Blogs / Cosmic Variance

Last night, watching a recorded episode of the Daily Show from last week, where Jon Stewart interviewed Elizabeth Edwards, Stewart took the conversation in the direction of health care. At one point, Edwards mentioned that “the President of UnitedHealth made so much money, that one of every $700 that was spent in this country on health care went to pay him.” I was totally floored by this statistic - could our for-profit health insurance industry be that twisted?

So here are some facts. In 2007, according to HHS, total health care expenditures in the US were $2.2 trillion, and expected to grow at a steady 6.1% to $2.33 trillion in 2008. Others, like the National Coalition for Health Care, estimate that in 2008 it was $2.4 trillion, fairly close. Now, 1/700 of that is $3.4 billion, which is actually a thousand times larger than Stephen Hemsley, the CEO of UnitedHealth Group, makes.

So was Elizabeth Edwards wrong? Turns out, she might have been referring to UnitedHealth’s former CEO, Willim McGuire, who was ousted in late 2006 after an options backdating scandal. McGuire made $125 million in 2005. That’s a mere 1 in every $20,000 spent on health care I guess. Taking into account the stock options he sat on, it might bring the ratio down…but I must conclude that there was some hyperbole on Edwards’ part.

I forgive her, mainly because this isn’t the point. What I find truly impossible to accept is that we have a for-profit healthcare insurance system at all. As I have pointed out in the past in CV, this seems to me to be one of the clearest conflicts of interest that you could devise: reward health insurance companies and their shareholders for giving as little actual health care as possible for every dollar received. What other way is there to maximize profits? Oh, right, I almost forgot: keep the costs of health care rising so that this industry grows out of control as a fraction of GDP.

The system where we rely on our employers to provide health care coverage is broken. The rising costs have driven some employers, like the big automakers (who spend more on healthcare than steel) to the brink of bankruptcy, and have driven others to continually pare back the level of coverage for their workers. Underinsurance is as serious a problem as the nearly 50 million not covered at all. Should the particular disease you get wipe you out financially just because it’s too rare a situation to be covered by your plan? Should companies and their shareholders be making profits while our loved ones are being denied treatment? Or even denied coverage at all due to a “pre-existing condition”?

The health care companies have realized that change is coming, quite possibly in the form of a government-run alternative plan with much smaller administrative costs and no profit motive. A report appeared recently in The Washington Post that Blue Cross Blue Shield is launching a large PR campaign against the possible government-sponsored public insurance option. In addition, the health cartel has put forth a plan a couple weeks ago promised to reduce the rate of growth of costs by 1.5%, to about 4.5% presumably. Whoopie.

The right wing is fearful of rationing, long waiting times, or being unable to choose a doctor. The problem is that they simply don’t seem to give a hoot about the 50 million un(der)insured, who wait until they are terribly ill and then show up in ER’s. Guess who pays for that.

Another huge factor in the exorbitant cost of health care in the US is a topic that seems to be very seldomly discussed in the media: the end of life. Something like 27% of Medicare costs go to the last year of a patient’s life. How much of this is simply due to the fact that the patient, and their family, wants to try anything possible to achieve a cure, when in fact the doctors and the nurses know full well that the patient is terminal? Greater emphasis on counseling patients and families, plus a change in our culture that would make us more accepting of death, and an increased focus on preventative and palliative care rather than heroic but clearly futile and expensive late-stage treatments could save our society hundreds of billions of dollars per year.

I am not saying that no one should make a profit performing or delivering health care. Doctors, nurses, hospitals, medical suppliers do what they do to make a living. (Let’s leave Big Pharma out of it for a moment - that deserves a whole post by itself.) What I *am* saying is that no one should turn a profit by adding an unnecessary and bloated layer of bureaucracy. As Donald Cohen pointed out in March at the Huffington Post, the for-profit players are crying foul at Obama’s plan, essentially for a government-run Medicare-like option, because they don’t want the competition. As Cohen points out:

Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. There is big money to be made in health insurance. The top 7 “for profit” health insurers made a combined $12.6 billion in 2007– an increase of 170.2% from 2003. The same year, the average CEO compensation package for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million.

Government-sponsored single-payer healthcare, which succeeds admirably in many other countries around the world, is probably not a realistic possibility in the US. I think that the next best thing in the long run is that an array of private, not-for-profit companies like Kaiser Permanente could run the for-profits into the ground. The government can encourage the non-profits in any number of ways, with little cost to taxpayers. One way or another I hope that Congress and the Obama administration can create a viable option for the 50 million uninsured, soon.

Access to quality health care should be a basic human right in a civilized, technologically advanced society like the US. It has become our greatest shame in the world that we cannot provide that for one in six of our people.

I am going to go out on a limb here and write about a subject that I know next to nothing about. But that’s part of the problem…

Imagine the sensation it would cause in the news media: a new disease appears in the US, killing hundreds, then thousands, then tens of thousands per year. The death rate closes in on 100,000 people per year. People are terrified, the medical community launches a massive campaign to control and eradicate the new pestilence, the federal government creates a new bureaucracy, a special arm of the CDC to deal with this growing death toll.

Here’s the weird thing. It’s here, and we may well top 100,000 dead per year soon in the US. There is no media outrage, no massive federal programs, and precious little available public information at all about it.

The disease? MRSA: methicillin-resistant staphlyococcus aureus. This “superbug”, a virulent strain of staph, has a chilling death rate: about 20-30% of the people who get it die from it. This is a highly variable statistic, because most of these infections are occurring in hospitals, and the people who are there are already very ill, and often immune-compromised. This so-called health-care-associated MRSA (HA-MRSA) is to be distinguished from the growing number of cases of community-associated MRSA (CA-MRSA) which account for around 15% of the incidence.

In fact, getting the total US death toll number is rather difficult to do, because hospitals don’t want to report these deaths and have actively lobbied against state laws requiring them to do so. In California, I am happy to say, The Governator signed into law in September a bill requiring such reporting (though he killed such a bill a year ago!) As of October, only half the states in the country had such laws. (Interesting aside: in 2003, then-Illinois state senator Barack Obama championed such legislation and got it passed.)

Maybe the media is finally getting the story. The Seattle Times recently had an editorial on the subject, lashing out at the hospital industry for bring this pestilence upon us, after an investigative report.

Okay, so what about that 100,000 number? Okay, I made that up. But in 2005, it is documented all over that there were about 19,000 deaths in the US, and infection rates were climbing very, very rapidly. In California the Department of Health Services estimated about 9,600 deaths from hospital related infections, which extrapolates to around 80,000 deaths nationwide. Not all of these are MRSA, clearly. But I am going to take a wild guess that the 9,600 number was low-balled. It is striking that we don’t know how many people are dying from MRSA, but it could become the fifth or sixth leading cause of death soon.

There are a lot of things that need to change, not least of which:

- There need to be more media stories; people need their awareness raised.

- The government, and the CDC in particular needs to get very serious about getting accurate statistics out and available openly.

- Hospitals need to put in place whatever measures they can, from copper door knobs to better MRSA screening on intake, to better staff education (no pun intended) on infection control.

- There should be a major research effort launched to understand the new-gen superbugs like MRSA, C. difficile, and the lovely new one from the Iraq battlefield, A. baumanni.

I guess what I find most chilling here is the almost unbelievable cynicism of the hospital/health insurance companies who actively fight against having to report statistics on MRSA infection rates. To me, it just underscores a general conclusion that I have formed in the past several years: our health care system should not be managed by organizations that have a profit motive. Think about it: the free market has not produced an efficient, responsive health care system. The profit-based health insurance industry has only created an enormously expensive bureaucratic layer whose main effect has been to drive up health care costs at quadruple the inflation rate while continually restricting actual health care services, and has left 50 million Americans with no health care coverage at all.

I blame them.

Well into my household’s Year of Sensory Input Issues, my husband is dealing with a detached retina. It’s been a sometimes frightening experience — for example, did you know that if you have to leave an international flight en route, that the customs agent will come out and clear your passport on the ambulance? And that in spite of their stinginess with blankets and pretzels, United Airlines really can come through in a crisis? Annoying as it’s been, the experience has been filled with Cool Applications of Physics, which helps me pass the time.

A retinal detachment involves the retina (which lines the back of your eye like wallpaper) sagging away from the back of the eye (as your wallpaper might do in a damp bathroom). Now, if you’ve ever tried to wallpaper a curved surface, you know it’s not easy to get some intrinsically flat thing to stick smoothly to the inside of the curve, especially when that bitch Gravity is pulling it down all the time. The clever way that retinal surgery deals with this (squeamish people stop reading now, please) is to suck some of the goo out of your eye and replace it with a gas bubble. You then tilt your head into the right position to have the gas bubble float up into the correct portion of the eye while the retina re-attaches. For a month. If you’re lucky, you get to sit up, but if you’re unlucky, you spend a month looking at the floor. In addition, you cannot go up or down in altitude by more than a thousand feet or so, because when you have an air bubble in your eye pressure changes are not a great idea.

My husband has been lucky enough to have a sitting-up kind of detachment so far (though I’m writing this while waiting for him to get out of surgery a second time, since it seems to have detached again, and based on where he lost vision and knowing the inversion of the image that takes place in the eye’s reimaging system, I’m worried he’s going to be a floor-looking guy when he comes out). The cool bit about getting to look at him face-on is that you can actually see the bubble! He looks like a human level, as the bubble readjusts as he tips his head.

The other physicsy bit is that when you have a gas bubble in your eye, your index of refraction is all wrong, and in spite of having a working retina attached in the right place, you still can’t see, because the air-lens interface steers the light to the wrong place. This gets better as the air is absorbed by the body and replaced with fluid. It’s also better when you tip your head down so the bubble floats away from the lens.

The upshot of all this is that I think that modern medicine is pretty darn clever, though I wish I didn’t have to know about it.

For his second guest post, Tom follows in our proud tradition of fearless eclecticism,
mixing neuroscience and current events with a bit of materialistic philosophizing. His first post was here, and his third is here.

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Burrowing into tragedy: a story behind the story of the Iraq War Suicides.

My thanks to all here who gave me such a warm welcome on Monday (and, again, to Sean for asking me here in the first place).

This post emerges out of this sad story of a week or so ago.

Over Memorial Day weekend this year there was a flurry of media coverage about the devastating psychological toll of the Iraq and Afghanistan wars. The single most awful paragraph in the round-up:

“According to the Army, more than 2,000 active-duty soldiers attempted suicide or suffered serious self-inflicted injuries in 2007, compared to fewer than 500 such cases in 2002, the year before the United States invaded Iraq. A recent study by the nonprofit Rand Corp. found that 300,000 of the nearly 1.7 million soldiers who’ve served in Iraq or Afghanistan suffer from PTSD or a major mental illness, conditions that are worsened by lengthy deployments and, if left untreated, can lead to suicide.”

(For details and a link to a PDF of the Army report – go here.)

This report, obviously, is the simply the quantitative background to a surfeit of individual tragedy – but my point here is not that war produces terrible consequences.

Rather, the accounts of the Iraq War suicides — 115 current or former servicemen and women in 2007 – struck me for what was implied, but as far as I could find, not discussed in the mass media: the subtle and almost surreptitious way in which the brain-mind dichotomy is breaking down, both as science and as popular culture.

How so? It is, thankfully, becoming much more broadly understood within the military and beyond that “shell shock” is not malingering, or evidence of an essential weakness of moral fiber. PTSD is now understood as a disease, and as one that involves physical changes in the brain.

The cause and effect chain between the sight of horror and feelings of despair cannot, given this knowledge, omit the crucial link of the material substrate in which the altered and destructive emotions can emerge. PTSD becomes thus a medical, and not a spiritual pathology.

(This idea still faces some resistance, certainly. I launched my blog with a discussion of the attempt to court martial a soldier for the circumstances surrounding her suicide attempt. But even so, the Army is vastly further along in this area that it was in the Vietnam era and before.)

Similarly, depression is clearly understood as a disease with a physical pathology that underlies the malign sadness of the condition. (H/t the biologist Louis Wolpert for the term and his somewhat oddly detached but fascinating memoir of depression.)

This notion of the material basis of things we experience as our mental selves is not just confined to pathology. So-called smart drugs let us know how chemically malleable our selves can be.

More broadly, the study of neuroplasticity provides a physiological basis for the common sense notion that experience changes who we perceive ourselves to be.

All this seems to me to be a good thing, in the sense that (a) the study of the brain is yielding significant results that now or will soon greatly advance human well being; and (b) that the public seems to be taking on board some of the essential messages. The abuses (overmedication, anyone?) are certainly there. But to me, it is an unalloyed good thing that we have left the age of shell shock mostly behind us.

At the same time, I’m a bit surprised that the implications of this increasingly public expression of an essentially materialist view of mind haven’t flared up as a major battle in the science culture wars.

Just to rehearse the obvious: the problem with cosmology for the other side in the culture war is that it conflicts with the idea of the omnipresent omnipotence of God. The embarrassment of evolutionary biology is that it denies humankind a special place in that God’s creation, destroying the unique status of the human species as distinct from all the rest of the living world.

Now along comes neuroscience to make the powerful case that our most intimate sense of participating in the numinous is an illusion.

Instead, the trend of current neuroscience seems to argue that the enormously powerful sense each of us has of a self as distinct from the matter of which we are made is false. Our minds, our selves may be real—but they are the outcome of a purely material process taking place in the liter or so of grey stuff between our ears.

(There are dissenters to be sure, those that argue against the imperial materialism they see in contemporary neuroscience. See this essay for a forceful expression of that view.)

I do know that this line of thought leads down a very convoluted rabbit hole, and that’s not where I am trying to go just now.

Instead, the reports of the Iraq suicides demonstrated for me that the way the news of the materiality of mind is is slipping into our public culture without actually daring (or needing) to speaking its name.

That the problem of consciousness is still truly unsolved matters less in this arena than the fact of fMRI experiments that demonstrate the alterations in brain structure and metabolism associated with the stresses of war or the easing of the blank, black hole of depression. The very piecemeal state of the field helps mask its potentially inflammatory cultural implications.

To me this suggests two possibilities. One is that it is conceivable that when the penny finally drops, we might see backlash against technological interventions into the self like that which has impeded stem cell research in the U.S.

On the other hand, I don’t think that the public can be motivated or even bamboozled into blocking the basic science in this field. Too much rests on the work; any family that has experienced Alzheimers knows just how urgent the field may be — not to mention anyone with a loved one in harms way.

This actually gives me hope for a shift in the culture war. For all the time and energy wasted over the last several years defending the idea of science against attacks on evolution, with the cosmologists taking their lumps too – the science of mind could force a shift in the terms of engagement decisively in the right direction.

Or I could be guilty of another bout of wishful thinking. Thoughts?

Image: Brain in a Vat, article illustration. Offered in homage to my friend and source of wisdom, Hilary Putnam, who introduced the brain-in-a-vat thought experiment in this book. Source: Wikimedia Commons.

You know what’s a really big problem? The Farm Bill. The quintennial piece of legislation that steers billions of dollars into subsidies for farmers who mass-produce the raw materials of which junk food is made. Yeah, I know, not exactly a hot topic, nor our normal fare. But Michael Pollan in the Times lays out a devastating indictment of the current system, which encourages our economy to overproduce food that is incredibly bad for us, while busting the federal budget, ruining the environment, and hurting small farmers and developing countries to boot. (Via Marginal Revolution.)

Here is the basic econo-physics of the situation:

As a rule, processed foods are more “energy dense” than fresh foods: they contain less water and fiber but more added fat and sugar, which makes them both less filling and more fattening. These particular calories also happen to be the least healthful ones in the marketplace, which is why we call the foods that contain them “junk.” Drewnowski concluded that the rules of the food game in America are organized in such a way that if you are eating on a budget, the most rational economic strategy is to eat badly — and get fat.

This perverse state of affairs is not, as you might think, the inevitable result of the free market. Compared with a bunch of carrots, a package of Twinkies, to take one iconic processed foodlike substance as an example, is a highly complicated, high-tech piece of manufacture, involving no fewer than 39 ingredients, many themselves elaborately manufactured, as well as the packaging and a hefty marketing budget. So how can the supermarket possibly sell a pair of these synthetic cream-filled pseudocakes for less than a bunch of roots?

For the answer, you need look no farther than the farm bill. This resolutely unglamorous and head-hurtingly complicated piece of legislation, which comes around roughly every five years and is about to do so again, sets the rules for the American food system — indeed, to a considerable extent, for the world’s food system. Among other things, it determines which crops will be subsidized and which will not, and in the case of the carrot and the Twinkie, the farm bill as currently written offers a lot more support to the cake than to the root. Like most processed foods, the Twinkie is basically a clever arrangement of carbohydrates and fats teased out of corn, soybeans and wheat — three of the five commodity crops that the farm bill supports, to the tune of some $25 billion a year. (Rice and cotton are the others.) For the last several decades — indeed, for about as long as the American waistline has been ballooning — U.S. agricultural policy has been designed in such a way as to promote the overproduction of these five commodities, especially corn and soy.

I remember the moment it first dawned on me that Coke was significantly less expensive than orange juice. But making soda is a complicated chemical process, while oranges literally grow on trees! Of course, once you master that process, mass-producing the chemicals is fairly straightforward, while growing oranges requires a certain amount of patience. At the time I didn’t really appreciate the other aspect of the puzzle: we pay people to grow corn, which is turned into high-fructose corn syrup, which sweetens all of the processed food we find on our supermarket shelves.

Now, there does seem to be an obvious point missing in the article: the popularity of Twinkies over carrots cannot be put down solely to the greater density of calories per dollar. A lot of people like how Twinkies taste, deep-fried or not. But that doesn’t mean we should be actively subsidizing their production.

Pollan strikes an optimistic note at the end of his piece, suggesting that the importance of the Farm Bill may finally be percolating up to the national consciousness. (At least until the next time that a celebrity with fake boobs dies of a drug overdose.) It’s long been considered political suicide to even suggest messing with farm subsidies, especially with the Iowa caucuses playing such a large role in Presidential primaries. We’ll see if next year is any different.

You’ll read on a blog or hear on the news that it is Bike to Work Day in California on Thursday May 18th. On your way to buy that pint of milk, you’ll smile indulgently at the well-meaning cyclists out there during the whole of California’s Bike to Work Week, trying not to curse them (as perhaps you usually do at other times of the year) for getting in your way as you pilot your nice comfortable car past them, probably over-revving the engine and driving way too close to them as you do so.

You click on one of the websites of a participating local transport organisation and cleverly remark to yourself how amusing it is that the prize you could win for bringing your bike onto their subway, train, or bus system that special day is…. a bike. So if you don’t have a bike, you can’t participate, and so can’t win a bike….which would allow you to participate. Well, maybe you could borrow one and give it a try…..? Anyway…..

You’ll agree that it is in principle a good thing that those cyclists do (and you noted before that you’ve seen many more of them in the last few weeks due to the rising gas prices), and that it is a pity that your own special situation makes it impossible for you to join them, or perhaps use the bus or train, or some combination of them. Or does it? You make a mental note to try it next year. Or perhaps the year after…..

Happy Bike to Work Day!

-cvj

Again, apologies to Girls Are Pretty.

It seems that Europe, led by the UK in a surprising display of the items usually kept in a jar on George Bush’s mantlepiece, has decided to stand up against one of the most disgusting and damaging abuses of science by the current administration. As The Guardian reports

Europe, led by the UK, last night signalled a major split with the United States over curbing the Aids pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.

The statement with which the article is concerned makes clear that rejection of science is the problem here

We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness,” it says.

The current US stance on tackling AIDS in Africa is hopelessly hamstrung, requiring, among other absurd demands, that no funds be distributed to any organization that even counsels a pregnant woman that abortion is an option, and that two-thirds of funds go to programs that stress abstinence (a third goes to abstinence only programs). If you want to understand how experts in the US see this, see what Planned Parenthood has to say.

A specific example is provided by Uganda, which used to be the poster child for AIDS programs in Africa, and which has suffered a recent setback that is at least partially linked to a decrease in the availability of condoms due to US policies.

The issues here are entirely obvious to anyone who is not blinkered by ideology and/or repression. As the British international Development secretary, Hilary Benn, put it

“Abstinence works if people can abstain, but I don’t think people should die because they have sex. We need to make sure people have all the means [of prevention] at their disposal - condoms and clean needles. It includes education and access to sexual and reproductive health services.”

This is an example of what people mean when they say that the Bush administration is ignoring science in favor of ideology. It is an established scientific fact that abstinence only programs do not work. Yet these are the ones we are using to fight a disease that is ravaging parts of Africa. This shouldn’t be a partisan issue. It is one of common sense, and of common decency. Is there any chance that sensible, reason-based people, Democrats and Republicans, could agree on this?

No, this isn’t one of those bait-and-switch titles. It really is about sex in space. Via Deepen the Mystery, a Guardian story on the hazards of sexual encounters on long-duration space missions.

They should be out-of-this-world experiences. But US experts have warned that sex in space will bring problems not pleasure for men and women heading to the moon and Mars.

A panel of scientists has told Nasa interplanetary passion could cause chaos to its latest plans to send humans on long missions.

Cramped in spaceships for years, surrounded by the starry void, astronauts thoughts are bound to turn to romance, states the report, ‘Bioastronautics Roadmap: a risk reduction strategy for human exploration of space’.

The resulting close encounters could have profound consequences, it adds. Without supplies of the necessary precautions, zero-gravity romps could lead to zero-gravity pregnancies.

Snickering aside, I’m sure it’s a real problem — send a bunch of people into isolation in close quarters for a period of years, and something will happen.

Now, I know that certain of my co-bloggers are reliable readers of the Guardian science section, but apparently they were going to keep this story to themselves. The extra value-added you get from Cosmic Variance, of course, is that we will actually link directly to the NASA Bioastronautics Roadmap from which the story derives. Although, as it turns out, a cursory inspection didn’t turn up anything nearly as off-color as you’d find in a novel by a recently indicted former high-ranking White House staffer. But this bit was interesting:

Serious interpersonal conflicts have occurred in space flight. The failure of flight crews to cooperate and work effectively with each other or with flight controllers has been a periodic problem in both US and Russian space flight programs. Interpersonal distrust, dislike, misunderstanding and poor communication have led to potentially dangerous situations, such as crewmembers refusing to speak to one another during critical operations, or withdrawing from voice communications with ground controllers. Such problems of group cohesiveness have a high likelihood of occurrence in prolonged space flight and if not mitigated through prevention or intervention, they will pose grave risks to the mission. Lack of adequate personnel selection, team assembly, or training has been found to have deleterious effects on work performance in organizational research studies. The duration and distance of a Mars mission significantly increases this risk. The distance also reduces countermeasure options and increases the need for autonomous behavioral health support systems.

Oh, great. I see a Stranger in a Strange Land scenario on our horizon.

AMERICAblog has a good post about Target’s email response to a complaint that one of their pharmacists has refused to fill a prescription for emergency contraception (EC). Here’s the email from Target

From: Target.Response Target.Response@target.com
Date: Oct 20, 2005 7:18 AM
Subject: Filling Prescriptions at Target

Dear Target Guest,

Target places a high priority on our role as a community pharmacy and our obligation to meet the needs of the patients we serve. We expect all our team members, including our pharmacists, to provide respectful service to our guests, particularly when it comes to their health care needs.

Like many other retailers, Target has a policy that ensures a guest’s prescription for emergency contraception is filled, whether at Target or at a different pharmacy, in a timely and respectful manner. This policy meets the health care needs of our guests while respecting the diversity of our team members.

Your thoughts help us learn more about what our guests expect, so I’ll be sure to share your feedback with our pharmacy executives.

Thanks for taking the time to share your questions, thoughts and comments. I hope we’ll see you again soon at Target.

Sincerely,

Jennifer Hanson
Target Executive Offices

I’ve written before about this kind of nonsense. My Orange Quark post began

A pharmacist in California refuses to fill the prescriptions of AIDS sufferers, because that would be interfering with God’s plans for gays. Another pharmacist, in Michigan, won’t provide arthritis medication, because gnarled hands are God’s way of stopping masturbation. A third pharmacist, in Florida, refuses to fill Viagra prescriptions, because, after their child-bearing years are over, God does not intend women to have to put up with the advances of their wrinkly old husbands.

whereas AMERICAblog has their own examples of equally ridiculous possibilities that would seem to be consistent with paying pharmacists not to do their jobs.

It’s just a gut feeling, but I would guess that there are many more readers of this blog who might occasionally shop at Target than at, say, Walmart (Don’t ask me why - maybe it’s the Michael Graves collection - I don’t know). If so, then this is a real opportunity to make a difference. If you get a chance, follow the advice at AMERICAblog, and call Target’s press office at one of these numbers

Susan Kahn, 1-612-761-6735
Cathy Wright, 1-612-761-6627 or 1-847-615-1538
Paula Thornton-Greear, 612-696-3400
Carolyn Brookter, 1-612-696-6557

Instead, or in addition, you could call or write to your local Target and tell them how you feel about this. We really need to stand up against this insanity. I’m going to make my calls tomorrow. Perhaps I’ll do it instead of teaching. After all, just because I’m paid to teach doesn’t mean I should be forced to do it!

If our logs of traffic to this site are to be believed, many of you will read this post extremely late at night, much later than your parents would have thought of as bed-time. Yet more of you will read it in the wee hours, with precious little time left before you need to get up and go to work or school. And it’s not just our visitors who behave this way. You’ll often see our posts coming in after midnight, even on a school night, and even then we’re rarely straight off to beddy-byes right after posting.

It certainly seems that most people are burning the candle at both ends these days, partly because of work and family responsibilities, and partly because of the increasing availability and variety of communication and entertainment options, such as the Internet and cable television.

I’ve always been one of those people who wholly embrace such new freedoms and, since I’ve never really needed a lot of sleep, have often found myself taking advantage of them late at night and early in the morning. I frequently read or deal with email and refereeing requests after midnight, and spend part of the early morning, around 6am, reading news sites and blogs before (when things are going ideally) exercising and heading off to work. This means that I can devote most of the day-time hours, plus large chunks of many evenings, to working, plus going out with my wife or with friends on occasion. I like living this way, although I must say that, now and then (every couple of months or so), it all catches up with me and I spend a Saturday essentially curled up in bed reading a novel while watching baseball.

Many of my friends and colleagues have schedules of a similar tempo, although with different weightings of activities (often including getting up to get kids to school, which seems to be an immensely time-consuming process all on its own). We all seem pretty happy; but then again, we all also seem pretty exhausted from time to time.

But maybe we shouldn’t be so complacent. Sunday’s Washington Post has an interesting article about recent scientific studies concerning the health implications of living with a long term sleep deficit. Although, as I’ll mention briefly below, I don’t think this is a stellar science article, it nevertheless made me sit up and think.

Starting from the observation that most people need between seven and nine hours of sleep per night, the health complications that some researchers claim correlate with getting less than, say, six hours, comprise a scary list: heart disease, obesity, colon cancer, breast cancer, prostate cancer, diabetes and stroke. And I most definitely got the impression that they were just getting warmed up.

This is a timely article because the results of several new studies, with rather large sample sizes, have recently been released. I found it a little difficult to ferret out serious details of these studies from the article, but one involves 10,000 subjects, and another is out of Harvard Medical School and involved 82,000 nurses.

One thing I didn’t like was that there was an attempt to provide balance with the usual glib “but others think differently” comment:

“There are Chicken Little people running around saying that the sky is falling because people are not sleeping enough,” said Daniel F. Kripke of the University of California at San Diego. “But everyone knows that people are getting healthier. Life expectancy has been increasing, and people are healthier today than they were generations ago.”

Other researchers acknowledge that much more research is needed to prove that the apparent associations are real, and to fully understand how sleep disturbances may affect health. But …

This seems like it is an interesting and potentially important comment from a credible researcher. However, the details behind Dr. Kripke’s objections are not followed up, and one is left thinking either that his comment is unimportant or that something crucial is being ignored.

This criticism aside, I did learn some interesting nuggets about the kind of research that’s going on and what it might tell us about the potential hazards of our changing sleep habits. The connection with obesity leads to some particularly cute evolutionary speculation

The newest study on obesity, from Columbia University, is just the latest to find that adults who sleep the least appear to be the most likely to gain weight and to become obese.

Other researchers have found that even mild sleep deprivation quickly disrupts normal levels of the recently discovered hormones ghrelin and leptin, which regulate appetite. That fits with the theory that humans may be genetically wired to be awake at night only when they need to be searching for food or fending off danger — circumstances when they would need to eat to have enough energy.

“The modern equivalence to that situation today may unfortunately be often just a few steps to the refrigerator next door,” [Emmanuel] Mignot [of Stanford] wrote in his editorial [in the journal Sleep].

Despite all this, I can’t imagine dramatically changing my lifestyle any time soon - I just like it too much. However, I think I will try to be a little more alert for those signs that I’m becoming over-tired, and maybe take that lazy Saturday or the occasional lie-in a bit more frequently than I do at present. It’s for my health you understand. The fact that those sleepy mornings usually lead to deliciously decadent afternoons of baseball and contemporary literature is just a side effect of the medication.