BBC DRUG ADVICE HORSE SHIT BBC Bases Drug Advice on a FILMThis is an unedited copy of the BBC’s report this morning on cognitive enhancers. Unedited apart from the fact that for parsimony I’ve replaced a steaming pile of horse shit with an actual steaming pile of horse shit. This kind of useless, fact devoid nonsense is exactly what I was trying to get at with last month’s article (Public Service Announcement: Drugs Misinformation Kills). Okay, they do cite two different experts on the subject but the BBC don’t use this opportunity to ask tough questions or listen to what they have to say, no they throw it in their faces and cut whatever they said in to a one line sound bite thus wasting said experts valuable time and slandering their good names. All of this rare and valuable expert opinion is counterbalanced by a ratio of at least 10 to 1 with useless editorial and made up bullshit.

Here are a few simple facts about the one and only (real life) drug they report on in this article, modafinil. From my psychopharm textbook (Stahl, 2009):

  • Less is more, it has been demonstrated clinically (Sahakian, 2003) that cognitive enhancing effect appears only in the 50-200mg range for most people. This is “paradoxically”, more effective than the higher doses needed for stimulant effects (200-800mg). That means students who are getting this illicitly and who aren’t cutting their pills in quarters are probably not getting the effects they are expecting!
  • Though it doesn’t appear to be addictive the effective dose does creep upwards so regular “drug holidays are advised”, therefore it is considered “habit forming”.
  • Originally developed for narcolepsy, patent has been extended to ADHD and “shift work sleep disorder” (for which it is the only agent approved). Used off label for jet-lag.
  • Patent expires in 2012 (so expect the price to crash when generics appear.)
  • Immediately reduces affects on sleepiness but cognitive effects take up to 2 hours. Has been demonstrated to improve attention.
  • Does not appear to actually prevent sleep if the individual wants to sleep.
  • Used effectively to counter side effects of antidepressants and sleepiness caused by depression.
  • There have never been any reported fatalities however should never be used if a patient is at risk of hypertension or cardiac arrhythmias.

If you’d like to read a half decent editorial on the topic check out this ageing piece by the New Yorker. The New Yorker actually did their first review of this drug a whole 10  years ago and it still had more information than this BBC piece which suggests to me that this article is not in the slightest bit to do with it’s headline and is in fact just shameless film promotion. If the BBC isn’t getting a backhander for this then they are even bigger mugs than they appear. I want to say they deserve tax payers money, no really, I do but they sure as hell don’t if this is what they do with it.

Disclaimer: I’ve been pretty hard on the BBC here, this kind of thing makes me angry but they are still, on the whole the best at what they do in this country (however tragic that may be). One of their editors, Mark Easton, has an outstanding blog and he’s just got twitter.  It’s just a shame the BBC don’t allow him to just get on down and right the news stories outright, his recent blog editorials have been more balanced and factually accurate than any one news story I’ve seen this year.


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  • Neuro Skeptic

    Yeah that is pretty stupid

  • Neuro Skeptic

    Yeah that is incredibly stupid. To be fair though, the film is pretty good, so long as you bear in mind that it’s fictional and has no bearing on real life.

  • jamougha

    “Less is more, it has been demonstrated clinically that cognitive enhancing effect appears only in the 50-200mg range for most people. This is “paradoxically”, more effective than the higher doses needed for stimulant effects (200-800mg). That means students who are getting this illicitly and who aren’t cutting their pills in quarters are probably not getting the effects they are expecting!”

    Eh? Most pills you can buy over the internet are 100-200mg. You’d have to be quite stupid to take 300mg+ for the cognitive effects; it’s very obvious that 300mg is enough to make me jittery and easily distracted. I can’t even imagine someone taking 800mg!

    • http://neurobonkers.com Neurobonkers

      My point is that diminishing of effect comes in to play long before the 300mg mark. Even a 200mg dose is less effective than placebo in some measures of memory and error correction for example whilst a 100mg dose would give a powerful effect on the same measures.

      For a detailed breakdown of the dose-response effects see Sahakian, 2003 (Open access PDF).

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