BREAKING NEWS: Have you ever fallen asleep at the wheel?

Inside the war for rest and big medicine's new frontier—the sleeping illness sector Curt Richter had a dozen rats. It was 1919 and as the rest of America held its breath before plunging into the Roaring Twenties, the young Richter began his life's work by observing his rodent subjects. The rats ate, rested, moved, then ate, rested, and moved. What he eventually brought to the scientific community's attention was circadian rhythm—a living thing's intrinsic schedule. For his reward, he became the chosen son of psychobiology, a trailblazer without peer. Richter's breakthrough was just a single strand in a very long and confusing saga about the discovery of sleep. In previous centuries few records existed of how or why humans slept, much less its value. From the modern conceptualization of the 'biological clock' to identifying the yawn-inducing hormone called melatonin, slow progress is still being made finding out why humans need rest. This was best described by a questing magazine writer who simply declared “the predominant theory of sleep is that the brain demands it.” Today, scientists feel they have only scratched the surface. Even then, their curiosity has unearthed a trove of medical nightmares. Among the most insidious is Obstructive Sleep Apnea (OSA), or just plain sleep apnea, first described in a research paper by German doctors Jung and Kuhlo in 1965. Sleep apnea was deemed an exotic condition where the sleeper's breathing was blocked by muscle contractions in the throat. Unfortunately, further research proved sleep apnea was very dangerous. It occurs when either the nasal or oral airways are blocked during sleep, causing mild suffocation that could last up to a minute. In the course of an eight hour sleeping cycle, this could happen hundreds of times, sabotaging the body's normal functions come morning. It was found out that obese people were more prone to sleep apnea, especially since the fat in their neck and lower jaw can 'recline' and collapse the mouth's soft tissue airway. After Jung and Kuhlo's breakthrough, it took 14 years before Dr. Colin Sullivan, an enterprising American dentist, channeled his inner-handyman and custom-built what became the first Continuous Positive Airway Pressure (CPAP) machine in 1979. What the CPAP machine did was simply pump a constant stream of air inside the patient's nose and mouth. To his dismay, it was received with skepticism by the medical community. But in the course of the next three decades, Sullivan's miracle apparatus became the number one product in a booming industry. As the population of North America and Western Europe got older, the elderly demographic proved the CPAP machine's biggest customers. Together with out of control obesity and the precariousness of modern lifestyles, what was a peripheral medical anomaly 50 years ago is now, according to sleep apnea patient Dr. James E. Metz, “...one of the biggest health issues facing our population.” Cleve's ConditionAlmost ten years ago, Cleveland Yu fell asleep behind the wheel. On previous occasions he would collapse, just black out all of a sudden, usually in the afternoon. At the time he was in semi-retirement after successfully riding the great late 90s tech boom. He also dabbled in angel investing and was putting down seed money for medical start ups. Then his doctor told him he had sleep apnea. “Because I'm a Type A personality my first inclination was 'Okay let's go for surgery,'” Cleve says. This was UPPP, short for uvulopalatopharyngeal plasty, an invasive procedure where throat tissue is cut to clear the mouth's airway. The problem was in Cleve's case it did not alleviate his condition—and it hurt. A lot. “There are female patients who will tell you it's worse than childbirth,” he shares. So Cleve resorted to the CPAP machine he uses to this day. He also raised money and together with his wife, a childhood friend-cum-business partner, and a leading Filipino doctor specializing in sleep, launched N2Sleep in 2004. Its name was derived from NREM 2, an early stage in the sleeping cycle. Despite having joined the legion of CPAP dependents, Cleve's background in IT and experience with the medical sector—not to mention his business instincts (“I'm a serial entrepreneur,” he says)—allowed him to spot an opportunity. What if he joined a firm that provided clinics with the equipment and data to treat sleeping disorders like his? See, beginning in the 1980s when sleep apnea was recognized by doctors and dentists as a serious disorder among a hundred other sleeping disorders, a slow but steady market began to emerge. Metrics are hard to come by at this point, though Cleve himself confidently predicts that it is the “fastest growing field in medicine.” He is correct, because when doctors started using sleep tests to observe patients, a whole ecosystem of devices, procedures, and personnel was needed. Cleve Yu and co's N2Sleep (www.n2sleep.com), describing itself as “...one company to handle everything and provide you with unparalleled support,” services this need. Its growth record has been solid enough that Cleve boasts “I have to turn down offers to buy us every month.” Yet N2Sleep so far has a bit part in the greater drama of sleep medicine. It is no longer about pills and insomnia and stress. Servicing huge markets in developed countries has spurred demand for research, treatment, and equipment. Taking the perspective of sleep apnea, since the European Sleep Research Society (ESRS) was established in 1971, more than a dozen other organizations have cropped up to address the illness and its related maladies. Foremost today is the American Academy of Sleep Medicine (AASM) and its sibling the American Academy of Dental Sleep Medicine (AADSM), the National Sleep Foundation (NSF), the Association for the Psychophysiological Study of Sleep (APSS), and the American Board of Sleep Medicine (ABSM). Sleep apnea itself has grown beyond a respiratory anomaly to a major precursor for life threatening illness. Everything from cardiac failure, psychological problems, and even impotence are being ascribed to it. Worse, its scope has extended beyond the elderly to people as young as their 20s all the way down to infants. Apparently, the consensus is gaps in regular breathing while asleep—at any age—are closely related to numerous diseases. No wonder an economic news site reported that sleeping related medical-treatment in the United States would be worth US$32.4 billion this year. Meanwhile, Cleve Yu is eagerly scouting for opportunities here in Asia. He's convinced a lot of people aren't sleeping well. He's right.

 

BREAKING NEWS: Diplomatic Sentiments

A brief journey inside one ambassador's vivid imagination Tomas Javier Calvillo Unna doesn't exactly fit the stereotype of a diplomat. His manner and speech strike the newly acquainted as belonging to a professor, which he is. Or rather used to be. He even founded a school (The Colegio de San Luis). These days, Ambassador Calvillo is the steward of warm diplomatic ties between his country, Mexico, and the Philippines. While economic interdependence hasn't been felt since the galleon trade, the Philippines has more in common with Mexico than other countries in Asia. The ambassador's academic background leans heavily on political science (international relations, history, social sciences), though his private life is balanced between painting and verse. “When I was a student in Mexico, I remember we read a lot of the Generacion del 27,” he says, carefully enunciating veintisiete in accented English. He is referring to a seminal group of Spanish artists from 1927, before they were engulfed by Franco's civil war. “That was Federico Garcia Lorca, Rafael Alberti Merello, Pedro Salinas, Jorge Luis Borges [an Argentinian],” he enumerates. As a Mexican, however, he cites the other half of his literary foundation. “Starting in the 1950s, there was Octavio Paz, Carlos Fuentes, Alfonso Reyes,” he says. “They started a resurgence in Mexican letters and are an inspiration for the young generation.” SadnessAmbassador Calvillo is by himself. None of the invited guests and media had arrived yet for the ribbon cutting of his solo exhibit. The PA system is blaring string music. He is free to ponder his work. It's the opening night of his exhibit at the RCBC Plaza, where an entire wing of the Yuchengco Museum features his paintings. The ambassador explains that it's “the texture of color” that compels him to take up the brush every night after work. He often spends three hours recreating scenes that flicker in his mind's eye. The collection of poems and art book-ended by the theme 'Traces of Sadness' is quite grim. “The concept is the landscape of sadness,” Calvillo says. His style borrows heavily from the modernism that defined Picasso and Matisse—all vivid color but, this time, blurring into smudged figures. In his hands, the retrogressive modernism becomes intertwined with Mexico's own early-20th century heritage. “Like what they did with the color or texture,” he says. He recalls, “while watching the Olympic games, came the news from Aleppo [Syria].” “The very disturbing images caused me to think 'What is happening?' So you had the emotion and joy of the Olympic games and at the same moment you had this tragedy.” This contradiction of “night and day,” as the ambassador puts it, is what he's trying to address. In doing so, he revisits atrocities as diverse as a shooting spree in Norway, missing political activists, the bus hostage fiasco that tarnished the Aquino administration's first year and, of course, the Middle East turmoil. Balancing his peculiar take on recent events are his more candid 'Sentimientos Filipinos,' a body of work inspired by his local experiences. It's quaint, colloquial, and broad—a hundred oil and acrylic paintings of his were on exhibit for the whole of October. Then there's his poetry. The ambassador's last collection was published in 2010. When it comes to writing, Calvillo reveals it's because he likes meditating first, then scribbling his thoughts down. For Traces of Sadness and Sentimientos Filipinos, the ambassador produced 15 poems translated into English (by his son) and Tagalog (Marlon James Sales). One of them, called We See Faces..., reads: There's no single Nor collective history There are many histories Comprehensive or not

 

BREAKING NEWS: Longtime Frenemies

Why China and Japan must depend on each other even when they are frequently at odds Recall mid-September. In the streets of a dozen Chinese cities—Beijing, Suzhou, Chongqing, Nanjing, Yunnan, Qingdao, Chaoshan—angry crowds went on a rampage. The source of their collective angst was the drawn out standoff in the Diaoyu/Senkaku Islands, a string of five islets belonging to Japan located a hundred kilometers off Taiwan. The dispute had been simmering since mid-year but finally came to a boil after the Japanese government made it official that it would “buy” four of the islands from a Japanese businessman affiliated with the influential Koga family. In response to the decision, thousands of Chinese protesters indiscriminately targeted what they believed were unjustified Japanese encroachments on Chinese public life. The Japanese Embassy was spared an all-out siege (although Ambassador Uichiro Niwa was harassed in his chauffeured car), but great corporate brands that had done so well in the mainland like Toyota, Honda, and Nissan were assaulted amid extensive media coverage. The vicious display of rabid nationalism meant shops, retailers, dealerships, and motorists became the subject of public rage in China. Countless Japanese cars were overturned, mauled, and torched, even if Chinese nationals were driving them. A number of Chinese commercial establishments openly proclaimed anti-Japanese sentiments with banners and signs. The worst incidents were compiled in a popular photo-sharing site and disseminated via social media. An earlier attempt at conciliation at the latest Apec summit produced a short, 15-minute session between Hu Jintao and his counterpart Yoshihiko Noda. A similar meeting with the Philippine president, also embroiled in a thorny territorial row, never materialized and amounted to a snub by China. (This minor drama produced a sequel a week later during the 9th China-Asean Expo, when Xi Jinping and appointee Mar Roxas had a more fruitful dialog.) The fallout from the widespread riots amounted to a new low in Sino-Japanese ties. In the same week, the Japan-China Economic Association canceled its impending visit to China, while commemorative activities marking 40 years of renewed ties between the two countries fizzled. Toyota's Akio Toyoda, no doubt troubled by the implications of the crisis, lamented how “the large-scale anti-Japanese movement in China really affected the car sales. What we hope now is to recover as soon as possible.” Quid Pro QuoThe fact that Toyoda mentioned recovery is proof that underneath the noise of conflict is a mutually beneficial relationship between two powerful nations. Ever since Japan was relegated to the world's third largest economy after China's ascension to second in 2010, both have moved closer together in different ways. Since relations officially normalized in the 1972 China-Japan Joint Statement, the two rivals have weathered numerous bumps and have been able to profit from each other. Before the hysteria over the Diaoyu Islands, which is perceived as either a saber-rattling exercise by China before its historic leadership change or naked geopolitical one-upmanship, business relations were very exciting. Until April this year, Japanese companies had invested more than US$2 billion in China, itself a mere sliver of the actual trade volume both share—worth US$27.5 billion as of May 2012. An amusing aspect of the strong bilateral ties between Japan and China is that accurate investment figures between them are hard to come by, yet experts agree that it always runs in the billions. For example, from 2001, Japanese FDI into China was less than US$4 billion as Japanese companies spread outward from their initial beachhead in Dalian and began engaging in joint ventures. The amount has risen exponentially and is only now on a downturn, with 2012 FDI so far at a meager US$8.33 billion. During the previous decade, which saw its fair share of sour diplomatic episodes—usually involving erring fishermen—spending on joint ventures totaled a whopping US$83 billion. Meanwhile, Japanese manufacturers wasted no time establishing factories in the mainland and currently plan to move facilities deeper into the interior. The scale of interconnectedness today has established China as Japan's largest trade partner, while Japan is China's fourth largest trade partner. The countries of both governments are actually very eager to enhance the ease of doing business with each other thanks to the EUs economic decline. This is why Frederic Neumann, senior economist for Asia at HSBC, said in an interview that despite the heated dialog among Chinese officials, the higher rungs of leadership preferred a more restrained rhetoric. The reality is China cannot do without Japan and vice versa—now more than ever. With the Chinese economy at large moving away from manufacturing, the new focus on consumer spending and services means that Japan has an enormous market waiting for its leading brands. For Japan, its industrial base needs access to raw materials and the R&D potential from Chinese technology firms is badly needed. This symbiosis is the underlying bond that remains unshaken no matter how vitriolic diplomatic ties may be. The lesson here is Japanese cars torched by furious mobs are mere gestures, equal parts ugly, misguided jingoism and thuggery. Beijing is smart enough to keep everything cool in secret.

 

BREAKING NEWS: Ivory's Agony

China's unprecedented economic growth in the last three decades has created a new monster: “the suddenly wealthy Chinese,” whose lust for ivory is causing the death of at least 100 elephants a day in Africa's slaughter jungles Elephants used to mingle with the Maasi tribe in southern Kenya. Believing that they also have souls, the Maasi people revered them as almost humans. In a sense, they provided the largest creatures living on earth today with a safe haven where they are rarely hurt nor killed. Their neighboring tribes would even go so far as to say that elephants were once humans themselves. That they have become elephants is but because of their vanity. Even so, none among the tribes people would dare to lay their hands against any of the elephants. For doing so would eventually mean being accursed themselves. But that is not so anymore. The elephants' flashy tusk are now meant to be the target of most, if not all, of African poachers, whose business ultimately boils down to that of satisfying the lust of human vanity thousands of miles away from home. So laments a concerned member of the Maasi tribe, “In the last few years, everything has changed. The need for money has changed the hearts of Maasi.” CrisisKenya's tourism business suffered a great blow in 2008 when it was cut into half by the local post-election ethnic violence and the global economic woes. Then also came the worst droughts to ever hit the country in living memory. All of a sudden, many Kenyans, the Maasis included, found themselves stripped of their rather scarce sources of living. Aside from losing their jobs, many of their cows died. And so were their crops. Life, which for centuries has known nothing but abject poverty, only became much more difficult since then. Then came an “opportunity,” with the sudden rise of the price of ivory. It's a risky business, though. Should any one dares to venture into it, as their tradition informs them, it would mean misfortune on the family. But their empty stomach constantly compels them to break what their tradition forbids. For this reason, many of them have decided to join the growing army of poachers elsewhere across the vast African continent. There had almost been no poaching around the more than 39,000-hectare Amboseli National Park (which used to be home to about 1,200 elephants) in the last 30 years. That was so until a Chinese construction company started building the 70-mile long highway just above the park in 2009. As investigative journalist Alex Shoumatoff puts it, “Since the road crews arrived, in 2009, four of Amboseli’s magnificent big-tusked bulls have been killed, and the latest word is that the poachers are now going after the matriarchs—a social and genetic disaster, because elephants live in matriarchies, and removing the best breeders of both sexes from the gene pool could funnel the Amboseli population into what is known as an 'extinction vortex.'” The second most popular in the country, the Amboseli park is located across the Kenya-Tanzania border, and is easily accessible to both tourists and ivory brokers. Right there, elephant tusks are sold at somewhere around US$20 per pound, which, for the poverty-stricken Africans, smells like a fortune. Last year alone, elephant rich areas in Africa witnessed the arrest of more than 150 Chinese citizens for smuggling ivory. NotoriousBut this sad story goes beyond the Kenya-Tanzania border. Shoumatoff notes that “across the continent, in their 37 range states, from Mali to South Africa, Ethiopia to Gabon, elephants are being killed, some believe, at the rate of around 100 a day, 36,500 a year.” This figure, however, is too conservative at any rate, Shoumatoff admits. While it is nearly impossible to get to know the exact number of elephant population in the continent, some say that they run from 400,000 to 600,000, with as many as 60,000 of them being slaughtered yearly for ivory's raw material – their tusks. But it's not only poverty that encourages Africans to join the notorious army of poachers. Shoumatoff notes of an Al-Qaeda affiliate African youth militia called Al-Shabaab, “has been coming over the border and killing elephants in Arawale National Reserve. Ivory, like the blood diamonds of other African conflicts, is funding many rebel groups in Africa.” To which Kenya Wildlife Service director Julius Kipng’etich adds, his country “is in the unenviable position of sharing over 1,700 kilometers of border with three countries with civil wars that are awash with firearms: Somalia, Ethiopia, and Sudan.” Jeffrey Gettleman of the New York Times confirms this to be the case, referring to Africa's notorious armed groups like the Lord's Resistance Army and the Darfur's janjaweed, “hunting down elephants and using the tusks to buy weapons and sustain their mayhem.” Organized crime syndicates, officials say, are linked up to these groups to move the ivory around the world, “exploiting turbulent states, porous borders and corrupt officials from sub-Saharan Africa to China.” The business of poaching elephants and ivory deals, however, is not the outlaws' monopoly. As Gettleman is quick to note, only in April this year, guards of the Garamba National Park in Congo reportedly spotted a Ugandan military chopper attempting to hunt elephants within the vicinity. “They were good shots, very good shots. They even shot the babies. Why? It was like they came here to destroy everything,” laments Paul Onyango, Garamba's chief ranger, who for 30 years have never grown tired in fighting poachers. Twenty-two elephants were then killed, while the Ugandan soldiers spirited away more than US$1 million worth of ivory, according to Congolese officials, who also noted that the Ugandan military is America's closest ally in Africa. China's Suddenly WealthyBut why is there such a kind of booming underground business in Africa? If the great African elephanticide of the 1970s and the 1980s was driven by Japan's economic boom, Shoumatoff and Gettleman agree that it is China's “suddenly wealthy” that is to blame for today's massive elephant slaughters. As Shoumatoff describes them, they are the middle-aged Chinese “who have just made it into the middle class and are eager to flaunt their ability to make expensive discretionary purchases.” Back then, Africa's elephant population was greatly reduced from official estimate of 1.3 million to some 600,000. Kenya had it down to 15,000 from 150,000. Today, it has been officially declared to be twice as that. An astounding 70% of this illegal ivory trade is now happening in mainland China, catering to vast majority of middle-class Chinese lust for ivory who have so far pushed its price to a staggering US$1,000 per pound. So that ivory chopsticks, cups, rings, combs, bookmarks, which are traditional symbols of wealth and status, are selling almost like hotcakes in China. Even high-ranking Chinese military officers, says Gettleman, are guilty for their fondness for ivory trinkets as gifts. Robert Hormats of the US State Department must have been right when he said, “China is the epicenter of demand. Without the demand from China, this would all but dry up.”

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