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Pill that boosts productivity gaining favor, raising concerns among medical ethicists

By Steve Johnson, Medicine & Health / Health
In a place like Silicon Valley, where career prospects often hinge on a person's intelligence and ability to work hellishly long hours, "brain doping" probably was inevitable.
The expression refers to a growing national trend that troubles some medical ethicists, in which pills designed to treat sleep and mood disorders are being popped by healthy people to help keep them mentally sharp and boost their productivity.

In April, the prestigious journal Nature reported that one-fourth of the 1,400 people responding to an informal survey admitted they had taken drugs for nonmedical reasons to improve their concentration or memory. The medicines included Ritalin, a stimulant for treating attention-deficit hyperactivity disorder; Provigil, for sleep disorders; and so-called beta blockers for cardiac arrhythmia.

The practice appears to have gotten at least a foothold in Silicon Valley, especially with Provigil, a prescription medicine approved for narcolepsy, obstructive sleep apnea and shift-work sleep disorder. Although local police and drug counselors say they've had no experience with it, Provigil seems to be gaining favor among workers here, according to TechCrunch founder and influential Internet commentator Michael Arrington,

In a blog posting titled "How many Silicon Valley startup executives are hopped up on Provigil?" Arrington declared in July that "I've spoken with one executive who says he uses it regularly to work 20-hour days, and the buzz lately is that it's the 'entrepreneur's drug of choice' around Silicon Valley."

Arrington couldn't be reached for comment. But his blog triggered a spirited and contentious outpouring from its worldwide readership. Of the 150 or so responses it generated, about 20 reported having used Provigil, also known generically as modafinil.

Some denounced the idea of using prescription medicines for nonmedical purposes and blasted Arrington for writing about the topic, saying it would encourage people to try the drug. But others described the medicine's effects glowingly.

"I use Provigil when we have a large amount of work that needs to be done," Nick wrote. "Sure beats caffeine."

"You can stay up pretty much as long as you want, then hit the sack and sleep like normal," added Murphy.

Hank Greely, a law professor and director of Stanford University's Center for Biomedical Ethics, said he also knows some academics and doctors who have tried Provigil and who apparently didn't have sleep disorders. He added that some of them may have had prescriptions for it, however, which muddies the issue of how appropriate it was for them to use the drug.

Doctors can legally prescribe a medicine for off-label uses, purposes not specifically approved by the U.S. Food and Drug Administration. But Casey McEnry, spokeswoman for the U.S. Drug Enforcement Administration's San Francisco office, said it is illegal to sell Provigil or give it away, as well as to buy or use it, without a prescription.

Using the drug without a prescription also can be hazardous.

Cephalon, Provigil's Pennsylvania manufacturer, says in its literature that the drug "is structurally distinct from amphetamines" and "promotes wakefulness without causing generalized stimulation in the brain." But it also notes that Provigil, approved for sale in the United States in 1998, "may cause you to have a serious rash or a serious allergic reaction that may result in hospitalization or be life-threatening."

In addition, Cephalon warns, Provigil can lead to dependence and cause such side effects as headaches, nausea, nervousness, diarrhea, back pain, anxiety, dizziness and upset stomach - not to mention trouble sleeping.

Oakland native Kelli White lost the two track gold medals she won at the 2003 world championships after testing positive for using the drug. And last year, a container ship piloted by Capt. John Cota, who had a sleep disorder he was treating with a Provigil prescription, slammed into the San Francisco-Oakland Bay Bridge, causing a major oil spill. Investigators are trying to determine whether the drug contributed to the accident.

McEnry said the DEA officials she checked with in several Northern California offices were unaware of anyone being arrested for illegally selling or using Provigil. Sgt. Dave Moody of the San Jose Police Department's narcotics unit similarly hadn't heard of arrests in that city related to Provigil or attention-deficit drugs such as Ritalin.

The clinical directors contacted at three Silicon Valley drug-treatment centers also said they could think of no one they had treated specifically for brain-doping Provigil.

One Bay Area professional who asked not to be identified said he tried Provigil in hopes it would help him stay awake on a red-eye airplane flight.

"I was very alert," he said, adding that he obtained the drug from someone with a prescription for it. "I worked productively on the flight."

Nonetheless, the idea of taking such drugs to improve performance could have mixed consequences, some ethicists say.

"If, in fact, drugs are able to make people smarter and more effective in their work, that could produce net benefits to society," said Stanford's Greely. But he expressed concern that the poor might not have equal access to the drugs and that bosses might coerce employees to take them to increase the work they do.

Those fears are shared by Anjan Chatterjee, a University of Pennsylvania neurology professor who has written about the subject and believes brain doping will increase.

"I think there is this kind of worship of progress or productivity" in society today, he said. "I am worried about it."

___

Provigil, known generically as modafinil

What is it: A prescription medicine to improve wakefulness in adults who experience excessive sleepiness due to narcolepsy, obstructive sleep apnea or shift-work sleep disorder.

Who else is taking it: It reportedly is gaining popularity among healthy people as a so-called brain-doping agent to increase concentration and productivity.

Who makes it: Cephalon of Frazer, Pa.

Most common side effects: Headache, nausea, nervousness, stuffy nose, diarrhea, back pain, anxiety, trouble sleeping, dizziness and upset stomach.

Source: Cephalon, San Jose Mercury News reporting

___

© 2008, San Jose Mercury News (San Jose, Calif.).
Visit MercuryNews.com, the World Wide Web site of the Mercury News, at http://www.mercurynews.com.
Distributed by McClatchy-Tribune Information Services.

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Posted by drel 09/05/08 16:07
Not rated yet.
Using (abusing) a crutch like these pills may appear harmless until your body says ENOUGH! and your brain goes into "sleep-mode"...

... mean while your 7-series beamer or worse yet your crew cab pick-up crossed the centerline going 60mph and takes out your neighbors wife and kids.

Unfortunately instead of being summarily executed, you most likely will just get 6-months suspended and a few weekends community service (if that).

Get a life looser!
Posted by Catch 09/05/08 23:37
Rank: 3/5 after 4 votes
Learn to spell loser.
Posted by aussiecarter 09/05/08 23:53
Rank: 5/5 after 4 votes
People consume caffine during work, and caffine after work. Caffine is a drug that is accepted by society. What would it take for a new drug to be accepted into society? It would be very difficult for this to occur when people write the drug off as dangerous without much expereince with it.
Posted by Jayman 09/06/08 02:45
Rank: 4.5/5 after 2 votes
I am a software developer and I absolutely
live on Modapro. It does not cause dependency
and I am able to do without it on the weekends.
But, on weekdays, it is a heaven-sent. I am
able to work longer and more productively.
Being in the wrong side of the thirties, I
am able to keep up with the 20-somethings
rather effortlessly. After 2 years on it,
I have experience no side-effects whatsoever.

Posted by Gozar 09/06/08 10:45
Not rated yet.
The makers of provigil really are stepping up their advertising campaign.
Posted by NanoStuff 09/07/08 14:17
Rank: 5/5 after 1 vote
Summary: Ethicists believe it's unethical for people to make their own decisions. Meanwhile, awesome brain boosting pills are awesome.
Posted by Velanarris 09/08/08 07:37
Not rated yet.
Summary: Ethicists believe it's unethical for people to make their own decisions. Meanwhile, awesome brain boosting pills are awesome.


Yeah that's about it. Oh, and drel has forgone the pills leaving him incapable of spelling the word loser.
Posted by artful 10/14/08 15:37
Not rated yet.
Unlike Jayman who is only on the "wrong side of the thirties", i'm on the wrong side of the forties and see something like having the ability to schedule one really productive day of work every now and then to be really cool. I would also like to try it while painting to see if it allows me to paint for much longer periods in the studio. Question though: Just how does one approach a physician with a request for something like this? I would think that it would be hard to fake narcolepsy or the other known use cases. Someone is writing scripts because this stuff sure seems popular.

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