your doctor and keep doing the best you can.
For all of you who aren’t diagnosed with ADD/ADHD, who are you to judge people taking these medications legally? You haven’t experienced their symptoms, so grow up. Taking these drugs legally is the same as someone taking an antidepressant for depression. These drugs don’t give people with ADD/ADHD an unfair advantage, they just level the playing field.
I understand the concerns regarding the ‘flexibility’ of an ADD/ADHD diagnosis, but that’s why medicine is an art. I am able to do well in medical school due to my hard work, all without the use of stimulants. I am not diagnosed with ADD/ADHD, so I don’t dare use the drugs. I do, however, have many classmates who use stimulants legally as well as responsibly. They have to work as hard as me to perform as well as me, even though they use stimulants. Stimulant usage by these classmates is an equalizer, not an unfair advantage.
The therapeutic usage of stimulants in a legal manner is just the same as treating any other disease. Compassion and understanding is missing in a lot of medical professionals today, and that is scary. If you truly believe that these drugs offer an unfair advantage to those taking them in a legal way, then maybe you should rethink going into medicine. It isn’t your job to judge a patient, but to help them lead a healthier, and thus happier, life. If you are smart, you will do well in medical school with a lot of hard work. Worry about yourself, not your classmates with ADD/ADHD!
Eddie…wow…well said!
Chronic use of these drugs leads to irritability which is not an acceptable quality for a physician… well maybe for a surgeon. However, considering residents commonly work 80+ hour weeks and are forced to treat patients while sleep deprived, residents using these drugs to stay alert may actually be saving lives.
My only issue with these drugs is regarding the unknown long-term effects of abuse. And when I say abuse, I’m talking about my classmates who obviously don’t suspect they have ADD/ADHD but take it anyways based on the notion that these drugs are “study aids.” My personal view has always seen taking a drug when there is no need as a definite, easily-preventable risk to mental and physical well-being.
People lacking discipline and real ability are the major offenders, they get short term gains but in the end they end up in a profession they can not keep pace with.
They will hate their lives when they realize they aren’t able to hang with the big dogs without this stuff.
Good luck to them and I will see them hooking on the corner looking for a few extra bucks to pay for their habit after I anonymously turn them in to Law enforcement agents.
The use of stimulants in medicine is no different from performance enhancement in any other field. Just as professional athletes take steroids and supplements, just as actresses and models obtain breast implants, doctors and medical students consume coffee and other stimulants for the purpose of improving their daily performance. In general terms, use of performance enhancers is a logical consequence of capitalism – self-interested individuals looking to gain a competitive edge to preserve their own survival.
Personally, I think it’s a shame that caffeine has become a fixture in the medical profession. There is something wrong with a system that essentially requires doctors to consume stimulants just to be able to perform adequately. I am aware that this problem is quite widespread throughout American enterprise. Use of amphetamines is a logical next step for individuals working under this system. In my opinion, health professionals should be permitted to practice healthy lifestyles so they can have credibility in promoting health in their patients. This means doctors should not suffer sleep deprivation and be forced to consume stimulants just to stay awake.
ADHD medication is like glasses for those with ADHD. Although there are many causes, an intriguing theory is that some ADHD patients is a genetic expression of hunter/gatherer behavior. People are made to move, it is only fairly recently in evolutionary history we are required to sit still and focus on a one dimensional input such as reading.
As a practicing psychiatrist, I can tell you that making a “diagnosis” of ADHD in adults is junk science at its best. the “testing” that is done is all self report. Very easy to learn to right answers and score highly. Everybody likes amphetaimes. There is a study in the literature that examined the response of “normals’ to those with ADD and — guess what? — everyone did better on amphetamines. It’s SPEED for god’s sake. I’ve seen many student struggling in professional school — law, medicine, dentistry, PhD, etc. And when we test them, they have average IQ’s. I’m sorry, but it’s just not enough horsepower to get through these demanding programs. These are class II medications, easily abused, dangerous. I’ve seen several cases of amphetamine induced psychosis. It’s a pathetic job we are doing educating MD’s who think the public demands they work miracles, and even more pathetic that they believe they can get such miracles in a pill. It really does not enhance your performance. Again, read the literature and you will find stimulants do not improve grades. They pump up dopamine and your grandiosity, so that you think you are doing better. Worse, nobody is reading the literature. They are basing choices on observation of one. Very poor practice.
Quick question, why haven’t we considered lightening the load(s)? When so many people feel the pressure to use stimulants, perhaps that’s a sigh the workload is too crazy and needs to be reduced?
Well it is doctors like PsychMD who I have the greatest problem with. Take this soundbite from his post… “Again, read the literature and you will find stimulants do not improve grades. They pump up dopamine and your grandiosity, so that you think you are doing better.”
I would never be the type to argue, but I really feel that given that this is a discussion forum of the article, I have to express my disapproval for the type of people who think that studying medicine can substitute for rational thought.
Why not assume people are honest? If a patient comes to you with a problem, you should help them, not judge them. If you are unsure if they need the medication, spend more time with them. Maybe they don’t need the medication but you can encourage them to (this part is lame, I know, I’m a noob) exercise, get better rest, practice yoga/relaxation, have a better diet, etc…
What the real argument comes down to is “What tolerable rate of false-positives for adderall is optimal?” and this takes into account that obviously some patients are prescribed who don’t really need it, but also it acknowledges that some people who need it will have a terribly dificult or impossible time getting diagnosed and treated.
I did not make this post to initiate any discussion (last post is a week old, hopefully it’s died down). I am a good writer, and a solid architect of arguments but felt bad about not saying anything at all, when I perceive non-neutrality in a possibly influential comment.
I understand and appreciate both sides of the debate here, but as a current resident, all I can say is that without ritalin I would never have made it this far through residency, and I certainly wouldn’t have lasted more than a month or two of internship without it. Despite the self-righteous indignation that oozes from some of the above posts, the reality is that the system makes me work 30 hour shifts, and I have to be just as awake and alert on hour #29 as I am on hour #1, and the bottom line is that when, not if, your judgement becomes impaired from fatigue and you start walking and talking like you’re drunk because you’ve been up all night, you’re going to screw up and very likely make a mistake that will hurt or even kill a patient. And when that happens, you can’t just say “I was tired…waah”…you’re still responsible and accountable and you will have to deal with the consequences. When your 8th admission rolls in at 5:30am and you still haven’t eaten dinner and you feel like you’re going to collapse, take a ritalin and see how the seemingly impossible becomes manageable. For me, I don’t view it as much as performance “enhancing” as I do a survival tool…I don’t take it on my call nights to perform better than anyone else, I take it because I wouldn’t be able to survive those 30 hour shifts without it. I can’t stand when people get all preachy about this and compare it to athletes using steroids or crack addicts–there’s nothing out there that you can compare this with because there’s no other job out there that has professionals with such a high level of responsibility being forced to work under such extreme and unreasonable conditions. So what are my options? I can’t change the system, so I’m stuck with doing what I have to do to perform my job as safely and effectively as possible. For me, that means taking ADHD drugs. It’s certainly not an ideal situation and believe me, I’m not proud of the fact that I depend on this stuff to help me get through residency. Tell me a reasonable alternative that will ensure that I’ll be as mentally sharp and alert at 4am on a busy call night and I’ll gladly flush the pills down the toilet, but until then, I’m sticking to what I know works.
It’s not just students. A friend of mine got through a PhD without Ritalin and then started taking it as a professor while I was working on an article about medical students and cognitive enhancement: http://www.scienceprogress.org/2008/09/the-end-of-impairment/
a_resident hits the nail on the head. Medical training and residency in particular (the one invented by a cokehead) forces you to do things that are beyond humanly possible. It’s the system that’s broken, not the people just trying to keep up. And, why? So the hospital can turn a profit.
The truth is, medical schools, hospitals, and residency programs don’t give a shit about the well being of their learners. Just like every business they’re motivated by the power of the almighty dollar. The saddening part is that the people who really suffer are the patients.
When I went through basic training, I thought I was going to be sleep deprived much of the time. To my surprise, I never was. The military knew that depriving its members of sleep was a bad idea for someone who holds a gun and has to make decisions. Why can’t the medical system figure this out? It’s not rocket science.
People use drugs for all sorts of motivations. Some to get high and others to feel normal. Doctors like a_resident use drugs so they can function like every other person who’s had 8 hours of sleep. I think that’s reasonable.
Okay there is so much going back and forth on here, it’s making my head spin.
This is very basic.
So you are doing a self-DDx for the nonspecific S/Sx of “problems studying”, decr. concentration, etc. (I’m not necessarily talking about ADHD)
Now you not only are going as far as self-treatment even including selection of specific agent(s) (mixed amphetamine salts, methylphenidate, etc.), but you are playing pharmacist as well and obtaining the medications somewhere.
What makes me uneasy about the situation is not only the complete lack of objectivity and ethics in the self-DDx/self-Tx approach, but that there is a missing link. That missing link is the diagnosis and an adequate list of S/Sx. (I’m NOT saying that psychostimulants are only indicated in ADHD) The best reflections of this are the reports that students “try” the psychostimulants first and then decide later that they might be helpful. This is borderline substance abuse behavior.(medication self-administered–>(+) Effects–> self-readministration[d/t desirable effects]) Perhaps it would be better to first evaluate your problem.
Do you have trouble concentrating, starting tasks and later not completing them, anxiety, poor-encoding of information(reduced retention), etc?
My stand on this issues is that there is no right and wrong about taking psychostimulants. If you do feel that you need/want them though, consult a specialist. What would you tell your patient to do? I’m sure it wouldn’t be to buy pills off a friend, or take a self questionnaire about a possible Dx.
Talk to a psychiatrist or neurologist (depending on the nature of your problems/desires) and discuss the most reasonable approach to this, and please obtain a legal Rx. This way no one can criticize you for taking the medication.
All of this said, I take amphetamine/dexamphetamine 20mg tid, as prescribed by my neurologist. I don’t have ADHD, narcolepsy, or any of the other FDA-approved indications for the drug. That’s okay though. Given other factors in my life (including severe polyneuropathy as a result of malignant hyperthermia a few years back, stresses in my family, and my refusal to take opioid pain medications because they impair my judgement and cognition), the reasonable conclusions were: 1) that I WAS suffering from a minor to moderate impairment in my concentration and academic functioning ability, 2)Elective pharmaco-management of the situation has a (+) [Benefit]-[Risk], 3) With psychostimulants, my functioning would return not only to normal, but enhancement would also be present.
I chose to take the medication. I have no unfair advantage over the student who decided not to take medication.
Take this analogy– We are doctors (or studying to be doctors), we give patients unfair evolutionary advantages every day. That’s our job. We cheat the natural system that is supposed to cause problems in lives by deceiving it with medications, surgeries, and other techniques. We improve quality of life. Should a terminal CA pt. be in pain because it is the natural course of the illness given to them? Of course not. Should that same pt. receive a dose of morphine to make them feel like the rest of us, or should that pt. receive more to ease the non-physical pain of impending death? Whatever the answer, it should never be made by the patient alone. Take Botox Cosmetic injection for an example. Are bags under a woman’s eyes and minor wrinkles technically pathological disorders?–No. Does pt. quality of life improve w/ Botox Cosmetic Tx, given no contraindications? YES.
What I hope you get from this is that the reasons for/benefits from psychostimulant treatment must outweigh risks, and no matter what medical school you graduated from (or are in now), you are not qualified to make that decision for yourself.
Self-Diagnosis is a slippery slope that many early medical students start down. Try to avoid it at all costs.
Thanks for listening
Dr. Alexander Wick M.D.
Getting all A’s in undergraduate with little effort? I don’t know anyone doing this at my school (UC Davis) in science majors, so I imagine either this person went to a school that practiced significant grade inflation, or had a major in humanities, social sciences, etc.
Perhaps medical schools place too much weight on diversity. Would you rather a banjo player or a car mechanic work on your car? A car mechanic, I hope. Why do medical schools get excited over English students compared to someone in Genetics, Microbiology, Physiology, ie something more relevant to understanding disease? I have heard from friends in medical schools that students coming from humanities or social science college programs struggle for their first two years in medical school, whereas people with science majors perform better.
Is taking stimulant is ok in a medical school?
I’m just pretty curios on this article.
Could somebody help me clear this out??
Better Living Through Chemistry
while adderall will give you a superior academic advantage, the side effects are not worth it, for a while was becoming slightly delusional and extremely detached, both went away after i discontinued use…
Dr. Wick and others:
I am not a doctor or in the medical field currently. Nevertheless, I have had numerous associations with medical persons and here is the problem that I have with your argument.
Is not a physician supposed to be a “healer” on some level? As such, he/she treats a patient with the underlying hope that that patient’s body will at some point take over in the healing process and heal itself. Insulin for a diabetic would be an exception here. I’m not talking about a pre-existing or genetic condition. If a person has an operable tumor, he gets it removed. A course of radiation or chemo is prescribed with the hopes that a cancer will be prevented from recurring. If a person has an infection, he is given a short course of antiboitics that will enable his body to fight off the illness and obtain future immunity. These medical interventions are short term changes to the body’s natural state in order to allow it to affect healing on an organ, a tissue, a group of cells.
Many of the medications being prescribed today appear to be “open-ended” to me. That is, they are prescribed with no hope of the organism to overcome its current sick condition. Rather they are at best a form of symptom management. They do not effect a cure. Many of the current psychiatric drugs seem to be overprescribed to me, for the wrong conditions. Take ritalin or prozac, for instance. As long as you convince your specialist that you have symptoms that resemble ADD or depression, he will prescribe these medications like candy. You might feel better for a while but believe me the people around you notice that there is an incongruity to your behavior that is *not* natural. As you become dependent upon the drugs to function at what you consider a normal level, the psychiatric profession continues to let you down by offerring no long term solution to your problem other than to continue on the course of expensive medications or to try the newest ones out there. Your behavior and congnitive function frustrate your coworkers and patients. You have no idea of how you would function without the drugs. How is this addiction any different from being addicted to heroin or crack? The only difference that I see is that these drugs allow a person to be exploited more by society. In other words, society gets more work, more productivity out of you in your over-revved drug induced state than it would of a crack addict or heroin abuser (wants to dream the days away or bask in unending euphoria…)
It is you who are being cheated and exploited by your own specialist. Future doctors who use these medications, YOU are continuing to support a cycle of abuse. This abuse begins in medical school and continues into residency, and expects doctors to become superhuman beings that can operate on no sleep and still manage to provide good care to patients. No wonder physicians develop god-complexes. Now we have the drugs to make them even more deluded into thinking they can do it all. Wow, this is such a striking example of medicine that has gone awry. I still go to a physician to be healed rather than treated and unfortunately many patients still believe in the spiritual element of medicine…an element which is so completely lacking in the current approach of over prescribing pills.
Wow. There are a lot of opinions on this topic. I’m just a pre-med student right now, but if I get into medical school, I will not be using any study aids. I got this far without them and I’m doing just fine. All of my friends who are in medical school already talk about the volume of information, so maybe I will be eating my words once I actually get started.
Personally, I would rather perform at a lower level and know that the successes are mine, rather than become dependent on a pill or any other sort of a substance. Will that make me a less-competitive doctor? Maybe. I’m not becoming a doctor to run a race against other doctors, like a hamster on a wheel. I am naive enough to believe that I can build a career on collaboration instead of competition. My drive to succeed is based on being good enough to be a contributing member of a team. Will I be able to provide a “miracle” when patients demand it? Maybe not. But when did fallible humans become responsible for the inevitable fact that death stalks us all? Everyone gets sick and eventually we all die. Medicine is a powerful tool, but it has limits.
You only live once and I would prefer to perform at my natural peak for my career and not burn out because of stress. If that means that I make less money than my peers, then that is the price I will gladly pay for peace of mind. Pushing yourself to achieve is one thing, but we all have natural limitations. My older brother was a lineman on a division I NCAA football team. Even on our freshman football team in high school, I was never a starter. As a patient or a professional, I would rather interact with someone who accepts their limitations and finds healthy ways to cope with them, rather than someone who covers them up. I could have taken steroids to bulk up and earn a spot on the line. Instead, I decided to run track and I discovered that I am a great medium distance runner. I still go running several times a week and I love it. There is this dangerous culture in medicine sometimes that encourages students to annihilate themselves as they pursue someone else’s ideal. If your dream is to pop pills to live in an altered state of consciousness, then I hope you find happiness in what you are doing.
I guess there are consequences either way, so as long as no one is doing anything illegal, then to each his or her own. I hope that we can all be mature enough to let people decide how to live their own lives.
The dr. who treats himself has a fool for a patient.
the dr. that doesn’t has a fool for a doctor.
your patient is bleeding out and you forgot to take your secret brain-pill this morning. now he is dead because you cheated your whole life and put yourself into a situation you could not handle. every patient deserves a doctor who doesn’t anything more than their own brain, and sharp discipline. if you can’t cut it without a pill, then you can’t cut it. not everyone is meant to be a doctor.
The problem with the ADHD diagnosis is that it is unscientific and driven merely by misreporting in the media, and unscientific advocacy groups. You left that out. ADHD is exclusively a childhood disorder, and it is exclusively behavioral, not medical. Medical treatment for ADHD is merely covering up symptoms, not treating the disorder. People who have the disorder get much better treatment results from cognitive behavioral therapy. Adult ADHD does not exist, and getting into medical school precludes a diagnosis of ADHD. When symptoms of ADHD persist into adulthood, it progresses into Conduct Disorder, then Oppositional Defiant Disorder, and finally, in adulthood, it becomes Antisocial Personality Disorder.
Interesting. PsychMD says this: “I’ve seen many student struggling in professional school — law, medicine, dentistry, PhD, etc. And when we test them, they have average IQ’s. I’m sorry, but it’s just not enough horsepower to get through these demanding programs.”
And then he says this: “Worse, nobody is reading the literature. They are basing choices on observation of one. Very poor practice.”
You were right on until you started spilling the pscychobabble in the first quote. If YOU would read the literature, you would know that IQ doesn’t really show a lot, and it is a VERY poor predictor of success in ANY field (essentially no better than chance). Maybe if YOU would stop basing YOUR choices on the observation of one, you wouldn’t be practicing so poorly.
This just illustrates the poor amount of training we receive in behavioral science in our medical training. I’m glad I majored in behavioral science before medical school so I am not as uninformed as other doctors.
Any psychiatrist that denies the existence of ADHD, and claims that his/her views are supported by research needs to have his/her license revoked.
Since PsychMD has obviously not been reading the literature, here are just a few recent articles that you can get started on…that is if this person can even read:
http://www.ncbi.nlm.nih.gov/pubmed/19200423?ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18206857?ordinalpos=9&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/18179783?ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/pubmed/19482264?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
I’m on the same page as Josh. While ADHD drugs seem harsh, it sounds like ultra caffeine, from the effects I’ve heard described.
I take Omega-3 supplements everyday. Studies show that fish oil can boost brain power. So am I cheating too?
(It’s not an exact comparison, but I feel the message can be recieved)
I have ADD. Currently in my 3rd year of med school…. heres my story…
……Before diagnosis ………….
*bright straight A student till 10th grade when puberty hit
child hood to end of freshman year of high school…no problems
*freshman year GPA….3.7 out of 4.0
problems began
*sophomore year of high school GPA…1.2 out of 4.0
dropped out of public high school, forced into to private school…
with MORE downs then ups ….luckily got a 1340 on SAT to be admitted into a mediocre state university. graduated high school with a 2.3 out of 4.0 and this was VERY VERY HARD FOR ME (trust me when i mean lucky..i meant lucky)
freshman year of college GPA……..1.5 out of 4.0
placed in academic probation after first semester of college then dropped after second semester of freshman year…
kicked out of college after freshman year.
frustrated parents from sophomore year of high school to end of freshman year of college…….FINALLY took me to see a therapist as a LAST RESORT (at this point i was mildly depressed/extremely frustrated, didnt know what the hell was goign on, what was wrong with me, i came to a point where i thought i was just plain stupid and had a below average IQ…… i hated having to argue with my parents about grades and other family issues)
referred to some famous adolescent/adult psychiatrist who had countless number of varying learning disability degrees. who made me go thru 8 hours of intense testing spread out into 2 days (didnt enjoy it) consisted of various surveys, IQ tests, questionnaires, interview with 2 other colleagues of that specialist, had to sit in a room and click a button for a certain period of time and a bunch of other weird S*$&$.
final results: in a 10 page typed up document
#1.i had an above average IQ
#2.lack of organizational skills
#3.extreme inattentiveness/prone to be sidetracked very easily
final diagnosis: A.D.D.
treatment: adderall daily 20mg IR and had to take a organizational/study plan classes for 2 weeks everyday for 2 hours.
…………AFTER DIAGNOSIS………….
went to a community college for 5 semesters straight.
cumulative gpa for 60 semester hours ……………3.7 out of 4.0
transferred to the SAME state university which i was kicked out of from…….graduated with a major in chemisty ……cumulative GPA…3.75 out of 4.0!!!!!!!!!!
considering the fact that i had already messed up to the greatest extent one can possibly achieve in the lowest form during college…i didnt even TRY to apply for med school in the United states. applied to st. georges med school, got accepted(barely) and finished my first two years honoring in most …not all…of my classes!
currently studying for usmle step 1.
*for those who dont believe that medicine CAN help and that ADD/ADHD is TRULY a problem……i am one example out of MANYYYYY. its easier to judge and criticize those who have this problem as saying “yea your just faking it” or “everyone has some form of it” however….my past is my true testament to the actual disability. and its treatment is a GODSEND. for me and my parents both. one can ONLY IMAGINE how it MUST HAVE been for someone like me…..from attaining good grades at one point to dropping on the bottom of the academic ladder….and the personal and familial problems associated with it that were entailed for YEARS….the constant struggle and battle to figure out what truly was wrong with me. to being labeled as a dumb kid, with no future, and personally believing it at many points in my life….i am a true example of how this pathology can effect ones life…and how its treatment has changed my life and those around me for the better….
i ask you………….isnt that what medicine is about?…..isnt that what we try to achieve as physicians…..we take the Hippocratic oath….do we not understand it and abide by it personally and carefully? to try to aide the person with a certain ailment the best we can so he or she can prosper and live life to its fullest…..
If these prescribed stimulants are similar to caffeine, why did my classmate need to visit four different docs in order to obtain her intake of amphtm?
These decisions are easier to make without pressure. But when you have a test in 24 hours and your friend is up studying with no problems and you have trouble looking at your notes for more than 20 minutes and you need this test to pass, suddenly the decision becomes murky. People need to understand that others have different pressures. Is that how you’re going to treat your patients? With that level of arrogance and lack of understanding?
It would be interesting to give some people placebos and see how they function. The pill helps you stay a awake and focused, but it’s not a cure for lack of motivation etc. I don’t think these should be allowed for people w/o a real clinical need though. Cocaine has benifits too, but the negatives out way them.
Pharmacy school is hard for a reason, not everyone can do it. The fact of the matter is using drugs to get through it is not the way. If you want to know what the dangers of drug addiction are, go to a local board of pharmacy meeting and watch what happens to addicted professionals. Pharmacy school is stressful, true, but it’s not like once you get out into practice the troubles melt away. In fact you might have more troubles if you start a family after school. Now your not only making life altering decisions for patients and having to deal with all the stress that goes with that, you’re also getting lots of stress from your house. All this leads me to believe that if you rely on these drugs to get you through school, your more likely to rely on them after school and continue to have problems.
If you’re having trouble handling the workload, I recommend you talk to your counselor as opposed to dealing with it on your own using pharmaceuticals. Good luck!
prescribed stimulants or not, most of the stimulants are used on campus and unless this is banned, will continue to be used. I took them for 2 years and had a tough time giving up.
First off, if you are actually diagnosed with ADD/ADHD, the meds will not make you more hyper, they actually calm you down, its the first thing we learned about ADD/ADHD and amphetimines in medical school.
My story: I struggled so much in undergrad, I couldn’t sit still and study for longer than 15min. I had such an annoying inner restlessness, and during lectures (anywhere for that matter) my mind was going a mile a minute. I always was moving some part of my body, it was so frustrating. I was depressed because I couldn’t understand why it was so hard for me to focus! Nothing held my attention. But when I was diagnosed with ADD in med school, after a brain scan (actually shows areas of lower activity in PEOPLE WHO REALLY HAVE ADD/ADHD) and a psych evaluation, I started taking a very very low dose adderall, and the effects were amazing. For the first time in my life I am able to sit still and focus, and not feel the extreme restlessness that has always plagued me. I felt so calm! SO NO I am not using it as a crutch. It is so easy for someone who is completely normal to say its a problem with discipline. No one knows how it feels, except people with ADD/ADHD, to have to strain just to focus on anything. Its a constant mental exercise to try to study, pay attention in class, or to freakin pay attention during a movie. Its like your mind is running a constant marathon and there is no rest, on average it takes me 1hr to fall asleep because its hard to shut my thoughts off. SO all the idiots taking adderral need to stop, you are giving the people who actually need it a bad name. And everyone who says there is no such thing is foolish. Yeah I did well, but it was extremely difficult and draining to study. These meds don’t make med school easier for me, I still have to study my butt off, and I study just as much on the meds, but now I can use my brain power to learn the lectures, rather than on trying to focus long enough to learn the lectures.
The use of nootropic drugs cannot be compared to the use of steroids in sports. The fundamental premise of professional sports is that there is a level playing field on which people of exceptional ability can come and demonstrate their skills competitively for paying spectators. The use of steroids compromises this premise by giving an unreasonable advantage to one side, negating the purpose for both spectators and participants.
Medicine is not like this at all. The primary focus of a medical student isn’t to compete against other students, it’s to absorb as much information as possible and apply that information. They need gain these skills because they will be important to them as physicians.
Addressing the issue of “competition,” there are people with fundamental advantages from the outset; there are people who will not have to pay a dime for their medical school education. There are still others who have had extensive investment into their childhood and high school years to make them develop the skills to make them smarter. There are similarly those who were born into very poor or unsupportive backgrounds. All supposed disadvantages or advantages aside, as long as a physician is outstanding, why scrutinize the method by which he came to reach his or her greatness?
One possible response is that it could have long-term psychological consequences that are detrimental to the physician’s ability to treat patients in the long term. My response is that Paul Erdos, one of the most prolific mathematicians of our time, took amphetamine salts every day of his professional career to help him focus on math. I don’t think he was ever addicted. Secondly, there are many physicians who are on anti-depressants and other medications that would otherwise not be able to work or study to become a physician in the first place. Finally, those who have ADD and ADHD have demonstrated that amphetamine salts can be used responsibly and taken daily at controlled doses. Knowing my friends who have taken Adderall, I can say that they are educated, understand the possibility of addiction and measure their doses carefully. If this is “drug abuse,” I’m certainly finding it hard to connect the image a hard-working and enterprising pre-professional student in the medical field with that of a junkie.
I was astounded when I started med school last August and found out that schools don’t randomly check the students for drugs. Furthermore, in conversation with doctors, I came to find out that hospitals rarely, if ever, test doctors. They assume that the AMA would throw a fit about civil liberties and such, so they just use the honors system. What?!? When I was in the military, we were tested randomly – usually a couple of times per year. Can someone please explain to me why the health care profession feels exempt from a simple urine test?
How do you even begin to get help if you think you have ADD? I feel if I start spouting off symptoms like I can’t fall asleep, my mind is constantly racing, I can’t focus longer than x number of minutes, I am anxious all the time; and i tell them im a student, the doc might just assume i want the drugs to do better in school. Essentially I do, however, i want the help too! I really feel I’ve had this problem since middle school but no one wanted to help me. Now I am a drop out [got my ged] but scared of failing college because I feel inadequate when it comes to studying/learning. I feel I am stupid and everyone else is smarter and can focus better.
Common myths about ADHD that are perpetuated even by professionals:
1. adult ADHD
2. brain scans to diagnose ADHD
3. ADHD is a “neurobiological,” or other such made up nonsense word, disorder.
4. Med students have ADHD because med school is hard.
5. paradoxical effect of stimulants in ADHD
In all reality, if ADHD progresses into adulthood, it becomes antisocial personality disorder. This is supported by study after study. The DSM-IV-tr does not support a diagnosis of adult ADHD. Brain scans on people who allegedly have ADHD are NOT diagnostic and are indistinguishable from sleep deprivation. Even this is shaky, since many, many studies admit that the diagnostic criteria for ADHD are barely followed by anyone, in favor of personal opinion or poor diagnosis in the first place. Most, if not all, studies on ADHD use circular reasoning and authoritarian statements, instead of evidence, to support popular assumptions about ADHD. There has never been published evidence that there is any organic damage or abnormality involved in ADHD. Med school is hard (and boring), suck it up; it doesn’t mean you have ADHD. Doctor shopping is illegal and unethical. What kind of doctor are you going to be if you support this? Psychostimulant drugs affect ADHD patients exactly the same way they affect those not diagnosed with ADHD.
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In response to something “Ag” said:
My Background:
I have an information-processing disorder where I learn what I would ESTIMATE [no way to know for sure] that I learn about 3x slower than the typical student … and this results in dyscalculia as well as ADD-like symptoms. I take Adderall to help me focus better so maybe I can focus better and take in more information so I don’t have to study 48 hours a week (this is NOT an estimate- I am required to keep track of study hours for my sorority. I turn my phone off, don’t listen to music, and don’t have a Facebook).
My psychiatrist told me this:
There is NO placebo effect for students with ADD. I don’t know for certain if administering a placebo pill to non-ADD students would work. My opinion is, however, after reading a ton of research (about to graduate with a BS in Neuroscience) that there will be a slight placebo effect on non-affected individuals, but it won’t produce a hyper & focused all-nighter in the same way that a stimulant would.
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