Side Effects

From quirky to serious, trends in psychology and psychiatry

When the Remedy Is Far Worse than the Disease

A new product for “Shift Work Disorder” should be raising flags

While listening to the radio last night, I caught an ad for a product designed to treat "Shift Work Disorder." Granted, it was the first time I'd heard the term, but it struck me as having a distinctly Orwellian ring to it.

"Shift Work Disorder"? Really? It sounded like a sly new way to pathologize the growing number of Americans who are struggling to hold down two, sometimes three jobs to make ends meet. An ominous effort to extract from them yet more productivity, with the threat of a medical disorder assigned if they fail to reach ever-greater and more-impossible targets. The dystopian feel of the ad wasn't helped by the name of the product, which its manufacturer, Pennsylvania-based Cephalon Medical Services, has chosen to call "Nuvigil." It's as if our Brave New World has exchanged the Victorian workhouse for a drug that now stands in vigil over us, monitoring us by the minute to ensure we're working hard-enough.

But it was the astonishing list of severe side effects the drug is known to cause that really gave me pause. Nuvigil (armodafinil), the announcer intoned, "may cause ... a serious rash or a serious allergic reaction that may affect parts of your body such as your liver or blood cells, and may result in hospitalization and be life-threatening. If you develop a skin rash, hives, sores in your mouth, blisters, swelling, peeling, or yellowing of the skin or eyes, trouble swallowing or breathing, dark urine, or fever, stop taking Nuvigil and call your doctor right away or get emergency help."

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Incredibly, the side effects didn't end there; there were a great many more to come. And instead of rushing through them at the end of the ad, as we've come to expect, the announcer articulated each one of them so clearly, in the middle of the ad, that the effect was truly surreal, keeping in mind that the product is meant simply to help combat sleepiness.

"Mental (psychiatric) symptoms" caused by or associated with the drug, the announcer continued, include "depression, feeling anxious, sensing things that are not really there, extreme increase in activity (mania), thoughts of suicide, aggression, or other mental problems; symptoms of a heart problem, including: chest pain, abnormal heart beat, and trouble breathing. Common side effects of Nuvigil are headache, nausea, dizziness, and trouble sleeping. These are not all the side effects of Nuvigil."

The drug also carries severe warnings that it could cause Stevens-Johnson syndrome, "a severely painful skin disease," one website notes, "that is usually caused by a reaction to medication. Another form of the disease, which generally is also caused by a reaction to drugs is called Toxic Epidermal Necrolysis (TENs)."

Does it reassure you to know that Cephalon tried but failed to secure FDA-approval for Nuvigil to treat such common phenomena as jet lag?

Still, Nuvigil is FDA-approved to treat Shift Work Disorder. It's a prescription medication, the drug-maker confirms, "used to improve wakefulness in adults who experience excessive sleepiness" due to factors such as SWD. And the latter is known as a "medical condition" due to the fact that the hours one's required to work put one's body's "internal sleep-wake clock ... out of sync with your work schedule—your body is telling you to go to sleep when your work schedule needs you to stay awake."

Most physicians, one would hope, would counsel rest rather than encouraging their patients to take a drug that could put them in hospital with life-threatening conditions. But such is our manic, upside-down world that we're told such sleepiness is a disorder warranting treatment by a drug that, by any rational measure, sounds extremely dangerous.

"Tell your doctor," the ad announcer warns, if you experience any of the above side effects. Even so, the company's website urges, "Try Nuvigil free, then continue with savings."

With that list of side effects? No thanks. I'll stick with coffee.

www.christopherlane.org

Christopher Lane, Ph.D., teaches literature and intellectual history at Northwestern University and is the author of Shyness: How Normal Behavior Became a Sickness. more...

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