You Can Not Sleep? So What?

By: John Scott
Submitted: 2008-05-16 13:00:47
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When they do not suffer from the disease or disorder, people can be very selfish, not to say, callous. The same problems swirl around the politics of "Libertarianism" in the USA, where some activities such as drug and substance abuse are considered "victimless". The argument is made that what people choose to do to themselves should not be the concern of the criminal law. Such arguments essentially ignore the real costs to the public exchequer to support the notion that the general tax rate can be reduced.

Similarly, the inability to sleep is not a real disease like cancer or heart disease which are big killers. There is therefore no need to spend any money on finding out why sleep is elusive. Anyway, the pharmaceutical industry has already produced the cure. It is called ambien and this marvel of medical science is available from your friendly physician.

But just as there are very real costs associated with the completely mislabelled "victimless crimes", research shows there are equally real costs associated with the surprisingly pervasive insomnia. The fact that private capital makes a profit by selling ambien does not mean the rest of society bears no costs.

A recent survey in the United Kingdom of some five thousand randomly selected patients under the care of General Practitioners found that an initial 37% of respondents were affected by symptoms of insomnia. Twelve months after the first survey, a further 15% had developed problems with sleep. The data suggests that insomnia is closely associated with anxiety, depression and other conditions with chronic pain. It also seems more prevalent among older people. Ambien is one of the first resort medications.

But our transatlantic Libertarian friends are already contemptuous. So more Brits are waking up feeling tired. So what? You have already admitted that ambien is available to knock them out if they find sleep a problem. The British National Health Service picks up the bill. Americans who want ambien have to pay for their own prescriptions (or find a health plan that covers them). That is why the US health system is so great. If people get sick, they have to pay their own way back to health without burdening the taxpayers.

Libertarians almost certainly do not read Sleep, the official journal of the American Academy of Sleep Medicine — a publication guaranteed to send them to sleep when they least need it. In March, 2007, Ozminkowski led a team in a retrospective study to calculate the direct and indirect costs of untreated insomnia in the US. The sample was almost 140,000 younger adults who had been diagnosed with insomnia and 75,500 people who were aged 65 years. They were all members of self-insured health plans through their employment. Their medical claims before and after they developed insomnia were measured against a control group of matched individuals who did not develop insomnia. Over the same time, their employers supplied details of the indirect costs incurred through short-term illnesses and absenteeism.

The study found that the annualised costs per individual rose about $1,200 over the norm as the sampled people fell prey to insomnia. In part the costs rose because all the insurance plans paid for the ambien. About 94% received ambien or an equivalent medication. Thus, at the very least, all the other participants in the insurance plans were paying higher premiums. Equally, we customers have to pay higher prices if a proportion of employed staff are regularly ill or absent.

Because insomnia is so widespread and it costs us all money, self-interest says we should promote research into the cause. Although it is true that sufferers can and do use ambien and its equivalents to relieve the worst effects of sleeplessness, we need a better solution than a medication. Ambien is good in the short term but insomnia is not necessarily a short-term problem. Society should treat insomnia as a real medical condition and devote proper resources to relieving it. Simply relying on ambien should not enough even for a Libertarian.

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