Many of the most popular “smart drugs” (Piracetam, Sulbutiamine, Ginkgo Biloba, etc.) have been around for decades or even millenia but are still known only in medical circles or among esoteric practicioners of herbal medicine. Why is this? If these compounds have proven cognitive benefits, why are they not ubiquitous? How come every grade-school child gets fluoride for the development of their teeth (despite fluoride’s being a known neurotoxin) but not, say, Piracetam for the development of their brains? Why does the nightly news slant stories to appeal more to a fear-of-change than the promise of a richer cognitive future?

A big part is that we are finally starting to apply complex systems science to psycho-neuro-pharmacology and a nootropic approach. The neural system is awesomely complex and old-fashioned reductionist science has a really hard time with complexity. Big companies spends hundreds of millions of dollars trying to separate the effects of just a single molecule from placebo – and nootropics invariably show up as “stacks” of many different ingredients (ours, Qualia , currently has 42 separate synergistic nootropics ingredients from alpha GPC to bacopa monnieri and L-theanine). That kind of complex, multi pathway input requires a different methodology to understand well that goes beyond simply what’s put in capsules.
Since dietary supplements do not require double-blind, placebo-controlled, pharmaceutical-style human studies before going to market, there is little incentive for companies to really prove that something does what they say it does. This means that, in practice, nootropics may not live up to all the grandiose, exuberant promises advertised on the bottle in which they come. The flip side, though? There’s no need to procure a prescription in order to try them out. Good news for aspiring biohackers—and for people who have no aspirations to become biohackers, but still want to be Bradley Cooper in Limitless (me).
Still, the scientific backing and ingredient sourcing of nootropics on the market varies widely, and even those based in some research won't necessarily immediately, always or ever translate to better grades or an ability to finally crank out that novel. Nor are supplements of any kind risk-free, says Jocelyn Kerl, a pharmacist in Madison, Wisconsin.
With subtle effects, we need a lot of data, so we want at least half a year (6 blocks) or better yet, a year (12 blocks); this requires 180 actives and 180 placebos. This is easily covered by $11 for Doctor’s Best Best Lithium Orotate (5mg), 200-Count (more precisely, Lithium 5mg (from 125mg of lithium orotate)) and $14 for 1000x1g empty capsules (purchased February 2012). For convenience I settled on 168 lithium & 168 placebos (7 pill-machine batches, 14 batches total); I can use them in 24 paired blocks of 7-days/1-week each (48 total blocks/48 weeks). The lithium expiration date is October 2014, so that is not a problem
Overall, the studies listed in Table 1 vary in ways that make it difficult to draw precise quantitative conclusions from them, including their definitions of nonmedical use, methods of sampling, and demographic characteristics of the samples. For example, some studies defined nonmedical use in a way that excluded anyone for whom a drug was prescribed, regardless of how and why they used it (Carroll et al., 2006; DeSantis et al., 2008, 2009; Kaloyanides et al., 2007; Low & Gendaszek, 2002; McCabe & Boyd, 2005; McCabe et al., 2004; Rabiner et al., 2009; Shillington et al., 2006; Teter et al., 2003, 2006; Weyandt et al., 2009), whereas others focused on the intent of the user and counted any use for nonmedical purposes as nonmedical use, even if the user had a prescription (Arria et al., 2008; Babcock & Byrne, 2000; Boyd et al., 2006; Hall et al., 2005; Herman-Stahl et al., 2007; Poulin, 2001, 2007; White et al., 2006), and one did not specify its definition (Barrett, Darredeau, Bordy, & Pihl, 2005). Some studies sampled multiple institutions (DuPont et al., 2008; McCabe & Boyd, 2005; Poulin, 2001, 2007), some sampled only one (Babcock & Byrne, 2000; Barrett et al., 2005; Boyd et al., 2006; Carroll et al., 2006; Hall et al., 2005; Kaloyanides et al., 2007; McCabe & Boyd, 2005; McCabe et al., 2004; Shillington et al., 2006; Teter et al., 2003, 2006; White et al., 2006), and some drew their subjects primarily from classes in a single department at a single institution (DeSantis et al., 2008, 2009; Low & Gendaszek, 2002). With few exceptions, the samples were all drawn from restricted geographical areas. Some had relatively high rates of response (e.g., 93.8%; Low & Gendaszek 2002) and some had low rates (e.g., 10%; Judson & Langdon, 2009), the latter raising questions about sample representativeness for even the specific population of students from a given region or institution.
(On a side note, I think I understand now why modafinil doesn’t lead to a Beggars in Spain scenario; BiS includes massive IQ and motivation boosts as part of the Sleepless modification. Just adding 8 hours a day doesn’t do the world-changing trick, no more than some researchers living to 90 and others to 60 has lead to the former taking over. If everyone were suddenly granted the ability to never need sleep, many of them would have no idea what to do with the extra 8 or 9 hours and might well be destroyed by the gift; it takes a lot of motivation to make good use of the time, and if one cannot, then it is a curse akin to the stories of immortals who yearn for death - they yearn because life is not a blessing to them, though that is a fact more about them than life.)

Compared with those reporting no use, subjects drinking >4 cups/day of decaffeinated coffee were at increased risk of RA [rheumatoid arthritis] (RR 2.58, 95% CI 1.63-4.06). In contrast, women consuming >3 cups/day of tea displayed a decreased risk of RA (RR 0.39, 95% CI 0.16-0.97) compared with women who never drank tea. Caffeinated coffee and daily caffeine intake were not associated with the development of RA.
If you’re considering taking pharmaceutical nootropics, then it’s important that you learn as much as you can about how they work and that you seek professional advice before taking them. Be sure to read the side effects and contraindications of the nootropic that you are considering taking, and do not use it if you have any pre-existing medical conditions or allergies. If you’re taking other medications, then discuss your plans with a doctor or pharmacist to make sure that your nootropic is safe for you to use.
Racetams, such as piracetam, oxiracetam, and aniracetam, which are often marketed as cognitive enhancers and sold over-the-counter. Racetams are often referred to as nootropics, but this property is not well established.[31] The racetams have poorly understood mechanisms, although piracetam and aniracetam are known to act as positive allosteric modulators of AMPA receptors and appear to modulate cholinergic systems.[32]