This week we’ve watched a parade of Fox News hosts and conservative lawmakers argue with no evidence that President Joe Biden will be administered some sort of performance enhancing drugs prior to Thursday’s debate. “We anticipate that for this first debate he will be on something,” claimed Rep. Mariannette Miller-Meeks, an Iowa Republican. Controversial GOP Rep. Ronny Jackson of Texas, who served as the official White House doctor in the Trump administration, said Biden should be drug tested. “I’m going to be demanding on behalf of many millions of concerned Americans right now that he submit to a drug test before and after this debate, specifically looking for performance-enhancing drugs,” Jackson claimed on Fox News.
"We anticipate that for this first debate he will be on something" — GOP Rep. Mariannette Miller-Meeks spreads reckless, evidence-free conspiracy theories to no pushback on Fox pic.twitter.com/zx2f27jJOb
— Aaron Rupar (@atrupar) June 24, 2024
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These baseless accusations seem to be predicated on the belief that Biden is in some way cognitively impaired and thus would need some type of medication or drug to be able to function normally on the debate stage. From a medical standpoint, this makes no sense.
To begin with, there is no publicly available evidence to support the argument that Biden is clinically cognitively impaired, and his doctor gave him a clean bill of health last year. Thus the idea that drugs would improve his cognitive functioning or debate performance is simply not supported by scientific evidence. In my decades of experience studying the effects of potential cognitive enhancing agents for clinical use in cognitive and neurodegenerative disorders, I can find little to no evidence that such agents would improve public speaking or debating. If anything, attempting to use the limited selection of drugs we have developed could impair cognitive functioning in a healthy individual.
While certain drugs or medication may enhance athletic performance, and are therefore banned from competition, the brain works quite differently. Attention, memory and decision-making operate through a complex system of networks in the brain. These networks are dependent on small neurotransmitter molecules signaling between nerve cells within these cognitive networks.
Attempting to enhance cognition with these sorts of drugs in an individual who does not have deficits leads to no improvements at all.
Patients with certain cognitive disorders, such as Alzheimer’s disease, do appear to benefit from enhancing signaling in the brain via drugs that improve the availability of these small molecules. However, attempting to enhance cognition with these sorts of drugs in an individual who does not have deficits leads to no improvements at all. It might even worsen cognitive functioning. The healthy brain’s capacity for processing and memory storage is already at or near its optimal functioning, and overstimulating this existing system is not helpful.
Cognitive enhancers are typically designed to address specific deficits in neurotransmitter systems. Drugs such as stimulants (for example amphetamine and related agents) may help someone with attention-deficit/hyperactivity disorder (ADHD) function more normally. But again, in an individual without such a diagnosis, these drugs do not improve normal performance for most tasks, but instead can disrupt cognitive functioning and impair attention, memory and decision-making.
Another class of medications that we use to enhance cognitive functioning are drugs that affect the cholinergic nervous system. These drugs are used by individuals with Alzheimer’s disease and related disorders. Research shows that these agents only help individuals with evidence of damage to their brain due to disease. Administering them to normal individuals actually impairs performance. Furthermore, these agents require chronic administration to be effective and thus would not be helpful if administered immediately before a public event such as a debate. And it perhaps goes without saying, but drugs of abuse, such as cocaine or cannabis that also interact with neurotransmitters, have not been shown to reliably improve cognitive performance. (Over the weekend, Trump made a joke about cocaine “missing” from the White House and also speculated that Biden would get some sort of magic shot that would make him “all jacked up.”) To summarize, in healthy individuals, the brain’s neurotransmitter systems are usually well regulated, meaning that adding external substances or drugs will disrupt the natural balance rather than enhance it. This disruption can lead to side effects or impairment without meaningful cognitive gains. Many reported benefits from cognitive enhancers in healthy individuals can be attributed to the placebo effect. Believing that one is taking a substance to enhance cognitive performance can lead to a perceived improvement in cognition due to psychological factors rather than the pharmacological action of the drug. But cognitive enhancing drugs simply do not help normal people, primarily because the baseline cognitive function in healthy individuals is already optimized, and the drugs do not target any specific deficiencies. Moreover, the risks and side effects associated with these drugs can outweigh any marginal cognitive benefits. In conclusion, there is no evidence that use of so-called performance enhancing drugs would produce any benefit for an otherwise normal individual like Joe Biden. Allegations or claims to the contrary are not based on science and should be dismissed.
Dr. Paul Newhouse
Dr. Paul Newhouse is the director of the Center for Cognitive Medicine at Vanderbilt University Medical Center. He is also the Jim Turner Professor of Cognitive Disorders at Vanderbilt University School of Medicine and a professor of psychiatry, pharmacology and medicine. 
