Buoyed by its recent reception of the Innovation Award at the US-China Health Summit, Yale biotechnology startup Yiviva is forging ahead in its work with botanically-derived drugs.
Yiviva primarily develops a substance called YIV906, which is an herbal mixture based on 1800-year old Chinese formulae. The development of this mixture was based on the research of Yale pharmacology professor Yung-Chi Cheng. Through various clinical studies, YIV906 has been shown to reduce the harmful side effects of chemotherapy and increase the efficacy of cancer therapies. These results and years of research at the Yale School of Medicine helped Yiviva win the Innovation Award at the US-China Health Summit on Sept. 4 in the Chinese city of Xi’an.
“Our new paradigm for drug discovery is to revisit history and rediscover new medicines,” Cheng said. “Chinese medicine happens to have many of the polychemical, poly-target, holistic characteristics we are interested in.”
Shwu-Huey Liu, a medical school researcher and Yiviva co-founder, said she was working with Cheng when his lab first began investigating the possibility of using traditional Chinese medicines to increase the efficacy of chemotherapy. She added that Cheng has previously been involved in the development of important drugs for hepatitis B and HIV/AIDS and in the past biotech ventures relating to cancer treatment.
Liu also said that the researchers’ initial investigation went through over 20 formulations before finding YIV906, an herbal combination known in China as huang qin tang, to be the most effective in treatment. The YIV906 substance had previously been noted to treat gastrointestinal problems, according to Liu.
Wing Lam, an associate research scientist at the medical school, said that eight clinical trials investigating the effects of YIV906 treatments on colorectal, liver and pancreatic cancer have been conducted or are in progress across the United States, Taiwan and Hong Kong. Patients treated with YIV906 have been shown to experience reduced vomiting, nausea and diarrhea as well as increased survival rates, according to a 2012 study published in the Journal of Ethnopharmacology.
“Yiviva is a commercial vehicle to explore these ideas,” Cheng said. “The recognition of our company’s drug development technology [at the US-China Health Summit] says something about the value out work has.”
Peikwen Cheng, a co-founder of Yiviva, said that the attendees at the US-China Health Summit included Chinese ministers of health, researchers, industry professionals, regulators and entrepreneurs.
He described the competition as an important platform from which to connect with fellow entrepreneurs and the health care community in the US and China.He added that conversations which had taken place at the conference could spark future collaborations.
The company hopes to continue to use its drug discovery platform, which is able to screen across multiple pathways of the body, as well as its pioneering techniques in ensuring the consistency of herbally-derived extracts, to continue to tackle age-associated diseases, according to Liu.
Cheng added that the company faced regulatory obstacles in addition to scientific challenges, noting the dearth of botanical drugs previously approved by the FDA.
“I started other companies in the tech space, and I think the biggest difference that a pharmaceutical company faces is the time, resources and regulatory pathway required,” Cheng said.
Hepatocellular carcinoma, the most common form of liver cancer, has a five year survival rate of approximately 14%.
It was Wednesday night and while a strong contingent of Yalies attended Woads, I decided to try out the alternative — Wine, Weed and Wenzels Wednesdays, lovingly known as WWWW (pronounced “wa wa wa wa”). Laughter could be heard from inside the off-campus apartment where WWWW was being held. Nobody noticed the knock on the door over the sounds of music and voices until the third try. Finally, the door opened to a friendly face and the pervasive scent of weed.
Looking around the room, I could see where the name came from. Solo cups filled with Franzia Merlot were strewn across tables; plumes of smoke billowed from students’ mouths, their eyes red and glazed over.
At one point during the evening, a girl motioned to a disposable weed pen and tentatively asked another, “Is that your weed?” The other girl passed the pen over declaring: “This is a family of sharing.” Conversation floated like the smoky air. Smiling people passed in and out of the haze as the night wore on. They caressed, hugged, laughed and sang. To complete the night, the final W arrived with a 2 a.m. Wenzel run.
Recreational marijuana user Ricky, who spoke on the condition of anonymity out of legal concerns, had invited me to this longstanding off-campus get-together. He explained that WWWW was created as an alternative to Woads, a prescribed relaxation time and a context in which people can get to know one another. A “pot”luck of sorts, he calls it, where people bring what they can and don’t pay attention to work. During our conversation, Ricky discreetly mentioned the dispensary location where he sourced the marijuana for the gathering, highlighting the careful planning behind this laid-back social event.
Ricky emphasized the importance of getting high in fostering such relaxed moments. While high, friends are willing to accompany him on tangents. Emphasizing the liberation and revelations he feels while high, Ricky said, “I think sometimes people at Yale get so wrapped up into complaining about work and stuff that it’s nice to have those moments of sensory appreciation. You will listen to a song that you’ve listened to a million times and this time you’ll really hear it and love it in a way you hadn’t.”
* * *
Yale College Dean Jonathan Holloway doesn’t share Ricky’s positive feelings about these illicit, off-campus events. “I do know that there are smaller communities of Yale students who live on and off campus who smoke marijuana often,” he said over email. “Aside from engaging in illegal activity, they are a serious social irritant and seem not to care about how they are negatively affecting the quality of life for the people who live around them. In this way they demonstrate an abiding insensitivity to others.”
While Holloway strictly characterizes marijuana use as an illegal activity, Connecticut state law presents a fuzzier picture.
Since 2011, Connecticut is one of 19 states to have decriminalized marijuana possession, meaning that possession of small quantities does not warrant jail time. Decriminalization is not synonymous with legalization. Possession of small quantities of marijuana warrants a small fine; additionally, medical marijuana is legal in Connecticut for treatment of specified illnesses. Though they have not by any means approved a full-fledged legalization, Connecticut legislators have softened what was once a harsher restriction on cannabis.
Less than three weeks ago, the sixth medical marijuana dispensary opened in the state of Connecticut. According to a recent poll conducted by Quinnipiac University, 90 percent of Connecticut voters approve of legalized medical marijuana and 52 percent of voters support legalizing recreational marijuana.
***
Wallace* began selling edibles his freshman year in the form of “high-quality” brownies. A baking enthusiast, he learned how to make edibles during his junior year of high school. He acquired a reputation as a prominent dealer on Yale’s campus but was caught and faced the Executive Committee. Since then, he has ceased producing and selling edibles.
Laughing at his notoriety on campus, Wallace said, “Contrary to common belief, I didn’t just wake up one morning and say, ‘I’m gonna start a drug empire on a college campus.’”
When Wallace came to Yale, he realized marijuana was not always readily available and that he needed to find his own supplier. Almost every other week, his dealer would roll up to an agreed-upon location on a black bike, provide him with the product and speed away, usually without saying a word.
At first, Wallace made edibles in his residential college kitchen since he didn’t have the utensils to do it on his own. One day an operations manager walked in on him. Although the operations manager didn’t figure out that Wallace was using Yale equipment to make an illegal drug, the experience convinced Wallace that he needed to be more discreet. After that, Wallace started cooking on a hot plate in the early-morning hours in his dorm room so that the smell wouldn’t bother his suitemates.
At first, the edibles were just meant for himself, but oftentimes he made too many leftovers and invited friends to join him in eating them. Eventually, friends-of-friends began texting and asking for marijuana. Shortly thereafter, a steady flow of people was paying for the product.
He started enjoying it, delivering a product that students wanted.
To better market his product, Wallace explained, “I made cute packages with green wrapping paper and a red bow.”
His clientele swelled. People outside of his residential college, upperclassmen, fraternities and large sports teams started buying from him. He realized that in a single night he could walk into a party with a backpack full of “merchandise” and leave with a wallet filled with almost $500. He sent most of the money he made to his mother to help her pay the bills.
Then, everything changed. Wallace didn’t give a second thought to providing a friend with some edibles late one night around spring break. The next morning, he awoke to a text from a friend telling him they needed to talk about a serious incident.
A girl, whom Wallace had never met, had eaten one of his brownies while excessively intoxicated. Afterward, she needed to be brought to Yale Health by some friends and later went to Yale–New Haven. Wallace’s friend informed him that the administration was searching for whomever had baked the edibles.
Wallace came forward and has since quit selling edibles. He chose not to comment on the disciplinary process he went through because he was told not to by the Executive Committee.
** *
“I can get weed here faster than I can get a pizza delivered — less than ten minutes,” recreational user Joseph* bragged to me when I spoke with him.
But for other students, finding marijuana isn’t so easy.
Sophomore year, Annabelle* and her friends wanted to get high for Safety Dance. Sending out a slew of texts to friends, they discovered no one they knew had any marijuana available. So they started texting friends of friends. Many of the reputed stoners on campus looked at the screens of their phones to find a surprising message.
“Hi, this is Annabelle, I’m friends with Tommy*. I know this is awk, but do you have any weed????????”
After dozens of text exchanges, they finally obtained some marijuana, though it was by no means easy, Annabelle said.
The occurrence isn’t abnormal at Yale. Many students interviewed voiced the same sentiment — that although marijuana is not as common or as accessible as alcohol, the drug is not absent from campus culture. But at the same time, it does have to be actively sought out.
According to a Yale Daily News Survey administered to 42 students, 100 percent of Yale students surveyed said they have had alcohol while underage compared to only 50 percent of students who have tried marijuana at least once. Ricky believes this difference of usage contributes to a stigma against marijuana on campus.
Survey results demonstrated that while the drug’s usage is distributed among a variety of extracurriculars, some seem to exhibit higher percentages of use than others. For instance, 42 percent of students listing political groups as their top extracurricular said that they use marijuana a few times per week, with only 25 percent indicating less than regular use. On the other hand, a mere 10 percent of those who self-identified as athletes responded that they use marijuana a few times per week, while 40 percent indicated less than regular use.
“I think there is a stigma about it at Yale,” Ricky said. “People know how to treat people who are drunk but they don’t know how to treat people who are high.” The possibility of misusing alcohol is much higher than it is with marijuana, he added.
Ricky highlighted that one of his main reasons for using marijuana was to de-stress.
“[Marijuana] eliminates any sense of stress or interpersonal competition. I feel [it] gives me perspective on things that seem, like, really big, anxiety-inducing issues in the bubble of Yale and allows me to look at them not through the context of Yale but dissociated from that context and see that they are meaningless,” he said.
Alcohol does not have a bonding effect like marijuana, he added. “You don’t pass a beer around a circle,” he joked, alleging that drinking is more conducive to dancing whereas marijuana fosters conversation.
For Ashley,* marijuana facilitates more than just conversation — she often smokes to write. Brought up in a liberal college town in a Southern state, Ashley smoked marijuana for the first time as a junior in high school, a “late bloomer” compared to many of the kids in her town. Frequent marijuana users themselves, her parents approved.
While working late on many of her Directed Studies papers, she would smoke to get the creative juices flowing.
“Hemingway said ‘write drunk, edit sober,’ so sometimes I write high,” she chuckled.
Ashley said she has also used marijuana to help her with insomnia and depression. Five out of the seven recreational users interviewed said they often use marijuana to self-medicate.
Geoffrey,* who has a long history of alcoholism in his family, said he sees marijuana as a safe way to help brighten his mood. Outraged by the harm alcohol has caused to college campuses, he is dismayed weed is not more accepted at Yale.
A frequent user, Geoffrey believes the classification of marijuana as a Schedule I drug is unwarranted. Schedule I drugs are considered the most dangerous class of drugs, with a high potential for abuse and potentially severe psychological and/or physical dependence. This classification puts marijuana on a higher schedule than drugs like crystal meth and cocaine, while alcohol does not even make the list. Geoffrey, who smokes weed in lieu of drinking, is distressed by the much higher number of alcohol-related deaths among college students versus marijuana-related deaths, which are negligible. This, he says, renders the classification questionable.
Holloway provides some possible explanations for this distinction. “Alcohol is treated differently than marijuana in part because at any given moment one-quarter of our undergraduate population can legally possess, purchase and consume alcohol,” he said over email.
“I’m not blind to the fact that marijuana is used widely on the campus, and I would love to find a way to disrupt that practice for the general betterment of the Yale community,” Holloway noted. “Although I know that marijuana is smoked frequently I do not know how much of a role it plays in shaping Yale’s general culture. I certainly think that alcohol plays a more significant role in the broader culture and that is why we focus more of our energy there.”
* * *
A frequent user, Charles* is doubtful of Yale’s marijuana policy changing any time soon. He shrugged: “Yale is not the kind of place that is just going to let people smoke out on Cross Campus or smoke up the Ivory Tower.”
During his freshman year, Charles and a few friends were caught by the police smoking on camera in the Yale University Art Gallery sculpture garden. The cops arrived, and he admitted the joints were his. Inside the brightly lit rooms of Linsly-Chittenden Hall, he was given his court summons. At first, Charles was worried, but the police said if he showed up to trial in a collared shirt and told the judge he went to Yale, everything would be fine.
On his court date, Charles was the only person in court with a collared shirt and tie. His $150 fine was converted to a $50 donation to a charity of his choice, and the incident was wiped clean from his record.
But he wasn’t completely off the hook — Charles and his friends had to face the Executive Committee. Ultimately, all he received was a warning. Looking back, Charles said, “The buildup was a process totally designed to freak you out, but when we got into the room it was very fair, and they were concerned and respectful and asked all the right questions.”
Many small possession cases do not even make it to the Executive Committee. Ricky received a warning from his dean when he was caught his freshman year. Charles has heard of many similar cases to his own, in which offenders received a warning.
The Executive Committee is made up of ten “regular voting members” — three tenured faculty members, three untenured faculty members, three undergraduates and the dean of Yale College. It also includes a “Coordinating Group” consisting of three “officers” (chair, fact-finder and secretary) and an undergraduate student.
Between 2004 and 2011, 806 students came before the Coordinating Group for various offenses, only 19 of whom were summoned for marijuana-related incidents. Their punishments ranged from “reprimands” and “probation for the remainder of one’s time at Yale” to “suspension for three terms.” Notably, only two students received the more serious punishments (one probation and one three-term suspension, respectively) and the remaining 17 got off with a “reprimand.” Executive Committee members could not be reached for comment.
These data suggest that, even before the gradual decriminalization of marijuana in Connecticut, the Executive Committee was relatively mild in punishing offending students. Holloway explains that “it remains illegal to possess marijuana in the state of Connecticut. Yale is in no position to ignore that law,” but the process is often softer than this official stance. Connecticut law is less dichotomous: A relaxation in the prosecution of marijuana-related offenses has gone hand in hand with a gradual, uneven process of decriminalization.
* * *
Charles admired the way in which the Executive Committee showed such concern for his mental health throughout the process. Nevertheless, he said there needs to be more of an open conversation about marijuana on campus, especially with respect to mental health. He warned that the drug can easily become a crutch to assuage larger anxieties with which students do not know how to cope. He acknowledged that his own state of mental health the previous year led him to consume too much.
“It’s definitely unfair — the policy differences between alcohol and marijuana — but where I was at last year, the situation I was in definitely should have been treated as a health issue,” Charles said.
Part of the reason it isn’t treated as such may be that there simply isn’t a large volume of medical cases involving marijuana.
Yale Health director Paul Genecin commented that Yale Health rarely sees any cases of marijuana incapacitation in comparison to the high rates of acute alcohol incapacitation. He added that their role is not disciplinary; they treat cases as matters of health. Under new alcohol policy, students can be mandated to have counseling for an abuse disorder.
Although medical marijuana is now legal in Connecticut, Genecin explained it is only allowed for a very specific set of illnesses including cancer, multiple sclerosis, epilepsy and Parkinson’s disease. At this time, Yale Health does not prescribe medical marijuana because Genecin said it does not seem necessary for the student population, but he added that no one can be sure of what the future will hold.
Although there are very few cases of people becoming addicted to marijuana, Genecin explained there are some people who have withdrawal symptoms with an abuse disorder that is now classified in the DSM-V.
“There is still not enough appreciation of how addictive marijuana can be in some cases,” Genecin said.
Although many recreational users interviewed said there are rarely negative consequences to marijuana use, survey respondents reported three cases in which severe health reactions occurred. One student described having a panic attack while under the influence, and another “fainted after a concert post-weed.”
Faithful WWWW attendee and frequent user, Anna* was upset by the lack of conversation about marijuana during Camp Yale. Over the course of her freshmen orientation, she remembers receiving multiple hour-long talks about alcohol safety, use and health concerns, while marijuana and other drugs received less than a sentence.
Marissa Medansky ’15, a strong advocate for drug policy change on a national level and a former opinion editor for the News, has done research on the University’s drug history. In 2001, she explained, Yale was the fourth university to reimburse students who lost financial aid because of the Higher Education Act Aid Elimination Penalty, an act that rescinded federal aid from students with drug convictions. Despite such advances, Medansky said she thinks the student body is no longer as open as it once was in discussing drug use and policy.
She surmises the openness about drugs that students like Anna and Charles desire no longer exists on campus because of the emergence of social media. Back in the 1960s, she said, “No one had any expectation that a YDN [issue] from 1968 about the price of weed on college campuses would then be recorded for all of time.” Medansky pointed out that drug culture was seen as something very much confined to college, so people were more forthright in discussing it.
In Medansky’s opinion, the advent of social media has contributed to a culture much more secretive and much less fun. The fear of being associated with drugs post-graduation has chilled an active drug discussion on campus, she added.
“Nobody is going to form a ‘Students for a Sensible Drug Policy’ on campus because nobody wants to be president of that group,” Medansky said.
So instead, students congregate in smoke-filled rooms at low-key, off-campus parties. Bongs and joints are passed around a circle. The marijuana conversations are hidden, confined to small rooms while others pre-game for Woads, walking through the streets tipsy, unabashed.
YTV-- A History of Medical Marijuana Legalization
* Names have been changed for the sake of anonymity
We were supposed to arrive at Randall’s Island in New York City for a final day of electronic music that never came. Throughout Sunday, engineers prepared to disassemble stages on which some of the world’s leading electronic artists should have been playing. Instead of identifying Armin van Buuren and Avicii, my ears detected machinists and forklift operators.
A collection of tablets believed to be ecstasy (known as MDMA), which might have otherwise fit into an empty pack of gum, brought about the deaths of two young adults, hospitalized several others and prematurely ended Electric Zoo. Tens of thousands of fans streaming to Labor Day’s electronic rave woke up to the unfortunate news on their Twitter feeds. Despite electronic music’s automated and computerized nature, human emotion surged profusely in the aftermath.
Our crew of five congregated in the small rented apartment in Queens which we had used as a home base for the weekend’s event. Leading up to it, I was looking forward to expanding my musical horizons. I had done the background reading on the artists, and listened to the albums as well as the viewpoints of other fans. In a dimly lit and muggy room, sympathy, frustration and bewilderment fluctuated within us for several cycles until we finally arrived at lethargy. For many, the concert represented a significant chunk of summer wages put towards accommodation, transportation and food. The atmosphere resembled that which follows a destructive flood.
As a neophyte to the electronic concert scene, I took refuge in the expertise of my fellow concert chums. My friend James, a student music artist with an electronic-heavy repertoire often hired at Yale events, sagged on the futon. “People are looking to heighten their experience and find creative ways to get substances through security,” he explained to me. The lyrical lingo describing the use of ecstasy in popular culture misleads concertgoers about the destructive capacity of the drug. With softened synonyms such as “Molly” or “disco biscuit,” it grants the possibility of a more invigorating musical experience. It is not uncommon to find a subversive chapter of dealers who roam concert venues offering questionable hallucinogens to attendees caught in the moment. Dr. Danielle Ompad, an epidemiologist at NYU, stressed to me that users often have no clue what they are ingesting: “It is not always clear that the pill that was purchased is always MDMA.”
Leading into the weekend, I had fully expected to see substances, and pockets of individuals who used them — to deny this would be to deny the reality of an electronic concert. But I thought there was safety in numbers. No concert that attracts over 100,000 visitors could ever be canceled. That version of affairs lay outside my realm of possibilities.
Just prior to Electric Zoo’s cancellation, a concert in Boston hosting a techno band saw three reported overdoses from ecstasy, with one resulting in death. College campuses aren’t insulated from the growing prevalence of the drug either. As one acquaintance told me at the dining hall: “Let’s just say that Toad’s isn’t the only thing popping on a Wednesday night.” The illicit nature of ecstasy inhibits an accurate estimate of usage on campuses, but according to the Justice Department’s website, nearly 10 percent of incoming freshmen will have tried ecstasy at least once before even having stepped foot at their respective colleges.
The decision by the New York Mayor’s Office to cancel the final day of Electric Zoo highlighted the inextricable link between illicit substances and electronic music for me. The logic now flows: If there is an electronic concert, then there will be ecstasy. Vice versa, there cannot be an electronic concert without users of ecstasy. This is almost an inherent fact, not a personal belief.
The strong response to Electric Zoo will repel moderates like me who fluctuate between music styles. Prior to my descent upon New York, I was really excited to broaden my musical knowledge and investigate emerging artists. Instead, the events have cognitively distorted my attraction to electronic music and made the genre less accessible. Sunday’s twist will nurture the intimidating image I have of rave culture and harm what was once a growing attraction to the scene. It will take some time before I feel comfortable venturing off to an electronic music fest or fully investing in EDM artists. It is not a rational reaction, but the reinforced stigma of raves remains looming in the back of my head.
If I had to pinpoint where exactly I fell in love with “Orange is the New Black”, it would be during one moment, midway through the third episode. In it, the show cuts between two shots of Sophia Burset (played by Laverne Cox) in front of a mirror: in the first, as a male firefighter; in the second, as a female prison inmate. You immediately notice the big changes: Sophia has a new body, new hair, and a prison uniform. But, despite these physical differences, her expression is barely altered. She’s gotten what she wanted, and yet she’s still trapped.
The show is based on Piper Kerman’s memoir, which follows her vertiginous fall from upper middle class fiancée to prison inmate after being implicated in her ex-girlfriend’s drug ring. When I first heard the plot synopsis, I nearly groaned — just another Hallmark Channel export in which prison teaches a college-educated white girl some dangerous lessons.
Initially, I seemed to be right. In the first couple of episodes, Piper Chapman (Taylor Schilling) spends a lot of time mooning around her new minimum level detention facility in upstate in New York, inadvertently offending most of the other prisoners and staff along the way. But the show quickly, and wisely, shifts its focus away from Piper and onto the other prisoners and staff, a cast of women (and men) more diverse and engaging than any other currently on television.
At this point during my ranting about how incredible the characters are in “Orange is the New Black”, most people begin suspect that the show takes the cheap way out. In a prison drama, this means establishing, through flashbacks, how every character, or at least every main character, is secretly innocent or exonerated by extenuating circumstances. This conceit makes it easy to love every character, because then the blame falls on the system: on wonky legal practices, cutthroat layers, or cycles of violence.
“Orange is the New Black”, however, does something different. It doesn’t let all those excuses add up. You can see it right in Sophia’s flashback (in an episode directed by Jodie Foster). In order to pay for her operation, Sophia commits credit card fraud. When she’s arrested, she leaves both her wife and her son behind. The show could portray this decision as heroic just as easily as it could chide Sophia for selfishness. Instead, it just holds close to her face, tracing both her pain and her victory.
As the series continues, Jenji Kohan (the show’s creator and head writer) pulls the same tricks on other characters. Miss Claudette (Michelle Hurst), Piper’s Haitian roommate, has committed an act of terrible violence and, while she had her reasons to do it, she still lives with the consequences. Pennsatucky (Taryn Manning), a redneck meth head, justifies her eye-for-an-eye vigilantism by claiming that she’s receiving instructions from God. Even Piper deludes herself into thinking that because she ran drugs just once, a long time ago and on her ex-girlfriend’s insistence (and because she has a line of artisanal bath soaps) she’s somehow different from all these criminals.
On “Orange Is the New Black”, everyone has their justification for what they’ve done. But instead of making each character seem pathetic, this common trait gives them all a certain, fascinating prickliness. Sure, these inmates might be in need of saving, but they’re not interested in anyone else’s help. They’d rather save themselves.
Cathy Huang ’15 usually sleeps from 10 p.m. to 6 a.m. She makes sure to schedule her other commitments around her eight hours.
She realizes that’s “not normal.”
When Huang first came to Yale, she found herself staying up late much more often than she had in high school and gradually consuming more caffeine. Part of it was the nocturnal lifestyle college seemed to demand. Part of it was the culture of meeting people for coffee, working in coffee shops.
Huang can list off the effects drinking caffeine has on her: “My palms sweat, my heart starts racing, my mental to-do list just starts forming without my consent in my head. I have a really hard time enjoying things just to enjoy them. I feel really intense.”
After a “bad” beginning to her sophomore year, Huang began seeing a counselor at Yale Mental Health and realized there was a correlation between her negative moods and not sleeping enough — and with having to use coffee to keep awake.
Now she’s back to her high school schedule. She has tried bringing friends around to her way of thinking, but hasn’t had much success so far.
After all, there’s a prevailing sense on campus that, in the words of a recent Red Bull campaign, “Nobody ever wishes they’d slept more in college.”
And we don’t have to. We don’t have to drink Red Bull either: We’ve got options. Reading “week” starts tomorrow, and from what I can tell through conversation osmosis, everybody is basically fucked. A News survey conducted earlier this week shows that more than 70 percent of students feel “somewhat” or “very” stressed about the upcoming finals period.
Over the next 10 days, Yale’s student body will deal with the end of year crunch by consuming stimulants including coffee, tea, energy drinks, 5-hour energy shots and prescription stimulant drugs intended for the treatment of Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD).
“I’m not classically against drugs,” said Hedy Kober, an assistant professor of psychiatry and psychology at the Yale School of Medicine. “But everybody who takes drugs has a responsibility to know exactly what they’re taking and what they’re doing [to their brains and bodies].”
***
According to a 2005 New Scientist article reassuringly titled “Coffee: The demon drink?”, 90 percent of adults in North America consume caffeine daily in some form, and the Internet of 2013 seems to pretty much agree with that number.
I’m not sure if that’s us already, or just future us. But we’re getting there.
The longer we stay awake, the more our brains produce a chemical called adenosine, which makes us want to go to sleep. While sleeping, we make less and less adenosine, so that in the morning we wake up feeling less tired than when we went to bed. Caffeine is primarily an “adenosine antagonist,” Kober explained: Technically it is a “sleepiness-reducing” agent rather than an “energy-producing” agent, though feeling less sleepy may leave us more energetic.
Caffeine also increases the action of dopamine and norepinephrine, neurotransmitters associated with, among other things, energy and euphoria. But this is a secondary action. What caffeine mostly does is stop the brain from following through with its natural sleep-promoting processeses.
All of which makes me pretty nervous. I’ve been dealing with the opposite problem on and off for most of the last eight years. During peak angst times (grades six through 12), I’m pretty sure 3/4 of the emotions I experienced were produced by insomnia. It’s hard not to feel Kierkegaardian levels of Despair when you’re consistently the only one awake in your house during the witching hours.
Drinking caffeine has, until recently, been unthinkable. Once, in sixth grade, I tried a cappuccino. I didn’t sleep for a full day and a half. At home, my parents still get mad at me for eating so much as a piece of dark chocolate after 7 p.m.
John Sununu ’15 has always had coffee in his house and in his life. Starting around age 12, he began to sample some himself. It made him feel grown up.
His freshman year of high school, Sununu first started drinking coffee in the evenings to help him make it through late nights of studying. By junior year, Sununu realized he was drinking between seven and eight caffeinated beverages a day. He decided it was time to stop.
“I was alone and irritable and interning, and detoxing cold turkey,” Sununu recalled. “I was really fidgety and always falling asleep in the middle of important things, which is not good when you’re interpreting.”
Sununu went back to drinking coffee after the summer, but feels he has a healthier relationship with it now that he knows he could quit if he really needed to. Still, he added:
“It’s just easier to have a little extra energy — or a lot of extra energy.”
For most of this year, even if I’d slept nine hours out of the past 48, it didn’t occur to me try anything stronger than weak green tea. But I’ve started to think about experimenting. First, though, I decided to seek out a few of the uncaffeinated 10 percent, and see what they had to say.
For Kerri Lu ’14, coffee just doesn’t work. She gets about 20-30 minutes of nervous energy before she crashes and falls asleep. The same thing happened when she tried 5-hour Energy, but she admitted she wasn’t brave enough to pound the whole thing at once. Lu more or less summed up the concerns seven other students interviewed cited about the product when she said she was worried it would make her heart “explode.”
“It scares me, because I think I would really enjoy drinking [5-hour Energy] to stay awake,” Lu said. “I would probably resort to those things if they helped me physically.”
But for at least a small portion of Yale’s student body, whether or not coffee would help doesn’t matter. What does is maintaining a sense of spiritual responsibility over what does — and doesn’t — go into the body. The Church of Latter Day Saints’ health code requires Mormons to abstain from consuming “harmful and addictive substances,” said Russell Ault ’14. The church explicitly forbids alcohol, tea, coffee and tobacco.
“Mormonism has a strong emphasis on agency,” Glorianna Tillemann-Dick ’14 said. “Developing an addiction reduces agency because we feel the need to partake in the same specific substances.”
Glorianna and her sister, Mercina Tilleman-Dick ’14, have different approaches to living through the prohibition. Mercina allows herself the very rare Diet Coke, but generally plans her schoolwork so as to avoid needing to stay up too late.
Glorianna pulls all-nighters fairly regularly but keeps herself up with lots of water and small naps. When done naturally, it’s hard to feel that it’s “no big deal” to stay up all night, Glorianna added. By allowing herself to feel the physical consequences of her decision without the aid of stimulants, she keeps the emphasis on her own agency — and what she describes as her failure to plan her time better.
Huang would prefer to email a teaching fellow and tell them she’ll be turning a problem set in late rather than compromise her health in the long run.
But when it comes to sleep, she said, “I think we’re the few and the proud here.”
***
When Rachel* found herself left with a single night to cram for a final her freshman year at Yale, a friend asked her if she wanted some Adderall. She needed to stay up all night, and coffee had always made her feel jittery. The Adderall kept her awake, and she felt like she was getting a lot done.
According to a 2009 study by the Substance Abuse and Mental Health Services Administration, full-time college students 18-22 are twice as likely to use unprescribed Adderall as their non-full-time student counterparts. The report underscores Adderall’s role as a ‘study drug’ on campuses across the nation.
Sadie*, another sophomore girl, has used un-prescribed Adderall as a study aid on several occasions. She drinks coffee at other times to keep herself awake, but said that it doesn’t give her anything close to the increase infocus and motivation she feels when on Adderall.
Otherwise, Sadie said, taking it doesn’t make her feel much different. She has never experienced any negative side effects and doesn’t know anybody who has. She said she knows a broad spectrum of users on campus.
And with reading and finals period ahead, she is asking around for more Adderall.
“But it’s not 100 percent necessary,” Sadie maintained. “I can organize my [work] so I don’t need it. It’s not like I plan to use it … If I can find some, I’ll use it, but I’m not going to seek it out unless the people I usually go to have it.”
She can get it from friends who have it prescribed to them or others who have obtained it from someone else with a prescription. Prices vary with the dose of the pill she’s buying.
Sununu also knows students at Yale who use the drug regularly.
“On the whole, [stimulants like Adderall are] relatively easy to access, and college kids have grown used to the idea that if they need to access them they can,” he said.
But he is not prepared to condemn his classmates’ Adderall use outright: “I don’t want to judge anyone for their personal decisions. As long as people stay healthy and safe, I think it’s their prerogative to do what they need to do.”
Sadie said that the only people at Yale she would peg as not using Adderall would be those who already devote so much time to school work that they would not need the extra boost.
Adderall and many other ADD/ADHD medications are part of a category of stimulants called amphetamines, which keep you awake by entirely different means than caffeine does. They do not bind onto adenosine. Instead, like other stimulant drugs such as cocaine, amphetamines work primarily on dopamine and norepinephrine, which also have roles in promoting wakefulness. Amphetamines are extremely close relatives of the methamphetamines (see: Breaking Bad).
Students don’t think of them that way. Sadie doesn’t see developing an addiction to Adderall as a concern, given the infrequency and low doses of her consumption. And she added that she finds students see Adderall as ‘less illegal’ than other drugs, since “no doctor is ever going to prescribe you cocaine.”
“Adderall is not generally viewed as a party drug — it’s viewed as a drug for college students that have to get their shit done,” Sadie said.
Part of the reason Adderall may seem less intense than other drugs has to do with the method of taking it rather than its chemical composition. When taken in pill form, part of the pill is degraded in the stomach, and the effects are felt more gradually. If snorted, some of the drug would get lost in the nose, but what was ingested would go to the brain much more quickly, Kober said. She added that the effects of snorting Adderall would be more akin to snorting something like crystal meth. And the faster the drug enters the brain, the greater the chance of one’s forming an addiction.
Kober said because the drug is relatively new, the medical world lacks research on whether taking these stimulants in college will harm you in the long run. But researchers also don’t know that it doesn’t.
Robert Malison MED ’87, a professor of psychiatry at the School of Medicine who studies stimulant use and addiction, said the best current research demonstrates that one in 10 people who try Adderall or similar amphetamines will develop an addiction. That might sound like good news: it means that 90 percent probably won’t. But it’s a gamble students should at least know they are taking, Malison feels.
He is worried about students’ growing use of such stimulants. To illustrate its risks, he brought up the example of the methamphetamine craze that has swept over Thailand in the past decade. It began with over-the-counter capsules, which he said were used primarily by university students and truck drivers to stay up through the night.
The pills have now crossed over into all parts of Thai society. Malison recounted how on a research visit to Thailand, he saw eight and nine-year-olds in hospitals for addiction. And while they used to be called “diligence pills” they are now commonly called “crazy pills”: once users become addicted, the pills can make them psychotic.
Malison sees the rise of Adderall in the States as having “all the hallmarks of our country’s next stimulant epidemic.”
He is interested in further studying how the kind of sleep loss Yale students report can make individuals more vulnerable to addiction and said correlative (though not causal) studies have shown a link between the two.
“If you’re going without sleep for weeks, you’re most likely to feel those benefits and euphoric effects. We know young people are sleep deprived,” Malison added. “It’s fertile soil for the use of stimulants to plant themselves in. Mood changes evaporate on stimulants.”
When we lose sleep, our cognitive performance declines, said Dr. Vahid Mohsenin, director of the Yale Center for Sleep Medicine. Malison said some of the positive effects these stimulants have on cognitive function would likely be far more modest if users were sleeping enough in the first place.
The one time Rachel took Adderall, she experienced some of the euphoric effects Malison described.
“I was just intensely content and happy; I felt like everything was going to work out,” she said. “[When sober] I realized it was a fake, temporary feeling.”
But Rachel found herself crashing by the time of her final and had to drink two cups of coffee in the morning to stay awake. The exam didn’t go well, and she felt unable to eat or function normally for the rest of the day before passing out at 6 p.m. Looking back on the experience, she’s not at all sure that taking the drug had helped her study more than she would have on her own.
“At the time I was like, ‘Wow, I definitely need to take this all the time!’” she said. “After, I was like, ‘No way. I don’t want to do that to my body ever again.’”
***
So, to recap: the less you sleep, the more likely you are to resort to stimulants, such as amphetamines, and the more likely you will be to experience positive effects from taking them that can then lead to addiction — and which you might not experience if you had just slept more in the first place.
So why aren’t we just sleeping more?
Different animals sleep very different amounts, Mohsenin said. Horses and donkeys only need to sleep for about 3 hours a day. Large cats do about 16.
“Humans have been programmed for 7 to 8 hours,” Mohsenin said. “It’s all hard-wired.”
That is about one third of all of the hours we have each day. That means we’re supposed to be spending a third of our lives asleep, which sounds a little excessive. And four students interviewed agreed that at least part of what’s keeping us awake isn’t papers or problem sets: it’s FOMO, or fear of missing out.
Kevin Ho ’12 SPH ’13 said everyone at Yale loves sleep. But when it comes down to it, they just value other things more. According to the News survey, 60 percent of students sleep an average of 6 hours or less per night.
“The opportunity cost of sleeping at Yale is higher than at other places.” Ho said — there’s just so much else to do with your time. “We have the rest of our lives to sleep.”
And anyway, we are young! We’ll bounce back! And we all like to have a good battle story or two at the very end of the year. Last semester, I took five exams and turned in a term paper in the span of four days. On day five, I took a two-hour final about fish after sleeping two and a half hours. I later described the experience as both “harrowing” and “epic.”
Mohsenin said that a normal sleep pattern would mean that our internal sleep-producing forces are aligned with the external cycles of light and darkness. When these fall out of alignment, a range of things can happen, including increased insulin resistance—which is what leads to diabetes—and increased risk for stroke.
But sleep remains one of the few things we are collectively not that afraid of missing out on.
Science is telling us we’re wrong, but Science also tells us a lot of things. Whether wine/chocolate/tobacco/organ meat are recommended to us as healthy or carcinogenic can vary wildly from one decade to the next, and we don’t always listen. We’ve all heard the new studies saying the brain doesn’t finish developing till well into our 20s, that we shouldn’t be binge drinking so young. Many of us just don’t seem to care.
***
I remember hearing a particular verse read during Wednesday Lenten services at my Russian Orthodox church back home. It turned out to be Psalm 127:2, and of all the verses intoned by candle-light, it’s the only one I can recount almost from memory: “It is in vain that you rise up early and go late to rest, eating the bread of anxious toil; for He gives to His beloved sleep,”
Of course, if you look through the Bible hard enough, it seems you can find instructions telling you to do pretty much everything (lots of stoning to death).
In offices at the Joseph Slifka Center for Jewish Life, I asked for interpretations from two people who have spent considerably more time studying the text than I have: Rabbis Noah Cheses and James Ponet ’68. Cheses is young and soft-spoken. Ponet has gray hair but a lively and intense manner of speaking. He said he would offer me tea if he had more time.
Ponet explained that part of the idea of the “ever-watchful God” is that it gives us, people, permission to go to sleep. But especially in ego-driven environments like Yale, it’s hard to let go of the idea of constantly exerting control over bodies and minds.
“We feel a certain shame at limitations; we seek to show we aren’t bound by them,” Ponet said. “Sleep seems to be a thief that steals time.”
When the promise of control provided by caffeine didn’t work out for Lu, she had to come to terms with the fact she couldn’t push herself infinitely. She said that learning her own limits has been a college-long struggle for her, one that’s ongoing. “[By using stimulants] people think they can control nature and not subject themselves to the limitations of physiology, of their humanness,” Cheses said. “It’s the illusion of control.”
Ponet thinks there is room for us to think of sleep as more than just a physical weakness to be overcome. He linked the origin of the expression “I’m going to sleep on it,” to the sayings, “I’m going to pray on it,” or “I’m going to give it to God,” explaining that they all point to the fact that there are some things we can only understand with the unconscious mind. He also cited the many instances of revelatory dreams to be found in the Bible.
“There’s a connection between effort and attainment of truth in life,” Ponet said. “But that’s not always the case. There are gifts, miraculous insights. There are times exhaustive efforts prevent us from seeing what’s there already.”
On some special days in the Jewish calendar, one is asked to stay up all night long learning and studying the Torah. Cheses said these practices originate from around the time when coffee began to spread out of Northern Africa during the 15th century. But such celebrations are viewed as “exceptional evenings, when you’re intentionally going above and beyond nature,” he said. From a pastoral perspective, he counsels students to sleep.
“When they don’t sleep, they don’t have full access to their emotions, and they make dumb decisions because they are not fully aware of themselves,” Cheses said.
Ponet admitted, though, that he does find something special in the experience of being up and lucid at 11, 12, 1, 2.
I know what he means. Even in my insomnia years, I sometimes felt the exhilaration of being awake and reading long after midnight. It meant hearing things no one else around was hearing, being the only one to see and notice all the different kinds of darkness. Right up until this year, I wouldn’t take back any of the all-nighters I’ve pulled, however reluctantly.
But sleep has never been the enemy for me. Until, suddenly, it was. This semester, I planned my schedule knowing there was no way I could get more than 6 hours a night for most of the week, and would often have to make do with less. What worries me is that that this didn’t concern me. Since I came to Yale, I have gone from thinking of sleep as something with obvious, intrinsic value to seeing it as an inconvenience at best.
Common phrases like “I’ll sleep when I’m dead,” make us think of sleep as opposed to life. Sleep is not-doing. When we sleep, we give up acting on ourselves and on the world around us. We wake up with nothing tangible to show for it, except, hopefully, a reduction in the amount of adenosine floating around in our brains.
We won’t always live by semesters, with papers and p-sets to make us stay up. Yet 90 percent of us will go on drinking caffeine daily. And I think part of it has to do with the way we view sleep, and our bodies: as tools to control instead of to take care of, by drinking a cup of something or by taking a pill.
Red Bull says no one ever wishes they had slept more in college. It’s up to us to decide whether we’re going to believe them.
***
I wrote almost this entire article after midnight on a single night. When my friend went to G-Heav at around 2 a.m., I made a decision, and asked him to bring me a cup of coffee.
I could instantly taste the difference. It was sharper, more metallic than the decaf I’d been having for my entire life.
Within 20 minutes, I no longer felt like I was going to fall asleep, and I didn’t crash for a good few hours after drinking less than half the cup. So unlike Lu, I know it works for me now. I also felt surprisingly cheerful, more optimistic. I stayed focused for three more hours, but found myself more hung up on small details of word choice and grammar, however hard I tried to force myself to look at the big picture.
I also started to feel other things. I became weirdly, intensely aware of my heartbeat, which seemed to be getting faster and faster. My hands were shaking. After a while, everything was shaking. Still, I couldn’t believe how awake I was. I began to question why I hadn’t been doing this all along. I also thought about how, if I did choose to start drinking caffeine, I would probably never feel it quite like this again.
I thought of something Kober had told me. The other things it’s possible to experience when you take stimulants, such as increased jitters and anxiety, aren’t really side effects. They are just other effects. Stimulating our central nervous systems might mean less sleepiness, but it also means more of everything else, whether we want it or not. As Huang put it, I felt “really intense.”
Around 5:30 a.m., the effects began to wear off. I was surprised to find out it was light outside.
