Users describe the drug as making them feel unusually “crisp” and “alert.” They describe marathons of work—all-night programming or writing jags—without the decrease in quality that typically comes from working long hours. Their descriptions closely track what the psychologist Mihaly Csikszentmihalyi describes as “flow”: “that state in which people are so involved in an activity that nothing else seems to matter; the experience itself is so enjoyable that people will do it even at great cost, for the sheer sake of doing it.”
The drug has been studied for two decades. The most comprehensive review, a 2015 metastudy that looked at twenty-four placebo-controlled tests conducted on healthy, non-sleep-deprived subjects from 1990 to 2014, tested how people performed simple tests of attention, executive function, memory, and creativity, as well as more complex tasks. The results, particularly on the more complex tasks, showed that the drug helped people perform better in most areas, with no adverse effect on mood and only rare, minor side effects. The researchers concluded: “Modafinil may well deserve the title of the first well-validated pharmaceutical ‘nootropic’ agent.” (A “nootropic” is a drug that enhances cognitive function.)
The 2015 study created a new round of publicity. “Should you take [modafinil] to get a raise?” asked the Atlantic. Writer Olga Khazan didn’t exactly answer that, but the evidence seemed to lean toward yes. Studies show no safety concerns, she reports, and there seems a strong consensus that modafinil is safer than amphetamines like Adderall or Ritalin. “Millions of people take [modafinil] . . . and yet, investment bankers and corporate lawyers aren’t dropping dead at their desks.” She asks: If this drug is as safe as existing research seems to suggest, should anyone be able to take it—and someday, will companies even encourage employees to take pills that allow them to work harder?
Since first trying the drug more than a decade ago, Asprey has emerged as its most outspoken advocate. Modafinil is just one of the many “biohacks” Asprey has used to improve his life; he’s best known as the creator of the best-selling Bulletproof Diet, which espouses adding a special kind of butter to one’s morning coffee. (He also takes handfuls of specialized vitamin supplements.) Asprey’s biography says he lost a hundred pounds, gained substantial IQ points, and reduced his biological age on the regimen. Today he oversees a large empire selling supplements and advice on taking them. If you Google the word modafinil, the second and third hits (after its Wikipedia entry) are on Asprey’s Web site, and the comments section of his Web site are filled with referrals to overseas Web sites where people can buy the drug without a prescription. (When I asked him if he profits from hawking the drug, Asprey insisted, “I’ve never made a penny from any modafinil seller, nor from marketing it.”)
His enthusiasm for the drug is unabashed. When I tell him I’ve seen a press report that President Obama may have taken modafinil on overseas trips, Asprey responds simply, “He’s stupid if he doesn’t. If you’re the leader of the free world and you’re going overseas and you can take something that absolutely eliminates jet lag, how could you with any sense of moral responsibility not take that drug?”
Asprey is disdainful of people who cite ethical reasons for not using a cognitive enhancer. Leveraging technology to perform better is what humans have done for centuries, and instead of criticizing early adopters, it’s more appropriate to look askance at the Luddites who are abstaining and ask them why they’re voluntarily performing at a subpar level. If I were typing this book on an old-timey typewriter, you’d think I was a kook—and Asprey sees people who object to drugs like modafinil in the same light. “I’m not sure why this isn’t okay in some people’s books,” Asprey says. “Is using fire to stay warm ‘cheating’? I think it’s a vestigial effect of living in a society that was founded by Puritans. There’s no rational reason to say a pharmaceutical that offers quality-of-life benefits isn’t okay. Yes, there are risks with modafinil, but they’re in line with the risks from a drug like ibuprofen”—which is to say, minimal.
Asprey is a smart and successful guy, but there is a hucksterish quality that makes me leery of his testimonials. (For weeks after I speak with him, my Web browser keeps delivering ads for his proprietary Brain Octane oil.) In any case, Asprey says he doesn’t regularly take mondafinil anymore. His diet and supplement regimen have made it largely unnecessary, he says. But he does keep a tablet in his backpack. He feels better knowing it’s there if he needs it.
4.
One winter evening I’m sitting in the crowded waiting room of a medical office. I’m here to see a certified nurse specialist, and I’ve brought a shopping list. By now I’ve heard enough secondhand praise for the wonders of performance-enhancing drugs. It’s time to try them for myself.
The nurse opens her door. I enter and sit in a chair underneath her framed diplomas. She taps a digital tablet throughout. She asks for my biographical information—name, address, employer, insurance. Then she delivers the classic opening line: “So what brings you here today?”
I tell her the truth: That I’ve come to refill a prescription for a sleeping pill, and I’m hoping to try two more medications.
I begin by asking for a refill for a sleeping pill I take sporadically for insomnia. The nurse proceeds through a lengthy discussion of my overall health, my family history, my emotional well-being, all the while tapping my information into her tablet.
When she asks about my professional life, I tell her that I spend most days writing and editing, but that my job does require occasional public speaking. In my thirties, my job required periodic appearances on television; although this is rare in my current job, it still happens once in a while. When it does, I experience the classic markers of performance anxiety: the dry mouth, the tight throat, and the rapid heartbeat. When my kids have seen me on TV, they’ve teased me about compulsive blinking. I tell the nurse about my friends who take beta-blockers before speeches. “They say it takes the physical signs of nervousness off the table, and it’s made a big difference in their careers,” I say.
The nurse nods approvingly. She’s had patients who’ve had great results with propranolol. In fact, she suddenly scowls and looks annoyed. Earlier that morning, she’d seen a patient who was distressed because she’d become extremely nervous during a job interview. In retrospect, the nurse says she wishes she’d recommended propranolol, and she makes a note to call the patient to discuss it. It’s appears she’d be happy to prescribe me this drug.
I nudge the conversation toward the next item on my list. I’m nearing the end of a book project, I explain. Although I’ve written books before, I find myself unusually distracted lately. I’m multitasking, and checking my phone, e-mail, and social media too much. There are days when I’m not as focused as I should be. I’ve read about a drug called modafinil that helps improve attention. I wonder if I’d benefit from it.
She seems skeptical. She explains that modafinil is typically used to treat sleep narcolepsy or specific sleep problems caused by shift work. Since neither of those situations apply to me, she says, this would be off-label usage, and she’s not sure if my insurance plan would cover it.
I emphasize that I don’t want to try anything unsafe. But I explain that for the next few months, as I rush to meet the book deadline, I will be putting in a second shift some evenings to finish the book. “I’m definitely not looking for a pill I’d take every day. I’d only be looking to use it on a handful of days, when I want to be really focused and productive,” I say.
She’s listening, but she’s also playing with her tablet. I realize she’s still focused on the question of whether my insurance would cover modafinil. I tell her I’m not very worried about the cost. Really, how expensive could it be? She taps a few buttons. “It looks like it costs $923 for a thirty-day supply,” she says. Yikes. I gulp, but tell her I’m more worried about whether the drug is medically safe for me. At this point in the conversation, I’m guessing she will decline to prescribe
me modafinil.
I’ve misread her. “Actually, from a medical standpoint I’d be more concerned about the side effects of the beta-blocker,” she says, since that drug can cause light-headedness and drops in blood pressure. She feels both drugs are safe. She talks about the need to try a small dose of the beta-blocker at a time when I’m not speaking in public, to get a sense of how my body handles it before I take it in an actual high-pressure situation. I shouldn’t take either with too much caffeine or with any alcohol.
As we wind down our discussion, she uses her tablet to send two prescriptions to my local CVS. When I go to pick up the pills the next day, I brace myself for a gargantuan bill. In fact, my insurance covers it; my total co-pay for thirty tablets each of propranolol and modafinil is fourteen dollars, and each script is renewable three times.
5.
A few days later, on President’s Day, I drive a half hour to the college I attended and take up residence in the university library. At just after 10 A.M., I take my first 100-milligram tablet of modafinil.
Let’s stipulate up front that from an experimental standpoint, this is an extremely poor design, the antithesis of a double-blind controlled study. I’ve read a lot about the effectiveness of this drug, so the odds of a placebo effect are quite high. I want it to work and believe it will. I’m also trying it in a college library—a place where I love to write, and one where I’m unusually focused and productive.
Even without the pharmaceutical aid, I’d probably get a lot done today, so it’s hard to say how much better I’d work while taking modafinil. Nonetheless, after taking the pill, I worked steadily with few breaks for eleven hours. I am less distracted and more focused. I’m in a state of flow. My sense of time feels different; I’m working so steadily that hours pass quickly. By the end of that stretch, I feel much less tired than I would ordinarily be. When I pack up my briefcase to go home, I feel like if I wasn’t obligated to get a good night’s sleep before work the next morning, I probably could have put in a few more hours.
The side effects are minimal. At times I’m slightly more aware of my heartbeat. My appetite seems slightly diminished. But that’s it.
I take modafinil a half dozen times over the next few months. It never seems quite as effective as it did that first day, for reasons I can’t explain. I take it once at my magazine job, and while I’m marginally more focused, the effect is less remarkable amid the distractions of my open cubicle than it had been in the library. During another ten-hour day at the library, I notice that while my brain feels alert, the modafinil does nothing to alleviate other signs of physical tiredness—the sore back, arms, shoulders that come from spending long hours in a chair working on a keyboard. This noncognitive fatigue serves as a limit on my marathon work sessions. After another long and productive workday while using modafinil, I sleep horribly and have unusually vivid dreams; afterward, I’m a little reluctant to try it again.
My modafinil test-drives go better than my attempt to use propranolol. A few weeks after I’d obtained my new prescription, I’m scheduled to moderate a panel discussion before an audience of seventy-five people at a conference. The event takes place on a Thursday. On Monday and Tuesday, I do a trial run with my beta-blocker, taking 10 milligrams with no discernable effect. On Wednesday, I manage to leave the pills in my car at the airport. I moderate the panel without the drugs. I’ve drafted lots of questions and done a prep call with the panelists in advance, so I’m not particularly nervous, and it goes fine.
As I wait for my next opportunity to try propranolol, one Sunday evening I get a text from a close friend. He’s six months into a big job at a large corporation. On Tuesday morning, he’s making a two-hour solo presentation to the CEO—a well-known figure I’ve read about in business magazines—to outline his strategy to turn around a flagging division. Although he’s been in large meetings with the CEO, this will be their first substantive one-on-one interaction, and he’s worried. He’s heard of new executives who’ve been terminated after botching their first presentation to this CEO. “I’ve done tons of public speaking, and usually nerves aren’t a problem,” my friend said. “I’m well prepared, but I’m really anxious. The stakes are so high.” In particular, he’s worried about breaking into a sweat, which has happened a couple of times previously when he’s been really nervous.
He cuts to the chase. “You know those pills you were telling me about for performance anxiety? Can I grab some from you before I get on the plane tomorrow?”
I say no. Although I’m not a lawyer, I suspect that sharing the prescription medication would be illegal. But he keeps after me. “Come on, hook a brother up.” I want to help, but beyond the legal issues, I’m worried about the moral responsibility if he has a bad reaction to the pills. There’s not enough time for him to consult his doctor: It’s a Sunday night, and he leaves for the airport at 6:20 A.M. the next morning.
I come up with a compromise. “Okay, I’ll drop some pills off late tonight,” I tell him. Then I drive to CVS and spend ten minutes scanning the vitamin aisle, looking at pill colors and shapes to determine which vitamin could most plausibly pass for a prescription medicine. I buy a bottle of Vitamin B12, and leave five tablets in an envelope taped to his door. I text him careful instructions: Take one pill ninety minutes before the presentation, and another fifteen minutes beforehand if he still feels nervous.
The next morning he texts me from the plane: “What is this medication called?” “Propranolol,” I lie. He Googles it and starts reading online reviews. “Wow, people really rave about this stuff,” he says.
On Tuesday, I text him: “How did it go?” “Really well,” he replies. “Those pills are magic.”
Later, we debrief by phone. The primary reason the presentation went well—I can’t emphasize this enough—is because he’d spent weeks preparing for it and he has excellent presentation skills. Still, he believes the pills made a difference. “I’m not sure I could have gotten through it without the medicine,” he says. Knowing (or rather, thinking) that there was medicine to counteract the possibility of a quavering voice or a sweaty brow helped him relax . . . and of course, relaxing dramatically reduced the odds of a quavering voice or a sweaty brow.
Within two weeks of that first CEO presentation, he’s visited his doctor and obtained his own script for propranolol.
I only hope the real drug works as well as the vitamins.
6.
My friend’s wife is upset. She thinks taking propranolol before his presentation is cheating, no different than if an Olympic athlete used a performance-enhancing drug. “You’re going to get addicted. You won’t be able to do a presentation without it,” she warns him. She also sees taking the medication as a sign of weakness. “What would you think if you found out someone reporting to you was taking an antianxiety medication before meeting with you?” she says.
My wife isn’t happy either. She knows I’ve taken modafinil a few times, and she doesn’t approve. “Do you really want people to know you’re using drugs to do better at work?” she asks. “Is that the message you want to send to your kids as they look ahead to college?”
Other questions come to mind. What’s the line between using these drugs and abusing them? Just because it’s possible to convince a medical professional with a prescription pad that you need this drug, does that make it acceptable to use it? To what extent are prescription drugs intended only to fix a problem versus to “enhance” the life of a healthy person?
These are hardly new questions. In the stacks of the college library where I first tried modafinil, there are shelves of books that look not only at this broad issue, but also at how it applies to specific drugs. (Examples include Listening to Prozac, Talking Back to Ritalin, The Adderall Empire, and so on.)
A deep discussion of the ethics of biohacking and pharma-powered cognitive enhancement are beyond the scope of this book; there are already plenty of books on that subject. But
I have sampled this literature. Based on what I’ve read, my thoughts keep returning to three points:
First, there are smart people who make a strong case for letting many more people gain easy access to cognitive-enhancement drugs. In an extreme example of this, the University of Richmond philosophy professor Jessica Flanigan wrote a 2013 journal article titled “Adderall for All: A Defense of Pediatric Neuroenhancement,” in which she argued that pediatricians should be open to prescribing the medication to every child regardless of whether he or she qualifies for an ADD/ADHD diagnosis. She compares the use of these drugs to elective cosmetic surgery. Expanding legal, doctor-supervised access to these stimulants would also erode the black market, nonprescribed use that some critics believe is pervasive, particularly on college campuses. I don’t find Flanigan’s arguments convincing, but they are proof that the case for expanded access isn’t limited to self-experimenters like Dave Asprey; in fact, this group includes people who’ve built careers studying and teaching at the intersection of medicine and ethics.
Second, even if you think you know where you stand on this question, medical ethicists can find new angles that make you second-guess your stance. For instance, in a 2014 journal article on the ethics of modafinil, Julie Tannenbaum asks a series of thought-provoking questions. If the primary purpose of modafinil is to let people work or study for longer hours, does it make a difference what kind of work they’re doing? Although most anecdotal accounts depict white-collar knowledge workers popping the pills to get ahead in their careers or make more money, what if the work involved is drudgery, and what if bosses coerce workers to take the drug? Or what if the person taking modafinil is a research scientist, and what if by working longer hours she’s able to achieve some larger, selfless goal, such as curing cancer?
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