Success Academy is going all in on the APs

 At Success Academy, we’re going all in on Advanced Placement exams.

We had to rent room at the Javits Center to have the space needed for our 1,317 students taking AP exams this year.

And beginning next year, our primarily low-income students will be required to take at least 13 AP classes starting with pre-calculus and English in ninth grade.

To be sure, these tests are challenging.

The New York Times recently reported that low-income students only score well enough on these tests to earn college credit 40% of the time.

But that’s no reason to abandon these tests, which can play an important role in ensuring students enter college ready to do college-level work.

Only 22% of students who take the ACT college admissions exam meet its benchmarks for college readiness in English, math, reading and science.

The numbers are even worse for Hispanic (11%) and black students (6%).

As a result, many pupils, including 65% of those who attend community college, have to take remedial classes when they enter college.

Sending so many underprepared students to college has consequences.

Forty percent of students who enroll in four-year colleges fail to earn a degree within six years.

Low-income and minority students are even more at risk: 49% of Pell Grant students fail to earn a college degree, as do 54% of black students who enter four-year colleges.

Sadly, even the strongest students from disadvantaged communities can have difficulty since they are more likely to end up at top colleges at which they’ll compete with students who’ve already done college-level work at private and selective public schools.

At Thomas Jefferson, a selective public school in Virginia, 100% of students pass at least one AP exam. 

At Stuyvesant, a New York City selective high school, 92% do.

Students who’ve never been exposed to the concept of diminishing marginal returns, the fundamental theorem of calculus or Shakespeare’s sonnets are at a disadvantage.

Even a student who hasn’t done well enough on an AP exam to earn college credit is better off than a student who’s had no exposure whatsoever to this material.

Taking AP courses can also help prepare students psychologically for college.

When our school’s graduates struggle with college courses, it can be a terrible blow to their self-confidence.

Since their scholarships are usually conditioned on keeping up their grades, it can also be frightening and overwhelming.

And it comes at the worst moment: when they are living away from home for the first time.

It’s better for students to struggle with challenging coursework in high school when they have social supports at hand and won’t lose their college scholarship if they fail.

The AP exams are particularly important because many states lack rigorous examination requirements.

Take New York.

The Regents exams once set a high bar. 

In 1996, only 21% of New York City’s public school students earned “Regent diplomas,” which required passing five Regents exams.

Other students earned “local diplomas.”

That year, the state made Regents exams a graduation requirement for all pupils.

When many students failed them, passing was made easier.

A student can get a passing grade on the Algebra I Regents with a raw score of just 26 out of 86 points.

In fact, even a student who earns 23 points — just 27% of the available points — will be deemed to have passed the exam if he or she passes the rest of the course.

The content of the Regents exams isn’t very advanced.

Many schools administer these tests in middle school.

At Success Academy, our middle schoolers take four Regents exams, and virtually all pass them.

Students who fulfill relatively lax graduation requirements can mistakenly think they are prepared to do college work when they aren’t.

Many will end up dropping out with nothing to show for their efforts but debt.

One study found about 2 million students a year drop out of college with student debt.

Yes, it’s disappointing that low-income students pass AP exams only 40% of the time, but killing the messenger isn’t a solution.

Dumbing down or eliminating standardized tests won’t solve the underlying problem any more than discarding temperature measurements will solve global warming.

The reality is colleges, particularly the best ones, are challenging.

We owe it to students to give them a sense of what they’re in for and to give them practice doing college-level work before it really counts.

The AP exams play a vital role in ensuring students have this opportunity.

Eva Moskowitz is the founder and CEO of Success Academy Charter Schools.

https://nypost.com/2024/01/10/opinion/why-success-academy-is-going-all-in-on-the-aps-disadvantaged-students-deserve-to-be-prepared-for-college/

Some House Republicans Willing To Force Government Shutdown After Eagle Pass Border Visit

 by Ryan Morgan via The Epoch Times (emphasis ours),

Following a visit to the southern border last week, some House Republicans urged their colleagues to treat the situation at the border as a major national security risk and to be willing to force a government shutdown to get Democrats and the Biden administration to accept stricter immigration policies and border security measures.

Around 60 House Republicans visited the west Texas border town of Eagle Pass last week. Speaking with NTD’s “Capitol Report” on Tuesday, Rep. Matt Rosendale (R-Mont.) said that the trip marked his fourth visit to the U.S. southern border and that he agreed to go once again to see “how bad the conditions had evolved over the last year.”

“We have major, major problems and I continue to say this is an imminent national security threat,” he said.

Mr. Rosendale noted reported preliminary estimates that U.S. border personnel recorded about 302,000 encounters along the U.S. southern border in December, which would represent the busiest month on record for border officials.

Mr. Rosendale said that upon arriving in Eagle Pass, he also learned that border officials in that sector were working to process about 10,000 illegal immigrants, of whom 200 were deemed individuals of special interest “meaning that they weren’t sure exactly where they were from, they weren’t sure what exactly their intentions were when they arrived here.” He said these 200 special interest individuals and the broader group of 10,000 illegal immigrants were ultimately “whisked off and distributed around the country” before border officials could perform additional vetting efforts.

The Montana Republican said he learned border officials have identified members of up to 168 nationalities who’ve attempted border crossings, including Chinese nationals and people from Middle Eastern countries. Even more concerning, he said, is the approximately 2 million “gotaways” that border officials have estimated have been able to cross into the United States without being stopped. Mr. Rosendale said some of these “gotaways” have even been observed wearing sophisticated camouflage suits to avoid being detected.

“If it is so easy to cross the Rio Grande and Eagle Pass Texas and get a new pair of shoes, clean underwear, and a basically a bus ticket or a flight ticket to go anywhere in the country that you want, why would you go through all the work to sneak in under the cover of night? How bad of a criminal do you have to be?” Mr. Rosendale wondered.

Mr. Rosendale said that if even a fraction of the 2 million gotaways intend to cause harm to the United States “they can wreak havoc across the nation with our national security.”

Looking beyond the national security concerns, Rep. Andy Biggs (R-Ariz.) said the influx of people at the southern border still puts a strain on the United States and border communities in particular.

“People are trying to understand why, if you’re a resident of Eagle Pass, you might be waiting in the waiting room of the ER, because illegal aliens, who aren’t supposed to be in your community, are going ahead of you in line. You may be wondering why there’s five ambulances in Eagle Pass, but one of them is dedicated solely to dealing with the illegal aliens who are coming across the border,” Mr. Biggs said. “And people are fed up with it in that community.”

Republicans Weigh Shutdown Fight

Mr. Rosendale said the various official Republican visits to the southern border may indicate that Republican awareness of border security concerns is rising, but expressed doubts about whether they are willing to take a stand on the issue.

“I think when Jan. 19 rolls on, and we are faced with funding government or doing something about securing our southern border, at that point, that’s where I’m drawing the line and say ‘until we can see the numbers reduce that are crossing into our country illegally from the southern border, I’m not willing to fund the balance of the federal government,” he said.

Mr. Rosendale said Social Security, Medicare, Medicaid, and veterans benefits would continue to be funded in a partial government shutdown, while about 15 percent of the government budget would go unfunded if Congress doesn’t agree to a new budget or continuing resolution by Jan. 19 when the current round of government funding runs out.

“That is a small price to pay, and if we can use that as leverage to secure our nation’s borders, I think that we absolutely should be doing so,” he said.

Mr. Biggs said several officials and advocates Republicans had met with during their visit to Eagle Pass had “begged” Republicans in Congress not to fund the federal government until the Biden administration commits to greater efforts to enforce existing border security policies.

“If you’re going to get this administration to actually enforce the law, you’re going to have to reduce their funding in the programs that they want to have funded, which is a twofer because we spent way too much money as it is. But the second thing is they would be incentivized to actually enforce the law,” Mr. Biggs told “Capitol Report.”

In a letter to colleagues last week, Rep. Chip Roy (R-Texas) said Republicans had the opportunity to tie their border security demands to a measure to temporarily fund the government last fall, but said his “more conservative” colleagues in Congress “were instrumental in shooting down” the effort.

Mr. Roy said the decision not to tie border security to that earlier government funding measure was a “disastrous mistake, and as equally tiresome and problematic as the excuses Republicans typically give about fearing ’shutdown.' Thus, this letter is directed to all of us, for while Democrats own the crisis and abuse of our laws, we Republicans own the failure to force a response to that crisis.”

Asked to respond to Mr. Roy’s letter last week, House Speaker Mike Johnson (R-Ala.) told CBS News that Republicans aren’t threatening to shut down the government over their border security demands, but that House Republicans “understand this is a critical issue.”

Republicans in both the House and the Senate have already attached their demands for border security to a more than $100 billion supplemental spending request submitted by President Biden this fall. The president’s supplemental spending proposal linked several billion in new border and immigration funding to his other spending priorities, like continuing to fund Ukraine in its ongoing war with Russia.

Mayorkas: Border Crisis is on Congress to Resolve

Homeland Security Secretary Alejandro Mayorkas paid his own visit to Eagle Pass on Monday, during which he placed the responsibility on Congress to alleviate the “tremendous stress on our broken immigration system” and fund “our under-resourced facilities.”

Mr. Mayorkas argued that lawmakers should approve President Biden’s spending supplemental, arguing that money will allow the Department of Homeland Security to hire more Border Patrol agents, as well as asylum officers and immigration judges to adjudicate a backlog of more than 3 million immigration cases that has built up over the years, and to fund new facilities to detain people arriving at the border.

“We will continue to do everything we can, and we will continue to enforce the law, but we need Congress to make the legislative changes and provide the funding that our frontline officers so desperately need,” he said.

The DHS secretary’s remarks come as the Republican-led House Committee on Homeland Security is set to consider whether he should be impeached.

Mr. Rosendale suggested the Mr. Mayorkas had simply made his visit to Eagle Pass in order to win support in the oncoming impeachment deliberations.

“He was trying to deploy a PR stunt to try and generate a little bit of support so that his impeachment wouldn’t move forward,” Mr. Rosendale said. “The problem is that he has demonstrated that he has no regard for the law whatsoever. He has not only violated our laws and allowed the southern border to be in the state of an invasion by anybody’s description, but he’s also stopped [Immigration and Customs Enforcement] from doing their job once all these illegals do arrive in our country, keeping them from performing raids and removing and deporting the illegals once they come upon them.”

During his Monday press remarks, Mr. Mayorkas rejected allegations that the DHS is not enforcing the existing immigration laws. He claimed the DHS has removed, returned, or expelled the majority of people it has encountered at the southern border over the course of the Biden administration, and that more noncitizens without a basis to remain in the United States were removed in the five-month period since May of 2023 than in any other five-month period in the last decade.

“We are doing everything we can, within a broken system, to incentivize noncitizens to use lawful pathways, to impose consequences on those who do not, and to reduce irregular migration,” he said.

https://www.zerohedge.com/political/some-house-republicans-willing-force-government-shutdown-after-eagle-pass-border-visit

The First Amendment, Brought To You By Pfizer

 Via The Brownstone Institute,

Pfizer now claims the right of a corporate sovereign, arguing that states have “no legitimate interest in regulating” the company’s commercial speech while demanding the power to censor Americans’ newsfeeds.

The call for pharmaceutical supremacy came in Pfizer’s response to Texas Attorney General Ken Paxton’s suit alleging that Pfizer committed fraud and “conspired to censor public discourse.”

Pfizer embraces its merger with the state when convenient, arguing that it cannot be held liable for misleading the public on its Covid vaccine because the company “acted pursuant to its contract with the United States Government.”

The court documents insist that the PREP Act, invoked by President Trump’s Secretary of Health and Human Services Alex Azar, provides complete immunity for Pfizer’s Covid products.

While the PREP Act prevents citizens injured by the company’s vaccines from recovering money damages in court, it does not nullify state laws concerning fraud.

Pfizer’s affinity for the state is reserved for the expansive legal favoritism awarded to Big Pharma, achieved through decades and billions of dollars in lobbying efforts.

The company insists that “The State of Texas has no legitimate interest in regulating Pfizer’s truthful, non-misleading speech concerning the benefits of receiving the Covid-19 vaccine.” Further, the brief calls Paxton’s suit an “attempt to punish Pfizer for spreading truthful, FDA-approved information educating the public regarding the Covid-19 vaccine.”

At no point, however, does Pfizer respond to Paxton’s detailed allegations that the company’s information was not truthful, but was instead a lucrative marketing campaign designed to “deceive the public.”

The filing does not deny Paxton’s detailed allegations that Pfizer “coerced social media platforms to silence prominent truth-tellers,” including a former FDA Director, and “conspired to censor the vaccine’s critics.”

Pfizer Board Member Scott Gottlieb “persistently contacted senior persons at Twitter and…other social media platforms, in a clandestine effort to silence challengers to Pfizer’s deceptive scheme to promote sales and use of its vaccine products,” including targeting doctors who touted natural immunity, according to Paxton’s suit.

Further, Paxton alleges that Pfizer, led by CEO Albert Bourla, “affirmatively intimidated vaccine skeptics to perpetuate its scheme to confuse and deceive the public.”

The company makes no attempt to refute these allegations. Instead, the brief cites its government contracts as carte blanche to take any actions related to Covid.

Pfizer thus not only claims to work in tandem with the State, but it asserts a sovereign power unshackled from the restraints of constitutional law. The First Amendment allows its executives to usurp citizens’ freedom of speech but prevents prosecution of the company’s lies, according to this theory.

This is an attempt to close one of the few existing (possible) legal avenues to hold pharmaceutical companies accountable. No doubt that the Biden administration, and all the kept federal agencies, will agree with this.

When the courts stop working to hold the powerful accountable, where are the victims to turn next? How can we claim to live in a representative democracy when its citizens’ paths for the redress of wrongs are deliberately closed for the benefit of its most powerful institutions?

https://www.zerohedge.com/political/first-amendment-brought-you-pfizer

BridgeBio: Positive Results from Phase 3 Study in Transthyretin Amyloid Cardiomyopathy (ATTR-CM)

  ATTRibute-CM demonstrated a significant treatment effect of acoramidis on the primary endpoint (a hierarchical analysis inclusive of all-cause mortality (ACM) and frequency of cardiovascular-related hospitalization (CVH)), with a Win Ratio of 1.8 (p<0.0001)

- Acoramidis demonstrated an observed 30-month survival rate of 80.7% in the treatment arm of ATTRibute-CM; recent data from the U.S. Social Security Administration estimated 30-month survival at 85% in an age-matched cohort of the general population; similarly, the annualized CVH rate of 0.29 in the treatment arm can be viewed in the context of the annual overall hospitalization rate of 0.26 in the U.S. Medicare population

- Acoramidis is the only intervention to demonstrate cardiovascular outcomes benefit in a prospective clinical trial in the contemporary ATTR-CM population to the Company's knowledge

- Acoramidis was well-tolerated, with no safety signals of potential clinical concern identified

-   BridgeBio has submitted a New Drug Application (NDA) to the U.S. Food and Drug Administration (FDA) and intends to submit marketing authorization applications to additional regulatory bodies in 2024

https://www.globenewswire.com/news-release/2024/01/10/2807550/0/en/BridgeBio-Pharma-Announces-Publication-of-Positive-Results-from-Phase-3-ATTRibute-CM-Study-of-Acoramidis-for-Patients-with-Transthyretin-Amyloid-Cardiomyopathy-ATTR-CM-in-the-New-E.html

Ecuador's fruit, cocoa exporters say military is securing operations

 Ecuador dispatched security forces to its main port terminals and to some key transportation routes for fruit and cocoa in the country to allow export operations to continue, exporters said on Wednesday.

Ecuador is the world's largest exporter of bananas and the third largest global producer of cocoa, the chocolate-making commodity. The family of President Daniel Noboa has a large banana exporting business.

The country has been rocked this week by violence coming from criminal gangs linked to drug trafficking. Noboa said on Wednesday that the country is at war with the gangs.

He declared a state of emergency on Monday.

Port operations in the main export hubs such as Guayaquil, Posorja and Manta, continued normally despite the violence in several cities, said the head of the banana exporting group AEBE, Jose Antonio Hidalgo Molina.

He said the group has been working with the government to create safe corridors for the fruit to be transported from the farms to the ports.

Some companies operating with agricultural commodities were not fully staffed on Wednesday, said Hugo Francisco Hernandez, a director at cocoa exporting group Anecacao, as many people are avoiding commuting to offices.

But loadings at ports have not been impacted yet, he said. 

https://www.marketscreener.com/news/latest/Ecuador-s-fruit-cocoa-exporters-say-military-is-securing-operations-45718206/

White House's Infrastructure Goals Risk Disruption... By The White House

 by Michael Ireland & Michael Johnson, Michael Philipps via RealClear Wire,

For Americans to start seeing evidence of the Biden Administration’s Infrastructure Investment and Jobs Act (IIJA) taking shape in their hometowns, the construction industry will need the building materials to do the work. But should a newly proposed Environmental Protection Agency (EPA) particulate matter (PM) standard take effect in the next few weeks, those materials might not be readily available over the course of the next few years. 

The actual proposed reduction may seem small, but it would be an enormous change if put into practice. Meeting this change would not only hurt local communities, but it would also thwart the Biden Administration’s flagship IIJA goals.

To comply with the lower standard, U.S. manufacturers may have to cut back hours of operation, which would lead to fewer construction materials being produced, potential layoffs at manufacturing plants and inevitable delays in construction.

In other words, if the Administration chooses to move forward with the new EPA standard, it could be hindering its own plan to revamp the nation’s infrastructurea $550 billion agenda — and the opportunities to provide building materials would be punted to the U.S. construction industry’s competitors overseas. The supplies in other countries would likely be ready and in abundance, as the U.S. enforces some of the strictest emissions regulations in the world, and America’s manufacturers follow them or are shut down.

Those in the nation’s construction industry do care and continue to take action to improve the environment and the air we breathe. For decades, the U.S. cement, concrete, and aggregates industries have spent millions on state-of-the-art technologies to adhere to EPA standards and yield more sustainable products.  

Currently, the U.S. cement industry contributes only a 0.1% share of the PM emissions being targeted, and through the efforts of regulated industry and government officials, PM emissions have been reduced by 37% during the last two decades. This downward trend will continue through programs already on the books, including the PM standards EPA retained in 2020.  

Our industries have invested heavily in efforts to make our products more sustainable because of one simple truth: we are aware of how much society depends on these materials essential in construction, and we know life would be completely disrupted without them. These materials are not frivolous or luxury items that only accommodate some of the population. They are not a fleeting architectural fad that is in vogue today and outdated tomorrow. They are likely the foundation of the home or building where you currently sit, the sidewalk under your feet, and the roads and bridges you rely on to get you where you need to go. 

For centuries, U.S. construction materials have proven to be resilient, reliable, and strong. We checked those boxes long ago. This is why our industries are focusing now, more than ever, on making them more sustainable. 

The IIJA promises $550 billion in construction projects by 2026, which means manufacturers will need to supply tens of millions of tons of their products for those projects to happen. If anything, there is a need for greater investment in U.S. building material production capabilities.

The nation’s manufacturers are well-regulated. They have been for decades. Costly new regulations would negatively impact the U.S. construction industry, ramp up sales in the U.S. for foreign competitors, and we would all witness the same presidential administration that worked so steadfastly to champion the IIJA become the very administration to stifle it.

­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­ ­­­­Michael Ireland is President and CEO, Portland Cement Association. 

Michael Johnson is President and CEO, National Stone Sand and Gravel Association. 

Michael Philipps is President, National Ready Mixed Concrete Association. 

https://www.zerohedge.com/political/white-houses-infrastructure-goals-risk-disruption-white-house

Is This the Cure for Restless Legs?

 I don't rightly remember when I first learned of restless legs syndrome (RLS). It was many decades ago, and I recognized that once in a while, I would be restless during sleep, tossing and turning, seeking a favorable sleeping position. I felt like I just needed to move my legs around; my gastrocnemii and hamstrings might cramp; and my torso skin might strangely "crawl" a bit, but then normal sleep would return. I never sought medical care for it and used no treatment, except moving my legs when indicated.

My trusty LLM (large language model), Bard, tells me that there are about 53,000 articles about RLS in English, of which, some 20,000 are in the primary source, peer reviewed literature. Count this as one more article. Will it make a difference? Read on and see.

For many centuries (since Sir Thomas Willis in 1672), the symptoms now grouped and categorized as RLS have been recognized and reported but were often dismissed as bizarre and unexplained. The name was applied in 1948 by Dr Karl-Axel Ekborn.

In the 1960s, in sleep labs, RLS became better studied and characterized.

Mayo Clinic describes RLS as "…compelling, unpleasant sensations in the legs or feet…both sides of the body…within the limb rather than on the skin…crawling, creeping, pulling, throbbing, aching, itching, electric…difficult to explain…" Not numbness, but a consistent desire to move the legs.

When I read about it many decades ago, I realized that I may have RLS. But then many months would pass with no recurrence, so I dismissed it as just another of those "symptoms of unknown origin" that my late friend Clifton Meador has written about so eloquently.

I am sure that a lot of people experience this, don't understand it, and don't consider it important enough to do anything about. Between 1% and 15% (a wide range) of Americans are believed to be affected by RLS. The cause is unknown, but it seems to run in families. It may be autosomal dominant, but no causative genes have been confirmed.

Treatment of RLS

Many pharmacologic and physical treatments have been tried with some success for some patients, but over time, these treatments have mostly failed.

We know how Big Pharma often operates. A company owns a drug, preferably under patent protection, but without an apparent profitable indication. They need to find a medical condition, ideally one with troublesome symptoms, that the drug might ameliorate to some degree. Armed with a plausible candidate symptom, the company embarks upon a campaign to find people who might want to take the drug. Mass communications, such as direct-to-consumer advertising, can identify large numbers of people who match to pretty much any symptoms, although many of these people never suspected they had a disease, much less a treatable one.

I figured long ago that RLS was just another of those nonspecific entities experienced by many people, making them good candidates for disease mongering.

In 2005, the marketing of GlaxoSmithKline's (GSK's) dopamine agonist drug Requip (ropinirole) was approved by the FDA. GSK had already undertaken an intensive promotional campaign for Requip, issuing press releases, advertising to doctors in medical journals, and advertising directly to consumers. To increase general awareness of RLS, GSK's campaign told consumers that a "new survey reveals that a common yet underrecognized disorder-restless legs syndrome—is keeping Americans awake at night." GSK was accused of "disease mongering," trying to turn ordinary people into patients who needed specific drugs.

Within a year, sales of the drug had doubled, climbing from $165 million in 2005 to nearly $330 million in 2006. Soon, 4.4 million prescriptions were written annually for the drug, with sales reported to be nearly $491 million. However, the focus on RLS faded rapidly as the Requip television commercials were pulled from the airwaves following approval of generic ropinirole.

And Requip had competition. Boehringer Ingelheim manufactures pramipexole (brand name Mirapex) another dopamine agonist. Gabapentin enacarbil (marketed as Horizant by UCB Pharma) is also approved for RLS, and Pfizer's pregabalin (brand name Lyrica) is used off-label to manage symptoms of RLS. Janssen Pharmaceuticals manufactures rotigotine, (brand name Neupro), a dopamine agonist delivered via a transdermal patch.

It is safe to say that RLS is a real clinical entity composed of clearly recognizable symptoms, with no cure and no ending, unless it is associated with iron-deficiency anemia. However, as a disease, it seems to lack etiology, pathology, pathogenesis, pathophysiology, diagnostic findings on physical examination, laboratory tests, or imaging, and any clear strategy for prevention.

Pharmacologic treatments include dopaminergic agents, benzodiazepines, opioids, anticonvulsants, alpha 2–adrenergic agonists and iron salts. Yes, you read that right; RLS is treated with a broad array of different drugs, which is usually a sign that nothing works very well. Some agents work for a while, but none seem to be the definitive solution.

Same for the physical interventions: sleep hygiene, exercise, hot or cold bathing, limb massage, vibratory or electrical stimulation of the feet, stopping caffeine before bedtime. Try everything and see if something works.

Taking the Sugar Challenge

Could the culprit be sugar?

Lacking clarity of scientific understanding of RLS or its treatment from an extensive clinical literature, after ascertaining that RLS is real, one might look for real-world evidence, including well-performed N-of-1 trials.

I am an antisugar guy. Read my prior Medscape columns. I practice what I preach, but sugar does taste good.

Early in November 2023, after a healthy, conservative dinner at home with some wine, I enjoyed a mini Dove bar for dessert. But I didn't stop there.

Mini Dove bars contain 11 grams sugar. It was also just a few days after Halloween. Having had fewer trick-or-treaters than expected, we had leftovers. Snickers, Milky Ways, Twix mini bars, each with at least 20 grams of sugar.

I ate several of these not long before bedtime. Lo and behold, in the dark of that night, and continuing off and on for a few fitful hours, I had bad RLS. Shifting, tossing, turning, compulsively seeking a new sleeping position only to have to soon move again. Plus, I had repetitive leg cramps and that creepy-crawly skin sensation. An altogether unpleasant experience. Sound sleep eventually arrived, and there were no recurrences over subsequent weeks.

The classic way to determine whether a drug is causing a reaction, condition, or disease is to apply the challenge-dechallenge-rechallenge testing method.

Give the drug, the patient demonstrates the disease finding. Remove the drug, the problem disappears. Rinse and repeat three times. We pathologists first worked this out for drug-induced liver disease, such as steatosis, in the late 1960s. Blinding or double blinding in these N-of-1 situations would be nice but often not practical.

Siwert de Groot, in the Netherlands, published a very convincing use of this technique in 2023: big-time sugar consumption for a week, then low intake of sugar for the following week, repeated three times on one patient.

Very elaborate RLS symptom reporting. I'm pretty convinced from my unintentional challenge and single dechallenge that my unusually high sugar intake resulted in RLS. I will not undergo a rechallenge, although it might be fun to binge on sucrose and see what happens.

If you are serious about identifying or treating RLS, I suggest that you incorporate the International Restless Legs Study Group Severity Rating Scale into your practice, and begin the systematic use of the dechallenge-rechallenge exclusion process for your patients with RLS. Start with sugar and see what happens. Keep records and let the world know what you discover. Be your own clinical investigator. Social media offers you abundant opportunity to share your results, whatever they may be.

How many millions of dollars would Big Pharma lose if patients with RLS just said no to sugar and it worked? Of course, humans being humans, many would probably prefer to continue to gorge on sugar, gain weight, develop diabetes, and then take medications to control their RLS symptoms. But patients ought to at least be given an informed choice.

 

https://www.medscape.com/viewarticle/999627