Out of curiosity, I went looking for medical error rates from before the max shift lengths were decreased a few years ago and, compared to now. The study I found on it concluded that error rates did not meaningfully change, even though the residents were theoretically better rested.
Upon further examination, they found that error rates due to fatigue had decreased, but that error rates related to patient handoffs had increased by a similar amount. The long shifts, while being a source of fatigue, did provide for good continuity of care, as the same doctor handled the case for longer.
Once the study team started addressing some of the problems in handoffs, such as going through the patients alphabetically instead of by severity, they began to see the error rates decrease.
I came across an article on this same topic, regarding a man who after being shot in the head could no longer sleep..... and apparently lived (as a fully functioning human being??) for 40 more years: https://en.wikipedia.org/wiki/Paul_Kern
The problem is that I cannot find any scholarly articles that mention him (searched on Google Scholar, do not have access to other journals) and the wikipedia article has an extreme dearth of scientific details/sources on this individual; the citations listed are mainly mass media stories.
As someone who has (mainly unsuccessfully) waged a battle against sleep almost my entire life, this story that I came across yesterday intrigued me greatly, and the lack of medical details frustrated me to no end.
I found this article - http://tvblogs.nationalgeographic.com/2010/07/02/the-end-of-... - which mentions some other cases and claims that Paul Kern didn't sleep... but did close his eyes and rest for a couple of hours each day. The whole thing's setting off some skeptical alarms in my head. I think it's pretty telling that all but one of the examples are unverified and from before 1950, when things like EEGs weren't available to verify if someone was sleeping or "just resting their eyes". The only modern case was followed for just four days, which is a long time to go without sleep but certainly not impossible.
It reminds me of credulous studies of people who claim they don't need to eat and drink, surviving off sunlight or air or something mystical. Dig into them a little and you invariably find that they were only monitored for a few days or they were left alone to bathe or pray or whatever else provided some gap where they could go and get food.
EDIT: Did a little more research and I came across a possible explanation that does seem to have some decent scientific studies to back it up (more than any of the non-sleeping examples, at least). "Sleep state misperception" (http://en.wikipedia.org/wiki/Sleep_state_misperception), where a patient doesn't think they've slept much or at all, even though they actually have.
Prahlad Jani has yet to be debunked and he was observed twice (in 2003, 2010) round the clock for up to 15 days without food and water intake or waste movements.
That's probably the one I was thinking of when I mentioned people going without water being allowed to bathe. There's quite a few red flags there - just one researcher doing the experiments (despite offers from other teams and noted skeptics like Sanal Edamaraku to investigate), the research never being published in a journal, the fact that he noticeably lost weight over just ten days, the CCTV coverage being incomplete... The "Reactions" section of the article covers a lot of them, enough to say that the studies are pretty much worthless.
In a case like this, it's up to the ones making the extraordinary claim to provide the evidence, not up to anyone else to debunk it.
The first time he was tested, he dropped a small amount of weight and the second time he didn't. Neither test was only done by one scientist and the second test was a much larger fanfare with Indian defense/government researchers present.
Bathing was also observed as was gargling (what he spit out was also measured). Even so - these "red flags" come from the same scientists that you don't trust. So, they should not support your cynicism in any way.
What are we left with?
- Not published in a journal.
- Incomplete CCTV coverage.
Also, it should be stated that according to many cynics, the CCTV coverage is incomplete because Jani moved out of view for moments at a time. He also received visitors and was allowed to take sun baths.
Anyway, I'm not really here to debate this case. I am just being an anti-cynic because it's been shown time and again that even the smartest people in the world have been dead wrong about what they think they know. Here is a terrific video that sums up this point very well - https://www.youtube.com/watch?v=E8V8rtdXnLA
Most of the issues with the experiment were identified by other scientists, not the ones involved in the study. That's probably why it was never released in any reputable journal - the study design wouldn't pass peer review. Incidentally, releasing your results to the press before you've published academically is also a fairly reliable warning sign of pseudoscience.
When the entire experiment is based around constantly monitoring someone, any time where you can't see them is a pretty serious flaw in the experiment design. Even if he was only out of view for a few seconds (and I wouldn't mind a source for that), that's all it would take to drink some gargling/bathing water or quickly have a snack that some devotee left hidden.
Smart people can certainly be wrong and often have been. Sometimes due to their own preexisting beliefs and prejudices, sometimes because they were limited by the knowledge and technology of their time, and sometimes even because they're being deliberately deceived and their particularly expertise isn't suited to catching it (I cited Project Alpha in a comment below and there are many other examples).
The key thing about science, and remember that organised science is a relatively new idea in the span of human history and one that's made tremendous advances possible in a short time, is that it's about a consensus backed up by the evidence, not any single scientist's opinion. Sure, sometimes one scientist or a small team will come up with a radically new opinion in some field. When their evidence is examined and their experiments repeated by their peers, sometimes they're a Gallileo. More often they're a Pons and Fleischmann (http://en.wikipedia.org/wiki/Cold_fusion#Fleischmann.E2.80.9...). But if, and quite rightly only if, they've got good evidence and a theory that fits the facts better than any other, the consensus will shift.
It's not about cynicism, it's about rationality and skepticism. As the old saying goes, keep an open mind, but not so open that your brain falls out.
“Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.” - Einstein
The chief scientist, Sudhir Shah, was the same each time and you're right that he is "an ardent proponent of Jain philosophy" according to his wikipedia page.
However, both tests were done with other researchers (in 2010, with "a team of 35 researchers from the Indian Defence Institute of Physiology and Allied Sciences (DIPAS) as well as other organizations") in the largest hospital chain in one of the most industrialized states in India.
So, still very believable to my mind, despite the reaction of the scientific community at large. Many are quick to say "impossible", citing what they know based on their own observations. It saddens me that modern scientists are such cynics. History has proven that "impossible" is just a point of view and that many things widely believed to be impossible in the past are completely doable.
India on the whole has a lot of trouble with this sort of thing. One of the skeptics who criticised the Prahlad Jani experiments, Sanal Edamaraku (http://en.wikipedia.org/wiki/Sanal_Edamaruku), had to leave the country to avoid arrest under outdated blasphemy laws for pointing out that the supposedly miraculous tears of a statue of Jesus were actually from a leaking sewage pipe. More recently, another noted skeptic, Narendra Dabholkar (http://en.wikipedia.org/wiki/Narendra_Dabholkar), was shot dead shortly after making significant progress towards outlawing some very lucrative "mystical" practices.
And a large, well-funded project doesn't guarantee reliability. Science involves a certain amount of trust of your peers and scientists studying these claimed phenomena often miss tricks by the participants that someone trained in deception wouldn't (there's a reason so many skeptics and "debunkers" are magicians by training). Look at Project Alpha (http://en.wikipedia.org/wiki/Project_Alpha) - a couple of amateur street magicians were able to make a whole department of researchers believe they had psychic powers for years without even being challenged.
When it comes down to it, science is about evidence. That's why scientists were able to overturn ideas like geocentrism - they examined them and they didn't fit with the evidence, so they had to go. Theories that had seemed "impossible" to some (certainly not all) people before them, like the Earth going round the Sun, did fit the evidence when scientifically examined and they became the accepted scientific consensus (to cut a long story short).
Scientists dismissing these studies aren't doing so based just "on their own observations". There's a very solid base of scientific, verifiable evidence that says that people need to eat. I don't think it's overly cynical to say that a couple of flaky studies should do little to change anyone's mind.
> "...both tests were done with other researchers (in 2010, with "a team of 35 researchers from the Indian Defence Institute of Physiology and Allied Sciences (DIPAS) as well as other organizations") in the largest hospital chain in one of the most industrialized states in India."
But this is exactly the problem, scientists in general are not trained to investigate cases where the phenomena studied is adversarial and has an interest in a given outcome. I am not saying that the man is a fraud, I don't know, but the mindset that you need to spot it will be very different from what most scientists hold. This is why I personally think that these kinds of people should at least initially be analysed by magicians and others who are trained in misdirection and illusion.
> "It saddens me that modern scientists are such cynics."
The amount of evidence required is usually proportional to the strength of the claim. In this case the man is asking us to suspend close to everything we know about how the human body processes waste and its energy requirements. Claiming that this is possible due to a deity. These are very grandiose claims and I think a lot of people are rightfully sceptical rather than cynical.
>It saddens me that modern scientists are such cynics. History has proven that "impossible" is just a point of view and that many things widely believed to be impossible in the past are completely doable.
Science is based on skepticism, you can't believe something just because somebody tells you to or because you hope it is true, and you can't trust all sources of information. This is why there is a system (we can admit it is improvable) where experts on a certain area review the quality and reproducibility of a work to ensure it reaches a certain/minimum level.
Obviously, something that we consider true today can be accepted as false tomorrow (even though usually in science more than false, the change is to not complete). And that's precisely the power of science.
Some people may not realize that rational folk are just humoring spiritual scam artists when we offer to test them. We don't actually waste our time investigating the results of some shoddy trial that doesn't catch them cheating.
Interesting question, both in its own right, and in terms of what Wikipedia should do about it (something I've had an interest in [1] for a while). Looking at the university databases I have access to, I don't really find anything substantive beyond what you've found on Google Scholar. All the stories allege that he suffered a brain injury in 1915 that left him unable to sleep, but the stories themselves are never earlier than the 1930s, and are relatively short newspaper articles (at least, those surviving reports that are digitized and searchable). Is it a real case? A hoax? Something in between, misreporting a real case? Something well documented in an undigitized archive somewhere, waiting to be discovered? No idea.
For a definitive weapon against sleep you could look into modafinil. I haven't tried it because all the shady websites where you can buy it only ship to the US, but apparently it turns off your need for sleep completely with next to no effects of sleep deprivation.
But I wouldn't use it to skip more than a night of sleep. Sounds like a bad idea because you do need to sleep. Sleep is good for you.
Certainly not all! While I don't have the undying patience necessary to wade through Gwern's entire list of modafinil suppliers[1], it does seem statistically likely that at least one of those is semi-reputable[2] and ships to countries beyond the US. Whether any of them ship to your country is a lower — but still probably finite — probability depending your country's chemical restrictions.
Just to make sure nobody takes the above as facts and decides modafinil is what they need: basically everything in parent is incorrect, except that sleeping is good for you.
Modafinil does have various side effects, does not allow you to never sleep, and you do have some effects of sleep deprivation if you use it to skip nights. The shady sites that sell it do ship to non-US addresses. Your doctor probably also has it (provigil), if you have narcolepsy.
Be very careful with modafinil: the side effects can be very severe
"later in the evening she fainted from exhaustion and woke up blind. It took the longest two minutes of all our lives for her eyesight to return fully, and she developed shakes like I’ve never seen, which we couldn’t stop"
“I was mid-conversation and my nose started to bleed uncontrollably, blood was gushing. I completely freaked out”
“Physically, he looked rough, says Charles. He was completely exhausted, his cheeks were pasty and grey, and his body was exhibiting clear signs of sleep deprivation.”
“One friend tried the drug just once, and was plagued by serious, mind numbing headaches. Another couldn’t sleep for two days, despite spending 8 hours in bed per night trying."
Those experiences seem strangely spectacular, they are very different from any experiences I've witnessed or read about. Also, they decided to just use it to skip every nights' sleep? That's not what modafinil is meant for, nor is it capable of replacing sleep in that way.
More people doing dumb shit without having a clue, I guess...
"With a Friday psychology exam looming, she stayed awake nearly sixty hours,
sleeping for just four. "
* The idea is pretty interesting; I feel like I'm drunk, but I'm undersleeping the last few months.
* The major reason I don't get enough sleep is that I need to binge from time to time to get things done or enjoy life. I think I'll do better if I could track my sleeping needs before I get to feel like I do now
Bad:
* TA looks like an advertisement
* The website uses words like "your workforce". I hope employers stay away from their employees sleep. What's next? Stool samples. Management in many places already likes to treat employees like lab rats or machines to be repaired.
> I hope employers stay away from their employees sleep.
In theory it could turn out well, if it turned out that the numbers said it was better to pay people to take an hour nap in the middle of the work day.
In practice I assume it'd turn out to be more of a mandatory unpaid nap, of course.
Thank you for your input. Upside of employees knowing how the staff sleep overall (nothing to a specific employee) could possibly lead to a better shift schedule and the ability to feel less fatigued in your free time
I think pilots wearing Readibands would quickly reveal that a large number of airline pilots are working well into what would be considered a fatigued state.
>>That means that in many cases, a good-but-legally-drunk driver will be vastly out-performing a terrible-but-sober driver.
Not really. Drunk-driving is illegal due to increased reaction times, not decreased driving ability. You can be drunk and properly follow the traffic laws, but if you run into a situation that requires quick reflexes you're much more likely to not react quickly enough.
Whereas terrible drivers are generally terrible in other ways.
Someone who has a low reaction time overall might have a better reaction time drunk than someone with a reaction time of a dead cow. My friend claims 0.1 reaction time on a game where you have to click your mouse (I believe him because he's a professional gamer so it makes sense), while I score 0.2 at best (which is average) and older people score worse and worse
Hence why some people are fighting the politically unpopular fight to get older people off the road. No one wants to be seen as the one that "stole grandma's freedom".
Good driving doesn't have that much to do with your reaction time. 40% slower to respond, with a well planned drive, is a lot safer than 40% faster driving too close.
Sure, but one aspect of "terrible" driving would be: following too close, leaving oneself insufficient space to brake in response to leading vehicles. So, someone who is terrible in that respect could be more dangerous sober than a better driver is when drunk.
Of course, the real reason the limit is there is because the greatest danger is the terrible driver, drunk. When you take 30% worse of "terrible", you get "really terrible".
That's the reasoning, but to me it just proves that drunk driving shouldn't be a crime separate from poor driving. (I guess it would be OK as an aggravating factor for other traffic crimes.) Someone who drives acceptably while drunk drives acceptably, period.
I figure the reason it's set up that way is because BAC is way easier to determine on the side of the road during a traffic stop than a comprehensive study of someone's driving, so we have to lean to the less permissive side.
(We opt not to lean to the more permissive side because drivers who are drunk are indeed already responsible for a great deal of injury, loss of life, and damage)
I don't know. You can't, unfortunately, stop everyone who drives poorly. Too many people do - and even if they just got off with points on their license, quickly enough they'd be banned and then out of work.
Seriously, I can drive for fifteen minutes and see dozens of people who are driving too close together or committing some other sin. All those people who, just going into a corner, you see lighting off their brakes one after another - when all you, a little further back, have to do is roll your toes back a little to take some of the speed out.
Considering random breath tests don't seem to be that big of a thing, (I think - https://www.askthe.police.uk/content/Q723.htm - that they can't do truly random testing,) they're probably picking the people liable to be the worst examples anyway. Which I suspect is the most we can practically hope for at the moment.
for better or worse, it's not far off. imagine we could cross reference some street level CCTV (license plate, maybe gate and facial recognition) and "select driver_dl from trips where driving_ability < 0.7"; revoke licenses from those who can't drive well, consistently... to pay for it, maybe, we could just issue some DUI tickets where the car was parked in-front of a bar for a while and the driver appeared to walk unusually (dozens of violations per habitual drinker, ez). cross reference some phone/text and CC metadata to determine sociability and spending, maybe more, and you can get a pretty good certainty who's probably driving under the infuence and/or a poor driver, and take them off the road.
barely fiction (maybe not at all?), but it won't be hard forever and they won't need to "stop" many people in the sense that is hard to do, for much longer.
>How do you know what percentage of ability corresponds to bad driving?
It is based on reaction time. So if you approach a stop light that turns red and you have a 70% score, you are taking approximately 30% longer to hit the car brakes.
You know I use to see these articles and think, 'that's not me, I can function just fine with 5-6 hrs and a nap, and it was true, I could function just fine.
What I didn't realize is the long term effects it would have on me, my memory became really bad, I was irritable to the point where I thought that's just who I was and worst of all I started having a really hard time grasping new concepts.
I've been getting 7-10 hrs of sleep a night for about two months now and I already noticed a drastic difference in my brains performance.
PSA: Those extra couple of hours of staying awake aren't worth it guys!
Someone with sleep apnea here. I think it is great when the problem of lack of sleep gets more attention. Though my snoring and pain at night has caused my sleep apnea, the lack of sleep is what has caused all of my health and mental problems. I've tried CPAP, dental appliance, and every other type of device you can think of. Ended up with a dental appliance but I still get very little REM and not enough sleep in-general. I haven't woken well-rested in maybe 25 years. It is horrible. Depression, weight problems, CRS (can't remember shit), people think I'm an idiot, often irritated, hopeless, tired all the time. Basically, it really, really sucks.
I'm curious of the different impact between normal sleep deprivation and primary insomnia. It's common that insomniacs don't feel sleepy during the day as compared to a normal sleeper that simply didn't get enough.
The device apparently uses actigraphy, which is super common. It is just measuring movement when sleeping, same as WakeMate (RIP) and Jawbone UP. Besides that I don't see what they are doing that is special except targeting specific sectors that optimize for job safety.
Can't remember exact resource right now, but I've been researching sleep deprivation and related topics for a chapter in my book and apparently every hour of sleep deprivation reduces your cognitive performance by roughly 25%.
This is interesting, especially for someone who has researched the concept before.
Some immediate questions come to mind, like: at what point do you start tracking hours as sleep deprived versus not? What areas of cognitive performance are being evaluated exactly? How was the research collected and what was the sample size?
Any time I see explicit numbers like this connected to neuroscience a bunch of little red flags start to fly up. But then again, I didn't sleep well last night.
If memory serves, they measured reaction time, short-term memory and ability to solve complex tasks. Can't remember how they measured what is a sleep deprived hour and what isn't.
Also "ability to solve complex tasks" seems like it might be difficult to quantify and I can't remember how they did that.
But it's fairly easy to measure the difference in reaction times and capacity to remember strings of numbers.
Swizec, if you are interested in additional resources for your book, I would be happy to connect you with some folks at Fatigue Science (they have a ton of data on how sleep deprivation contributes to reduced cognition and reaction time), or even hook you up with a two week trial of the Readiband for free.
Oh man that would be incredibly awesome if you could! My email is swizec@swizec.com, I'm open for talking to anyone who knows this stuff better than I do.
I'm writing a book called "Why programmers work at night" (http://nightowlsbook.com) and as part of it I'm tackling the problem of helping programmers (and their managers/clients) get the best out of their brain, which includes things like sleep deprivation, how nutrition impacts cognitive performance and feelings of fatigue etc.
There's been a lot of scientific research and animal experimentation on sleep the past several decades. Michel Jouvet[1] forced cats to stay awake until they drowned. Most cats survived for 35 days.[2]
Tony Schwartz in his book "The Way We're Working Isn't Working" also mentioned a study on laboratory mice. They were deprived of ever sleeping until they died.
From this Tony Schwatz advises we have a daily nap.
I'm sure there are countless other hellish and inhumane experiments animals are going through to better our understanding of sleep. But it seems like we still don't know much.
Upon further examination, they found that error rates due to fatigue had decreased, but that error rates related to patient handoffs had increased by a similar amount. The long shifts, while being a source of fatigue, did provide for good continuity of care, as the same doctor handled the case for longer.
Once the study team started addressing some of the problems in handoffs, such as going through the patients alphabetically instead of by severity, they began to see the error rates decrease.