Modafinil is a "smart drug" that leads toward the future of neuroenhancement.

Expanding our "natural" abilities through science and technology is not a new phenomenon - it has been a key driver of human societal evolution throughout history: wheeled transportation; compass navigation; wired communication. The field of "neuroenhancement" - using our understanding of how the brain works directly to try to improve how it functions - could well be the next such catalyst.

Our new study, dedicated to studying the cognitive effects of modafinil in the form of "smart pills," has shown that it can improve the productivity of healthy individuals in cognitive tasks, meaning it could be considered the first of these "neuroenhancing agents." But it is also clear that we need to radically improve the way we analyze the impact of this type of supplement on both the healthy brain and society as a whole.

Modafinil is a stimulant drug licensed by the Food and Drug Administration to help people with sleep disorders stay awake. This means that its safety for humans has been confirmed in a clinical context over a relatively long period of time and at multiple doses. It has been found that in these individuals, as well as in many others with psychoneurological disorders, modafinil consumption improves a wide range of cognitive functions, bringing them closer to "normal." In sleep-deprived individuals, including pilots and doctors, modafinil likely also has this effect.

But we wanted to find out how it affected healthy individuals who did not have a sleep deficit. In 24 studies that we reviewed from 1990 to 2015, it was found that modafinil consumption can also improve cognitive functions, particularly "higher" cognitive functions such as problem-solving and planning. This improvement was not observed every time, in every test, for every person; and for some cognitive functions, such as attention, learning, and memory, many studies could not show any differences at all.

We were even able to make some assumptions about how this might be happening: for example, the effects we observe can be explained by a "downward" effect on cognitive processing, caused by increased activity in the prefrontal cortex. It is important to note that in the studies we reviewed, people who took modafinil, reported very few side effects, all of which were observed in equal proportions in the placebo groups that took the same tests.

"Ceiling effect"

Collecting data for our study, we were surprised by the methodology used in the studies we examined. Firstly, the overall number of studies focused on healthy individuals was very low, as was the number of people they evaluated - on average about 30 participants per study. Secondly, many studies used cognitive tests that seemed inappropriate - tests typically used to assess cognitive deficits in people with psychoneurological or neurological disorders. The problem is that healthy individuals feel very well without taking the drug - known in science as the "ceiling effect" - making it harder, if not impossible, to detect improvements in substance performance.

Our study shows that in a controlled scientific environment, the use of modafinil to enhance cognitive functions is safe and effective, considering that most studies we reviewed provided the supplement only once, which reduces our ability to make long-term claims.

A New Approach to Cognitive Testing is Needed

There are strong reasons to continue this assessment using classical scientific approaches, with improved testing regimens, a wider pool of participants, longer intake periods, combined with other interventions such as cognitive training and non-invasive brain stimulation, and monitoring of the physiological state, changes, and age-related differences of the individual.

However, given the widespread use of modafinil by people without sleep disorders, a more useful and ethical approach may be to use a more realistic testing context to study its effects. Thus, perhaps the most important conclusion of our study is that the infrastructure we currently use to assess neuroenhancement is inadequate. We need to develop, improve, and standardize cognitive testing regimens for high-functioning individuals.

The Future of Neuroenhancement

Even the issues outlined above pale in comparison to the question of how best to integrate technologies and supplements that directly interact with the brain into everyday life. These agents will undoubtedly emerge soon: think of the next generation of smart pills and smartphones; Google Glass and Microsoft HoloLens.

These developments have enormous potential to change our inner essence: expanding the range and depth of human understanding and actions can allow us to delve deeper into the mysteries and beauty of the surrounding world, redefine relationships, and better understand it, our mental motivations, and ailments. Similarly, it can enable us to become more productive, innovative, and resilient.