Archive for August, 2012

Sleeping Our Way to Lower Healthcare Costs

When I say sleeping, I actually mean sleeping.

But first, a story:

A few years ago, I spent some time working with a company that had attempted, with less success than they would have liked,  to turn around and operate failing public schools on a for-profit basis.  Leaving aside basic business model issues, neither they nor anyone else has cracked the code on how to systematically deliver superior education results.  (Not quite true.  KIPP charter schools consistently delivers great results, but at the cost of teacher burnout.  Their teachers last an average of just two years).

Around that time, I came across research showing that children who eat a nutritious breakfast every day perform better in school than those who don’t.  Shocker, that.  I can’t find a citation for it, but I recall the impact being about one grade level – C’s turn into B’s and B’s into A’s.  I also encountered the work of Harvard Medical School psychiatrist John Ratey, who studies the impact of exercise on the brain (Spoiler Alert: it’s good).  Ratey, whose research includes a junior high school near me, has found that a half-hour of vigorous exercise in the morning alleviates depression as well as Prozac, scares the crap out of ADHD, and facilitates the production of new brain cells and connections, which improves learning.  Like breakfast, the academic impact turns out to be. . .wait for it. . . about one grade.

That got me to thinking – maybe we’ve been going about this education thing all wrong.  Perhaps we should forget about trying to perfect the curriculum, the instruction, the leadership and the school management models.  Maybe we should just bring those kids in, feed ‘em a big bowl of oatmeal, take ‘em out to the playground and run ‘em hard for half an hour.  Poof!  Two grade levels of improvement.  Take that, Taiwan!

What about the kids who can’t run fast?  Hey, this is America.  We leave no child behind.

It is in this spirit of heavy-duty problem-solving that I turn again to healthcare.

LinkedIn sends me lots (too much, actually) of interesting stuff these days.  One such was a recent blog post by Boston Globe columnist Tom Keane.  In it, he recounts how his father, during a recent stay at Beth Israel hospital, was actually allowed to sleep through the night, which Keane said made a big difference in Dad’s return to health.

His post resonated with me.  My first experience as an overnight guest in a hospital was about eight years ago.  I had gotten some mystery infection that got into a lymph node, which then had to come out.  That required what amounts to hernia surgery (getting a little personal here, I know), followed by a drip feed of every antibiotic known to man because they couldn’t figure out what the infection was.

The surgery itself was no big deal (I went skiing 2 weeks later), but the in-hospital recovery was an exercise in sleep deprivation (something the military describes as an “enhanced interrogation technique” so they don’t have to call it “torture”).  It wasn’t just the beeping equipment.  It was nurses waking me up every four hours to check my vital signs.  It was the pain management guy bursting through my door at 6:00 AM.  “Hi!  I’m here to see what we can do about your pain!”  “I don’t have any pain.”  “No pain?”  “No pain.  Get out of here.  And next time, please ask somebody if I’m in pain before you knock down my door.”  It was the food service people bounding in unannounced to serve me a breakfast I didn’t want at an hour when I wouldn’t have eaten it even if I wasn’t in the hospital.  And on and on and on.

After three days and nights of this, I negotiated a deal with my doctor and my nurse.  I got the doctor to prescribe an Ambien.  I asked the nurse to give it to me at 10:00 PM, and to wake me up in order to give it to me if she had to (she didn’t).  I also got her to agree to give me six hours between vital sign checks.  So I got six hours of uninterrupted sleep.  I woke up feeling so much better that they discharged me pretty much on the spot.

Ironically, I got home to find a big article in the Sunday Chicago Tribune explaining how important it is for hospital patients to sleep, and how bad hospitals are at allowing that to happen.  The link above is to the actual article published in 2004.  When I searched for it, I discovered that this issue has been covered in the Trib at least three or four times since.  The healthcare value of sleep, it seems, is not much of a secret.

Hospitalization accounts for 30% of the $2 trillion we spend every year on healthcare every year.  I figure a decent night’s sleep would have taken at least one day off my four-day hospital stay, maybe two.  25-50 percent.  Let’s split the difference and call it a third.

So here’s my big idea.  While the healthcare debate rages on, and it’s not going to stop raging anytime soon, how ‘bout we save ourselves $200 billion a year by just letting the poor patients get a little shut-eye?


2.5 More Random Thoughts

OK, I’m not even going to try to apologize for the short interval between my last post and this one.  A few quick thoughts, one that I should have included in my last post, one that’s an update on an item mentioned there, and one that’s new.

Should have mentioned last time:

One of the great stories of the just-completed Olympics is that a bunch of athletes complained that a competitor who is an amputee and runs on two prosthetic legs would have an unfair advantage over them.  That’s right. . .an ADVANTAGE.  It wasn’t long ago that we took it for granted that prostheses slowed people down.  If this isn’t a testament to science and engineering, I don’t know what is.  And the runner in question, South Africa’s Oscar Pistorius, doesn’t even look like Lee  Majors.

The real Six Million Dollar Man

Update from last post:

A grand total of one of my loyal readers clicked through to see The New Yorker article on the history of the debate over the right to gun ownership in America (that’s right, I can see what you do).  For everyone else, here’s the most interesting revelation in that article.  Apparently, from the adoption of the Bill of Rights until the mid-1960s, it was widely accepted that the Second Amendment established a collective right to gun possession specifically in relation to the state’s interest in maintaining a militia for the common defense.  Only in the mid-60s did it start to be interpreted as an individual right.

You might wonder who started that transition.  The NRA?  Nope.  A bunch of camo-clad militiamen in Montana or Michigan?  Nope.   OK, then, who was it?  The Black Panthers.  According to the article, the Panthers made the right to arm themselves part of their platform, and the extension of the Second Amendment to individuals became part of the 1960s “Rights Revolution.”  So what’s become a touchstone of what we now call conservatism got its start about as far to the left as you can get.  Go figure.

Enough silliness for now.  Next time, we’ll discuss sleeping our way to lower healthcare costs.

Random Thoughts – From Pleasure Centers to (Wannabe) Presidents

OK, I know I promised that I wouldn’t post more than once a week.  I’m far too polite to say “Bite me.”  I had these thoughts rattling around in my head, and they had to go somewhere.

Harvard on pleasure centers

Every week, I get an email newsletter called HBS Working Knowledge from my graduate alma mater, the Harvard Business School.  It’s mostly a summary of emerging faculty research.  Recently, it arrived with an article that began like this (italics added):

“In the early 1950s, two scientists at McGill University inadvertently discovered an area of the rodent brain dubbed “the pleasure center,” located deep in the nucleus accumbens. When a group of lab rats had the opportunity to stimulate their own pleasure centers via a lever-activated electrical current, they pressed the lever over and over again, hundreds of times per hour, foregoing food or sleep, until many of them dropped dead from exhaustion. Further research found pleasure centers exist in human brains, too.”

Yes, this is from the Harvard Business School.  I sure don’t remember a sex-ed class when I was there.  I’m certainly grateful to know that the pleasure center is “deep in the nucleus accumbens”  I always thought it was elsewhere.  And although electricity sounds decidedly unpleasant to me, based on what my parents told me, I would have thought those poor rats might be in danger of going blind, but not dying.

Who’s really in charge at Penn State?

Of all the ugly revelations about Penn State over the past year, the one I find most surprising is that the university is not, as I had always thought, a state school.  Turns out that it’s run by the Catholic church.

A remarkable kid with a heart for others

Here’s a terrific Chicago Tribune article about a remarkable child.  He’s the son of one of the musicians killed in the Rhode Island night club fire nearly a decade ago.  That event preceded his birth.  What he’s doing as the result of an experience he didn’t even have is exceptional.  He’s nine years old.  How do children get such perspective and wisdom at such a young age?

Regarding my last post (too many guns in the hands of people who shouldn’t have them. . .)

When I went to the Tribune website to find a link to the article mentioned above, I found this on the home page:

Those are the headlines from one day in one American city.

I was going to point you to a Time Magazine opinion piece on this subject by Fareed Zakaria until I discovered that he has been suspended by Time and CNN for plagiarizing most of it.  The article from which he ‘borrowed’ (shamefully and shamelessly) appeared in The New Yorker last April, and you can read it here.

It’s not a quick read, but if the issue is important to you, whatever side of it you may be on, I encourage you set aside the time to read it, especially for its enlightening history of the debate over gun rights in America.

Romney chooses Ryan

The addition of Paul Ryan to the presidential campaign certainly will liven things up.  Whatever you may think of Ryan’s principles, at least he has some.  This is now another race in which the vice presidential nominees are much more interesting (or, in Biden’s case, at least entertaining) than the guys who picked them. . .shades of Cheney vs. Lieberman.  Ryan is polarizing, and my guess is that he will wind up hurting Romney more than helping him.  But his presence will ensure that there is some actual content in the campaign, and I’m glad for that.

Ryan’s most controversial proposal is that Medicare should be turned into a voucher system.  I’ve said many times that I believe we will inevitably wind up with a single-payer system and that efforts to make what is inherently not a market behave like it is a market are a waste of both time and money.  That puts me squarely on the opposite side of the issue from Ryan.  I would love to be proven wrong about this.

Sacred Texts and Shotguns

A couple of weekends ago, my friend Tim Padgett took me out to shoot sporting clays.  This is roughly a cross between skeet shooting and golf.  You walk through the woods and stop at 14 stations, each of which has two hidden trap machines that toss clay targets in the air.  You get three or four cracks at each station, 100 shots in total.

This is only the second time I’ve exercised my Second Amendment right, and the first in more than 30 years.  I came away with a smile, an enormous bruise on my left shoulder and a score of 11/100, which is so far below “You Suck” that they don’t even have a name for it.  Those poor clay targets clearly had a lot more to fear from the ground than they did from me.  Killer Earth!  Killer Earth!

Time to be serious, though. My friend Tim is incredibly safety-conscious, and I felt completely comfortable wandering around a field full of people who were armed and loaded for bird.  Not a Dick Cheney in sight.  But I had this experience a week after a madman shot up a movie theater in Colorado and a week before another madman shot up a place of worship in Wisconsin.  It’s hard not to think about that.  I can’t be the only one wondering what these nutcases (I refuse to describe them as “alleged nutcases”) were doing in possession of firearms.

I had the privilege of seeing our sacred national texts, the Declaration of Independence and the Constitution a few years ago.  They are faded, withered and incredibly profound.  (And no, the National Archives don’t look like what you saw in National Treasure.)

The founders did an extraordinary job of creating a framework that has proven adaptable to an evolving world.  But when the Constitution was written, the available weapons were muskets and pistols, both of which fired single shots and took about 15 seconds to reload.  They were notoriously inaccurate because they fired round balls.  Rifling hadn’t yet been invented.

Fast-forward 225 years.  One of the weapons James Holmes used in Colorado was an AR-15, which is the civilian precursor to the M-16.  This is a semi-automatic .22 caliber assault rifle.  “Semi-automatic” means it fires as fast you can pull the trigger.  Holmes had a 100-shot magazine.  The combination of the AR-15’s small ammunition and high muzzle velocity causes the bullets tumble on impact, which enables a relatively small and light weapon to do extraordinary damage to the flesh at which it’s aimed.  (For a full discussion of what went right and wrong with this weapon, see James Fallows’ extraordinary 1980 book National Defense.)

The standard rationale for Holmes’ right to own this weapon is that an armed populace is the last line of defense against an oppressive government.  That argument is preposterous in an age in which the real military has nuclear weapons, tanks, and drones that can both spot and hit the rear end of a mouse from 30 miles away.  It also is not supported by the Second Amendment itself, which reads:

A well regulated militia, being necessary to the security of a free state, the right of the people to keep and bear arms, shall not be infringed.

The reference to militia doesn’t mean “a bunch of nut jobs in the mountains of Idaho preparing to stop the totalitarian assault.”  It means that the founders wanted farmers to be armed in case THE COUNTRY needed to raise an army in a hurry.

And by the way, we already have laws that infringe on the right to keep and bear arms.  What else would you call a background check and a waiting period?  Yet those laws have proven stunningly ineffective at keeping powerful weapons out of the hands of crazy people.

It should be shocking that in the wake of these two recent massacres, there has been no outcry whatsoever for some limitation on the right to gun ownership, nor even a call for some debate about it.  In fear, I suppose, of the NRA, our courageous current leaders and the equally courageous people who would replace them have fled in the opposite direction.  We’ve gotten used to these shootings, have learned to accept and even expect them.  The guy who shot up Virginia Tech killed 32 people.  Can you name him?  I can’t.

We place limits on our civil liberties all the time (see “Patriot Act”), but this particular liberty has become a third rail – completely off limits.  This amounts to a form of religious extremism.  Fundamentalism starts with a narrow and excessively literal reading (or misreading) of sacred texts, which is then used to justify the unjustifiable.  How else to describe our slavish adherence to an outmoded expression of the right to armament?

I don’t pretend to know where the line should be.  My friend Tim certainly should be able to shoot clay targets out of the sky.  I should be able to go along and miss them.

But it seems like we should be able to agree that it would be a good idea to keep firearms and the insane apart, and that we should both want and be able to have a conversation about what tradeoffs we might accept in order to make it safe, or at least safer, to go to the movies, to temple, to church, to college, to high school.

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August 2012
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