November 2, 2007
Daylight Savings Time and Your Internal Clock
Slate.com has an interesting piece on the impact of daylight savings time on your overall well-being:
This week, Dr. Sydney Spiesel discusses the disruptive effect of daylight-saving time on the body's internal rhythms, . . .
Question: After midnight next Sunday, the clocks where you live will move backward by one hour to shift an hour of daylight from afternoon to morning over the next four winter months. You will share this experience of daylight-saving time with about one-quarter of the people on Earth. What happens to your body's internal clock when it is suddenly reset by society's clock?
Context: The body's daily cycle of activities—the circadian rhythm—determines when we are sleepy and alert, when we want to eat, and even when we produce less urine so our nighttime sleep will be less interrupted. Though there is a spectrum of preferences, from "larks" to "owls," the internal clocks that set our circadian rhythm are mainly regulated by the time the sun rises. (Here's how to figure out which kind of bird you are.) We are not consciously aware of this dependency, and our time of awakening is often affected by external forces, like the need to get to work on time. Chronobiologists, the scientists who study our internal clocks, correct for these effects by comparing awake and asleep times on work days and free days. They have found that the relationship between the arrival of dawn and the midsleep point—the time halfway between the moment you fall asleep and the moment you wake up—remains constant, even as the time of sunrise changes when the length of the day varies with the seasons.
Study: A new German study uses this predictable relationship to study what happens to our internal clocks when the external clocks jump an hour forward or backward. Drawing from a database of 55,000 Central European subjects who submitted daily sleep records, they showed that the normal correlation between dawn and the sleep cycle becomes disrupted during the transition to daylight-saving time.
Findings: In an effort to clarify whether this change was due to the changed clock or to some other phenomenon, the authors zeroed in on the sleep-wake and activity cycles of 50 people during the weeks around the spring and autumn leaps forward and back. They found that the spring institution of daylight-saving time was exactly the moment when the coming of dawn disconnected from the body's sleep-wake cycles. When standard time returned in the autumn, the body's circadian rhythm again linked itself to the time of sunrise.
Conclusion: Practically speaking, what does this mean? If, as some recent research has suggested, sleep and psychiatric illness may be closely tied, perhaps the sleep disruptions associated with time changes might affect the incidence of psychiatric disease during the transition periods. An early study suggested that this was, indeed, the case; more recent research on patients with depression casts doubt on the association. There is clear evidence of a spike in car accidents associated with the spring transition to DST and the fall transition back to standard time. I am tempted to think that disturbances in circadian rhythm are the cause.
Enjoy that extra hour of sleep!
Immigration and Uninsured Rates
Ezra Klein posts a nifty chart showing the rate of uninsured over the past few years. The chart debunks the notion that the uninsured rate has increased due to immigration issues. He writes:
You occasionally hear conservatives argue that the problems of the uninsured in this country are entirely due to immigration. No immigrants, no increases in the uninsured. I've shot this point up before, but EPI helpfully graphed the debate, showing what would have happened to the population of the uninsured had immigration been frozen in 2000.
As you can see, freeze immigration and the 2.1% increase in the uninsured population becomes a...1.9% increase in the uninsured population. Which equals out to 5.7 million more Americans uninsured.
November 1, 2007
Evaluations of the Candidate's Health Care Plans
Matthew Yglesias writing for the Altantic.com examines the National Journal's evaluation of the Presidential Candidate's health care plans.
It's true, of course, that when the crazy kids downstairs at National Journal put together a bipartisan group to evaluate the presidential candidate's health care plans that the results showed the Democrats' plans to be good, whereas the Republicans' plans are bad. More telling, though, is actually the specific nature of where the different plans did well. This is especially true because in some respects the categories appear to have been gerrymandered to make the total scores less embarrassing for the GOP. . . .
He does a nice job discussing the various ways the health plans would impact quality of care, employers, access and more. He concludes,
All of these proposals are vague in some key respects, and nothing that's proposed on the campaign trail is going to be enacted as is by congress. But these plans show something about the values and priorities of the different parties. Republicans, basically, are looking to make sure that the federal budget contains as much headroom as possible for tax cuts for high-income and high-wealth individuals while minimizing financial burdens on large employers. Democrats, by contrast, are looking to improve the quality and accessibility of American health care.
Commercial for Health Insurance
Ezra Klein finds a funny ad for health insurance - boy those marketing people sure know how to sell their product. By the way, I just hope the man, whose injury is discussed in the commercial, did not have some sort of pre-existing injury that would lead to a denial of coverage . . . . Click here.
Number of Uninsured Americans Increases
What a surprise and a not-so-nice news story to start November - Reuters reports:
The number of Americans lacking health insurance rose by nearly 8.6 million to 47 million from 2000 to 2006, with children and workers from every income level losing coverage, a new report said on Thursday. The increase was "driven primarily by the continued erosion in employer-provided health insurance," said the report by the Washington, D.C.-based Economic Policy Institute.
In 2006, 2.3 million fewer Americans received health benefits from their employers than in 2000, the report said, noting the decline does not take the population increase into account. Nearly 60 percent of the nation's children are covered by the insurance provided by their parents' employers, but 3.4 million fewer children had benefits in 2006 compared with 2000.
"Public health insurance is no longer offsetting these losses," said the report by the nonpartisan think-tank. For jobholders, this was the sixth straight year of declines in health insurance coverage. The rate fell to just below 71 percent from nearly 75 percent in 2000. "No category of workers was insulated from loss of coverage," as even workers whose earnings placed them in the top quintile saw coverage rates fall, the report said.
More men lost employer-provided health benefits than women. For men, the rate fell by almost 5 percentage points in the six-year period to 69 percent. For women, the rate fell just under 3 percentage points to nearly 73 percent.
October 30, 2007
Responses to Medical Mistakes
The New England Journal of Medicine published a commentary recently concerning the emotional toll of medical mistakes - both on family members of the loved ones injured by the mistake and by the doctors. The New York Times ran a brief piece on the commentary and an upcoming documentary about medical mistakes this past weekend.
The New England Journal of Medicine tackled the [emotional toll of medical mistakes] issue yesterday in a moving commentary called “Guilty, Afraid and Alone: Struggling with Medical Error.’’ The writers, Dr. Tom Delbanco and Dr. Sigall K. Bell of the Harvard Medical School, note that while the medical community has focused largely on reducing error rates, hospitals also need to address the “human dimensions” of treatment blunders and to assist in the emotional recovery of patients and families.
The doctors, who are making a documentary film on the subject, talked to numerous patients and families affected by medical errors. The authors found that family members often feel guilty for not having protected loved ones from the caregivers’ mistakes and that many feared retribution if they did complain. And Dr. Delbanco and Dr. Bell note that physicians who err often shut out patients and their families, “isolating them just when they are most in need.’’
When mistakes happen, relatives often berate themselves for not keeping close watch on their loved ones. In one case cited in the commentary, the family of a man with sickle cell anemia repeatedly warned health care workers not to administer morphine. But somehow it happened anyway, sending the man into kidney failure and a coma. “The feeling was impotence, because you can’t stay with a patient 24 hours a day,’’ said his sister. “That’s why you rely on hospitals — you rely on nurses. You feel like you failed your family in terms of ‘I should have been there.’ That’s a guilt that everyone shares.” . . . .
Several family members said that they simply wanted their doctors to talk to them and to explain how the mistake had happened. “What we needed was for someone to reach out and connect with us in human terms,” said one. “The sense that somebody could empathize and know what I was feeling . . . that was almost totally lacking.”
The authors note that honest and direct communication are often the “best antidote” to flawed treatment. Patients and families also want to know that some good has come out of these mistakes, and that the event has taught both caregivers and their institutions.
Psychiatric Advanced Directives (PADs)
The Wall Street Journal's Health Blog reports on a recent development in the area of advanced directives:
Psychiatric advance directives, or PADs, are legal documents that patients can prepare to state in advance of an acute psychiatric crisis what medications, hospitals and other treatments they would prefer or like to avoid.
Twenty-five states have laws allowing PADs. In North Carolina, a sample form includes such items as preferences about electroconvulsive therapy, or ECT, and tips for medical personnel on how to minimize the use of restraints or seclusion. A model form in Texas lays out details on a patient’s consent, or lack of it, for specific medications. A Michigan form guides a patient in legally designating a personal advocate in case of crisis.
But how are PADs actually used? And what happens if, in the breach, a doctor’s judgment clashes with the stated wishes of the patient? The Health Blog asked medical sociologist Jeff Swanson (pictured) from Duke University, who’s been active in research on mental health policy and treatment options for people with serious mental illness.
First, Swanson laid out a key difference between the advance directives for psychiatry and those typical for medical care. A living will focuses primarily on “forgoing unwanted treatment,” Swanson said. “The goal of the psychiatric advanced directive is to [help you] recover. You’re trying, in a way, to protect yourself from decisions you might make when you’re ill.” . . . .
Though PADs are legal documents, most state laws on the subject contain override clauses, Swanson said. In a crisis, a doctor can invoke his or her clinical judgment to act in the best interest of the patient, essentially ignoring the PAD. Empirical data are hard to come by. But “clinical experience and anecdotal reports suggest that overrides occur with some frequency,” according to a commentary Swanson published last year in the Journal of the American Academy of Psychiatry and Law.
October 29, 2007
Surgeon General Recess Appointment?
ThinkProgress reports that President Bush's surgeon general nominee, Dr. James Holsinger may receive his position through a recess appointment.
President Bush’s Surgeon General nominee James Holsinger appeared before the Senate health committee on July 12, forced to defend his controversial positions on homosexuality. Yet three months later, Holsinger is “no closer to becoming the nation’s next surgeon general.”
ThinkProgress today spoke with a spokesperson for chairman Edward Kennedy (D-MA) who said the committee still has not received a response to a follow-up questionnaire it sent Holsinger three months ago:
We sent out the questions on 7/26 and requested that they be returned by COB on 8/10. We have not received the answers and there is no Committee action scheduled at this time.
Holsinger’s lengthy delay indicates that Bush may be angling to recess appoint Holsinger. The Louisville Courier-Journal reports:
The committee must vote before the full Senate can consider the nomination, and senators are hoping to adjourn for the year by mid-November.
The delay leaves open the possibility that Holsinger will either have to wait until next year for a confirmation vote or get the job through a “recess appointment” by Bush. […]
A recess appointment would allow Holsinger to serve as surgeon general until the end of the current Congress late next year. . . . .
Holsinger has come under intense criticism for his long history of prejudice toward gays and lesbians. He founded a church that “ministers to people who no longer wish to be gay or lesbian” and “opposed a decision to allow a practicing lesbian to be an associate pastor” in the United Methodist Church. In 1991, he also authored a graphic document arguing that gay sex is “intuitively” unnatural and can lead to “lacerations, perforations and deaths.”
Autism Screening Recommended
The Associated Press reports that the American Academy of Pediatrics is recommending that all children be screened for autism twice by age 2. The AP reports,
The advice is meant to help both parents and doctors spot autism sooner. There is no cure for the disorder, but experts say that early therapy can lessen its severity.
Symptoms to watch for and the call for early screening come in two new reports. They are being released by the American Academy of Pediatrics on Monday at its annual meeting in San Francisco and will appear in the November issue of the journal Pediatrics and on the group’s Web site. . . . .
The academy’s renewed effort reflects growing awareness since its first autism guidelines in 2001. A 2006 policy statement urged autism screening for all children at their regular doctor visits at age 18 months and 24 months. . . . .
“With awareness comes concern when there doesn’t always need to be,” he said. “These resources will help educate the reader as to which things you really need to be concerned about.”
Another educational tool, a Web site that debuted in mid-October, offers dozens of video clips of autistic kids contrasted with unaffected children’s behavior. That Web site is sponsored by two nonprofit advocacy groups: Autism Speaks and First Signs. They hope the site will promote early diagnosis and treatment to help children with autism lead more normal lives.
The two new reports say children with suspected autism should start treatment even before a formal diagnosis. They also warn parents about the special diets and alternative treatments endorsed by celebrities, saying there’s no proof those work.
Interview and Job Talk Advice
Concurring Opinions' Daniel Solove has a great piece on how to prepare and give a terrific job talk. Here is some of his advice:
The first thing is to understand your audience. Here's my perspective as a member of your audience. Your job talk is taking place during the middle of my day. I'm busy. I've got a ton of things to do, classes to teach, papers to work on, emails to respond to. I'm not coming in eager and excited to give my valuable hour to some unknown person plucked off the street after a 30-minute interview at the meat market. So you've got to work to get my interest and make that hour an interesting part of my day. That involves getting out your thesis quickly, making an interesting argument, and then having a good discussion with the faculty.
Sounds easy, right? You wouldn't believe how many fail at doing these basic things. I've seen countless candidates crash and burn during their job talk. It's like reading a Kafka novel -- things start out bad, and then they get much worse, and then you die.
Here is what I'm looking for in a job talk:
1. Were you able to articulate a coherent thesis? Your talk must have a point, and the point of your talk should be stated towards the beginning.
2. Was the thesis of your talk original and not an obvious point? I should not be saying "duh" to myself throughout your talk.
3. Were you able to defend your thesis?
4. Did you recognize the arguments on the other side of your thesis?
5. Was your talk interesting and engaging?
6. Were you articulate and clear? If not, I might have doubts about the clarity of your thinking as well as about your ability to explain concepts to students in a class.
7. In the Q&A, did you respond well to the faculty's questions?
8. If a question posed a severe challenge to your thesis, were you prepared to address it?
9. Did you demonstrate adequate command of your topic? I expect you to be familiar with the literature and cases on your topic.
Professor Solove provides further helpful tips as well.