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Challenges exist in access to high-quality care for insomnia disorder. After the recent publication of a clinical practice guideline on behavioral and psychological treatments for insomnia in adults, the American Academy of Sleep Medicine (AASM) hosted a 1-day virtual Insomnia Summit in September 2022 to discuss improving care for patients with insomnia disorder. Fifty participants representing a variety of organizations (eg, medical, psychological, and nursing associations; patient advocacy groups; and federal institutions) participated in the event. Videos highlighting patient perspectives on insomnia and an overview of current insomnia disorder treatment guidelines were followed by thematic sessions, each with 3 to 4 brief, topical presentations by content experts. Breakout groups were used to brainstorm and prioritize issues in each thematic area. Top barriers to care for insomnia disorder include limited access, limited awareness of treatment options, low perceived value of insomnia treatment, and an insufficient number of trained clinicians. Top facilitators of high-quality care include education and awareness, novel care models to increase access, expanding the insomnia patient care workforce, incorporating research into practice, and increasing reimbursement for psychotherapies. Priorities for the future include increasing awareness among patients and providers, increasing the number of skilled behavioral sleep medicine providers, increasing advocacy efforts to address insurance issues (eg, billing, reimbursement, and performance measures), and working collaboratively with multidisciplinary organizations to achieve common goals. These priorities highlight that goals set to improve accessible, high-quality care for insomnia disorder will require sustained, coordinated efforts to increase awareness, improve reimbursement, and grow the necessary skilled health care workforce., Citation: Schotland H, Wickwire E, Aaronson RM, et al. Increasing access to evidence-based insomnia care in the United States: findings from an American Academy of Sleep Medicine stakeholder summit. J Clin Sleep Med . 2024;20(3):455-459., (© 2024 American Academy of Sleep Medicine.)

A new type of research has emerged with United States and European Union pediatric laws that request/demand separate clinical studies for vaccines and drugs in minors less than 18 years of age. Physiologically, minors mature before their 18th birthday. Medicine treats the body, not the administrative status. Many "pediatric" studies are performed in minors that bodily are no longer children, which makes them pointless. Traditional malpractice litigation in clinical research involves patients that were harmed in clinical studies. In the new type of "pediatric" studies, drugs known to work in humans are retested, pretending that "children" are uniquely different, which is incorrect. Minors are not another species. Patients are not treated at all (placebo group) or below standard-of-care (comparison to outdated treatment). Pediatric laws are the law, but not a free pass for harming patients. Where "pediatric" studies violate accepted norms of medical practice, lawyers should be aware of this challenge at the interface of medicine and law., Competing Interests: The authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this manuscript.

Introduction: Regulatory authorities recognize two human populations: adults and children defined as <18 years. For drug approval, they demand separate studies. But humans mature slowly during puberty. The 18 th birthday is an administrative limit that does not correspond to a physiological change. Separate drug approval before/after the 18 th birthday reflects the children-are-therapeutic-orphans concept that emerged after 1962. The Food and Drug Administration (FDA) has backed away from this concept for antiepileptic drugs, but sticks to it in other areas. In contrast, the European Medicines Agency (EMA) is continuously expanding its demand for 'pediatric' studies. Parents hesitate increasingly to let their children participate in questionable studies., Areas Covered: Neurologists challenge the children-are-therapeutic-orphans mantra. Young patients do not need separate proof of efficacy & safety, but appropriate dosing recommendations. Minors should be treated as human beings, instead of being abused in questionable studies., Expert Opinion: Young patients with multiple sclerosis and other neurological diseases deserve studies with therapeutic intentions. 'Pediatric' careers have emerged in academia, regulatory authorities, and pharmaceutical companies. Institutional Review Boards/ Ethics Committees should suspend questionable 'pediatric' studies and reject newly submitted ones. The medical professions should distance themselves from questionable 'pediatric' research that reflects massive conflicts of interest.

Objective: This international omnibus survey investigated the prevalence and characteristics of sleep problems, as well as strategies for resolving sleep problems, in the general population of the USA, France, Germany, Italy, Spain, the UK and Japan., Research Design and Methods: A representative sample of the general population aged > or = 15 years was recruited from each country. Questions focused on the nature of sleeping problems, the impact of problems on daily functioning and behavior with regard to resolving sleeping problems., Results: A total of 10 132 individuals were included in this survey. The prevalence of sleeping problems was 56% in the USA, 31% in Western Europe and 23% in Japan. Most individuals with sleeping problems considered these to have an impact on their daily functioning, with family life most affected in the Western European sample, personal activities in the US sample and professional activities in the Japanese sample. Almost half of individuals with sleep problems had never taken any steps to resolving them, and the majority of respondents had not spoken with a physician about their problems. Of those individuals who had consulted a physician, drug prescriptions had been given to approximately 50% in Western Europe and the USA and 90% in Japan., Conclusions: Sleeping problems continue to present a considerable burden across Western Europe, the USA and Japan. Despite this, they are under-reported and under-treated, with almost half of affected individuals not taking any steps to resolve their sleeping problems.

This paper presents a critical reaction to the Surgeon General's recent report and recommendations on American health. Entitled Healthy People, the report has been described as providing impetus for a "second public health revolution." Our analysis leaves us less than enthusiastic. We first summarize the Report, noting its heavy emphasis on lifestyle. We then compare its tenets with those of the nineteenth century public health revolution. The Report recognizes social and economic conditions as significant factors in determining health but fails to incorporate this recognition in its policy recommendations. Instead, it places the burden of its recommendations on the reform of individual behavior. We explain this focus in terms of the continued centrality of the ideology of individualism and its collective counterpart, social and political pluralism. We then examine the ways in which these ideologies act on the Report and we suggest why the proposals they shape are unlikely to be successful.