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Speed Kills

Finally--a miracle cure for everything!

Every now and again, the pharmaceutical industry stumbles upon a product with the power to transfix and transform a segment of society. Birth control pills were a biggie. Ditto cholesterol medication and anti-depressants. But this week, the Food and Drug Administration (FDA) announced that it was taking steps to protect consumers from what has the potential to become a culture-transforming pharmaceutical side effect: sleep-driving.

As the name suggests, sleep-driving is basically sleep walking with a twist: Instead of wandering around the yard in your jammies while semiconscious, you instead fire up the family Hummer and take it for a spin. According to the FDA, such motorized somnabulation is a rare but disturbing side effect of the 13 prescription sleep aids classified as sedative-hypnotics--Ambien, Halcion, Lunesta, Restoril, et cetera. The names may sound soothing, but any one of these meds has the potential to send you on a midnight run to Denny's, with no recollection of the outing whatsoever.

Given the clear potential for disaster in such behavior, the FDA has ordered drug makers to print up consumer-info pamphlets on sleep-driving, alert doctors to the condition, and slap clear warning labels on all sedative-hypnotics. And, since some of these drugs are thought to be riskier than others, the agency is also recommending that the drug companies conduct some clinical trials to determine the worst offenders. Yeah. Right. That's likely to happen. With around $1.7 billion in annual Ambien sales on the line, I'm sure Sanofi-Aventis is just raring to conduct a trial that has any possibility of showing that a competitor's offering might be safer. If the FDA is really serious about consumer protection, it should grow a pair and demand that these drugs be studied more thoroughly. It's one thing if my neighbor wants to take some wacky weight loss drug that he knows could give him a heart attack. It's quite another for him to be popping sleep meds that increase the odds he'll plow his Bronco into my family room.

To be sure, sleep-driving is thought to be rare--although just how rare is anyone's guess since, as the FDA points out, this is the sort of behavior many folks find too embarrassing to report. Complicating matters, the risk of sleep-driving rises dramatically when meds are mixed with alcohol, which means people may be even more hesitant to complain about odd behavior for fear of having their drinking habits scrutinized. Think about it: Some poor schmuck pops a couple of Lunestas with a glass of pinot then awakens six hours later to find himself sitting half-dressed in his Camry outside his daughter's middle school. Do you really think the guy's first impulse will be to notify the authorities?

Putting aside the question of underreporting, it bears noting that an estimated 44 million prescriptions for sedative-hypnotics were written last year. So even if we're talking about an incidence rate of, say, 0.1 percent (which seems reasonable since the makers of Ambien have said that, in their early clinical trials, fewer than 1 in 1,000 users reported somnabulance troubles) that translates into some 44,000 of our friends and neighbors out cruising while snoozing.

If that vision isn't disturbing enough, it turns out that sleep-driving is far from the only type of bizarre behavior caused by sedative-hypnotics. Less common side effects to be reported include sleep-phoning, sleep-cooking, sleep-binge-eating, sleep-painting, and, of course, sleep-sex. Apparently, pretty much any complex activity can, thanks to the magic of pharmacology, now be performed in your sleep, without your knowledge.

Here's where the transformative promise of sleep-driving starts to become clear. Pop a couple of sleeping meds. Behave badly. Blame the drugs. The possibilities are endless: Having trouble staying on that diet? Scarf down a bag of pork rinds, blame the Ambien. Itching to tell your mother-in-law what you really think of her? Dial her up, let it rip, blame the Lunesta. Sick of your husband's snoring? Pick a night when the kids are away, stab the noisy bastard with a butcher knife, blame the Restoril.

Already, the sleep-driving excuse is surfacing in DUI cases. Just this week, some poor schmoe went on CNN to blame Ambien for his drunk-driving. More famously, it was Representative Patrick Kennedy's Ambien-induced wreck last May that won sleep-driving its first wave of national buzz. This is not to suggest that sleep-driving isn't real. But as word of the condition spreads, you can bet that its use as an all-purpose defense will as well.

Which brings us to the subculture where I think this phenomenon could have the greatest resonance: Washington--a land where claims of memory failure and ignorance remain among the most enduring and popular excuses employed by prominent figures caught doing naughty things. Take Attorney General Alberto Gonzalez's current struggle to explain his office's firing of all those federal prosecutors: He wasn't involved. He didn't know what was going on. He has no memory of talking with President Bush about the situation. He doesn't understand how early congressional testimony on this subject could have been so wrong. Yadda yadda yadda. Now, I have no inside knowledge about the contents of the AG's medicine cabinet, but at this point the best explanation he might offer for his role in this mess--at least, one that doesn't center around criminal misbehavior and/or rank incompetence--is that he experienced an episode of sleep-firing.

Indeed, thanks to FDA's announcement, many of the scandals to occur on this administration's watch can now be explained in a more benign light. Scooter Libby's loose lips: Sleep-leaking. The interrogation techniques at Abu Ghraib: Sleep-torturing. The FBI's investigative overreach: Sleep-spying.

While I first saw this sleep-driving business as bad news for drug makers, I now think it could prove to be a major windfall. Sure, a few faint-hearted folks may abandon their meds for fear of sleep-driving their Harley into the neighbor's pool. But these defectors could be more than made up for by savvy, forward-thinking politicos grateful to have a medically approved excuse at hand for whatever sticky situation might arise. Hell, the Bush White House alone could more than make up the difference, considering how much time this administration has spent turning the notion of accountability on its head.

"Sleep-governing." It would explain a lot, no?