Thanks to Carl Willat.
Mo Ibrahim, a friend of mine, teaches high school in New York with hard-to-teach students. He and I want to find out if my ideas about teaching can help him. His blog posts here are the story of that.
I moved to New York in the summer of 2004 to start the Teaching Fellows summer training program at City College of New York. My wife and kids stayed in Chicago until I could find an apartment.
I found an apartment through a Teaching Fellows message board. It was in a nice section of The Bronx, but I only had three months before I had to find another apartment. I spent the first two months taking Master’s degree classes at City College and studying for two teacher certification exams — a general exam that all aspiring teachers took and a specialized one for students who majored in special education. There was a lot of pressure to pass the exams, because if you failed you would be expelled from the program.
By the end of the summer, I had passed both exams, gotten a provisional certification to teach, and gotten a job teaching at a high school near Columbus Circle that served underprivileged students. Most of the students were poor and performed far below grade level in reading and math. But I didn’t have a place to live anymore, because my lease was up and the landlord refused to renew it. I applied for a number of apartments all over New York City, but all of my applications were denied. Once I called to make an appointment to visit an apartment and the owner asked me to come over immediately, but when he saw me he said the apartment was no longer available. On another occasion, I was told that the apartment was no longer available after I faxed over a copy of my driver’s license. I assumed all this was because I was black but an elderly Jewish lady said it was due to my Islamic name. So I moved into a hostel in the East Village. By September, I was teaching full time during the day and taking classes at City College at night. Due to the hostel’s two-week limit, I moved to a different hostel in Manhattan every two weeks.
A couple of things struck me when I starting teaching. One was the New York slang. I found myself frequently asking students to translate words and phrases they used. For example, “Yo, it’s mad brick in this class!” meant “It’s very cold in this class!” I was also struck by their apathy. Most of the students appeared to care little about completing class assignments, turning in homework, and studying for quizzes and exams. I would say, “Why didn’t you do your homework?” They would respond, “What’s the big deal? It’s just homework.” Their measure of success was “Did I pass?” Not all of them were like this, but most of them were.
The first subject I was assigned to teach was 11th and 12th grade math — the two grades were mixed in one class. I had diligently reviewed my high school and college math over the summer, so I was confident I knew the subject. I was assigned to co-teach this class with a veteran teacher. By then he’d been teaching at least fourteen years.
I had gone to a professional development workshop for co-teachers. It had taught seven different co-teaching methods. For example, one was “you teach one day, I teach the next day” or “you teach the first half, I teach the second half”. Different ways of sharing the teaching. In fact, not only did I not teach a single lesson, but I was relegated to the back of the classroom. My co-teacher was really nice otherwise, but he would not let me teach the class. I don’t really know why. When the students were allotted time to work on math problems I would rush to the special education students (students with a learning disability or who were emotionally disturbed, e.g., anger management problems) to give them one-on-one help, but they were usually resistant. They stared at me blankly, or asked off-topic questions like, “Did you see the Yankees game last night?”
Occasionally, students, including non-special education students, would ask me for help. But often in the middle of my explanation the whole-class discussion would resume, and I would have to stop teaching, because my co-teacher asked me not to talk to students while he was teaching. That was my role during my first semester of teaching. I wasn’t despondent, though, because I considered it a blessing in disguise. Since my co-teacher kept me from teaching, I didn’t have to prepare any lessons. He didn’t even allow me to grade any papers, which was a good thing since I was in night school and still living in hostels.
Things changed drastically after the first semester. A veteran English teacher took an emergency leave of absence and I was given her English classes. My math co-teacher asked that all the poor performing special education students be given their own class to be taught by me. A young and friendly English teacher lent me her English curriculum and I developed a modified math curriculum based on the class where I sat in the back. And I was finally able to leave the hostels. I moved into a shared apartment in Brownsville, Brooklyn, the neighborhood where Mike Tyson grew up. It took an hour and twenty minutes on the subway to get to work. During my first commute to work, I overheard someone say: “Did you know Brownsville’s the worst neighborhood in New York?” I hadn’t known that.
I speculated that bedtime honey improves sleep because it consists of an equal mix of glucose and fructose. Glucose is used by the brain during the first half of the night. By the second half, the fructose has been converted to glucose. However, honey has other ingredients, so it is not obvious that fructose and glucose are responsible. I focused on them partly because a need for glucose and fructose during sleep would explain (in evolutionary terms) why we eat dessert after meals, a puzzling separation.
Other carbohydrates also increase blood glucose. Do other carbs also improve sleep? Stuart King (who told me how much bedtime honey improved his sleep) pointed me to a 2010 discussion on a body-building forum. One person wrote:
I save a good portion of my carb intake for my last meal as I’ve found I sleep better afterwards. The worst nights of sleep I’d have during my prep were during my low carb days. Brutal.
Which supports the idea that blood glucose is running down, with bad consequences, during sleep. Even more telling was what someone else said:
Why does this happen to me? Before I was eating 2 cups of milk and a banana right before bed and would sleep fine. In the past few days I’ve tried to switch to 1 cup cottage cheese and 2 tbsp natty peanut butter. I’ve figured out this is why these past few nights I’ve had much more trouble sleeping and have had to resort to taking more OTC sleep aids. Then I’ll still wake up in middle of the night and can’t fall back asleep so I end up having a peanut butter and jelly sandwich and a cup of milk and 20 min later fall back asleep and sleep fine through the rest of the night.
Bedtime Snack A (2 cups of milk, banana): Good sleep. Bedtime Snack B (1 cup cottage cheese, 2 T peanut butter): bad sleep. There are hundreds of differences between the two snacks but one is that A, because of the banana, has about 6 g glucose and 6 g fructose (plus 3 g sucrose) and B has neither glucose nor fructose (nor sucrose). Stuart and I and several others have found that one tablespoon of honey (20 g) at bedtime greatly improves sleep. That much honey has about 8 g glucose and 8 g fructose. This is excellent evidence that it is the glucose and fructose in bedtime honey that improve sleep. Further evidence is that a snack with lots of sucrose (jelly) also produces good sleep.
More about bedtime honey and sleep.
Thanks to Casey Manion and Richard Sprague.
When I moved back to Berkeley from Beijing last spring, I noticed that my sleep was worse in Berkeley, months after arrival. I woke up less rested than in Beijing. There was no obvious explanation. My life was similar in the two places, especially on dimensions that influence sleep. I had expected my health to be better in Berkeley than Beijing because of Beijing pollution.
Wondering why my sleep was different, I realized my Beijing bedroom was probably darker than my Berkeley bedroom. In Beijing I live in an apartment complex and cover most of my bedroom windows to block outside light and for privacy. In Berkeley, I live in a house. My bedroom window looks out over an enclosed backyard. That my Berkeley bedroom might not be dark enough had never occurred to me. It was fairly dark — no street light, no alley light, no light from neighbors.
Did the (likely) difference in darkness contribute to the difference in sleep? I tested this possibility by making my Berkeley bedroom much darker. Later I made it lighter, then darker again (an ABAB design). I measured sleep quality by rating how rested I felt when I woke up on a 0-100 percentage scale where I estimated how rested I felt compared to completely rested (= 100%). I have used this scale for many years. Here are the results:
To my surprise, when I made my bedroom darker my sleep improved. It got worse when I returned my bedroom to its original darkness. It improved again when I again made it darker. Until I graphed the data, I hadn’t realized that my baseline ratings probably shifted shortly before I made my bedroom darker. (I kept a paper record of my sleep, which made it hard to graph the data. Failure to notice this baseline shift was the last straw….I have gone paperless.) In spite of the baseline problem, the data are convincing that even at low intensities, light intensity mattered.
Depth of sleep (controlled by the amplitude of a circadian rhythm) is surely controlled by the amplitude of the light/dark rhythm. Below a certain threshold of light intensity, however, reducing light at night won’t make a difference. These observations implied that the threshold was lower than I’d thought. Support for the idea that the threshold is low — lower than other people realize, too — comes from a study published last summer after my experiment. Researchers reanalyzed old data to see if there was a correlation between lunar phase and sleep quality. Their subjects had slept in a windowless laboratory room. Nevertheless, sleep was worse during a full moon. One researcher was baffled. “What I can’t get my head around is, what would that cue be?” he said. In other words, how could the phase of the moon influence sleep? I’m not puzzled. The subjects spent only a few nights in the sleep lab. I believe there was carryover from when subjects slept at home, in rooms open to moonlight. Light from a full moon reduced the amplitude of sleep. This affected sleep later in the lab for the same reason jet lag lasts several days.
Is your bedroom dark enough? The light at night in Person X’s bedroom will differ in many ways from the light at night in someone else’s bedroom so a one-size-fits-all rule (your bedroom should be darker than . . . ) makes little sense. What does make sense is personal science: measure your sleep and test different levels of darkness.
Thanks to Dave Lull, Stuart King and Joe Nemetz.
A New York Times article about error in a risk calculator paints an unflattering picture of doctors:
1. The risk calculator supposedly tells you your risk of a heart attack, to help you decide if you should take statins. It overestimates risk by about 100%. The doctors in charge of it were told about the error a year ago. They failed to fix the problem.
2. The doctors in charge of the risk calculator are having trouble figuring out how to respond. The possibility of a simple retraction seems to not have occurred to them. As one commenter said, “That the researchers, once confronted with the evidence it was faulty, struggled with how to handle the issue is quite telling.”
3. In the comments, a retired doctor thinks the problem of causation of heart disease is very simple:
Statins . . . are only one component in the prevention and treatment of coronary artery disease. Item number one is to have a normal weight. Item two is never smoke. Item three is exercise. Four is to eat an intelligent diet. Five is to remove stress from your life as much as practical. If everybody did these five things (all of which are free), the incidence of coronary artery disease would plummet and many fewer would need statins.
This reminds me of a doctor who told me she knew why people are fat: They eat too much and exercise too little. She was sure.
4. In the comments, a former medical writer writes:
Several years ago, I wrote up, as internal reports, about two dozen transcripts recorded at meetings with local doctors that a major drug company held all around the country. The meetings concerned its statin. Two ideas presented at these meetings by the marketing team, and agreed with by the physician attendees, were: 1) the muscle pain reported by patients was almost never caused by the statin but was the result of excessive gardening, golfing, etc; 2) many children should be prescribed a statin and told that they would have to take the drug for life.
5. Another doctor, in the comments, says something perfectly reasonable, but even her comment makes doctors look bad:
I am a physician and I took statins for 2 years. Within the first 6 months, I developed five new serious medical problems, resulting in thousands of dollars spent on treatments, diagnostic tests, more prescription medications, and lost work. Neither I nor any of my 6 or 7 different specialists thought to suspect the statin as the source of my problems. I finally figured it out on my own. It took 3 more years for me to get back to my baseline state of health. I had been poisoned. I see this all the time now in my practice of dermatology. Elderly patients are on statins and feel lousy, some of whom are also on Alzheimer’s drugs, antidepressants, Neurontin for chronic pain, steroids for fibromyalgia. These poor people have their symptoms written off as “getting older” by their primary physicians, most of whom I imagine are harried but well intentioned, trying to follow guidelines such as these, and so focused on treating the numbers that they fail to see the person sitting in front of them. The new guidelines, with their de-emphasis on cholesterol targets, seem to tacitly acknowledge that cholesterol lowering has little to do with the beneficial actions of statins. The cholesterol hypothesis is dying. If statins “work” by exerting anti-inflammatory benefits, then perhaps we should seek safer alternative ways to accomplish this, without subjecting patients to metabolic derangement.
6. A patient:
My previous doctor saw an ultrasound of my Carotid Artery with a very small buildup and told me I needed to take crestor to make it go away. That was four years ago and I still suffer from some memory loss episodes as a result. The experience was terrible and he’s toast because he denied it could happen.
7. A bystander:
For the past couple of years my job has involved working with academic physicians at a major medical school. After watching them in action — more concerned with personal reputation, funding and internecine politics than with patients — it’s a wonder any of us are limping along. And their Mickey Mouse labs and admin organizations can barely organize the annual staff holiday potluck without confusion and strife. So these botched-up results don’t surprise me at all.
I am not leaving out stuff that makes doctors look good. Maybe this is a biassed picture, maybe not. What I find curious is the wide range of bad behavior. I cannot explain it. Marty Makary argued that doctors behave badly due to lack of accountability but that doesn’t easily explain ignoring a big error when pointed out (#1), an immature response (#2), a simplistic view of heart disease (#3), extraordinary callousness (#4) and so on. In her last book (Dark Age Ahead), Jane Jacobs wrote about failure of learned professions (such as doctors) to police themselves. Again, however, I don’t see why better policing would improve the situation.
Thanks to Alex Chernavsky.
When I started eating honey at bedtime to improve my sleep, my fasting blood sugar values suddenly improved. Alternate-day fasting had pushed them into the mid-80s; now they were often in the high 70s, values I had never seen before. Without long walks and alternate-day fasting, my fasting blood sugar values would have been more than 100, which is pre-diabetic.
This made me wonder: Does bad sleep cause diabetes? Plenty of evidence, I found, supports this idea. Here is one example:
Just three consecutive nights of inadequate sleep can elevate a person’s risk [of diabetes] to a degree roughly equivalent to gaining 20 to 30 pounds, according to a 2007 study at the University of Chicago. . . .This revelation backs up previous research from Yale and the New England Research Institutes, which showed that people who clock six hours or less of sleep a night are twice as likely to develop diabetes in their lifetime as those who snooze seven hours.
In the study, published in the October issue of the Journal SLEEP, short sleepers reported a higher prevalence of coronary heart disease, stroke and diabetes, in addition to obesity and frequent mental distress, compared with optimal sleepers who reported sleeping seven to nine hours on average in a 24-hour period. The same was true for long sleepers, and the associations with coronary heart disease, stroke and diabetes were even more pronounced with more sleep.
Maybe there is something to it.
Thanks to Phil Alexander and Claire Hsu.
I recently posted that an Oakland woman found that wearing orange glasses (which block blue light) in the evening greatly improved her sleep, which had been bad for decades. My post underestimated the improvement. Before she started wearing the glasses, it took her 2-4 hours to fall asleep. After she started wearing the glasses, it took 15-30 minutes. She wears the glasses from 8 to 10 pm. After that she goes to bed and tries to fall asleep.
I was very impressed by her story and started wearing orange glasses starting at 8 pm, even under incandescent light. Previously I only used them when looking at a computer screen in the evening. I’m not sure if wearing them more improves my sleep, but if I had to guess I’d say it does.