transport-sleep-apnea-scam

Todzo wrote:

Todzo wrote:

Todzo wrote:In a post by chunkyfrog on Sat Jun 01, 2013 6:52 am:

Trudger is gone.
The truth is a light bulb switching on; as the cockroaches scurry under the sofa.

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In a post this thread by Todzo on Sun Jun 02, 2013 2:47 am

Trudger wrote: I'm still here, I have thick skin. lol

Ah, the wild wild web. Were you you before? Are you you now?? We have no way of knowing.

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This is the wild wild web. Anyone can pose as anyone.

Are there 50 people regularly posting here - or - are there three who each pose as 10 and 20 others? We do not know.

Probably those who claim to be in the medical field should be required to identify themselves sufficient for us to take any concerns about their advice or conduct to those who oversee them professionally.

I am suspicious that a libelous fishing attempt, for example, would not be considered as professional behavior.

examples abound

Still don't see any examples of libel. I have seen opinions but nothing else.

49er wrote:

Todzo wrote:

49er wrote:

chunkyfrog wrote:It appears that timing of the 10-hour breaks is irrespective of the drivers' ability to sleep in daylight hours.
This would tend to weed out many drivers unable to sleep any time, at the drop of a hat.
Either the timing needs to change or the driver needs to find a different company or a different career.
Public safety is still the primary consideration.

Chunky,

I am not disagreeing with you. But if a company has policies that jeopardize public safety in other ways, then having an apnea screening policy seems hypocritical to me when you don't even allow drivers to have adequate rest at the risk of losing pay.

49er

I remember some news stories about a planning algorithm UPS made to keep drivers safe. Basically it planned their route using only right hand turns thus eliminating the much more dangerous left hand turn.

Would it be so hard for a company to make an algorithm which looked at circadian sleep rhythms and planned to allow for sleep safety? I hope they do so. We would all be safer and the company would be saved from higher insurance premiums I do believe.

It makes too much sense Todzo, that is the problem.

49er

Another problem is that they are actually putting those tested to have sleep apnea right back on the road with brand new CPAP. It is very likely, they being under the gun as well as new to CPAP, that they will not do well with CPAP!!!! An accident waiting to happen indeed!!!

Hi Nate,

I understand the point you're trying to make but using psych meds as your example is not the best one in my opinion because the way success rates have been calculated are quite questionable. For example, in depression meds trials, if your score is reduced by 50% on the self depression rating scale but you are still depressed, that counts as a success. Sound familiar?

When I went to the link you provided, I found this regarding the 83% success rate you quoted:

Medicaid patients taking atypical antipsychotics, those who achieved less than 80% of ideal concordance were about 50% more likely than fully concordant patients to have been hospitalised

Unless I am missing something, that is more about adherence than the actual success rate of antipsychotics which according to this this psychiatrist, has been inflated in the literature:

http://www.madinamerica.com/2013/03/opt ... roduction/

Also, keep in mind that many people who end up in the hospital deemed as non compliant because they didn't take their meds ended up that way due to withdrawal symptoms as the result of going off meds way too quickly or cold turkey. Withdrawal symptoms constantly get marked as a relapse even when the person might no longer need the AP. And for you folks who think APs are for life, go back to the link I provided as Dr. Steingard, the psychiatrist, says that isn't necessarily the case.

http://apt.rcpsych.org/content/13/5/336.full
Why don’t patients take their medicine? Reasons and solutions in psychiatry[/b]
http://apt.rcpsych.org/content/13/5/336.full

Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional.

By this measurement, if we were to apply the argument made by the poster presently claiming to be "Todzo", pharmaceutical companies would be required to reduce the success rates reported out of clinical studies of psychotropic medications by 75%. For example, if a particular psychotropic medication was effective for 80% of those patients who took the medication, the companies would be required to report that the drug had a success rate of only 20% (1/4 of 80%), because only 25% of those who were sent home with the prescription actually took the medicine.

Again, unless I am missing something, you seem to be equating an a goal of 80% adherence with an 80% success rate. And as I have previously mentioned, a well designed psych meddrug study, needs to take into consideration the drop out rate, if it is huge and had horrific side effects, including suicides attributed to the drug.

Let's say for a hypothetical situation that drug X worked well for 10 people in the trial. But 10 other people dropped out to horrific side effects. It wasn't an issue of refusing to try a benign treatment like pap therapy. While obviously, you can't claim that the success rate was now zero logically, to not mention that as a factor would be essentially presenting a study that was fraudulent.

So getting back to the points that Todzo made, maybe it is a fair question to ask your doctor what the adherence rates are with pap therapy. Because if he/she doesn't know or seems not care about the issue, then the question I would have as a patient if if I am the person who has problems as that is what exactly has occurred, is that person going to work with me to make it work or do I do need to move on and find someone else?

49er

allen476 wrote: Still don't see any examples of libel. I have seen opinions but nothing else.

libel 1) n. to publish in print (including pictures), writing or broadcast through radio, television or film, an untruth about another which will do harm to that person or his/her reputation, by tending to bring the target into ridicule, hatred, scorn or contempt of others. Libel is the written or broadcast form of defamation, distinguished from slander which is oral defamation. It is a tort (civil wrong) making the person or entity (like a newspaper, magazine or political organization) open to a lawsuit for damages by the person who can prove the statement about him/her was a lie. Publication need only be to one person, but it must be a statement which claims to be fact, and is not clearly identified as an opinion. While it is sometimes said that the person making the libelous statement must have been intentional and malicious, actually it need only be obvious that the statement would do harm and is untrue. Proof of malice, however, does allow a party defamed to sue for "general damages" for damage to reputation, while an inadvertent libel limits the damages to actual harm (such as loss of business) called "special damages.

In order for something to be libel it has to be stated as fact and untrue. I have argued with Todzo, and I believe he is dead wrong. But I have never said anything untrue. Nor is anything being said here actually harming him.

And unless I have missed something, nobody here knows who Todzo is in real life. So, how could a statement here possibly be harming him? We are not posting his personal info, making claims about his business (if he has one) or his employment to an employer.

On the other hand, Todzo is making claims that he states as fact, that are really untrue. And his statements, if read and believed by newcomers, would easily lead to people quitting their cpap treatment. Those people could then suffer major health problems. So, who's hurting people here?

On the other hand, Todzo is making claims that he states as fact, that are really untrue. And his statements, if read and believed by newcomers, would easily lead to people quitting their cpap treatment. Those people could then suffer major health problems. So, who's hurting people here?

If someone quits therapy because they read one post, that is on them, not Todzo. Heck, they shouldn't even be allowed to surf the net if they are going to accept as fact, one post, without doing more checking.

That would be like me taking a supplement based on someone's recommendations, suffering adverse affects, and then blaming that person. Since I am sure all of you would think my actions were rightfully absurd, then in my opinion, it would be unfair to blame Todzo for influencing someone to quit therapy.

49er

49er wrote:

On the other hand, Todzo is making claims that he states as fact, that are really untrue. And his statements, if read and believed by newcomers, would easily lead to people quitting their cpap treatment. Those people could then suffer major health problems. So, who's hurting people here?

If someone quits therapy because they read one post, that is on them, not Todzo. Heck, they shouldn't even be allowed to surf the net if they are going to accept as fact, one post, without doing more checking.

That would be like me taking a supplement based on someone's recommendations, suffering adverse affects, and then blaming that person. Since I am sure all of you would think my actions were rightfully absurd, then in my opinion, it would be unfair to blame Todzo for influencing someone to quit therapy.

49er

Most people who deal with a change (like adjusting to cpap) will go through the phase of denial. During that stage, we are looking for any reason to quit. All we need to see is some misinformation that looks like fact. How many people choose dental devices or surgery because they have an overstated success rate (with the definition of success being substandard), and the person is trying to avoid cpap?

Keep in mind that many people find this group by doing a specific keyword search and then finding a message from this forum. Many of us then check out the whole forum and stay. Some people may just read a few posts and leave. This is why I believe it is so important to challenge Todzo every time he posts these false statistics. If these posts go unchallenged, a newbie could stumble across the topic, read something that they think supports their decision to skip or quit cpap, and they won't see a rebuttal. Yes, they really should do more research. But people in denial usually aren't so good at research during that time.

zoocrewphoto wrote:

49er wrote:

On the other hand, Todzo is making claims that he states as fact, that are really untrue. And his statements, if read and believed by newcomers, would easily lead to people quitting their cpap treatment. Those people could then suffer major health problems. So, who's hurting people here?

If someone quits therapy because they read one post, that is on them, not Todzo. Heck, they shouldn't even be allowed to surf the net if they are going to accept as fact, one post, without doing more checking.

That would be like me taking a supplement based on someone's recommendations, suffering adverse affects, and then blaming that person. Since I am sure all of you would think my actions were rightfully absurd, then in my opinion, it would be unfair to blame Todzo for influencing someone to quit therapy.

49er

Most people who deal with a change (like adjusting to cpap) will go through the phase of denial. During that stage, we are looking for any reason to quit. All we need to see is some misinformation that looks like fact. How many people choose dental devices or surgery because they have an overstated success rate (with the definition of success being substandard), and the person is trying to avoid cpap?

Keep in mind that many people find this group by doing a specific keyword search and then finding a message from this forum. Many of us then check out the whole forum and stay. Some people may just read a few posts and leave. This is why I believe it is so important to challenge Todzo every time he posts these false statistics. If these posts go unchallenged, a newbie could stumble across the topic, read something that they think supports their decision to skip or quit cpap, and they won't see a rebuttal. Yes, they really should do more research. But people in denial usually aren't so good at research during that time.

Zoo, I am not disagreeing that you shouldn't challenge false claims just like I feel that people are wrong to state that dental appliances are mostly ineffective. But again, the issue is we are not responsible for people deciding to quit pap therapy based on a few posts. That is on them.

And by the way, people do have a right not to undergo pap therapy just like they do with any medical treatment. Just saying.

Of course, when it involves driving for a living, that is another issue.

49er

49er wrote:And by the way, people do have a right not to undergo pap therapy just like they do with any medical treatment. Just saying.

Of course, when it involves driving for a living, that is another issue.

How is that another issue?

If a guy with known severe OSA and documented EDS falls asleep at the wheel of his Escalade, drifts across the road and hits you head on at 60 MPH, is there any consolation as to how splattered you are (although it would probably be pretty close)?

mollete wrote:

49er wrote:And by the way, people do have a right not to undergo pap therapy just like they do with any medical treatment. Just saying.

Of course, when it involves driving for a living, that is another issue.

How is that another issue?

If a guy with known severe OSA and documented EDS falls asleep at the wheel of his Escalade, drifts across the road and hits you head on at 60 MPH, is there any consolation as to how splattered you are (although it would probably be pretty close)?

Good point Mollete as I didn't express my point very well. What I should have also added was that if you chose not to undergo pap therapy, you also have the responsibility not to drive unless you're damm sure you can do it safely.

By the way, I realize some people have no idea as how impaired they are but some people do. And there are people who don't have sleep apnea and are not drunk but shouldn't be driving for various reasons. They think they are fine to drive but aren't. I experienced this up and close and personal with one person and it was scary as heck.

And just because someone undergoes pap therapy, doesn't guarantee they will be a safe driver as evidenced by many posts from people who state that they feel worse after starting therapy and their EDS has not been resolved.

49er

49er wrote:Hi Nate,

I understand the point you're trying to make but using psych meds as your example is not the best one in my opinion because the way success rates have been calculated are quite questionable. For example, in depression meds trials, if your score is reduced by 50% on the self depression rating scale but you are still depressed, that counts as a success. Sound familiar?

When I went to the link you provided, I found this regarding the 83% success rate you quoted:

Medicaid patients taking atypical antipsychotics, those who achieved less than 80% of ideal concordance were about 50% more likely than fully concordant patients to have been hospitalised

Unless I am missing something, that is more about adherence than the actual success rate of antipsychotics which according to this this psychiatrist, has been inflated in the literature:

http://www.madinamerica.com/2013/03/opt ... roduction/

Also, keep in mind that many people who end up in the hospital deemed as non compliant because they didn't take their meds ended up that way due to withdrawal symptoms as the result of going off meds way too quickly or cold turkey. Withdrawal symptoms constantly get marked as a relapse even when the person might no longer need the AP. And for you folks who think APs are for life, go back to the link I provided as Dr. Steingard, the psychiatrist, says that isn't necessarily the case.

http://apt.rcpsych.org/content/13/5/336.full
Why don’t patients take their medicine? Reasons and solutions in psychiatry[/b]
http://apt.rcpsych.org/content/13/5/336.full

Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional.

By this measurement, if we were to apply the argument made by the poster presently claiming to be "Todzo", pharmaceutical companies would be required to reduce the success rates reported out of clinical studies of psychotropic medications by 75%. For example, if a particular psychotropic medication was effective for 80% of those patients who took the medication, the companies would be required to report that the drug had a success rate of only 20% (1/4 of 80%), because only 25% of those who were sent home with the prescription actually took the medicine.

Again, unless I am missing something, you seem to be equating an a goal of 80% adherence with an 80% success rate. And as I have previously mentioned, a well designed psych meddrug study, needs to take into consideration the drop out rate, if it is huge and had horrific side effects, including suicides attributed to the drug.

Let's say for a hypothetical situation that drug X worked well for 10 people in the trial. But 10 other people dropped out to horrific side effects. It wasn't an issue of refusing to try a benign treatment like pap therapy. While obviously, you can't claim that the success rate was now zero logically, to not mention that as a factor would be essentially presenting a study that was fraudulent.

So getting back to the points that Todzo made, maybe it is a fair question to ask your doctor what the adherence rates are with pap therapy. Because if he/she doesn't know or seems not care about the issue, then the question I would have as a patient if if I am the person who has problems as that is what exactly has occurred, is that person going to work with me to make it work or do I do need to move on and find someone else?

49er

49er, I see your point and I agree that it is a valid point.

However, I picked psych meds as a worst case example. Actually, non-adherence to prescribed therapy or medication is a universal issue, not limited to psych meds. You might want to take a look at these articles too:

The International Journal of Healthcare Improvement
Patients’ problems with new medication for chronic conditions

Methods: A longitudinal survey with data collection at 10 days and 4 weeks was performed on 258 patients recruited from 23 community pharmacies in south east England. Patients were eligible to participate if they were starting a new chronic medication and were either 75 years or older or had one of the following chronic conditions: stroke, coronary heart disease, asthma, diabetes, and rheumatoid arthritis. At each time point a semi-structured telephone interview was conducted and a postal questionnaire was sent.
…
Conclusions: A significant proportion of patients newly started on a chronic medication quickly become non-adherent, often intentionally so. Many have problems with their medication and information needs. Patients need more support when starting on new medication for a chronic condition and new services may be required to provide this.

http://qualitysafety.bmj.com/content/13 ... f_ipsecsha

and you might find this very general study particularly interesting, if not somewhat astounding:

Journal of General Internal Medicine
April 2010, Volume 25, Issue 4, pp 284-290
Primary Medication Non-Adherence: Analysis of 195,930 Electronic Prescriptions
Michael A. Fischer MD, MS, Margaret R. Stedman PhD, Joyce Lii MS, MA, Christine Vogeli PhD, William H. Shrank MD, MSHS, M. Alan Brookhart PhD, Joel S. Weissman PhD

KEY RESULTS
Of 195,930 e-prescriptions, 151,837 (78%) were filled. Of 82,245 e-prescriptions for new medications, 58,984 (72%) were filled. Primary adherence rates were higher for prescriptions written by primary care specialists, especially pediatricians (84%). Patients aged 18 and younger filled prescriptions at the highest rate (87%). In multivariate analyses, medication class was the strongest predictor of adherence, and non-adherence was common for newly prescribed medications treating chronic conditions such as hypertension (28.4%), hyperlipidemia (28.2%), and diabetes (31.4%).

CONCLUSIONS
Many e-prescriptions were not filled. Previous studies of medication non-adherence failed to capture these prescriptions. Efforts to increase primary adherence could dramatically improve the effectiveness of medication therapy. Interventions that target specific medication classes may be most effective.

http://link.springer.com/article/10.100 ... 010-1253-9

Regards, Nate

However, I picked psych meds as a worst case example. Actually, non-adherence to prescribed therapy or medication is a universal issue, not limited to psych meds. You might want to take a look at these articles too:

Yes - One of the reason we are getting antibiotic resistant bacteria is that people will not take the full course of the treatment. They stop as soon as they start to feel better. According to Todzo this is the fault of the medical system and means we don't have a way to treat people because they refuse to take their meds properly. I suppose he likes they way they now treat TB patients - they are put in isolation for 6 months and their meds are supervised.

BlackSpinner wrote:

However, I picked psych meds as a worst case example. Actually, non-adherence to prescribed therapy or medication is a universal issue, not limited to psych meds. You might want to take a look at these articles too:

Yes - One of the reason we are getting antibiotic resistant bacteria is that people will not take the full course of the treatment. They stop as soon as they start to feel better. According to Todzo this is the fault of the medical system and means we don't have a way to treat people because they refuse to take their meds properly. I suppose he likes they way they now treat TB patients - they are put in isolation for 6 months and their meds are supervised.

Hmm, I thought the major reason was that antibiotics are way over prescribed. Maybe more people need to stop taking them

But regarding your point about people stopping ABs prematurely, has any study been done about whether they are instructed to take the the full course or not? Logically, one would say that doctors are providing instruction but in this era of rush rush medicine, I have my doubts.

Still, your point is very well taken about pointing out the flaw in Todzos logic regarding cpap usage.

Nate, thank you for providing those links regarding med adherence. I will take a look.

49er

49er wrote:

BlackSpinner wrote:

However, I picked psych meds as a worst case example. Actually, non-adherence to prescribed therapy or medication is a universal issue, not limited to psych meds. You might want to take a look at these articles too:

Yes - One of the reason we are getting antibiotic resistant bacteria is that people will not take the full course of the treatment. They stop as soon as they start to feel better. According to Todzo this is the fault of the medical system and means we don't have a way to treat people because they refuse to take their meds properly. I suppose he likes they way they now treat TB patients - they are put in isolation for 6 months and their meds are supervised.

Hmm, I thought the major reason was that antibiotics are way over prescribed. Maybe more people need to stop taking them

But regarding your point about people stopping ABs prematurely, has any study been done about whether they are instructed to take the the full course or not? Logically, one would say that doctors are providing instruction but in this era of rush rush medicine, I have my doubts.

Still, your point is very well taken about pointing out the flaw in Todzos logic regarding cpap usage.

Nate, thank you for providing those links regarding med adherence. I will take a look.

49er

49er, I would agree that all success rate percentages could/should be introduced with a qualifier such as:

"Among those who are compliant with the prescribed therapy/medication, the success rate is …"

as that would not only be a more accurate way to understand success rates, but might also serve to encourage more people to strive as much as they reasonably can to be compliant.

But I vehemently disagree with Todzo's logic that we should simply dilute the success rates by lumping non-compliant patients in the sample when calculating success rates, because this would be false and misleading and, as BlackSpinner and others have said, would give prospective therapy patients a falsely dismal prospect of achieving success in therapy, thus providing a disincentive to make the appropriate effort to comply.

Regards, Nate

Todzo wrote:http://www.ncbi.nlm.nih.gov/pubmed/23713371

Very interesting study of compliance in the State of Israel.

I wonder if there are similar studies of compliance in the US, and how they compare.

Regards, Nate