I had a long back and forth with trubo at my site, that I will just copy here -- I think I may have copied it here before: and it is slightly edited to remove...unnecessary information. Peace.
To convince a brain surgeon a nootropic could enhance "learning and memory" in healthy subjects, one would bring the results from at least 5, but best about 20 randomized, double-blind, parallel-group, and unconfounded comparisons of healthy subjects in which one group is given a "nootropic," another a placebo, for a treatment duration of greater than one month. If the data from several such trials demonstrated (relatively) consistent - and significant results for subjects in the treated group, I am sure a proper Cochrane review would convince more than 90% of all MDs the treatment worked.
Unfortunately, there are very few such comparisons available in current medical literature as cognitive enhancement for healthy subjects is not a concern for the USFDA; thus why would a pharmaceutical company invest billions into such ventures? The USA is by far the biggest market for drugs, so only a radical shift in FDA's ideology on the matter could change things. I guess there is some fringe appeal for nootropics, but believe it or not there are serious "ethical" issues involved.
When Dr Jerome Yesavage (Stanford University) performed a trial on healthy (mean 52 years old, non demented) male airline pilots using the acetylcholinesterase inhibitor Aricept, the drugged group were better able to retain complex training than the placebo group
(1) (2).
The ethical question he raised is this:
"Will it worsen the gap between the haves and the have-nots when the rich are cognitively enhanced not only through better education, but also through drugs and other technologies? How should the use of these therapies be regulated in settings beyond aviation or normal ageing, such as chess matches or test-taking among college students?"
Just because I have access to cognitive enhancers, what about the rest of the kids in the class/school? Implications?
Some drugs that folks expect deliver benefits in cognition are really just dopamine enhancing agents; and for those of us already endowed wiith plenty of dopamine this might in fact get more distracted and underperform in some cognitive tasks. It is most important to know ones own neurochemistry before messing with any mind altering/affecting chemicals.
Increasing acetylcholine appears to be the most effective strategy to increase learning and memory. I guess a safe way you could to do would be to try Alpha GPC. I am not sure 1000-1200mg elemental Alpha GPC will increase acetylcholine will increase as much as evidenced in studies using only elderly subects
(3). There is some compelling evidence that contends alpha GPC increases acetylcholine (and GH) levels in normal, healthy subjects...
To affect memory positively, one almost sure fire was is to take drugs that positively modulate (or up-regulate) the cholinergic system.
We already know how important the cholinergic system is in the formation of memories. How do we know this? Because we notice that whenever we degrade the cholinergic system with “anticholinergics,” the memory facility fails; then when we "regenerate" the cholinergic system with pharmaceutical drugs, the memory in the animals we study improves.
So we know that there are several drugs which up-regulate or increase cholinergic activity in the human brain. And it has already been proven that when we increase the “memory neurotransmitter” (acetylcholine) in healthy subjects, they perform better on memory tests. Acetylcholine is the basis neurotransmitter for the cholinergic system. Increasing cholinergic activity in the human brain is similar to saying: “increasing metabolism of the cholinergic system (or the acetylcholine system).”
Another study conducted by Mumenthaler and Yesavage (Yesavage is the second author on this) also confirmed that nicotine gum affects the memory system positively because nicotine is a nicotinic receptor agonist (big suprise!)
(4).
I hope this answers your question...now tell me what you want to take nootropics for...specifically...
i definitely didn't get the surgeon aspect across as i had meant to. i don't mean 'could i convince a surgeon'.
i think it is a fair statement to say that most people who have spent 20+ years studying the brain ALREADY know what these supplements are. do they take them? if so, then i'd hop right on, as i know they know their stuff. if they think it's a dumb idea, who am i to argue? they know what they're tlaking about.
don't get me wrong, the research and facts you tell me make ME think it's a good idea. however, many bodybuilding companies made me feel EXACTLY THE SAME WAY when i first began. i now know that i had just been experiencing teh placebo effect. this is what i am driving home. do nootropics, used for cognitive enhancement in healthy individuals, look promising? yes. does that mean they necessarily work? no. Nobody fully understands the brain, but there are some people who know it better than anyone on these boards.
those people are people who work with the brain and study it as their career. they know all the ins and outs. they, assuming they're of 'normal' cognitive ability, would be expected to use these products if they deemed them likely to cause a boost in intelligence. if they think they're worthless, i don't know how you'd make an argument against them, at least a respectable one, without first bringing yourself to their level of knowledge.
i'm sorry i haven't specified as to what reasons i want nootropics. the reason is that i don't have a specific problem. i'd like quicker visual processing time. better linguistic skill. better memory, both short and long term. i'd like better 'executive function' cognitive abilities. i don't really have any shortcomings, i am looking for a boost in brainpower. i don't really care which aspect. sorry i'm being so vague, but i guess this would be like an wrestler saying 'look, i don't care if it makes me stronger, builds my endurance, reduces perceived exertion, increases aggression, reaction time, whatever. it doesn't matter, because any edge helps'. that's what i'm getting at. i don't know of any 'deficiencies' i have, i would like my brain to function better if it is possible. i like taking adderall (amph/dextroamph) because it makes my reaction time quicker, perceived effort lower, etc etc etc. But it makes you feel like crap, and is only a very, very short term solution, albeit hugely useful for what it is.
i'm not comign into this convo saying 'i have noticed a little bit of issues with memory recovery, particularly names. what do you prescribe?'. I am a (very) ambitious kid about to graduate college and make my mark on the world. you will likely have heard my name by the next 10 years if you live on the west coast. i take various supplements for sports and strength, but i know vast amounts about the muscular systems, and about nutrition in general, so i can make wise decisions. i also can attest that roughly 3 out of 4 products sold to bodybuilders are either completely useless, or so close to it that it doesn't really matter. however, i can confidently shop those thigns because i know.
i do not know the brain, which is why i am interested in proven methods, not things that 'should work because when looked at in this particular study it showed an effect'. creatine is proven to enhance skeletal muscle strength. period. are there nootropics like that, or do they all fall under the umbrella of 'maybe'? the reason this is so pivotal to me is because in the bodybuilding arena, anythign falling under the 'maybe' umbrella is almost always useless. and highly subject to the users experiencing placebo effect.
i know the argument that 'acetylcholine is involved in memory, and increasing it should increase memory' seems solid enough, but after years of comparably convincing claims, i am wary to the point where i need more conclusive evidence.
i hopped right on to the noot bandwagon without any real reasoning, after reading a few abstracts, and am now afraid that i made the same damn mistake as i did when i began bodybuilding.
do you know anyone who does real brain work? is in school for it? do any of them take it? do they laugh at the idea? if something is solidly proven to help, i am interested in ordering (through you), but to spend 80$ a month on stuff that isn't even fully guaranteed seems foolish, unless i am just too ignorant to how the brain functions to see where the heavily convincing evidence is that warrants those price tags. (and i'm not talking life extension stuff here, i'm talking about the 80$ stack you prescribed for me based on my requests for general cognitive enhancement).
sorry again for harrassing you with soooo many quesitons, but my plan is to just get to the point where i can determine if this is a solid venture, buy a ton of it in bulk, cap it, and forget about it for a year, and then when it all runs out maybe i'll customize more. right now i want to get soemthing i know for sure works, and cap them up, and get these discussions out of my life (not that i am not enjoying and thoroughly appreciating the info you're giving me, it's just that i don't want to be 'into' nootropics. if there's nootropics that will definitely give me a cognitive edge, i'm all game 
The reason why I answered your question (regarding the brain surgeon) the way I did is because I want you to understand that
the scientific method can be employed to convince anyone that a treatment is effective.
1. Observe some aspect of the universe.
2. Invent a tentative description, called a hypothesis, that is consistent with what you have observed.
3. Use the hypothesis to make predictions.
4. Test those predictions by experiments or further observations and modify the hypothesis in the light of your results.
5. Repeat steps 3 and 4 until there are no discrepancies between theory and experiment and/or observation.
Proof
should be the same whether a particular Doctor specializes in brain surgery or not. Most competent Doctors of Medicine won't render a treatment effective without results from a wealth of controlled trials.
How can you be sure your results were just placebo effect? The problem with experimenting on oneself is one cannot easily discern if results are placebo effect
or not. You should be determined enough to choose for yourself what may or may not be effective. Do your own research...
Nootropics (such as the racetam class) definitely protect the brain; they also seem to be effective in improving the memory of folks affected with some sort of age-associated mental decline; they also have virtually zero toxicity (so they are very safe). So it really depends on your assessment of how excellent your memory is in its current state whether or not you might want to start inquiring into such drugs (and your budget).
Let us suppose that you are taking a full load of courses at your local university and you feel yourself unable to keep up with the rest of the students in your physics course, no matter how hard you study. Then you start taking a new drug, and you go from a D to an A on your next exam and your grades in your other courses also improve. Then you might be able to safely attribute that success to that drug; hopefully there are no confounding variables to skew the results -- so in this example hold all other variables constant.
I can tell you from my personal experience -- but what is that worth?
The problem with nootropics is that they really take a few months to really kick in while the prescription drugs are effective (almost) immediately. The nootropics also require one to be most diligent about taking pills on a very regular basis.
Once again, I repeat: a brain surgeon requires proof that a treatment is effective; a competent brain surgeon will not offer his opinion and suggest it is fact...s/he needs results of controlled trials...
Executive function might be improved by enhancing the functionality of Acetylcholine, Norpinephrine, or Dopamine system(s). It really depends on YOUR neurochemistry, nobody elses! For me, a combination of three prescription drugs were most helpful in moving me from "average" to B+/A-. The rest of the nootropics kicked me, I would say; from B+/A- to setting curves in my quantitative courses. The combination that works best for me might be very different than what works for you.
I don't blame you; I would argue you would not really know you had a deficiency unless you are challenging your brain to process a lot of data and be able to understand it, interpret it, and reformulate it in your own words.
To Nothing is guaranteed to work in "the real world."
Cognitive enhancement will, without doubt, be more profound for folks challenging the brain. I found cognitive enhancers to be very effective when I was taking challenging courses at school...it was only then that I could identify my deficiencies and see measurable improvement with a particular treatment...all this staring at computers does not call for extensive nootropic stacks.
Edited by nootropikamil, 19 May 2006 - 05:32 AM.
