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The value of a good nap
Editorial
The value of a good nap
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One editor at The Lancet once worked for a psychiatrist who had a large couch in his study. The temptation to recline was not for the purpose of psychoanalysis, or any other moral misdemeanour. Every day after lunch he would take a 30 minute nap. His rule was that he should not be disturbed on any account. A generation of medical students affectionately considered his predilection as nothing more than an academic eccentricity. In fact, it turns out his behaviour was wise and ahead of its time. Naps are back in fashion. According to an immensely valuable guide for navigating night shifts, produced by Nicholas Horrocks and Roy Pounder at the Royal College of Physicians of London, “Naps are powerful means of staying refreshed, both before and while on duty, and even naps as short as 20 to 45 minutes have been shown to provide positive benefits to shift workers.” Evidence-based sleep? Apparently so. The occasion for this advice is the European Working Time Directive. In the UK, this much disliked law means that almost all trainee doctors now work night shifts. There is an urgent need, therefore, for guidance about how to prepare. A first recommendation is that trainees
should not work more than four nights in succession. However, the key to really successful night work has little to do with working at night. What matters, say Horrocks and Pounder, is keeping your sleep debt—the accumulation of missed sleep—to a minimum. Why? Because sleep deprivation, combined with fatigue and a poorly adapted body clock, is closely connected with clinical error. The solution is disarmingly simple, but sometimes difficult to realise. Doctors working nightshifts need to sleep well at home. And they need to get a good deal of sleep before their first night on call. An afternoon rest after a late lie-in ensures proper preparation. But the nap is a doctor’s “indispensable” secret weapon to survival. Horrocks and Pounder also have sensible advice about avoiding bright light, eating prudently, and using caffeine to maintain alertness. Patients will always need medical care at night. And doctors will always be needed to deliver that care. What this latest guidance provides is the kind of practical common sense, informed by science, that benefits both doctor and patient. It deserves to be widely read. ■ The Lancet
Research versus treatment for neglected diseases
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Rights were not granted to include this image in electronic media. Please refer to the printed journal
448
For all the disregard evoked by their name, the neglected diseases—which include AIDS, tuberculosis, malaria, and other tropical scourges such as leishmaniasis, Buruli ulcer, and Chagas’ disease—have been receiving a lot of attention of late. The current wave of interest began in February, 2005, with a campaign led by scientists to promote a global trade framework on medical research and development. Momentum increased in June with the launch of the Global Appeal on R&D for Neglected Diseases, supported by 18 Nobel laureates. Both initiatives were subsequently cited in a Kenyan call for more research into global health priorities, which was discussed at WHO’s Executive Board meeting last month. WHO itself has set up a new department dedicated to neglected tropical diseases and, this week, the European Parliament is preparing for a public hearing on the issue. Most campaigns to invigorate efforts to combat neglected diseases focus on the absence of incentives for appropriate research and the high prices of drugs that
result from intellectual property protection. But this stance reinforces the false belief that the persistence of disease is solely due to a lack of effective and affordable treatments. In fact, for most tropical diseases there are relatively cheap drugs that work—some are even donated free by the companies that manufacture them. Efforts to distribute drugs to all individuals with leprosy—a project that has made slow progress despite Novartis’ commitment to providing the treatment for free—show that high drug prices alone cannot take all the blame. Improving access to medicines depends on a financial mechanism to support delivery of drugs to the people most in need—not just the development of new agents or promises of price limits. Until it can be guaranteed that the global health infrastructure is sufficiently well equipped to allow patients to reap the benefits of existing treatments for tropical diseases, the gains from additional research will inevitably fail to meet scientists’ high expectations. ■ The Lancet www.thelancet.com Vol 367 February 11, 2006
The value of a good nap
Getty Images
Rights were not granted to include this image in electronic media. Please refer to the printed journal
One editor at The Lancet once worked for a psychiatrist who had a large couch in his study. The temptation to recline was not for the purpose of psychoanalysis, or any other moral misdemeanour. Every day after lunch he would take a 30 minute nap. His rule was that he should not be disturbed on any account. A generation of medical students affectionately considered his predilection as nothing more than an academic eccentricity. In fact, it turns out his behaviour was wise and ahead of its time. Naps are back in fashion. According to an immensely valuable guide for navigating night shifts, produced by Nicholas Horrocks and Roy Pounder at the Royal College of Physicians of London, “Naps are powerful means of staying refreshed, both before and while on duty, and even naps as short as 20 to 45 minutes have been shown to provide positive benefits to shift workers.” Evidence-based sleep? Apparently so. The occasion for this advice is the European Working Time Directive. In the UK, this much disliked law means that almost all trainee doctors now work night shifts. There is an urgent need, therefore, for guidance about how to prepare. A first recommendation is that trainees
should not work more than four nights in succession. However, the key to really successful night work has little to do with working at night. What matters, say Horrocks and Pounder, is keeping your sleep debt—the accumulation of missed sleep—to a minimum. Why? Because sleep deprivation, combined with fatigue and a poorly adapted body clock, is closely connected with clinical error. The solution is disarmingly simple, but sometimes difficult to realise. Doctors working nightshifts need to sleep well at home. And they need to get a good deal of sleep before their first night on call. An afternoon rest after a late lie-in ensures proper preparation. But the nap is a doctor’s “indispensable” secret weapon to survival. Horrocks and Pounder also have sensible advice about avoiding bright light, eating prudently, and using caffeine to maintain alertness. Patients will always need medical care at night. And doctors will always be needed to deliver that care. What this latest guidance provides is the kind of practical common sense, informed by science, that benefits both doctor and patient. It deserves to be widely read. ■ The Lancet
Research versus treatment for neglected diseases
Getty Images
Rights were not granted to include this image in electronic media. Please refer to the printed journal
448
For all the disregard evoked by their name, the neglected diseases—which include AIDS, tuberculosis, malaria, and other tropical scourges such as leishmaniasis, Buruli ulcer, and Chagas’ disease—have been receiving a lot of attention of late. The current wave of interest began in February, 2005, with a campaign led by scientists to promote a global trade framework on medical research and development. Momentum increased in June with the launch of the Global Appeal on R&D for Neglected Diseases, supported by 18 Nobel laureates. Both initiatives were subsequently cited in a Kenyan call for more research into global health priorities, which was discussed at WHO’s Executive Board meeting last month. WHO itself has set up a new department dedicated to neglected tropical diseases and, this week, the European Parliament is preparing for a public hearing on the issue. Most campaigns to invigorate efforts to combat neglected diseases focus on the absence of incentives for appropriate research and the high prices of drugs that
result from intellectual property protection. But this stance reinforces the false belief that the persistence of disease is solely due to a lack of effective and affordable treatments. In fact, for most tropical diseases there are relatively cheap drugs that work—some are even donated free by the companies that manufacture them. Efforts to distribute drugs to all individuals with leprosy—a project that has made slow progress despite Novartis’ commitment to providing the treatment for free—show that high drug prices alone cannot take all the blame. Improving access to medicines depends on a financial mechanism to support delivery of drugs to the people most in need—not just the development of new agents or promises of price limits. Until it can be guaranteed that the global health infrastructure is sufficiently well equipped to allow patients to reap the benefits of existing treatments for tropical diseases, the gains from additional research will inevitably fail to meet scientists’ high expectations. ■ The Lancet www.thelancet.com Vol 367 February 11, 2006