Medicine: Jet lag is a disorder? But then what about ...

At Mind Hacks, we learn (April 7, 2009) from Vaughan that “Drug company pushes jet lag as a medical disorder”:

The Wall Street Journal's health blog reports that drug company Cephalon are trying to get jet lag recognised as a 'circadian rhythm sleep disorder' in an attempt to promote their stay-up-forever drugs modafinil and armodafinil.

Modafinil, under the trade name Provigil, is currently a big seller for the company owing to the fact that it deletes the need for sleep and improves concentration typically without making the person feel particularly 'wired'.

It's licensed for the treatment of narcolepsy but is widely used by people without a prescription to stay awake and fend off mental tiredness.

But as it happens, the patent is running out, and competitors can easily produce the product cheaper.

He charges,

Because in many countries drug must be approved for a medical problem, Cephalon are trying to get jet lag classified as a disorder so they have a whole new market for their compound.

Hmmm. This story certainly brings back memories. Many years ago, I had a college roommate who took a more primitive version of this sort of wakey wakey - just a super jolt of caffeine, and it was sold over the counter. Under especially heavy stress due to exams, she took far too many and ... well, she ended up having to continue her studies later.

I had a different view myself: I always insisted on lots of sleep during exams because a really tired person might not know when she is studying inefficiently. I also usually stopped studying 24 hours before a given exam (having reviewed the material thorough beforehand, of course).

The interval gave the material time to "settle" in my mind, to ensure that the central ideas emerged clearly. Why be confused by a forest of facts and factoids whose hierarchical relation to the central ideas is uncertain or unimportant? Good idea, bad idea, I don't know. But I performed very well on the essay questions, because my responses were formed around central ideas.

Question: Jet lag is uncomfortable, but if it is a disorder, what about ennui and frustration over long, uncomfortable, annoying rides on overcrowded transit buses and subways, where you are shoved into the elbow of someone you've never met for twenty minutes? At least on a plane, you are guaranteed your own seat.

My view: If one reacts negatively to what is really abnormal, that is not a disorder, it's a sign of healthy functioning. And, I'd stay well away from the "stay awake" pills.

Hat tip: Stephanie West Allen at Brains on Purpose

A third recent ChristianWeek column: Faith as one of the healing arts

Faith as one of the healing arts

by Denyse O'Leary

According to an article in Jewish World Review (October 3, 2006) hospitals in the United States have finally begun to pay attention to patients' religious beliefs. "The last thing you want to worry about while somebody is sick is that they might have to transgress on something they believe in," says Zahava Cohen, Englewood Hospital's patient care director (New Jersey). Cohen is surely right; and we can only hope that this trend spreads.

Yes, yes, illness and death come to us all. And serious illness may require abrupt actions and intimidating technology. But, especially among older people, many illnesses are chronic. There is no "pill for every ill." We adapt our lives to illnesses and illnesses to our lives, and go on from there. We instinctively resist being packaged as "the pancreas in # 209" or ultimately the "corpse" to be disposed of, with no acknowledgement that this is or once was part of a person who was in turn part of a community. After all, even in death, the silenced corporal reality is still "Nana" or "Unkie Joe." Acknowledging the community to which the sick, dying, or deceased belong, in which they will be remembered at least by a few for decades to come, is good medicine.

The way in which we receive health care makes a huge difference to its ultimate effect. This reality has long been disguised under the misnamed and misunderstood "placebo" effect. Literally, the word means "I will please." Originally, it referred to sugar pills given to a patient who believes that they are potent. Over one third of patients get better simply because they think the placebo is a powerful medicine. The placebo effect probably underlies traditional shamanism. The reason so many tribal Christians continue to surreptitiously visit shamans is not that they are deluded into believing that shamanism works but because it so often does work. Unfortunately, the shaman typically attributes the healing to specific bizarre practices rather than to the power of belief to trigger healing processes.

Indeed, since the 1970s, a proposed new medication is expected to perform about five percent better than a placebo, if it is to be licensed for use by physicians. Now, let's stop and think about what that means for a moment: We may be taking medications that are only a small percentage more effective than our own belief in them! The placebo effect is thus an interesting demonstration of the power of the mind over the brain and body. It might better be called the cognosco or "I am aware (of healing)" effect.

The placebo effect is not a cure-all; a recent study suggests that it is ineffectual against cancer. However, a 2004 study compared thirty Parkinson's patients who received controversial embryonic stem cell implants with patients who thought they were receiving them (but were actually undergoing a sham surgery). Those who thought they had received stem cells reported a better quality of life a year later than those who thought they had received the sham surgery, regardless of which surgery the patients had actually received. And the medical personnel's assessments of patients tended to concur with the patients' own views.

Doctors use the placebo effect automatically in their work. For example, they behave confidently and reassuringly even when completely stumped by the patient's symptoms or faced suddenly with a life-threatening disorder. They are right to behave this way. A doctor's anxiety would trigger the placebo effect's evil twin, the nocebo effect. "Nocebo" means "I will harm," and nocebos really do harm. Patients may be ill for longer periods and suffer worse symptoms if nocebo effects convince them that they are doomed.

Some consider the placebo effect a mystery. In March 2005, British science magazine New Scientist listed thirteen "Things That Don't Make Sense", and the placebo effect was number one on their list. Of course, the placebo effect doesn't "make sense" if you assume, as they do, that the mind either does not exist or is powerless. The traditional Christian view is that the mind is grounded in the brain so long as we live in this world. Therefore, what the patient's mind perceives expresses itself in the brain and body. Both the placebo and nocebo effects are strong support for the traditional view.

My other blog is the Post-Darwinist, detailing events of interest in the intelligent design controversy. My most recently published book is By Design or by Chance?, an overview of the intelligent design controversy.