Modafinil first came to the public notice when it was suggested that this was the ideal pill to ensure that judges stayed awake in the court room and that it might have the additional advantage that it might make their already-keen brains even sharper.

Reports about the clinical use of modafinil first appeared in the journal Neurology in 1997; the following year an even larger study was published in the Annals of Neurology about an American trial of the drug. Following these initial research papers there has been a host of other papers describing its use in different neurological conditions. It is now the drug of choice in treating narcolepsy, which can cause an overwhelming need to go to sleep, often at inconvenient moments. Modafinil is also prescribed to counteract the tiredness associated with shift working, and in those who suffer from sleepiness or lack of energy as the result of obstructive sleep apnoea (loud snoring and restless sleep).

The Army, which during the Second World War used amphetamines to keep soldiers awake, is said to have stocks of modafinil as it is safer than amphetamines and is not thought to be addictive. However, psychological dependence can develop and it has many potential side-effects. It should not be taken by those who have cardiovascular problems, liver or kidney disease.

Within the past two or three years it has been tried as a drug that might sharpen up the intellects of people who have suffered strokes, and in general it does seem to have the ability to improve short-term memory.

As with any useful drug there is the possibility of abuse and misuse. Some students take modafinil so they can work all hours of the day and night. They don’t realise that the brain, like any other organ, needs periods of rest in between activity if it is to give its best performance.

If someone continuously takes a stimulant day after day to cut down on sleep, they are likely to become sleep deprived. They will then become tense, edgy, irritable, aggressive and even confused and paranoid. Not the ideal mindset to have before sitting an exam.

There is a well-known danger that athletics contests can degenerate into a competition between pharmacologists rather than sportsmen.

It would be even more socially destructive if the difference between a first and a second at a university was determined by the skill of the student doctors’ and their understanding of pharmacology rather than the inherent ability of the student.

The drugs

Modafinil

— Licensed in 1997, it is used to treat narcolepsy and other sleep disorders. Helps users to stay awake when needed but still sleep at night. Is not a cure but reduces sleepiness

— Sold under the name Provigil; Modafinil is the active ingredient

— Less likely than Ritalin to cause jitteriness; side-effects can include headaches

Ritalin

— Licensed in 1997, it is used for attention-deficit hyperactivity disorder. Children with ADHD tend to be restless and find it difficult to concentrate

— Its active ingredient is Methylphenidate hydrochloride

— Side-effects can include headaches, loss of appetite, jitteriness

Sources: Cephalon/provigil.com; Novartis

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