Intellectual Debt: With Great Power Comes Great Ignorance

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 fi nds a sentence like this one for the wakefulness drug Provigil, after the subheading ‘ Mechanism of Action ’ : ‘ The mechanism(s) through which moda fi nil promotes wakefulness is unknown. ’ 1 That sentence alone might provoke wakefulness without assistance from the drug. How is it that something could be so studied and scrutinized to fi nd its way to regulatory approval and widespread prescribing, while we don ’ t know how it works?