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If you could take a pill that would give you a competitive edge at work—a little extra focus and memory-grip, a dose of calm before public speaking—would you? Asked whether they'd used certain drugs to enhance cognition, one out of five readers responding to a survey by the journal Nature (they tend to be researchers and scientists) acknowledged they had. The most popular was Ritalin, a stimulant prescribed for ADHD (62 percent had taken it), followed by the narcolepsy drug Provigil (44 percent), then beta-blockers that treat hypertension but also have an antianxiety effect (15 percent).

"I hope it's not going to turn into a pharmaceutical arms race, where everybody has to be medicated to compete," says David Gutman, MD, director of psychopharmacology at Columbia University Medical Center Eastside. All these drugs have side effects—most seriously Ritalin, which can make you anxious and jittery, cause insomnia, raise your blood pressure, and be addictive. "If you have existing heart problems, it could also give you an arrhythmia, and that can be lethal," Gutman says. Provigil carries less risk (common side effects include headaches and nausea) but still requires careful monitoring, as do beta-blockers, which can cause you to pass out if you have low blood pressure or a heart condition. "As long as you've been screened, these medications are safe for most people," Gutman says, "but they're not like having a cup of coffee."