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Andrew Galan's avatar

I do want to give some very mild pushback on the Rolling Stone article's characterization of Provigil/Modafinil as "Speed". I study neuropharmacology and psychology full time and I can categorically state that there is a fairly vast gulf of difference between Modafinil and amphetamines. If the academic bona fides weren't enough - I also have been prescribed both at different points in my own life as my doctors attempted to grapple with a circadian disorder and ADHD. The actual effect of both is very, very different, in my experience.

To the best of our knowledge, Modafinil is not physically addictive, amphetamines are. Provigil will keep someone awake but it will not get them high if taken in excess. Provigil does not promote direct dopamine release in the way that amphetamines do. Both have legitimate medical uses. Both are serious drugs that should not be prescribed lightly. I am not surprised that a presidential administration would rely on provigil to keep staff members going, it's very useful for that but really the fact that the White House at any point has had to rely on drugs to accomplish the people's work speaks to the ludicrous workload of any given White House staffer and the need for considerably more people to handle that workload, without pharmaceutical assistance being necessary.

To be clear, the article does elaborate on Provigil's method of action and makes clear some of these differences. The FAR more worrying thing is how cavalier the Trump White House was with prescribing benzodiazepine medications like Xanax. These are very powerful, very effective anti-anxiety sedatives that must never be used as long term solutions to anything because they are phenomenally addictive. What's more, not only are they addictive, their withdrawal syndrome is one of very few withdrawal syndromes that can actually be lethal in and of itself. That isn't even true of opioid withdrawal. Having gone through Benzo withdrawal myself after chemotherapy (it is also used as an anti-nausea/anti-emetic medication for people in chemo) I can say that I would not wish that ordeal on anyone. Tapering safely off those medications took longer than my fight against cancer did.

The human brain is a tremendously powerful and relatively poorly understood entity. We know a lot, but what we know is dwarfed by the scale of what we still do not know. These are some of the medications you want to be most judicious in prescribing - they are useful, they do work, but they have profound drawbacks that likely eclipse what we already know.

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Sherm's avatar

Marx said history repeats first as tragedy, then as farce. Something that amazes me is just how many ways Donald Trump embodies the second coming of so many of the Presidential tragedies of the Baby Boomer era. Nixon was a man who used resentment and greed to win, a crook unpunished who escaped out the back door. Trump has all Nixon's worst qualities, and none of his intelligence or reverence for the office of President, and so we get All The Presidents' Men by way of Yes, Prime Minister. Bill Clinton was a genuine Aristotelian tragedy; a man whose appetites drove him to overcome a terrible childhood and become President, only for that lack of control to lead him to some horrible acts against vulnerable people. Trump too is a man who made it to the Presidency purely because of his appetites; his overwhelming desire for respect and love drove him to pursue the Presidency, and then his inability to control that desire meant that he was singularly unable to navigate a pandemic in a way that would make people feel the sort of psychological comfort that could have helped him cruise to reelection. Even now, he and the Republicans are reenacting the tragedy of Hillary in 2016; party leaders convinced that they have the only possible candidate, an alternative pulling 20-40% who is ignored by those leaders Even though it should be a giant, flashing warning sign, and an opposite party running a guy who most people think can't possibly win, even though he's actually better at campaigning than his detractors give him credit for.

I firmly believe that the current Trump drama is the denouement of the Baby Boomer era. Catharsis is coming.

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