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Thursday, December 18

Part 4 of Shoot Yourself in the Foot health care: Chrono-Chaos

If lately you've been getting the feeling there's an increasing number of crazy people in the world, this is probably not your imagination....  

It's been established at least since the early 1970s that frequent jet flights between very different time zones has severe negative physical and mental consequences for the frequent flier. The travel disrupts the body's roughly 24 hour cycle of rest and wakefulness (the Circadian Cycle).  It wasn't long after this momentous discovery that researchers realized that rotational night shift work had the same negative effect on the Circadian Cycle as routine time-zone hopping.  

This was bad news for society's critically important workers -- emergency room doctors, police, fire fighters,  and so on -- who must maintain a high degree of mental clarity for their jobs often under life-or-death circumstances allowing no time for hesitation or 're-do.'   

And of course, it was bad news for the societies that depend on such workers.  And while there are workarounds, there is no real solution to the problem.  Yet decade after decade, evidence keeps piling up about the cost of fooling around with the Circadian Cycle -- and that even night shift work, without the added strain of rotational shifts, was dangerous to mental and physical health. 

By 2011 an American physician, Jessica Freedman, was reporting on "The exhaustion of emergency physicians, and its toll on patients and family."  She noted in part:
[A] recent longitudinal study of EM physicians by the American Board of Emergency Physicians ... reports that one third of EM physicians report burnout. Other studies suggest an increased incidence of breast cancer, obesity and other comorbidities in night shift workers. One survey of EPs over 55 reported several “age related concerns”;  74% found it more difficult  to recover from night shifts, 44% reported a higher level of emotional exhaustion after shifts, 40% were less able to manage high patient volumes, and 36% reported less ability to manage the stress associated with EM practice. ...  Anecdotal evidence supports these findings ...
Then in January 2014 came a stunning revelation, as reported by the BBC:  It's not just one of the body's clocks that go haywire when the Circadian Cycle is disrupted; it's all of them.  

All?  Scientists are now understanding that there's an entire complex of body clocks, all working in synchronization. When the synchronization is thrown out of whack it results in "chrono-chaos," as the syndrome has been termed. The chaos goes all the way down to the molecular level: 
Doing the night shift throws the body "into chaos" and could cause long-term damage, warn researchers.
Shift work has been linked to higher rates of type 2 diabetes, heart attacks and cancer.
Now scientists at the Sleep Research Centre in Surrey have uncovered the disruption shift work causes at the deepest molecular level.
Experts said the scale, speed and severity of damage caused by being awake at night was a surprise. 
The human body has its own natural rhythm or body clock tuned to sleep at night and be active during the day. 
It has profound effects on the body, altering everything from hormones and body temperature to athletic ability, mood and brain function.
The study, published in Proceedings of the National Academy of Sciences, followed 22 people as their body was shifted from a normal pattern to that of a night-shift worker.
Blood tests showed that normally 6% of genes -- the instructions contained in DNA -- were precisely timed to be more or less active at specific times of the day.
Once the volunteers were working through the night, that genetic fine-tuning was lost.
Chrono-chaos"Over 97% of rhythmic genes become out of sync with mistimed sleep and this really explains why we feel so bad during jet lag, or if we have to work irregular shifts," said Dr Simon Archer, one of the researchers at the University of Surrey.
Fellow researcher Prof Derk-Jan Dijk said every tissue in the body had its own daily rhythm, but with shifts that was lost with the heart running to a different time to the kidneys running to a different time to the brain.
He told the BBC: "It's chrono-chaos. It's like living in a house. There's a clock in every room in the house and in all of those rooms those clocks are now disrupted, which of course leads to chaos in the household." [...]
As to what we're going to do about Chrono-Chaos -- well, a few things are getting clear:

Megacities have evolved large populations of critically important night shift workers, including people who can only work at night to maintain the cities' vast infrastructures.  But city life has also created a large population of residents who live as if they're critical night shift workers, when actually all they're doing is staying up at all hours because they want to. 

Then around 2 in the morning these groggy people attempt suicide, or suffer other mental emergencies, get into accidents, or have a heart attack or decide to shoot a neighbor for playing music too loud, etc., etc. 

Then they all dial 911 or show up in hospital emergency rooms and have to be taken care of by facilities that are often underbudgeted and understaffed and working their groggy employees on double night shifts.  

Then these patients threaten to sue the facilities if the care seems -- groggy.

In short, we've evolved a lifestyle that is absolutely guaranteed to increase and perpetuate a host of mental and physical disorders, and is it ever costing societies a bundle. Just one cost is that there are now an awful lot of people who've been driven quite mad by their deranged body clocks.  Many of these people vote.  

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