On the Road to Fewer Fatigue Crashes
The appointment of Mark R. Rosekind, PhD, to administrator of the National Highway Traffic Safety Administration is an opportunity to further advance drowsy driving awareness.Two days before Christmas, Mark R. Rosekind, PhD, was sworn in as the 15th administrator of the National Highway Traffic Safety Administration (NHTSA) and became the most powerful sleep scientist in government.
He faces a tremendous challenge. NHTSA was without an administrator for a year before Rosekind was nominated by President Barack Obama and confirmed by the Senate. During this time, its number of car safety complaints went from around 45,000 to almost 80,000. Meanwhile, its $830 million budget remains the same as it was in 2009, having not increased in more than half a decade.
To confront this challenge, Rosekind says he will draw on more than just a career that uniquely covers the realms of science, business, and government. He will tap the lessons he learned as a Stanford University undergraduate working in the emerging field of sleep medicine and being mentored by William Dement, MD, PhD, the Stanford professor who co-discovered REM sleep and established the first US sleep laboratory.
“I feel so fortunate to have had Dr Dement as a teacher and mentor because that is my model for how you do these things,” Rosekind says. “His is a passion and dedication to science. Mine is both to science and to public service, but there is no question that it is that kind of passion and dedication that he demonstrated, along with some others along the way, that absolutely inform my opportunities at NHTSA.”
Informed by Sleep Science
When Rosekind arrived as a premed student at Stanford in the mid 1970s, sleep science was rich in talent and low on resources, not unlike the current situation he faces at the NHTSA. He met his wife, Debra Babcock, when they were both research assistants for a study on water beds and was soon captivated by both her and the sleep science field, humble as it was.
Back then, the field was so new that the only special training needed to begin studying sleep was learning where the electrodes had to be placed on a study participant, Rosekind says. He was soon conducting sleep studies and would go on to direct the Center for Human Sleep Research at Stanford University’s Sleep Disorders and Research Center.
What diverted Rosekind from his plans to go to medical school and attracted him to sleep science was that, although the field was little recognized and underappreciated at that time, Dement had a vision of its importance and what it could become.
“One of the things I learned from Dr Dement was to act now and fix it later,” Rosekind says. “If you sit there and think of all the reasons you can’t get something done, you are never going to see it happen.”
He is taking that positive perspective into his new role at NHTSA and challenging the staff to make some fundamental changes that can lead to improvements in highway safety that will last long after his 2-year tenure ends. “We have three top priorities,” he says. “First, we want to innovate the defect recall system. Second, we want to innovate our core safety programs, which includes household names like ‘Click It or Ticket’ and ‘Drive Sober or Get Pulled Over.’ Third, we want to support technology innovations such as forward collision warning systems, new crash-investigation technology, and car alcohol detection systems.”
From Science to Government
Being an effective government agency administrator is not easy. For every issue, there is a range of perspectives and individual concerns. What makes Rosekind uniquely suited to leadership and policy making is that his broad background in both sleep and transportation safety gives him the ability to understand multiple perspectives and make sense of them, says longtime colleague Charles A. Czeisler, PhD, MD, FRCP, director of the Division of Sleep Medicine at Harvard Medical School and chief of the Division of Sleep Medicine in the Department of Medicine at Brigham and Women’s Hospital in Boston.
Czeisler received his PhD and MD at Stanford and, like Rosekind, was mentored by Dement. They’ve known each other for decades.
“I don’t think there is any other individual with that background in so many modes of transportation,” Czeisler says. “It is just an extraordinary breadth of knowledge and experience that he brings to this new role.”
Rosekind, of course, began his career in science. After he graduated with honors from Stanford University, he earned his masters and doctorate at Yale University in New Haven, Conn. He then completed a postdoctoral fellowship in sleep and chronobiology at Brown University Medical School with Mary A. Carskadon, PhD, who he knew from Stanford.
He returned to the West Coast following his post-doc to work as a principal investigator at the NASA Ames Research Center near San Jose, Calif, in the heart of what is now known as Silicon Valley. During his 7 years at NASA, he led its award-winning NASA Fatigue Countermeasures Program and served as chief of the Aviation Operations Branch in the Flight Management and Human Factors Division. His work earned him the NASA Exceptional Service Medal.
A scientific collaborator he came to know well during this time was David Dinges, PhD, now chief of the Division of Sleep and Chronobiology and associate director of the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania in Philadelphia. Dinges notes that not only does Rosekind have a keen analytical mind, but also he is able to translate scientific thinking into business and government policy making.
“He fundamentally understands the science and its application to applied problems and appreciates the complexity and nuances that can happen when applied to policy,” he says.
From Science to Business
In 1998, Rosekind left NASA to found the scientific consulting firm Alertness Solutions with his NASA colleague Kevin Gregory. Over the next 12 years, he would make the Cupertino, Calif-based company a leader in helping high-risk industries as diverse as transportation (including rail, aviation, and trucking), healthcare, and energy develop solutions to the human risk factors posed by fatigue and lack of sleep.
Rosekind has contributed to more than 150 research papers and articles, but few researchers can go on to found successful companies. When working with industries, it is not enough to just be smart and well published. You need to be a good leader, communicator, and, perhaps most importantly, able to work effectively with those holding different views.
“He is an outstanding speaker, he can explain a complicated issue clearly and quickly to people and help them grasp the essence of the issue and what needs to be done,” Dinges says. “He is also a terrifically sincere person with a good sense of humor, but also very disciplined. He does not mix things that shouldn’t be mixed, such as letting personal relationships get in the way of making difficult decisions. He understands that you have to do what is right and what the evidence you have tells you to do without worrying what your friends may think. But he also leads in a way that keeps most people very comfortable and relaxed with the fact that he is in charge and will do the right thing.”
Dedication to Public Service
In 2010, Rosekind’s leadership skills, especially in transportation industry consulting, were recognized when President Obama nominated him as the 40th member of the National Transportation Safety Board (NTSB). Over the next four and a half years, he would serve on-scene for seven major transportation accidents and advance the agency’s advocacy goals on substance-impaired driving, rail mass transit, and fatigue. His presence increased the awareness of fatigue as a factor in transportation accidents, and for this he was honored with the Mark O. Hatfield Award for Public Policy from the American Academy of Sleep Medicine in 2011.
“Through [his work at NASA Ames], his later consultative work with air, rail, and trucking industries, and finally his service on the NTSB, Mark’s knowledge and wisdom have deepened,” Carskadon says. “He has a thorough understanding of human factors and how humans—especially when fatigued and distracted—interface with instruments, gadgets, and technology. He is also a charismatic leader who understands what it takes to have a significant impact. He wants to serve and to help make progress. I am sure that he will make a lasting impact on NHTSA, moving it forward to protect the driving public and to improve automotive industry standards.”
Loss Inspires Passion for Safety
What also helps drive Rosekind is his own understanding of what happens to individuals and families when preventable transportation accidents kill and maim. When he was only three and a half years old, his father, San Francisco motorcycle officer Barry Rosekind, was killed while racing through an intersection with his lights and siren on.
“Somebody ran a light and hit him,” Rosekind says. “That was over 50 years ago and we will never know if that person was drunk or drugged or distracted or drowsy or what was going on at that point.”
Rosekind, his younger brother Gary (who was only 2 at the time), and his mother Marilyn Rosekind moved to the San Francisco suburb of San Bruno. He lived there until he went away to college.
“I don’t put that on a flag, but you can’t ignore that from the very earliest age, the loss of my father has had a very significant effect on me personally and my family,” Rosekind says. “I have been touched personally by the tragedy [of accidental death] and share that. In 2013, the number of lives lost on our roadways was 32,719, and, while that number is coming down, it is still unacceptably high. For me, from three and a half years old, I share that personal tragedy with people.”
Knowing that each person lost leaves loved ones behind makes Rosekind insistent on using exact numbers whenever possible. “I have emphasized here at the agency that people need to know that exact number because every single one of those is a life and a person,” he says. “Part of what drives me here is that transportation safety touches every single person in this country every day. We all rely on roadway transportation, and it should be safe.”
Raising Drowsy Driving Awareness
Rosekind is well aware that his new role is a lot broader than just sleep and fatigue issues. In 2014, NHTSA was particularly criticized for its handling of auto recalls and improving its effectiveness in this area is a top challenge for him.
Coming into the job, Rosekind says he was struck by two things. The first was how talented and passionate all of the people at NHTSA were. “And this is from somebody coming from the NTSB where there are plenty of people who are talented and passionate,” he says. The second was how under-resourced the agency is for the job it has been given.
Still, although the job of NHTSA administrator is a big responsibility that goes well beyond just sleep issues, Rosekind notes that not addressing sleep and fatigue during his time at the NHTSA would be a missed opportunity. “I’ve started presenting that we need to conceptualize impaired driving as the four Ds: Drunk, Drugged, Distracted, and Drowsy,” he says.
Not every driver drinks, takes drugs, or even uses a cell phone while driving, but every driver must be awake to operate a vehicle and contend with occasionally being fatigued, and that makes drowsy driving arguably the most important D for Rosekind and other experts in sleep.
“Dr Rosekind could really change the public awareness and public policy about a hazard that has been largely unrecognized and for which policies have not been developed,” Czeisler says. “Drowsy driving represents an opportunity to reduce a huge fraction of preventable accidents.”
Measuring SuccessWith only 2 years to achieve changes, Rosekind says that he is focused on innovation and program change, and not specific metrics for success. “I want to be able to look back and see that we really made an innovative difference in safety,” he says. “When I first met with Department of Transportation Secretary Anthony Foxx about this position, one of the things he said was that in a couple of years we are not going to be able to get it all done. However, we can set significant markers down that set the path.”
As a Silicon Valley native, Rosekind passionately believes that no matter how good something is, there is always room for improvement and innovation. He also understands that focusing on immediate improvement in specific numbers such as lives saved or recalls increased may distract more than it helps. “I want us to be making an innovative difference, not just a new thing here or there, but really an innovative difference in how we enhance safety,” he says. “Show me some core programs at NHTSA that are innovatively different after my tenure and how these are going to have meaning for the next 10 to 20 years. That is how I’m going to be looking back and deciding if we were successful.”
Lena Kauffman is an Ann Arbor, Mich-based journalist. She is a former Sleep Review editor and has been covering sleep medicine issues since 2005.