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16 minutes reading time (3183 words)

An ethical dilemma

Most of us have, at some point in our lives, been urged to be the best that we can be—to work the hardest, study the longest, practice the most. But what if you hear that the person against whom you are competing for a job or important gig is taking enhancement drugs that allow them to need less sleep, stay more focused, and become mentally sharper than they would normally be without the ingested chemicals? Is that fair? Is the concept of fairness even relevant in our highly competitive world? Is the performance bar being raised to such a superhuman level that to be able to compete, one must turn to enhancement drugs?

In this article, Janet Finch explores the uses of beta blockers and neuroenhancement drugs. Find out what is being used and the arguments for and against their usage. Then read the response by a highly respected musician who anonymously writes of his journey before and after beta blockers became a performance enabling tool for him.

We would like to hear your thoughts on this controversial topic. Would you, or do you, take beta blockers or neuroenhance- ment drugs? Why or why not? Please send your signed or anonymous responses to This email address is being protected from spambots. You need JavaScript enabled to view it. or Pete Jutras, Editor-in-Chief, Clavier Companion, 250 River Road, Athens, GA 30602 

Is it right to drug our way to better playing?

by Janet Buswell Finch 

Some musicians experience severe performance anxiety when they perform publicly. This fear can be devastating to a performance, no matter how diligent the preparation. Some of these people rely on prescription drugs to calm their nerves and enhance alertness. 

Calming shaking hands 

For years, some musicians have used beta blockers—drugs sometimes used to treat high blood pressure and nervous tension— as a way to reduce performance anxiety. A 1986 study of 2,122 United States symphony orchestra musicians found that twenty-seven percent of those surveyed reported using beta blockers. Of those twenty-seven percent, nineteen percent took the drug for another medical condition, eleven percent used them for occasional concerts, and the remaining seventy percent obtained the drugs without a doctor's prescription.1 

A beta blocker stops the surge of adrenaline to the beta receptors in our bodies. When we become anxious, taking a beta blocker can prevent a rapid heartbeat. This non-addictive aid has helped many musicians attain consistency and reach high levels of performance in their playing. Best of all, the side effects are rare and usually minor. 

Musicians who take beta blockers say it enables them to play to the best of their natural ability. In The Partial Observer, Drew McManus reported the comment of an anonymous professional cellist: "Without Inderal I never would have reached my full potential. I've practiced just as long and just as hard as my colleagues. The only difference is they don't suffer from the gripping fear I do when I pick up my bow in front of other people."2 It is easy to see why so many musicians have found this drug to be so useful in fighting the symptoms of performance anxiety. 

Unfair advantage? 

So, is it right to drug our way to better playing? Many people think it is not. Some musicians who are opposed to the use of beta blockers view its use as an unfair advantage or a crutch when playing an audition. They believe that the drugs provide an artificial edge to audition candidates, allowing them to win a position over a competitor who might otherwise deserve to win the job. They argue that professional soloists who use beta blockers create an artificial product that is not representative of natural ability. Although opinions vary, most agree that the use of beta blockers should be carefully weighed. So far, there are no laws which prohibit highly motivated, driven, stressed musicians from using prescribed medications to function at their highest performance level. In fact, those who take the drug claim that the aid simply helps them be their personal best and makes the most of their talent. 

Using neuroenhancement drugs 

Neruoenhancements are another category of drugs used to enhance cognition and alter mood. Until recently, the main cognitive enhancer used was caffeine, but now other drugs exist to reduce the need for sleep, lengthening the hours available for practice, study, and work. Stimulant drugs such as Ritalin and Adderall, often used to treat ADHD, are being taken by high-functioning people with healthy brains in an effort to boost their level of achievement. Provigil, which promotes wakefulness, is used to improve academic performance. Aricept, used to treat Alzheimer's disease, is used by healthy individuals to improve memory. Even though there are potential side effects— including addiction—some musicians, academicians, and students are using these drugs in order to think more clearly, control emotions, improve concentration, and enhance their performances. 

College campuses have become a place for experimentation with neuroenhancement drugs. A 2001 study reported that seven percent of college students who responded to a self-administered mail survey indicated they had used prescription drugs such as Ritalin, Adderall, and Provigil for non-medical purposes.3 I recently interviewed a twenty-four-year-old college senior who shared his experience using cognitive enhancement drugs: "... it helps me suck in information ... During finals week, substances such as Adderall and Ritalin help students stay awake and keep your mind going without ever crashing." A student interviewed for a CNN article commented: "I'm more driven. I don't focus on anything else." He added that the drugs are not difficult to obtain: "It's easy—not sketchy or perceived in a bad way. Maybe a simple text or a phone call."4 It's a scene that is playing out on college campuses across the United States. Dr. Alan DeSantis tracked a study of drug use at a large, public, southeastern research university and found that thirty percent of healthy students in the study reported the illegal use of ADHD stimulants.5

Possible side-effects 

Although we know the psychological effects of neuroenchancement drugs, they have not been extensively tested in healthy individuals for efficacy. Physiological side-effects associated with Adderall include headaches, Tourette's-like symptoms, and heart attacks. Taking Aricept can result in nausea, diarrhea, and fainting. Modafinil, used for wakefulness by air traffic controllers and by soldiers in combat for improved focus and short-term memory, has possible side-effects including chest pain, nausea, and headaches.

Those in favor of using neuroenhancement drugs to achieve better academic work or musical performance argue that Ritalin and Adderall are given to children, so how could they possibly be unsafe when given to adults? Some people believe that medications that improve cognition should be available to anyone who wants them, provided they are used as prescribed. There are not any rules to prevent high-functioning, over-committed musicians from using prescribed drugs to function at their top performance level. Although it is commonplace to modify our bodies through plastic surgery, many doctors still do not support the idea of prescribing neuroenhancement drugs for brain function.

The medical world is just beginning to learn about the long-term effects of using these drugs. Should the problem of trembling hands be solved by using pharmaceuticals or by "mind over matter"? Many people are not waiting on a physician's opinion before taking the drug, for they can easily obtain these substances without a prescription—these drugs are easily available through the internet.

The negatives 

In a recent interview with Dr. Monte Finch, he had this to say concerning cognitive enhancement drugs:

Inderal, I'm not against, as it allows you to perform in your natural state without the associated performance jitters, but cognitive enhancement drugs give people an unfair advantage. I am against it because if you would have practiced all along would this be an issue or necessary? The psychological dependency and even physical dependency are important issues, as you may need something to bring you back down. Cognitive drugs such as Adderall and Ritalin are amphetamines with potential side effects such as mood swings. The psychological effect is that you feel like you can't study without it and still do well. While on these drugs, a person can become tachycardic, where the heart beats 100 beats per minute or more, and other people may become hypertensive. If they have an unknown cardiac condition, it could spark a cardiac event such as a heart attack or lethal rhythm abnormality.6

The positives 

In contrast, Hank Greely, a Stanford Law School professor, supports the use of cognitive enhancement drugs and tries to help society accept the benefits of controlled use. He said: ". . . we think there's more and more of this coming down the road, and we're just not prepared as a society yet for how we should deal with good, safe, cognitively enhancing drugs that will almost certainly be available in the next ten to twenty years."7 Greely explains that "[m]ore drugs are going to come along, and some of them will have the characteristic that they not only make sick people better but they also make healthy people still better. These drugs will be there; we need to think about how we should deal with them. One strong reaction is a knee-jerk 'We should ban them': that they're cheating, that they're unnatural, that they're somehow wrong."8 Greely believes that "enhancement" is something we do all the time. Education is a type of enhancement, and, as teachers and parents, our job is to enhance. But, when we start doing it through drugs, it becomes a dirty word. He concludes:

And yet, if this can help people do their job or their lives better, it's very hard for me to see why we should try to stop them. We've got these scary scenarios out there—people using them so that they can be 24-7 machines. There's also the possibility of the person who's struggling in school, who has always wanted to graduate or always wanted to be a doctor, always wanted to be something else, who maybe wasn't born with as much talent, or didn't grow up with a family that strongly supported education or had to work early in addition to schooling. And we should be very reluctant, I think, to condemn without good reason people's efforts to improve themselves, even if they involve drugs.9

Greely believes the FDA should modify its approach to drug approvals, and hopes to see some increased safety requirements and regulatory requirements for safety evidence. He states:

But I do think that some changes will be needed. I'm ultimately not pessimistic about whether we'll get those changes. I certainly don't believe we'll get the legal changes we need as soon as we need them in perfect form. But we're pretty good at muddling through, and if in fact—and this is of course the big if behind the whole subject—we produce drugs that have a significant cognitive-enhancing effect, we won't be able to ignore these issues. And then the laws will have to adapt to them one way or the other. It is an article of faith more than anything proven by experience that we're likely to adapt better the more we've talked about it and thought about it.10

Longer lives—greater needs? 

Like many things, neuroenhancement drugs can be used well or poorly. Should we welcome new methods of improving our brain function? We live in a world where our work and lifespans are increasing. Should cognitive enhancement and pharmacology be used to improve our quality of life and extended work productivity as we age? In "Better Brains, Better Selves: The Ethics of Neuro-Enhance-ment," Richard H. Dees supports the use of enhancement drugs. He writes:

. . . by becoming more productive, they may help to create a prosperous economy that can raise the standard of living for everyone. . . . Such enhancements would not create a utopia, but they could help to make the world a better place. Importantly, this argument comes with a built-in objection to its opponents: by banning the use of these enhancements, opponents are actively creating a world in which significant opportunities for improvement are missed.11

Dees concludes that: 

Most of the arguments typically made against the use of neuroenhancements, I have argued, fail: they simply do not show that the use of neuroenhancements has inherent moral problems or that they lead to unacceptable consequences. However, some neuroenhancements do, I contend, have the potential to separate people from reality so that they can no longer live authentically good lives. But even in the speculative world of neuroenhancements, such uses are rare. Few of the technologies being touted as the wave of the future would have such effects. If and when the drugs become safe, then many of these drugs may become morally permissible to use in many contexts. Only in a few contexts should their use be condemned.12

Ethics of prescription? 

Until medications designed for the sole purpose of neuroenhancement are developed for the general population, the drugs will remain as off-label uses of medication. Doctors who prescribe off-label neuroenhancement drugs for their patients have the responsibility to inform the patient that the drug has not been approved by the FDA, must explain the risks and side effects, and discuss the short- and long- term effects. In my opinion, doctors should resist the pressure of drug companies and patients in prescribing these drugs until they are very confident in the safety and effects of the drugs. Most of these drugs have not been tested on large samples of the population, and since they affect the brain, there is good reason to use them with caution.

But for me . . . What do neuroenhancement drugs mean for us as musicians? In my opinion, it is hard work, discipline, and dedication that define a serious musician. Would neuroenhancement drugs allow us to make changes too easily, thus undermining the very qualities that we have worked so hard to cultivate in ourselves? Classical musicians have the desire to achieve certain goals and a high level of performance, but do the ends justify the means? Do neuroenhancement drugs undermine our dignity? 

For me, living an authentic life of hard work, discipline, and dedication to the craft that I love is most important. Neuroenhancement drugs would alter the authenticity that I strive for in my life and musicianship. For each of us, it will be an individual decision whether to use neuroenhancement drugs.

Why I use beta blockers—a response

by "Mr. Still-Too-Aware-of-the-Stigma-Associated-with-Beta-Blockers"

My struggles with performance anxiety lasted nearly twenty years after completing my first degree in piano performance. During my college years I discovered that my hands would shake uncontrollably in performance. At first this frightened me and destroyed numerous performances. Then this physical symptom was no longer surprising; it was simply a struggle to be dealt with. I constantly explored ways to be bet- ter prepared, thinking this would ease my anxiety. As I began my teaching career I attended workshops on anxiety and began a meditation routine which I still use when I have a performance. All the while, the same problem continued. I could practice and prepare as much as I wanted; but I would still be faced with physical reactions that completely altered my technique when I performed.

At a coaching session one day, my mentor said, "Why don't you use Inderal? I do!" After processing this surprising information I consulted my physician. I expected her to question me and question use of this drug in this way. To my surprise her response was, "Oh, you should certainly try it. Physicians often use it when we have an important presentation to give." For years, I had heard beta blockers maligned at music conferences and in informal conversations. It seemed that the use of beta blockers was the deep, dark "secret" of some performing musicians. To find that other professions (especially physicians!) had no negative judgment about their use was a freeing revelation!

A new life of performing began for me when I tried Inderal. For the first time I was able to play using the same equipment with which I had practiced. My duet partner, who for years had performed beside my shaking hands, could not believe it. For once, my performance was about giving what I had to offer at the piano and not about overcoming my extreme physical reaction to anxiety. So, after many years of studying performance I was finally able to enjoy it. I still get nervous. My brain still needs my meditative practices to stay focused. The use of a beta blocker simply controls my biological wiring which is set for extreme reaction to stress.

As a teacher of young piano students, however, I do not discuss beta blockers or my use of them. These are young students who still need to explore all the ways they must work and prepare for a performance. As they become adolescents and performance anxiety becomes more acute, we discuss it and try different relaxation activities. I share with them my struggles over the years and the many things that have helped me. I do not, however, share this thing that finally gave me the help I needed. If I were working with college or post- college performers I would feel different. As it is, my pre-college students do well with their handling of performance anxiety. I have yet to see any of them with the extreme physical response to anxiety with which I struggled.

As a performer, beta blockers have made it possible for me to satisfyingly explore my own musical performance. I do not consider them "performance enhancing" but rather "performance enabling." As a teacher, I use my struggles with performance anxiety and the many techniques I have used to help me work with young people and prepare them for their performances.

1Beta blockers and performance anxiety in musicians. Retrieved from 

2McManus, D. (2004, September 27). Performance Enhancing Drugs for Musicians? The Partial Observer. Retrieved from 

3McCabe, S. E., Knight, J. R., Teter, C. J., & Wechsler, H. (2005). Non-medical use of prescription stimulants among US college students: prevalence and correlates from a national survey. Addiction, 99, 96-106. 

4Cooper, A. (2011, September 1). College students take ADHD drugs for better grades. CNN Health. Retrieved from adderall-concentration/index.html 

5DeSantis, A. D. Webb, E. M., Noar S. M. (2008). Illicit use of prescription ADHD medications on a college campus: a multimethodological approach. Journal of American College Health 57(3), 315-23. 

6Interview with Dr. Monte G. Finch (2012). Dr. Finch is the husband of Janet Buswell Finch. 

7Brain Boosters: How should we deal with cognitive-enhancing drugs? (2009, March/April). Stanford Magazine. Retrieved from rapr/farm/news/greely.html 




11Dees, R. (2008). Better Brains, Better Selves? The Ethics of Neuroenhancements. Kennedy Institute of Ethics Journal, 17(4), 371-395. 


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