The study of NOELs
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* John C. Clifford

*   © 2005 CMA Media Inc. or its licensors

As a member of the Biological Lecturers of Western Ontario (BLOW), I must respond to the study by Kenneth Rockwood and colleagues.1

I was frankly appalled at the aspersions cast upon the venerable tweed jacket. I can state categorically that while lecturing over many years, I have observed frequent NOELs (nod-off episodes per lecture) in my classes — whether or not I was wearing tweed! Nor should the authors seek to discredit our little friends, the insect-like creatures (ILC), who so nobly inhabit our tweed vestments.

The authors know (or ought to know) that there have been no well-defined, published studies (single-, 11/2- or double-blinded) linking ILC dander to cerebral dysfunction. In fact, I am aware of a preliminary report (personal communication) using an innovative “triple-blinded” study design (both researchers and subjects were blinded, while the ILCs were fitted with bilateral, opaque compound-eye patches) that suggests for the first time that the dander is actually linked to vasodilatation in the basal ganglia, corpus callosum and elbows of those exposed. The implication for the study of upper-extremity, crossover movement disorders in tweed-wearing BLOWs is, of course, enormous.

Blame for NOELs should be placed squarely where it belongs: on the backs (or more precisely, on the back of the necks) of those in our audiences who persist in nodding off.

My own personal theory is that this tendency is actually due to hyperactive stretch reflexes (HSR) in the posterior paracervical musculature (PCM) of those in the medical community who are given to nodding off. Therefore, rather than sacrificing BLOWs or ILCs, it might be far more beneficial to sacrifice a few of the more compulsive nodders among our medical students — perhaps circumventing the thorny issue of ethical approval. Information thus obtained might allow the scientific evaluation of the twitch capabilities (TC) of the affected posterior muscle spindles (PMS).

Establishing the appropriate control group for this study will of course be critical. I agree with Rockwood and colleagues that it would be most appropriate to use as control subjects physician-blaming nodders. Perhaps a prospective, longitudinal trial should be undertaken to determine whether administrators, politicians or lawyers would be best suited. Ideally this study would last for 20 years or more; if well publicized, it could have the added benefit of reducing the frequency of nodding off within those groups. Yet such an outcome may be pure fantasy if the protocol fails to distinguish between simple nodders and those administrators and politicians who can sleep with open eyes and still heads (OESH). Under these circumstances any available data would be classed as superficial, unnecessary clinical knowledge (SUCK).

Finally, funding for such a trial could be pursued through the Canadian Medical Protective Association — at arms' length of course, lest any of the associated tweed-wearing lawyers (TWL) also demonstrate upper-extremity, crossover movement disorders during their closing arguments.

## Reference

1.  1. Rockwood K, Hogan DB, Patterson CJ. Incidence of and risk factors for nodding off at scientific sessions. CMAJ 2004;171(12):1443-5.
    
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