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Straight, No Chaser In The News: A "Smart Drug" That's Actually Safe and Effective

By Jeffrey Sterling, MD July 21, 2019


When I hear medical news that’s too good to be true, it usually is. However science evolves, and new discoveries must be evaluated. Typically my first thought is “consider the source.” More often that not, the credibility of a claim is highly correlated with the credentials of the individual making it and/or the source publishing it. Another very important consideration is “does the discovery or proposed mechanism of action make sense in the context of what we know about anatomy, physiology and science?”


To that end, review of 24 existing studies on the topic and research at Harvard University and Oxford Universities have concluded that a safe and effective “smart drug” exists. This drug is named modafinil, and it is currently used for treatment of narcolepsy (a brain disorder that causes affected individuals to suddenly and uncontrollably fall asleep at inopportune times). You may have heard of “smart drugs” in the past, within the context of students using medications to enhance performance on tests – but this conversation goes beyond that use. This Straight, No Chaser will frame the conversation in “question and answer” form for your review. This is fascinating stuff!


1. How does this drug work on the brain? The prevailing (and admittedly oversimplified) thoughts are that modafinil may increase blood flow to specific sections of the brain that control attention and learning, and it may enhance activity in areas of the brain that manage memory, problem-solving and reasoning skills. At this point specific effects on a cellular level are not well understood.


2. What does this drug do to make one “smarter?” The data is pretty clear that modafinil can enhance attention, improve decision-making abilities, improve learning, improve problem-solving capacity and make certain individuals think more creatively. Research has also shown that modafinil’s effect were even more pronounced the long and more complex the task, and it made completing tasks more pleasurable.

3. Has this drug been used in this context before now? Modafinil is licensed and prescribed in the UK as Provigil and has been used since 2002, although it is not prescribed as a “smart pill.” Surveys in respected journals note that 44% of those seeking drugs to improve focus prefer modafinil.

4. Is this drug safe? Answering these types of questions is typically what makes physicians start equivocating, but the answer appears to be yes. In the context of short-term use, modafinil has very few side effects and no demonstrated addictive qualities. Importantly, the drug appears to have miminal effect on mood. It is acknowledged that ongoing information is needed regarding long-term use and its effects. Regarding negative effects, one study in the review showed those already deemed “creative” saw a small drop in that creativity, but this was not a consistent finding.

5. Does it work in both healthy and unhealthy people? Modafinil appears to be safe and effective in health and unhealthy individuals.


6. How does this compare to other “smart drugs” like Ritalin? Other drugs have a much more pronounced side effect profile than modafinil, meaning modafinil appears to be an overall safer drug.

7. Is this drug available? It’s available for use in narcolepsy but not in the context of improving performance. There really are two considerations. It would be difficult at best to obtain permission to conduct a research examining the long-term effects on the brain of such a drug; this presents a serious ethical dilemma. Similarly another ethical question is whether healthy individuals should be allowed to have access to a drug that improves performance when no problems exist? The manufacturer has indicated that they will not pursue license for modafinil in this context.

Stay tuned. I’m sure there will be much more to come on the topic. In the meantime, the smart choice would be to guard your overall health.
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