CAN’T SLEEP?

February 13th, 2017

Note (20FEB2017): Slept late all week. No new posting. Next week!

“To sleep, perchance to dream; aye, there’s the rub.” -from Hamlet by William Shakespeare (1564-1616)

Prince Hamlet was referring to death, but what if the rub refers to insomnia? What then to do?

insomnia n.: Prolonged or abnormal inability to sleep. -Taber’s Cyclopedic Medical Dictionary

So, insomnia comes in two forms. The first can be merely a prolonged inability to sleep, which per se may not be abnormal, dependent upon context. The second is abnormal, independent of context.

Environment
In the first case, the independent variable (controlling factor) is environmental. Some environmental stressor is eliciting a negative physiological response in the form of an inability to sleep, be it an inability to fall asleep, to stay asleep, or both.

Treatment? Simple! Remove the stressor, if possible, or at least try to diminish its potency.

How? There, too, lies a rub. The ability to meet that challenge is that which separates winners from losers in life — hugs, kisses, kind words, and other “warm fuzzies” notwithstanding.

Meanwhile, a simple set of procedures is available:
1) Use the bed only for sleeping or sexual activity. Do not lie awake in bed.
2) Avoid intake of stimulants such as caffeine with or after supper.
3) Avoid use of alcohol before bedtime, the rebound from which involves wakefulness.
4) Avoid stimulating activities directly before bedtime, including watching television; which, contrary to a widespread misconception, is not relaxing.
5) Practice meditation or Relaxation Procedure.

How detrimental is insomnia in healthy people? The answer remains unclear. Some claim that a lack of sleep per se never killed anyone — directly, that is; mishaps in the biological context of somnolence notwithstanding. In fact, forced wakefulness actually relieves depression, which does kill people. Two points: 1) worrying about insomnia promotes insomnia; and 2) best to avoid sleeping medications, if possible.

Biology
In the second case, the independent variable is biological. Some pathological condition is eliciting a negative physiological response in the form of an inability to sleep, be it an inability to fall asleep, to stay asleep, or both.

Treatment in this case depends upon the underlying diagnosis. What is the pathological condition? The answer may be complex if more than one condition is the cause.

In the elderly, for example, insomnia may herald the onset of dementia. Add to dementia delirium, and the combination can present a real medical challenge. By the way, delirium interfering with sleep may accompany dementia once manifest or other neurodegenerative diseases.

Regarding circadian rhythm, older insomniacs display advanced sleep-phase; whereas, young adults display delayed sleep-phase, often the consequence of simply remaining active past normal bedtime playing video-games. Treatment, especially for the elderly, may be use of a bright light possibly coupled with melatonin. Whatever the case, only a comprehensive medical evaluation by a competent physician can determine the underlying condition, if any.

That medical evaluation begins with a complete medical history, increasingly difficult to come by in this era of the Sovietization of American medicine when patients increasing are attended by “Doctor Nurse” instead of “Doctor Doctor” and even by the latter for diminishing periods of time. Often, the patient’s bed-partner provides the best information. Despite all the fancy and expensive technological innovations, 80% of medical diagnoses still are made by history, 10% by physical examination, and 5% by routine laboratory-tests.

Once diagnosed, the underlying condition can be treated as best as practicable. When such treatment proves inadequate, the physician can prescribe a pharmacological agent. Some newer agents are relatively safe even long term and maintain sleeping architecture; i.e., normal phases of the sleeping cycle. Avoid “over-the-counter drugs” because the benefit:risk ratio often is uncertain, at best.

Sleep is a natural function found in most vertebrates, if not all. It restores the neurochemical balance. Sweet dreams!

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“HEALTHCARE REFORM”: SOME HARD TRUTHS

January 23rd, 2017

Note (06FEB2017): More Republicans now plan not to repeal ObamaCare but to repair it. What would Mr. Peifer say (See below.)? Why? They have no credible replacement even though one has existed since 1994.

“But if thought corrupts language, language can also corrupt thought.” -George Orwell (1903-1950)

Elected and in-office, Republicans now face some hard truths associated with issues challenging this declining nation on fire. One is ObamaCare and the Republicans’ pledge to “repeal and replace” it. Words have power.

“Not on fire,” you say.

Witness the new President’s address at his inauguration; never mind the protests nationwide, some violent. Would you characterize it as conciliatory? Aggressive? Words have power.

“Healthcare”
In any debate, it is reasonable and appropriate to ask the opposition — the entrenched political establishment, Democrat and Republican — to define the terms that it uses; in this case, “healthcare”. Webster’s New Collegiate Dictionary (1977) does not list the term even. Whence cameth it?

What exactly is “healthcare”? As the term denotes, it is a governmentally concocted, pleasant-sounding euphemism that refers to caring for one’s health. (In contrast, “medicine” is not so pleasant-sounding because it denotes suffering.) “Healthcare”, however, is amorphous and includes everything from washing your hair to brushing your teeth to cutting your toenails. Simply put, “healthcare” is not synonymous with medicine. Words have power.

Another governmentally concocted euphemism, “healthcare-provider”, includes anyone and everyone who promotes himself as rendering advice, assistance, or instruction in the care of one’s health. It is intended to diminish the stature of the lynchpin in medical delivery, the physician. Words have power.

What is medicine? It the healing art based upon science the mission of which is the relief of suffering caused by disease and trauma. Its practitioners are known as physicians; those whom they diagnose and treat, patients. Words have power.

Repair Not Replace
Definitions notwithstanding, of “repeal and replace”, “repeal” is the easier; whereas, “replace”, the more difficult — the much more difficult. Accordingly, some Republican legislators now are talking about “repair” instead of “replace”. Surprised?

“An error lurking in the roots of a system of thought does not become truth simply by being evolved.” -John Frederick Peifer

The basis of this “repair” seems to be a new, politically concocted term — “Health Savings Accounts”, which are merely “Medical Savings Accounts” in new verbal clothing. Country-club Republicanism as its worst! The average American cannot afford a car, let alone a “Medical Savings Account” by whatever name.

“Catastrophic Coverage”?
Some opponents of ObamaCare, such as Tucker Carlson at Fox News, are promoting “Catastrophic Coverage” rather than basic medical coverage. “Catastrophic Coverage” may play well on television, but basic medical coverage offers the biggest bang for the medical buck.

Who most needs “Catastrophic Coverage”? The unproductive old.

It has been known for years, for example, that, during the last year of life, Medicare recipients spend 30-cents of every dollar expended on medical care during their entire lifetime. Of the 1% of Medicare beneficiaries with the highest costs in any given year, approximately 50% die. Of the 5% with the highest costs, approximately 40% die. Of the elderly who survive, 50% are demented by the age of eight-five. Therein lie the reasons that Medicare alone is bankrupting these United States of America. Hard truths!

PART TWO

Today, a major question facing physicians and the rest of American society is whether the consequence of past declines in mortality is an increase in active life-expectancy or merely an expanded and grotesque period of frailty, enfeeblement, and dependency. Apparently, the answer is the latter.

“Diaper, madam? Catheter, sir? Don’t worry. The young and productive will be paying tomorrow for the old and unproductive today.”

Not a pretty picture! Even physicians do not like looking at it. Chronic, debilitating illness — not dying — is becoming our worst medical enemy, individually and socially.

Meanwhile, who least need “Catastrophic Coverage”? The productive young who generally require only acute medical care for acute medical problems with occasional exceptions. Therein lies the reason that premiums would be so cheap to insure, really insure, all American young for serious medical events.

Fooling The Public
To paraphrase Abraham Lincoln, “You can fool all of the people some of the time and some of the people all the time, and them’s pretty darn good odds.”

Be not fooled by self-styled gurus on television or in the newspaper spinning misinformation. Be not fooled by power-hungry professional politicians seeking to retain control of medicine.

Remember Obama’s promises about the benefits of ObamaCare, such as keeping your doctor and your plan? Once again, those who direct public opinion are acting against the Public Good by promoting inefficient systems politically based and politically directed.

Science And Medial Delivery
A patient’s seeking medical care is a behavior. A physician’s providing medical care is a behavior.

There is a science that describes behavior as well as thoughts, feelings, and physiological responses. That science is Biobehavioral Science.

“What?” you say. “Biobehavioral Science? Never heard of it!”

Therein lies the problem not just for you but for nearly all humanity. Guess what? Ignorant about Biobehavioral Science themselves, were they not, the politicians would not want you to hear of it; especially its derivative, the Science of Human Behavior. To them, it would represent an anathema.

Were they willing to listen, they would screech in terror, “Specificity, Objectivity, and Accountability? Never! Never, I tell you!”

Any system not scientifically based and scientifically directed to deliver medical care to a population must be, by its very nature, fatally flawed and fated to failure — doomed to delivering care that is of decreasing availability and decreasing quality. Less availability. Lower quality.

“An ounce of prevention is worth a pound of cure.” ―Benjamin Franklin

Do you care? Actually, few do until they fall ill or become injured. Too late!

We already are suffering from the Sovietization of American medicine; whereby, for example, you see “Doctor Nurse” not “Doctor Doctor”. When you do see “Doctor Doctor”, he — or increasingly she — is looking mainly at the computer-screen not at you. Why? In order to fulfill the increasing regulatory demands of governmental bureaucrats for increasing documentation of decreasing care.

Meanwhile, a scientifically-based, scientifically-directed, detailed plan for delivery of universal medical care by a competitive private sector characterized by the following attributes is available and has been available for more than 20 years. It is characterized by the following:
1) Simple;
2) Straightforward;
3) Free of special taxes;
4) Minimal regulations;
5) Minimal bureaucracy;
6) Free of fraud at taxpayers’ expense; and
7) Acceptable to insurance companies.

No, it is not the failed ClintonCare. In fact, the opposite.

Will the politicians ever acknowledge it, let alone adopt it? Fat chance! Unless, of course, you make them. It’s your health. It’s your life.

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-End-

TRUMP DAY

January 16th, 2017

Another inauguration. Typically, the victorious politicians — this time in the charade of swapping stations, Republicans — will be celebrating their access to power; money; and, yes, sometimes even sex. Nothing new there.

“Never give a sucker an even break.” -W. C. Fields (1880-1946) in Poppy (1936)

Now in control of the federal government, will the Republicans the voters an even break? Will they embrace Science over Politics — the Science of Human Behavior? Fat chance!

Consider their call to repeal and replace the unconstitutional disaster called “ObamaCare”. Replace it with what? So-called Medical Savings Accounts? Country-club Republicanism as its worst. The average American can’t afford a car, let alone a “Medical Savings Account”.

Control of medical care by local politicians instead of federal? Good luck there!

See “MEDICAL DELIVERY: A TALE OF WOE”.

No, most likely it will be business as usual — the same toxin but with a different flavoring in a different bottle but with the same stench. Preferring politically-motivated and politically-manipulated policies and programs, once again their efforts will be doomed to failure. Then what?

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DISSATISFACTION GUARANTEED

January 9th, 2017

“Life outside society would be solitary, poor, nasty, brutish, and short.” -from Thomas Hobbes (1588-1679)

We Westerners live in societies that, throughout the relatively short history of our species, our forbears would have considered miraculous. Until well into the 20th-century, life for most remained as Hobbes as described it.

“Death borders upon our birth, and our cradle stands in the grave.” -Joseph Hall, Bishop of Exeter (1564-1656)

Consider the following: As late as the end of the 19th-century, one out of ten births ended in maternal death. Two out of ten, in fetal death. Surviving infants faced substantial mortality from commonplace disease and unavoidable trauma as well as even greater morbidity therefrom.

Depending upon geographical location and climatic changes, humans faced the threats of hunger from famine and thirst from drought. Periodic plagues swept across the land; for example, Bubonic Plague (“Black Death”) that killed as many as 200-million in the 14th-century. The threat continued; for example, influenza in 1918 that killed as many as 100-million. It continues today.

What changed a context dominated by fear and despair? Not idiosyncratic ideologies. Not superstitious myths. Not charismatic charlatans with their empty promises. Only Science and its applied derivative, Technology. The scientist Isaac Newton (1643-1727) alone contributed more to overall human betterment than all political leaders combined.

Science and Technology changed the quality and quantity of human existence. Consider just the luxuries of air conditioning to cool and central heating to warm, never mind the necessities of clean water to drink, untainted food to eat, and medicines to cure.

Consequence in the Western world? For one, satiation accompanied by dissatisfaction with the benefits with which Westerners have been blessed.

“A fool hath no delight in understanding,
But only that his heart may lay itself bare.” -Proverbs 18:2

Now, consider the hordes of whining, spoiled, self-indulgent ingrates demonizing those betters throughout history to whom they owe their comfort — nay, their well-being and, for most, their lives. More dangerous is their demonizing the means of their good fortune — Science and Technology — in favor of misguided ideologies and mystical superstitions.

“There is gold and a multitude of rubies;
But the lips of knowledge are a precious jewel.” -Proverbs 20:15

Beyond comfort, health, and longevity, we owe Science an unpayable debt for bestowing upon us the gift of knowledge — knowledge of our world; our universe; and, yes, ourselves. Yet, when we employ that branch of Science describing our own behavior, cognition, and emotion — the Science of Human Behavior — to better society, we reject it, preferring charismatic charlatans and pseudo-scientific myths.

“The light of life is insufficiently bright to overcome the darkness of reality.” -Erich Maria Remarque (1898-1970)

For our disregard of that branch of Science, we humans likely shall pay a heavy price. What price? Our existence.

The two, most perilous threats to human existence coming from the darkness of reality are nuclear war and plague. The former is a consequence entirely of our own behavior. The latter, largely a consequence of it.

“There are none so blind as those who will not see.” – John Heywood (1497-1580)

The time is not too late. The clock, however, is ticking. Tic-toc … Tic-toc … Tic-toc.

Before we as a species cease to exist and while time remains, let us try, at least, to see the Road to Redemption by brightening the light of life. How? By using the fuel of Biobehavioral Science and its offspring, the Science of Human Behavior.

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