Study Finds No Progress in Safety at Hospitals

Study Finds No Progress in Safety at Hospitals | NYT

By DENISE GRADY
Published: November 24, 2010

"Efforts to make hospitals safer for patients are falling short, researchers report in the first large study in a decade to analyze harm from medical care and to track it over time.

The study, conducted from 2002 to 2007 in 10 North Carolina hospitals, found that harm to patients was common and that the number of incidents did not decrease over time. The most common problems were complications from procedures or drugs and hospital-acquired infections....

It is one of the most rigorous efforts to collect data about patient safety since a landmark report in 1999 found that medical mistakes caused as many as 98,000 deaths and more than one million injuries a year in the United States. That report, by the Institute of Medicine, an independent group that advises the government on health matters, led to a national movement to reduce errors and make hospital stays less hazardous to patients’ health....

But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found....

A recent government report found similar results, saying that in October 2008, 13.5 percent of Medicare beneficiaries — 134,000 patients — experienced “adverse events” during hospital stays. The report said the extra treatment required as a result of the injuries could cost Medicare several billion dollars a year. And in 1.5 percent of the patients — 15,000 in the month studied — medical mistakes contributed to their deaths. That report, issued this month by the inspector general of the Department of Health and Human Services, was based on a sample of Medicare records from patients discharged from hospitals...."

As much as 90 percent of the published medical information that doctors rely on is flawed

Lies, Damned Lies, and Medical Science - Magazine - The Atlantic

"Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science."

"...Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted?

That question has been central to Ioannidis’s career. He’s what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences. Given this exposure, and the fact that his work broadly targets everyone else’s work in medicine, as well as everything that physicians do and all the health advice we get, Ioannidis may be one of the most influential scientists alive. Yet for all his influence, he worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem....

[Ioannidis] goes on to suggest that an obsession with winning funding has gone a long way toward weakening the reliability of medical research....

In poring over medical journals, he was struck by how many findings of all types were refuted by later findings....

And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.

This array suggested a bigger, underlying dysfunction, and Ioannidis thought he knew what it was. “The studies were biased,” he says. “Sometimes they were overtly biased. Sometimes it was difficult to see the bias, but it was there.” Researchers headed into their studies wanting certain results—and, lo and behold, they were getting them. We think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously. “At every step in the process, there is room to distort results, a way to make a stronger claim or to select what is going to be concluded,” says Ioannidis. “There is an intellectual conflict of interest that pressures researchers to find whatever it is that is most likely to get them funded.”....

How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.

For starters, he explains, the odds are that in any large database of many nutritional and health factors, there will be a few apparent connections that are in fact merely flukes, not real health effects—it’s a bit like combing through long, random strings of letters and claiming there’s an important message in any words that happen to turn up. But even if a study managed to highlight a genuine health connection to some nutrient, you’re unlikely to benefit much from taking more of it, because we consume thousands of nutrients that act together as a sort of network, and changing intake of just one of them is bound to cause ripples throughout the network that are far too complex for these studies to detect, and that may be as likely to harm you as help you. Even if changing that one factor does bring on the claimed improvement, there’s still a good chance that it won’t do you much good in the long run, because these studies rarely go on long enough to track the decades-long course of disease and ultimately death....

“The odds that anything useful will survive from any of these studies are poor,” says Ioannidis—dismissing in a breath a good chunk of the research into which we sink about $100 billion a year in the United States alone.

And so it goes for all medical studies, he says. Indeed, nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest....

Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.”...

Doctors may notice that their patients don’t seem to fare as well with certain treatments as the literature would lead them to expect, but the field is appropriately conditioned to subjugate such anecdotal evidence to study findings. Yet much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s, leaving it playing catch-up with a century or more of non-evidence-based medicine, and contributing to Ioannidis’s shockingly high estimate of the degree to which medical knowledge is flawed. That we’re not routinely made seriously ill by this shortfall, he argues, is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much.

Medical research is not especially plagued with wrongness. Other meta-research experts have confirmed that similar issues distort research in all fields of science, from physics to economics (where the highly regarded economists J. Bradford DeLong and Kevin Lang once showed how a remarkably consistent paucity of strong evidence in published economics studies made it unlikely that any of them were right). And needless to say, things only get worse when it comes to the pop expertise that endlessly spews at us from diet, relationship, investment, and parenting gurus and pundits. But we expect more of scientists, and especially of medical scientists, given that we believe we are staking our lives on their results. The public hardly recognizes how bad a bet this is. The medical community itself might still be largely oblivious to the scope of the problem, if Ioannidis hadn’t forced a confrontation when he published his studies in 2005....

[His] bigger worry, he says, is that while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”...

What [doctors are] not trained to do is to go back and look at the research papers that helped make these drugs the standard of care. “When you look the papers up, you often find the drugs didn’t even work better than a placebo. And no one tested how they worked in combination with the other drugs,” she says. “Just taking the patient off everything can improve their health right away.” But not only is checking out the research another time-consuming task, patients often don’t even like it when they’re taken off their drugs, she explains; they find their prescriptions reassuring.

In fact, the question of whether the problems with medical research should be broadcast to the public is a sticky one in the meta-research community. Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding. Ioannidis dismisses these concerns. “If we don’t tell the public about these problems, then we’re no better than nonscientists who falsely claim they can heal,” he says. “If the drugs don’t work and we’re not sure how to treat something, why should we claim differently? Some fear that there may be less funding because we stop claiming we can prove we have miraculous treatments. But if we can’t really provide those miracles, how long will we be able to fool the public anyway? The scientific enterprise is probably the most fantastic achievement in human history, but that doesn’t mean we have a right to overstate what we’re accomplishing.”...

But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.

“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.” "

The most effective way to lose weight is by drinking water before meals

A free diet trick that really works

"The most effective way to lose weight, a new study says, isn’t by taking pills or adopting extreme diets. It’s by drinking water before meals. Nutrition researchers at Virginia Tech found that subjects who drank 16 ounces—or about two glasses—of water before each of their three daily meals lost 50 percent more weight than control subjects did. The study volunteers, 48 overweight and obese men and women, were put on a low-calorie diet for 12 weeks. Half were given no instructions about what to drink; half were instructed to drink two glasses of water shortly before their meals. The first group lost 11 pounds on average, but the water group lost more—15.5 pounds on average. Notably, the diet itself seems to stick: A year after the study, the water drinkers had continued the regimen on their own and lost additional weight. Scientists aren’t sure why this works, but they do know water is filling, has no calories, and may take the place of other high-calorie drinks that might be consumed. “It’s a simple way to facilitate weight management,” study author Brenda Davy tells Scientific American. She suggests that dieters drink from a refillable water bottle throughout the day, in addition to their pre-meal infusions."

Beating Obesity - By 2015, four out of 10 Americans may be obese

Beating Obesity - by Marc Ambinder - The Atlantic

"By 2015, four out of 10 Americans may be obese....

In 1960, when President-elect John F. Kennedy fretted about fitness in an essay for Sports Illustrated titled “The Soft American,” roughly 45 percent of adults were considered overweight, including 13 percent who were counted as obese; for younger Americans, ages 6 to 17, the rate was 4 percent. Obesity rates remained relatively stable for the next 20 years, but then, from 1980 to 2000, they doubled. In 2001, the U.S. surgeon general announced that obesity had reached “epidemic” proportions. Seven years later, as the obesity rate continued to rise, 68 percent of American adults were overweight, and 34 percent were obese; roughly one in three children and adolescents was overweight, and nearly one in five was obese. Americans now consume 2,700 calories a day, about 500 calories more than 40 years ago. In 2010, we still rank as the world’s fattest developed nation, with an obesity rate more than double that of many European nations.

For that dubious distinction, we pay a high price. The obese are more likely to be depressed, to miss school or work, to feel suicidal, to earn less, and to find it difficult to marry. And their health care costs a lot. Obese Americans spend about 42 percent more than healthy-weight people on medical care each year. Improper weight and diet strongly correlate with chronic diseases, which account for three-fourths of all health-care spending. Type 2 diabetes is one of the leading drivers of rising costs for Medicare patients, and 60 percent of cases result directly from weight gain. In short, even as the nation is convulsed by a political struggle to “reform” health care, no effort to contain its costs is likely to succeed if we can’t beat obesity....

The bad news is that no one knows exactly why. And the debate on how to deal with obesity remains frozen. On one side are the proponents of individual responsibility, who believe that fat people suffer from a surplus of self-indulgence and a shortage of willpower. On the other are people who believe that Americans are getting fatter because of powerful environmental factors like cheap corn, fast food, and unscrupulous advertising....

The people most vulnerable to obesity, however, do not have access to healthy food, to role models, to solid health-care and community infrastructures, to accurate information, to effective treatments, and even to the time necessary to change their relationship with food. And if that is true for fat adults, it is even more true for fat children, many of whose choices are made for them. Their vulnerability to obesity is much more the result of societal inequalities than of any character flaw....

“But if you go with the flow in America today, you will end up overweight or obese,” Thomas Frieden, the director of the Centers for Disease Control and Prevention, told me when I met him at an obesity conference in Washington last summer. “This does not absolve individuals of the responsibility of trying to get more exercise and eat healthier. But it suggests a synergy between policy intervention and personal efforts to lose weight.” Frieden’s tenure as New York City’s health commissioner from 2002 to 2009 was intensely productive and attention-getting: under his direction, the city banned trans fats from restaurants....

The rise in obesity is associated with a rogue’s gallery of individual, social, and technological factors. The “Big Two,” as scientists call the leading factors, are reduced exercise and increased food consumption: Americans are ingesting more and more calories than they’re burning. But underlying that simple energy-in, energy-out equation is a complex, and so far inexorable, interplay between powerful physiological and societal forces....

But why did the obesity rate accelerate in the United States beginning in the 1980s, setting us apart from our peers in other developed countries?....

The average American spends half of his or her food budget outside the home....

This jumble of circumstances and effects is what Thomas Frieden means when he says that just being an American can naturally lead you to be obese: obesity is an almost inevitable consequence of living with our cultural norms, our history of agricultural production and subsidies, our long-standing socioeconomic inequalities, and the impact of technology on our behavior and bodies....

[T]he Robert Wood Johnson Foundation, the largest philanthropy dedicated to improving health care in America...its nationwide campaign against childhood obesity and become the “connective tissue of the movement,” as the director of the childhood-obesity project, Dwayne Proctor, told me....

States and cities have come up with some of the best structural initiatives. In Pennsylvania, for example, the state has partnered with nonprofits and supermarkets to open high-quality food stores in underserved areas. In Louisville, Kentucky, housing projects, including the one where Cassius Clay grew up, have been redesigned with a focus on health. In one, wide sidewalks ring the perimeter so families and kids can walk in groups with less fear of crime. Near the boxer’s childhood home, the local sanitation department has cleaned the soil of toxins for the creation of a community garden. And there is a farmers’ market at a school across the street every Saturday. With the strong leadership of the mayor, the blue-collar city of Somerville, Massachusetts, lowered the rate of obesity in its elementary schools by promoting exercise in schools, smaller portions in restaurants, health counseling, and biking and walking to school. (The Robert Wood Johnson Foundation supported all three of these initiatives.)...

Michelle Obama went public on February 9 with her campaign against childhood obesity. Almost a year earlier, she had decided to make fighting obesity her principal cause: working largely in secret, over a period of about six months in 2009, the first lady’s staff and the White House Domestic Policy Council began to draft a truly comprehensive anti-obesity strategy.... The proposals that Raben and his group pondered have a place in the framework: state and local cooperation, nutrition-labeling standards, money to promote programs to bring healthy food to poor communities, and reforms to the school-lunch program. The goal is to end the epidemic of childhood obesity within a generation...."

The total number of antibiotics used in agriculture is continuing to grow

Op-Ed Contributor - Cows on Drugs - NYTimes.com

"More than 30 years ago, when I was commissioner of the United States Food and Drug Administration, we proposed eliminating the use of penicillin and two other antibiotics to promote growth in animals raised for food. When agribusiness interests persuaded Congress not to approve that regulation, we saw firsthand how strong politics can trump wise policy and good science.

Even back then, this nontherapeutic use of antibiotics was being linked to the evolution of antibiotic resistance in bacteria that infect humans. To the leading microbiologists on the F.D.A.’s advisory committee, it was clearly a very bad idea to fatten animals with the same antibiotics used to treat people. But the American Meat Institute and its lobbyists in Washington blocked the F.D.A. proposal....

But the total number of antibiotics used in agriculture is continuing to grow. According to the Union of Concerned Scientists, 70 percent of this use is in animals that are healthy but are vulnerable to transmissible diseases because they live in crowded and unsanitary conditions.

In testimony to Congress last summer, Joshua Sharfstein, the principal deputy commissioner of the F.D.A., estimated that 90,000 Americans die each year from bacterial infections they acquire in hospitals. About 70 percent of those infections are caused by bacteria that are resistant to at least one powerful antibiotic.

That’s why the American Medical Association, the American Academy of Pediatrics, the American Pharmacists Association, the Infectious Diseases Society of America, the American Public Health Association and the National Association of County and City Health Officials are urging Congress to phase out the nontherapeutic use in livestock of antibiotics that are important to humans.

Antibiotic resistance is an expensive problem. A person who cannot be treated with ordinary antibiotics is at risk of having a large number of bacterial infections, and of needing to be treated in the hospital for weeks or even months. The extra costs to the American health care system are as much as $26 billion a year, according to estimates by Cook County Hospital in Chicago and the Alliance for the Prudent Use of Antibiotics, a health policy advocacy group.

Agribusiness argues — as it has for 30 years — that livestock need to be given antibiotics to help them grow properly and keep them free of disease. But consider what has happened in Denmark since the late 1990s, when that country banned the use of antibiotics in farm animals except for therapeutic purposes. The reservoir of resistant bacteria in Danish livestock shrank considerably, a World Health Organization report found. And although some animals lost weight, and some developed infections that needed to be treated with antimicrobial drugs, the benefits of the rule exceeded those costs...."

Donald Kennedy, a former commissioner of the United States Food and Drug Administration, is a professor emeritus of environmental science at Stanford.

Do You Only Live Once? Experiments Suggest Life Not One-Time Deal

Robert Lanza, M.D.: Do You Only Live Once? Experiments Suggest Life Not One-Time Deal:

"Do You Only Live Once? Experiments Suggest Life Not One-Time Deal...

The results of quantum physics confirm that observations can't be predicted absolutely. Instead, there's a range of possible observations each with a different probability. One mainstream explanation, the "many-worlds" interpretation, states that there are an infinite number of universes (the "multiverse"). Everything that can possibly happen occurs in some universe. The old mechanical -- "we're just a bunch of atoms" −- view of life loses its grip in these scenarios. Biocentrism extends this idea, suggesting that life is a flowering and adventure that transcends our ordinary linear way of thinking. Although our individual bodies are destined to self-destruct, the "me'' feeling is just energy operating in the brain. But this energy doesn't go away at death. One of the surest principles of science is that energy never dies; it can neither be created nor destroyed....Life has a non-linear dimensionality −- it's like a perennial flower that returns to bloom in the multiverse.

A series of landmark experiments show that measurements an observer makes can influence events that have already happened in the past. One experiment (Science 315, 966, 2007) confirmed that flipping a switch could retroactively change a result that had happened before the switch was flipped. Regardless of the choice you, the observer, make, it'll be you who will experience the outcomes −- the universes −- that will result....

"Whenever anything in nature seems to us ridiculous, absurd or evil," said Spinoza "it is because we have but a partial knowledge of things."...."

Food Rules From Michael Pollan Worth Following

Personal Health - Food Rules From Michael Pollan Worth Following - NYTimes.com:

"In the more than four decades that I have been reading and writing about the findings of nutritional science, I have come across nothing more intelligent, sensible and simple to follow than the 64 principles outlined in a slender, easy-to-digest new book called “Food Rules: An Eater’s Manual,” by Michael Pollan.

Mr. Pollan is not a biochemist or a nutritionist but rather a professor of science journalism at the University of California, Berkeley. You may recognize his name as the author of two highly praised books on food and nutrition, “In Defense of Food: An Eater’s Manifesto” and “The Omnivore’s Dilemma.” (All three books are from Penguin.)

If you don’t have the time and inclination to read the first two, you can do yourself and your family no better service than to invest $11 and one hour to whip through the 139 pages of “Food Rules” and adapt its guidance to your shopping and eating habits.

Chances are you’ve heard any number of the rules before. I, for one, have been writing and speaking about them for decades. And chances are you’ve yet to put most of them into practice. But I suspect that this little book, which is based on research but not annotated, can do more than the most authoritative text to get you motivated to make some important, lasting, health-promoting and planet-saving changes in what and how you eat.

Reasons to Change

Two fundamental facts provide the impetus Americans and other Westerners need to make dietary changes. One, as Mr. Pollan points out, is that populations who rely on the so-called Western diet — lots of processed foods, meat, added fat, sugar and refined grains — “invariably suffer from high rates of the so-called Western diseases: obesity, Type 2 diabetes, cardiovascular disease and cancer.” Indeed, 4 of the top 10 killers of Americans are linked to this diet.

As people in Asian and Mediterranean countries have become more Westernized (affluent, citified and exposed to the fast foods exported from the United States), they have become increasingly prone to the same afflictions.

The second fact is that people who consume traditional diets, free of the ersatz foods that line our supermarket shelves, experience these diseases at much lower rates. And those who, for reasons of ill health or dietary philosophy, have abandoned Western eating habits often experience a rapid and significant improvement in their health indicators.

I will add a third reason: our economy cannot afford to continue to patch up the millions of people who each year develop a diet-related ailment, and our planetary resources simply cannot sustain our eating style and continue to support its ever-growing population.

In his last book, Mr. Pollan summarized his approach in just seven words: “Eat food. Not too much. Mostly plants.” The new book provides the practical steps, starting with advice to avoid “processed concoctions,” no matter what the label may claim (“no trans fats,” “low cholesterol,” “less sugar,” “reduced sodium,” “high in antioxidants” and so forth).

As Mr. Pollan puts it, “If it came from a plant, eat it; if it was made in a plant, don’t.”

Do you already avoid products made with high-fructose corn syrup? Good, but keep in mind, sugar is sugar, and if it is being added to a food that is not normally sweetened, avoid it as well. Note, too, that refined flour is hardly different from sugar once it gets into the body.

Also avoid foods advertised on television, imitation foods and food products that make health claims. No natural food is simply a collection of nutrients, and a processed food stripped of its natural goodness to which nutrients are then added is no bargain for your body.

Those who sell the most healthful foods — vegetables, fruits and whole grains — rarely have a budget to support national advertising. If you shop in a supermarket (and Mr. Pollan suggests that wherever possible, you buy fresh food at farmers’ markets), shop the periphery of the store and avoid the center aisles laden with processed foods. Note, however, that now even the dairy case has been invaded by products like gunked-up yogurts.

Follow this advice, and you will have to follow another of Mr. Pollan’s rules: “Cook.”

“Cooking for yourself,” he writes, “is the only sure way to take back control of your diet from the food scientists and food processors.” Home cooking need not be arduous or very time-consuming, and you can make up time spent at the stove with time saved not visiting doctors or shopping for new clothes to accommodate an expanding girth.

Although the most wholesome eating pattern consists of three leisurely meals a day, and preferably a light meal at night, if you must have snacks, stick to fresh and dried fruits, vegetables and nuts, which are naturally loaded with healthful nutrients. I keep a dish of raisins and walnuts handy to satisfy the urge to nibble between meals. I also take them along for long car trips. Feel free to use the gas-station restroom, but never “get your fuel from the same place your car does,” Mr. Pollan writes.

Treating Treats as Treats

Perhaps the most important rules to put into effect as soon as possible are those aimed at the ever-expanding American waistline. If you eat less, you can afford to pay more for better foods, like plants grown in organically enriched soil and animals that are range-fed.

He recommends that you do all your eating at a table, not at a desk, while working, watching television or driving. If you’re not paying attention to what you’re eating, you’re likely to eat more than you realize.

But my favorite tip, one that helped me keep my weight down for decades, is a mealtime adage, “Stop eating before you’re full” — advice that has long been practiced by societies as diverse as Japan and France. (There is no French paradox, by the way: the French who stay slim eat smaller portions, leisurely meals and no snacks.)

Practice portion control and eat slowly to the point of satiation, not fullness. The food scientists Barbara J. Rolls of Penn State and Brian Wansink of Cornell, among others, have demonstrated that people eat less when served smaller portions on smaller plates. “There is nothing wrong with special occasion foods, as long as every day is not a special occasion,” Mr. Pollan writes. “Special occasion foods offer some of the great pleasures of life, so we shouldn’t deprive ourselves of them, but the sense of occasion needs to be restored.”

Here is where I can make an improvement. Ice cream has been a lifelong passion, and even though I stick to a brand lower in fat and calories than most, and limit my portion to the half-cup serving size described on the container, I indulge in this treat almost nightly. Perhaps I’ll try the so-called S policy Mr. Pollan says some people follow: “No snacks, no seconds, no sweets — except on days that begin with the letter S.”"

Sleep As the Key to Happiness and Peak Performance

Arianna Huffington: Sleep Challenge 2010: Sleep As the Key to Happiness and Peak Performance:

"Tony Schwartz, President and CEO of The Energy Project, whose new book, The Way We're Working Isn't Working: The Four Forgotten Needs that Energize Great Performance (coming out in May), has a whole chapter on the importance of sleep....

'the way we are working (and the way the world works) isn't working, for most people or most organizations.' And he singles out the role sleep plays in making people happier, healthier, and more productive.

'No single behavior,' writes Schwartz, 'more fundamentally influences our effectiveness in waking life than sleep... sleep may well be more critical to our well being than diet, exercise and even heredity.'

Sleep is so vital to success in everything we do, Schwartz titles his chapter about it "Sleep or Die." In it, he cites the role lack of sleep played in numerous high-profile disasters -- including the Three Mile Island meltdown, the Exxon Valdez oil spill, and the explosion of the Challenger space shuttle -- and points out that "Amnesty International lists prolonged sleep deprivation as a form of torture, and it has widely been used as an interrogation tactic."

He also highlights the fact that sleep isn't just a time for our bodies to rest -- it's also a time for learning. "Sleep is not simply cognitively restorative," he writes, "but also a time during which considerable learning occurs. Although the acquisition of knowledge occurs only during waking life, there is evidence that we process, consolidate and stabilize memory during sleep." So, if you still look at sleep only as "down time," you need to think again. Sleep is also practice time for a wide variety of mental skills -- and the full 90-minute sleep cycle allows for different kinds of learning. In our deepest sleep, according to Schwartz, "we appear to process and consolidate fact-based information, such as a new language or the capital of a state." REM sleep, meanwhile, "appears to play a key role in remembering how to do an activity, such as typing or driving a car." And visual learning is processed both in deep (slow-wave) and REM sleep....

...he puts getting enough sleep at the apex of the things we can do to achieve peak performance."

The secret about drugs is that they only work in about half of the people who take them

Making Personalized Medicine Pay - BusinessWeek:

"The dirty little secret about drugs is that they only work in about half of the people who take them. So says an educational nonprofit called the Personalized Medicine Coalition, and many drug executives concede as much. Of the $292 billion spent in the U.S. on prescription drugs in 2008, as much as $145 billion went to medications that didn't help individual patients, said Jerel Davis, project manager at McKinsey, at a recent conference. And billions more are being spent to treat adverse drug reactions and other complications. "When you look at the data, it's shocking," says Dr. Robert S. Epstein, chief medical officer at Medco Health Solutions (MHS), a $51 billion company that manages drug prescriptions for 60 million Americans.

Researchers know how to solve this problem. First, figure out the differences between those patients who respond to a drug and those who don't, then treat only to those who will benefit. But this personalized medicine approach 'has been slower to develop than we thought 10 years ago,' says Richard K. Schatzberg, CEO of Generation Health, a startup that offers targeted medicine services. Lack of enthusiasm in the drug industry is a big reason; companies would lose billions of dollars if only those who actually benefit were to use such blockbuster drugs as antidepressants, arthritis medicines, and cholesterol pills...."

Importance of sleep

Mark Hyman, MD: Sleep Tips: How To Sleep Better, Lose Weight, And Live Longer:

"You can lose weight without changing what you eat or doing one minute of exercise! It's a bold claim. And don't get me wrong: Nutrition and exercise are important! But there's another key to weight loss -- and most people don't even know about it. It's sleep.

In fact, besides eating whole foods and moving your body, getting enough sleep is the most important thing you can do for your health. On the flip side, sleep deprivation makes you fat -- AND leads to depression, pain, heart disease, diabetes, and much more."

Mark Hyman, M.D. practicing physician and founder of The UltraWellness Center is a pioneer in functional medicine. Dr. Hyman is now sharing the 7 ways to tap into your body's natural ability to heal itself.