‘Modafinil—better known as Provigil—is fast becoming America’s newest “go pill.” Made by Cephalon, a small publicly traded biotech firm in West Chester, Pa., Provigil is a central-nervous-system drug that promotes hyper-focus and alertness. Patients using Provigil in clinical tests functioned normally—for example, completing tedious computer tasks—after up to 54 hours without sleep.

In 1998 the FDA approved Provigil to treat narcolepsy, but doctors prescribe it “off label” as a fatigue fighter for airline pilots, long-haul truckers, and medical residents. Users say the drug doesn’t make them jittery the way caffeine does. One 200-milligram pill restores focus and alertness as effectively as three tall lattes and costs $5. And all the clinical data show that the drug has none of the addictive qualities of amphetamines like Dexedrine. Because Provigil has fewer side effects than Ritalin, it’s even being prescribed to some children with attention-deficit disorder…’ Fortune Magazine … and, as a psychopharmacologist, I can tell you that it doesn’t work for ADD, either in my clinical experience, according to the medical literature, or on theoretical grounds based on my understanding of its mechanism of action, which is totally distinct from that of psychostimulants. As far as its value as a fatigue-fighter or alertness-enhancing agent goes, as a ‘psychopharmacological Calvinist’, I assume you can’t get something for nothing in the CNS and, as is often the case in the first year or two after the approval of a new medication that seemed lily-white in premarketing suveillance, we will see a downside emerging. By the by, who is Fortune Magazine to practice without a license? People will take the 200-mg. factoid as a suggestion, sure as shooting, and it is in my opinion an irresponsibly high dose to recommend to anyone who does not have narcolepsy.