A new way of pulling an all-nighter

The Inca Empire thrived on the seemingly tireless efforts of its conquered subjects. Working for days on end without food or sleep, the multitudes toiled with a small wad of green leaves tucked in the corner of their mouths. Picked from a small bush the Incas called "k'oka" -- the "holy and highly exalted" -- the plant soon underpinned the exploitive Spanish silver industry, financed European wars, and, a bit later, helped 25-year-old Albert Neiman publish his doctoral thesis in 1860, entitled "On a New Organic Base in the Coca Leaves."

Fueling addiction for the next 140 years, cocaine soon became the drug of choice for workaholic Americans (among others) in the 1980s and 1990s, who rediscovered the ancient secrets of Inca labor. Far more potent and devastating than chewing coca erythroxylum, however, cocaine use fortunately declined under hefty metaphors of frying eggs and even heftier prison sentences, leaving caffeine as the sole recourse for safely managing increasing workloads and sleepless nights.

Then, in 1998, the Food and Drug Administration embarked on new uses for an old drug. Provigil (modafinil), a non-amphetamine stimulant discovered in France in the late 1970s and now produced by Cephalon in the U.S., was officially licensed for treatment of daytime drowsiness in patients with narcolepsy, sleep apnea, and nightshift worker syndrome.

Enter the coca leaf nouveau.

Patients on Provigil report a profound sense of wakefulness, without the jitteriness associated with caffeine intake or the absolute horrors of cocaine abuse. They function at peak performance for hours on end, without feeling anxious or euphoric, and are able to fall asleep when they choose, catching a normal night's sleep and awakening refreshed the next day. Remarkably, Provigil is also non-habit forming.

A telling account of Provigil's effects comes from Washington Post reporter Joel Garreau, who documented his hourly experiences with the drug in a June 17th article entitled "The Great Awakening":

"Friday, 2 a.m., Hour 19. The effortless mental focus brought on by modafinil is remarkable. No attention deficit here. The feeling is that you have been given a gift of time, and it is too precious to waste.

Friday, 4 a.m., Hour 21. When this stuff takes over, it takes over. Gently, not violently. No apparent loss of acuity. But you have definitely kicked into a gear you didn't know you had.

Friday afternoon, 4 p.m., Hour 33. Tired from all this writing. But not sleepy. Interesting to imagine a future in which those are two distinctly separate things. The problem isn't wakefulness. The problem is cranking through three or four days' worth of work in one burst."

With numerous descriptions similar to Mr. Garreau's floating across factory lunchrooms, executive board meetings, and college campuses, it is no surprise that many people are becoming interested -- very interested -- in securing a prescription for Provigil. A drug holding the promise of efficiency without effort, toil without trouble, cannot help but capture the attention of the world's most intensely employed population.

And therein lies the dilemma.

Assuming that Provigil could be safely used by everyone without harmful side effects or overt risk for abuse (granted, this is a strong assumption), then there appears no medically or legally relevant reason to deny this drug to the greater masses. Under such circumstances Provigil is just an improved form of caffeine, enabling individuals to stay awake as long as they choose.

Arguing that Americans are already sleep-deprived, and hence Provigil should be guarded from public consumption, is ultimately a red herring. Ongoing sleep deprivation alone appears insufficient to currently justify a nationwide ban on caffeine and nicotine, or federally mandated vacations, or imposition of French-style limitations on hours per workweek, so it is unclear why claims against Provigil should carry any additional moral weight.

The real danger is whether we are willing to accept a society driven entirely by work, where individuals feel compelled to pursue the next best thing in hopes of gaining a competitive edge or, in the least, not falling behind. It is easy to imagine the terror inspired by peers who are ready to pull 40-hour stints without blinking an eye and the subsequent desire to match this performance for fear of losing a job or promotion or admission at a top university.

Work could become less about what we do and more about who we are, subsuming our existence for its own sake in disregard of any other valuable life goals. Potentially adverse health consequences notwithstanding, widespread Provigil use might guarantee a competitive equilibrium on par with Inca servitude, worthy of Atahuallpa's nodding approval -- only with substantially less idle time.

With this dramatized apocalyptic vision of Planet Provigil in mind, please think twice about feigning narcoleptic symptoms to your family physician. Better to keep this genie in the medicine bottle, at least for now.

Jason Lott is a first-year student in the School of Medicine from Anniston, Ala. Whole Lotta Love appears on alternate Mondays.

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