May 15, 2008
Provigil, Viagra for the Mind
Johann Hari documents his experience with Provigil, a drug originally intended to help narcoleptics, that has been found to enhance mental acuity and IQ.
It was, they said, Viagra for the brain. It was originally designed for narcoleptics in the seventies, but clinical trials had stumbled across something odd: if you give it to non-narcoleptics, they just become smarter. Their memory and concentration improves considerably, and so does their IQ.
It’s not an amphetamine or stimulant, the article explained: it doesn’t make you high, or wired. It seems to work by restricting the parts of your brain that make you sluggish or sleepy. No significant negative effects have been discovered. Now students are using it in the run-up to exams as a “smart drug” – a steroid for the mind.
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11 Responses to “Provigil, Viagra for the Mind”
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I like this part, where he has asked a doctor about the safety of the drug he’s about to order from an online pharmacy:
“There is one known side-effect.” Oh, damn I thought. A downside. “It often causes people to lose weight.” Are you mad? You become cleverer and thinner? I whipped out my Visa card immediately.
This is tangential to your point, Daryl (truly, I know that it is — I’m not that far gone . . . yet), but people don’t always get ‘full disclosure’ from their prescribing physicians . . . because the prescribing physicians may not know how and why drugs have the effects they do. Take, for instance, the example of Zyprexa. Sure, eight or ten years ago most doctors warned people that taking the stuff would (very) more than likely precipitate weight gain, but who among the often acutely distressed patients (or the perfectly well-meaning and not incompetent doctors) thought to ask, “Hmmm . . . why would this drug be associated with this particular metabolic reaction?” Let’s see. What are some of the possibilities? Eh, something involving the body’s processing of glucose, perhaps? Well, maybe — in which case perhaps we’re looking at risks greater than the loss of self-esteem attending a significant weight change.
Again, Daryl, I do understand your point about online pharmacies. Absolutely. Just hoping to expand the discussion — if not here and now, then maybe later on clusterflock. Though I’m not sure I was capable of sustaining a civil conversation re: MDs and shrinks and psychotropic drugs, say, ten years ago, I believe I have it in me now, and I believe there are questions worth asking.
Oh, Sheila. As you know, the provision of medical information is my business. Every medical librarian, pharmacist and pharmacologist I’ve ever known is distressed by the fact that most physicians glean all of their drug information from the PDR–the content of which is, of course, provided exclusively by the drug manufacturers themselves. There is extensive research available on most drugs, but physicians rarely seek it out–they’re going by the short spiel the drug rep gives them, the little blurb in the PDR, and maybe the drug insert itself.
Bottom line, folks–if you really want to know more about the drugs you’re being prescribed, consult a pharmacist or visit an academic medical library. This kind of information is not available for free on the Internet–it’s proprietary and expensive to license, aimed primarily at pharmacologists and pharmacists.
I’m with you on that, Sheila. I don’t take any medications–although I’m sure Cindy would say sometimes that I should (paxil, maybe). And I even remember when Thalidomide was a great new drug for pregnant women! (Or I remember seeing the result, at any rate.) Anybody seen I Am Legend?
sorry, folks. I’ve taken provigil for an extended period of time and I’m neither brilliant, nor thin. One side effect you should note however is that provigil and hormonal contraceptives are a bad mix. i.e., if you’re on the pill and you take provigil, you very well may get preggers. And for the record, I noticed this side effect and pointed it out to my doc who was at that point unawares. Buyer beware!
Cindy, I’m glad you responded to my comment. I was hoping you’d speak your piece. (You, too, Daryl.)
What maddens me beyond expression, Cindy, is my hard-earned knowledge that you are absolutely right to encourage people to . . . well, to question and double-check the advice and information their doctors dole out (and I’m not just targeting MDs here — though I am a proponent of some of that weird alternative shit). The trust we place in those we ask to heal us is such an important part of the healing. It’s awful to recognize that sick people may be well-advised to approach a visit to the doctor in the same spirit they carry to the used-car lot.
Of course, burdened as I am with all of these odds and sods of historical revelation and all, I know that it’s not dramatically worse today than it was yesterday.
“Buyer beware!”, indeed, as tuscadero points out in the comment above.
When I first entered this profession 15 years ago, physicians were still in the habit of keeping information from their patients. I had to fight for Internet access in the Library, fight to make our resources available to patients and their families, even fight with information providers to put out medical information that a non-physician could understand. My efforts mirrored a nationwide trend, though, and these days physicians expect their patients to ask questions and seek out medical information. And I will say, in defense of doctors, they are so busy trying to see a million patients a day because of our fucked up health insurance and health delivery system that they are probably doing well even to get to the PDR. We have a huge, systemic problem on our hands, and questionable drug choices on the part of doctors is just a very small part of it.
Indeed, Cindy — we do have a “huge, systemic problem on our hands”, and I do try to avoid the Blame Game.
However . . . as a superb doctor and hospital administrator I know puts it, “We have a choice as to how we run our practice.”
(And though I agree that it’s good that medical information is no longer so deeply sequestered and that most physicians do not stonewall questions, still I must ask, Is it not a cruel burden to extend the directive caveat emptor to sick people and their frightened and confused friends and relatives? A ‘rhetorical question’, I know — and it’s not really one I ask of you or anyone else who’s been in the trenches, but one I pose of those lucky folk who’ve yet to face difficult situations involving life and health and madness and sanity and death.)
I guess this is where we differ. I became a medical librarian because, 20 years ago when Daryl had cancer, we needed to understand what was going on. I became adept at searching the medical literature. It was at that point that I realized that Medicine is not an exact science by any stretch. There are choices to be made, lots of critical thinking to be done. There are levels of evidence to be considered. There are complications upon complications, and each individual can have a completely unexpected reaction to each protocol.
You’re asking why the sick person should be the one to find the information. It’s certainly true that physicians have an imperative to recommend the best course of treatment and provide their patients with information on their illness and treatment options. I believe physicians always think they’re recommending the best course of treatment–they certainly aren’t trying to make their patients miserable. All good hospitals have Best Care processes that physicians go through, many have Evidence Based Medicine programs, still others have systems in place to review order sets to ensure that care standards are being met. But the fact is, nobody will ever care as much about your health as you and your loved ones do. People forget that physicians are simply people doing their jobs. Some are a lot better at their jobs than others.
In my opinion, the best outcomes come from a collaboration between doctor and patient, at every step of care.
Cindy, I’m with you one hundred per cent with respect to collaboration between doctor and patient. To the extent that we differ (and I’m really not sure that we do), I wonder whether I’m more idealistic or more realistic. Do I expect more than is reasonable from physicians? Do I take too dim a view of the capacities of patients and their families? Probably a little of both. And ultimately, I struggle to put together a whole new paradigm.
When I’ve got it just so, you’ll hear it first right smack here. I’ll announce it to the world on clusterflock.
Dearest Sheila, if anybody can get it just so, it’s you. I’m absolutely sure of it.