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Logo of bmjThis ArticleThe BMJ
 
BMJ. 2007 September 1; 335(7617): 428.
PMCID: PMC1962867

Me and my friends

Michael Reschen, senior house officer, John Radcliffe Hospital, Oxford

It was my guitar teacher who introduced me to the concept of peri-performance β blockade as a way of controlling the befuddling anxieties that could imperil my infrequent recitals.

Sitting in his front room one Saturday morning, I heard the rustle of pills in a bottle as he lifted his guitar from its velvet lined case. Keen to show off my own medical knowledge, I inquired gently as to the nature of his ailment, and he replied that the propranolol was used prophylactically for stage fright. At first I was disappointed to learn that my guitar hero was just as susceptible as his student, but later I realised the propranolol was not a treatment for genuine stage fright but rather another tool for squeezing the best out of every dying note.

In the following weeks I persuaded my GP to prescribe me some propranolol, and I began to test its physiological effects. As a medical student, I was faced with endless interviews and vivas, all of them marred by pounding in my temples, sweaty palms, and shakiness. Propranolol was very effective in dealing with these symptoms.

But one question remained; would propranolol impair my cognitive performance? I searched the literature and discovered that several rather circumspect trials had shown that propranolol improved cognitive performance during stressful events. However, taking it in the long term could cause memory impairment, albeit in rats.

Propranolol was one of my most treasured discoveries at medical school, and I shared my knowledge with only a few of my closest friends. Over the years, I have used it sparingly but to great effect, having fulfilled all of my ambitions thus far (except with MTAS, the medical training and application service). Nevertheless I cannot help but contemplate whether using propranolol constitutes an artificial advantage, or whether any benefit is simply imagined anyway. Still, there must be a reason why it is banned from professional snooker games.

Fortunately my love affair with propranolol ended abruptly when I nearly collapsed during an interview. These days my mouse pointer often hovers precariously close to the “Add to basket” button on websites proffering modafanil as the latest in cognitive enhancers.


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