Dr. Dement's Historic First Column

We have all lived through some very big surprises. The sudden and mostly unexpected collapse of the Soviet Union after decades of Cold War arms race and costly global geopolitics is one example. When I was in medical school at the University of Chicago, a renowned professor of surgery performed thousands of operations (vagtomy and gastroenterostomy) for intractable peptic ulcer. At great cost, many new surgical and medical approaches have been developed over the years including highly selective vagotomy and Tagamet. The etiology of peptic ulcer eluded generations of gastroenterologists. Stress? Abnormal acid secretion? I was astounded when the cause was finally found - a bacterium living in your gut. And now, peptic ulcers are easily treated with appropriate antibiotics.

For years, I have been gathering evidence to document the fact that the vast majority of sleep disorders patients remain undiagnosed and untreated or misdiagnosed and mistreated.

Even in the past year, our studies have confirmed this fact. On the other hand, many individuals have been very impressed by increasing media coverage though I remain somewhat unimpressed that media coverage can produce effective and lasting change. Will there be a big surprise in the area of sleep? After years of struggle, could there be a sudden radical change in knowledge transfer that would bring millions of patients effectively in to the healthcare system? If so, I believe it will be initiated by the internet and its various potentials and promise. I am therefore very pleased that Sandman and Sharon Keenan have invited me to participate in the activities of their web site by writing a no strings attached weekly column. Only the cautionary statement by Roy, " I would go easy on the weekly or monthly commitment. Whenever I have made such a commitment, I have regretted it because the press of business has often made it impossible to fulfill this commitment.

I would like to start with what I believe is of unsurpassed importance in the sleep area. There are people, babies, children, parents, brothers and sisters who are going to suffer and die needlessly today, this week, this year, and in the years to come if what we have learned about sleep deprivation and sleep disorders is not rapidly and effectively transferred tot he public domain. An effective knowledge transfer will not and cannot save everyone, but we know absolutely that I can save some. Personally, I cannot understand why this is not as great a crusade as any the world has ever known.

In early July, near Stanford University, a promising young woman who had just graduated form Los Altos High School fell asleep at the wheel. And she and one of her friends were killed, others were injured. Had her high school curriculum or driver's training program included knowledge about sleep deprivation and the danger of drowsy driving, there is a strong likelihood that this tragedy would not have occurred. For the cynics who say teenage behavior cannot be changed, I say this is not the issue. Without knowledge there is no choice. With knowledge there is a choice, and if even one person chooses to get off the road when drowsiness occurs, we must continue until we succeed.

I believe that there are societal forces that will drive this issue until as my friend Senator Mark Hatfield said, "This vast reservoir of ignorance about sleep, sleep deprivation, and sleep disorders shall be filled." But these societal forces grind with inexorable slowness. I ask everyone who loves someone including himself or herself, "Would you be content to lose your husband, your child, or your dearest friend today if you know this would not happen to someone else's husband, child, or dearest friend five to ten years from today?"

I have a confession to make. Occasionally I ask myself if I could not pursue a career in sleep, is there something else I would really want to do. In considering a number of possibilities, only one was unambiguously desirable. Without knowing the demands, the likelihood of success, the level of my own talent for such a thing, I would want to be a columnist. I have even gone so far as to develop a list of topics for a weekly column (who could write a daily column?). If the opportunity given to me by Sandman and Sharon is a dream come true, I must maintain great humility in the face of my likely lack of talent and my unquestionable lack of experience. At any rate, I hope it works out and has some positive benefit, however small, for the reader.

Thank you one and all.