xv. Why don’t doctors know?

28 November 2005 at 16:37 | Posted in Circadian rhythm | 11 Comments
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Not many doctors know anything about circadian rhythms.  Not even those calling themselves “sleep specialists” at “sleep clinics”.  Why? 
Well, the history of the field doesn’t go far back.  Some observations were made in the 1700s (the plant in the dark cupboard; Linne’s flower clock), 1800s (experiments and observations, again mostly on plants) and pre-WWII (humans in dark caves; photoperiodism – short and long day plants). 
Research and knowledge exploded in the last half of the 1900s.  In all directions, as explosions are wont to do.  Medicine studied brain waves and sleep stages in humans.  Biology, the mechanisms of seasonal migration and daily activity.  The terms “circadian rhythms” and “biological clock” weren’t even coined until less than a half a century ago.  There’s been constant work on all levels, evolutionary to molecular to wondering why organisms need to sleep at all.  Nature and nurture on all levels. 
No one can keep up with the details of all this as it is happening.  And no one is steering — setting priorities — except perhaps those who provide funding for research.  Someone has to choose what is sufficiently well documented and what is important enough for medical students to study. 
Apnea is widespread, dramatic (it kills) and treatable.  Fine.  Students learn about apnea.  Journalists pick up on and tell people about narcolepsy with cataplexy — both the words and the effects appeal; they sell newspapers.  Pills are provided for insomnia.  Sleep medicine is thus covered — on to the next item. 
Circadian rhythm disorders are “new”.  Discovered, defined and accepted by the 90s or so.  Many doctors now in practice were educated earlier than that and must be forgiven. 
The experts ’til now have been the psychiatrists and the neurologists.  Strange bedfellows, it seems to me, but that may just reveal how little I know about those fields.  In the USA, sleep medicine has now been approved as a sub-specialty for physicians practicing psychiatry, neurology, internal medicine and pediatrics. 
Requirements for the one year program include Chronobiological mechanismsCircadian rhythm disorders is mentioned under Treatment strategies.  The approval came in March 2005, and institutions wishing to offer the program were invited to apply for accreditation.  So no candidates can have completed the program to date.  That’s how new the field is!


Next post:  xvi. Treatment



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