Intellectual Debt: With Great Power Comes Great Ignorance

Abstract

The boxes for prescription drugs typically include an insert of tissue-thin paper folded as tight as origami. For the bored or the preternaturally curious who unfurl it, there’s a sketch of the drug’s molecular structure using a notation that harkens to high school chemistry, along with PRECAUTIONS and DOSAGE AND ADMINISTRATION and HOW SUPPLIED. And for many drugs, under CLINICAL PHARMACOLOGY, one finds a sentence like this one for the wakefulness drug Nuvigil, after the subheading “Mechanism of Action”: “The mechanism(s) through which modafinil promotes wakefulness is unknown.” That sentence alone might provoke wakefulness without assistance from the drug. How is it that something could be studied and scrutinized enough to find its way to regulatory approval and widespread prescribing, while we don’t know how it works?