Ever since the Stone Age when people started consuming caffeine, humans have been taking advantage of performance-enhancing materials and techniques. They have ranged from those as otherwise beneficial as exercise to those at least as destructive as 1950s “pep pills.”
Recently, though, the use of a medication prescribed for narcolepsy, or the tendency towards unwanted falling asleep, has found its way into workplaces. Many have found modafinil, which requires a prescription in the United States but not in Great Britain and elsewhere, to greatly help them with a variety of cognitive tasks, including learning, planning, concentrating, doing more thinking in less time, and even creativity. It has been described as “the entrepreneur’s drug of choice,” “the big leagues,” “Viagra for the brain,” and, more often than any of these, a “smart drug.” Unlike others used for these purposes it is not an amphetamine, and, although there have been no long-term studies on its healthy-person use, it was found, in a joint Harvard-Oxford study, to have “vanishingly few side effects.” Against that, research has not objectively shown that it is as effective as its adherents claim. That means that for some at least, modafinil may not be much better than the mild amphetamines, or “greenies,” many major league baseball players took around 1970, about which player and author Jim Bouton claimed helped perception of better play more than actual results.
Although modafinil is not considered addictive, some users report perceiving an ongoing need to take it. Robert Kolker, who wrote a 2013 piece on it in New York magazine, said that when he went without his dose it “was sort of like being thrust into dirty, messy reality… like crashing, and… the anxiety that got dialed down on the way in, when you were coming off it, all of a sudden you went through the reverse.” Since then, though, it has been favorably compared to the attention deficit disorder drug Ritalin, also used in work settings, and seems to be getting more and more common.
Beyond its pharmaceutical characteristics, Modafinil presents true ethical predicaments. One might be risking the “Outland effect,” named after a 1981 science-fiction movie about an outer-space mining camp in which many workers chose to facilitate longer hours by taking a performance-enhancing drug seeming benign but proving deadly. A second might be called the Bill Fralic Syndrome, after a top college lineman who, after joining the National Football League in 1985, publicly expressed disgust after determining that he would need to use steroids to be competitive. Should the same thing be allowed to happen with modafinil in workplaces? A third also invokes an analogy to steroids – since they are now forbidden for NFL players, stemming from Fralic’s speaking out, should we place the same restrictions on certain medications for other workers? Does it matter whether these employees are surgeons, who could save lives by being more awake, or corporate staffers who generally could not? Fourth, and most simply, if we accept caffeine in artificial as well as natural forms, drugs prescribed for other conditions, and, of course, measures such as getting plenty of sleep, where do we draw the line and why? What is fair and what is unfair? In 2011, Duke University officially said that “the unauthorized use of prescription medication to enhance academic performance” constituted cheating. That means that if it became legal to sell modafinil over the counter in this country, Duke’s judgment would no longer apply. Is that the standard we want to use?