Dr. Krakow, salesman extraordinaire? UPDATED

[jnk]

"There's no such thing as 'bad publicity.' "--Some guy people quote all the time.

I wouldn't bet against him. Seems to me his crews have a pretty good track record. I hope congress doesn't shut this site down for this long quote, and that Uncle Krakow doesn't mind me ripping wording from his site (if he does, he can PM me and I'll take my post down), but here it is:

Dr. Krakow's research team has established many firsts in the field of sleep medicine, including:

•The first randomized controlled study to demonstrate that a cognitive-imagery technique can successfully decrease chronic nightmares without medication or psychotherapy
•The first studies to show that trauma survivors suffer inordinately high rates of sleep breathing problems that worsen their insomnia, anxiety, depression, and posttraumatic stress symptoms.
•The first studies to link sleep breathing problems to insomnia complaints among psychiatric patients
•The first case series showing that treatment of sleep breathing problems decreases insomnia problems in many different types of insomnia patients
•The first study to show that a large proportion (50%) of sleep center patients with sleep apnea also suffer from clinically significant insomnia symptoms, which may interfere with their efforts to treat their sleep breathing problems
•The first study to show that evidence-based sleep medicine treatments could help crime victims with sleep problems
•The first study to show that evidence based sleep medicine treatments could help disaster survivors with sleep problems
•The first randomized controlled study to demonstrate that nasal dilator strips can reduce insomnia symptoms in patients with likely sleep-disordered breathing.

Dr. Krakow's research group is one of the most published on the evaluation and treatment of sleep disorders in mental health patients, including more than 30 peer-reviewed papers and abstracts in this field. In addition, he has authored or co-authored four books on this topic as well.

Dr. Krakow's research teams have consistently shown that insomnia and mental health patients frequently suffer from undiagnosed physical sleep disorders, which prevent them from resolving their sleep complaints, and which therefore often prevent them from improving their mental health.

With the publication of Dr. Krakow's new book, Sound Sleep, Sound Mind, he aims to spread the word that an enormously large number of insomnia patients and mental health patients can benefit a great deal by completing a full sleep evaluation and receiving evidence-based sleep treatments. In his view, sleep medicine needs to be thoroughly integrated into the fields of psychiatry and psychology in order to provide mental health patients the opportunity to rapidly recover their sleep health. We believe that aggressive treatment of sleep disorders in these patients will markedly improve their chances to improve their mental health.

http://sleeptreatment.com/index.php?opt ... temid=1742

Hope you don't mind me giving his boys equal time, Rocklin.

[SleepingUgly]

re: jnk... OK, so it seems that Dr. Krakow has the ability to conduct and publish research in his clinical practice (or was it conducted before he was in private practice?). So what is it he has to say about ASV, why hasn't it been published, and how likely is it to be published in the near foreseeable future? If it will be published soon, I can see why he wouldn't disclose the content. (Rocklin, how did you even find out his article was rejected by two journals?)

[jnk]

In my opinion, if the distinguished Dr. K submits something for publication, he likely has something worthwhile to say. But decisions by publishers (in "medical" journals, especially) are all about politics, plain and simple.

K ain't dumb.

Medically or financially.

And these days, if you want to make a difference, you have to be good at BOTH.

[DoriC]

I know from personal experience that getting published is all about politics. Another famous quote is "it's not what you know but who you know". It took my son a few years to get his 3-year research study published in Alternative Medicine. He followed all the rules for submission but they kept rejecting it, not for the content itself, but because he wasn't crossing all the T's and dotting all the I's. I don't know all the details but it wasn't until he was asked to sit on a prestigious panel at one of the big conferences out West and "schmoozed" with some powerful people, that his work was finally published and he's had 2 other research projects published since then in Integrative Medicine and another published by a government journal (can't remember the name). I know I sound braggy(and I am a proud Mama), but it seems that once you establish yourself in the medical community it gets easier to get your research accepted, so I'm kind of wondering with Dr.K's reputation, why is he having such a hard time getting his work published? I really don't know enough to have any opinion either way, I'm just wondering out loud.

[rocklin]

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so I'm kind of wondering with Dr.K's reputation, why is he having such a hard time getting his work published?

DoriC, I think you put your finger on it.

If Dr K. was just starting out, and he was aiming to be published in the New England Journal of Medicine, I could understand some of the excuses that jnk articulates.

But he's far from a babe in the woods. He knows the game, he knows the players.

He choose Chest as his first submission, and, I have to presume, he did so with the full expectation that they would publish it.

That they did not accept his paper as "publication worthy", and that an entirely different journal, with a different editorial board, also rejected Dr. Krakow's paper isn't an encouraging sign, imho.

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But this is beside the fact.

I am in poor shape. I sleep about an hour a night, and the quality of that sleep is poor.

The stress on my body is taking a tremendous toll, I am now falling dead asleep during work (and just traveling around NYC), with no warning that it is about to happen.

My doctors at SDI feel that I am an idea candidate for ASV.

They are open to discussing a new, successful protocol, but only if the author is serious, and there is some hard science behind it.

Neither of my doctors feels that Dr. Krakow fills that bill.

And they will not let me participate in their facility, using their staff and equipment, to conduct an unproven therapy that is not part of their own research.

Legally, they are simply not allowed to do that.

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During Ronnie's long battle with cancer, we had a number of doctors show us papers that hadn't been published yet, so we had some basis for making a decision on new, cutting edge therapies and diagnostics.

Rita Scheman, former editor of The Lancet, was a close friend, and she helped Ronnie and myself a number of times in this manner.

So Dr. Krakow's excuse as to why my doctors can't see the scientific basis for the medicine he is asking them to oversee just isn't borne out by the generally accepted standards of conduct practiced by the medical community as a whole.

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Look, I have no desire to "beat up" on the good doctor, I enjoyed talking to him over the phone, I know he has a number of enthusiastic fans here, and I really would like to hear his perspective on this.

I gladly and publicly invite him to present his point of view in this, or any other thread on CPAPtalk.

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[SleepingUgly]

My doctors at SDI feel that I am an idea candidate for ASV.

They are open to discussing a new, successful protocol, but only if the author is serious, and there is some hard science behind it.

Neither of my doctors feels that Dr. Krakow fills that bill.

And they will not let me participate in their facility, using their staff and equipment, to conduct an unproven therapy that is not part of their own research.

Legally, they are simply not allowed to do that.

I'm confused. They think you are an ideal candidate for ASV based on WHAT? If it's existing standards of practice, they don't need Krakow for that. If it's Krakow's non-standard standards, then they wouldn't have an opinion that you're an ideal candidate for ASV, as they wouldn't know anything about that. Will your doctors give you an ASV titration in their lab?

[jnk]

Maybe it would help if he included something about acupuncture?

http://www.guardian.co.uk/science/2011/ ... ew-science

[rocklin]

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They think you are an ideal candidate for ASV based on WHAT?

Based on my nighly ResScan reports (and the centrals that I am having), based on their own testing, based on their clinical judgement.

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If it's existing standards of practice, they don't need Krakow for that

Indeed. But I have been the one insisting on giving Krakow and his protocol a shot, based on his claimed deep experience with ASV, and the statements he has made.

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We have been negotiating the details via email and telephone.

But just today, I received a completely unexpected email where they said they had reviewed things with their lawyers and that this is how they wished to proceed:

I pay them in full, ahead of time. Neither I or my doctors will receive any proof that the protocol works.

That of, course, is a deal killer.

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My doctors at SDI have been very patient with me, and my attempts to bring Dr Krakow into the fold.

But, imho, his demands are self-defeating, few doctors will practice medicine blindfolded.

Over dinner tonight, Ronnie told me that by not even offering to reveal his abstract, he is putting my clinicians in an impossible position.

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I hope Dr. Krakow changes his mind.

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[SleepingUgly]

I don't even know how his protocol for ASV is different than others', in the presence of centrals. Admittedly, I don't know much about what his protocol is, but I thought he was using ASV for other uses besides the typical central sleep apnea.

If you haven't had an ASV titration, why not try the standard one and see how that goes before the non-standard method? Maybe the standard methods will be fine for you.

[SleepingUgly]

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BTW, what's with the above in all your posts? Why does this appear throughout your posts?? Is that a wood plank with two nails in it? Is it a coffin?!

[rocklin]

Maybe it would help if he included something about acupuncture?

http://www.guardian.co.uk/science/2011/ ... ew-science

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I asked her NotMuffy's question about her position on off-label use of ASV. She said it was an expensive machine that is designed to treat something other than OSA/UARS, so she can understand why insurance will not pay for it unless it is needed for what it is designed to treat. I guess New Englanders are more strict on that sort of thing than New Mexicans.

Mike6977 appears to me to have a contract out on K

I don't have a contract out on K, but if I did, and my contract specified bullets, I summize your contract specified spitballs when he isn't looking.

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So, jnk, have you settled on a position yet?


"Haven't I seen your face before?" a judge demanded, looking down at the defendant.

"You have, Your Honor," the man answered hopefully. "I gave your son violin lessons last winter."

"Ah, yes," recalled the judge. "Twenty years!"

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[rocklin]

If you haven't had an ASV titration, why not try the standard one and see how that goes before the non-standard method?.

Yes, that would seem to be my next move.

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BTW, what's with the above in all your posts? Why does this appear throughout your posts?? Is that a wood plank with two nails in it? Is it a coffin?!

You ask a lot of questions for someone with a true blue hue, sue.

Rotate the above 90% counterclockwise.

(she does, then slaps my face)

See? No good deed . . .



Love ya.

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[jnk]

My position is that if my machine wasn't doing it for me, and I had enough centrals to indicate an ASV was warranted, and I qualified for one, I would not wait for any distant doc to be on board, no matter how cutting-edge anyone's protocol was supposed to be.

My position on K is that I admire the man, whether I am fully on-board with all he does or not. (I am rarely 100% on-board with 100% of the choices of any human being, after all.) I have recommended books of his and his site to many people with sleep troubles over the years and a number have thanked me.

My position on calling any respected doctor a "salesman" is that it sounds disrespectful to my ears when the word is attached to the work of a man who has the reputation of being able to help people who haven't been helped after trying many mainstream (meaning the old standard) approaches to sleep problems. But I respect your journalistic right to ask the question to draw readers to the thread. I assume your editor chose the title anyway.

My position on you is that I hope you get to the bottom of your sleep troubles sooner rather than later. My heart goes out to you, friend. I wish there was more I could do.

[DoriC]

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If it's existing standards of practice, they don't need Krakow for that

We have been negotiating the details via email and telephone.But just today, I received a completely unexpected email where they said they had reviewed things with their lawyers and that this is how they wished to proceed:

I pay them in full, ahead of time. Neither I or my doctors will receive any proof that the protocol works.
That of, course, is a deal killer.
My doctors at SDI have been very patient with me, and my attempts to bring Dr Krakow into the fold.
But, imho, his demands are self-defeating, few doctors will practice medicine blindfolded.

My position is that if my machine wasn't doing it for me, and I had enough centrals to indicate an ASV was warranted, and I qualified for one, I would not wait for any distant doc to be on board, no matter how cutting-edge anyone's protocol was supposed to be.

My position on calling any respected doctor a "salesman" is that it sounds disrespectful to my ears .

Why would such an email be "unexpected"? I'm sure Dr.K didn't need a lawyer to tell him how he wished to proceed. I don't see anything demanding in his response, just plain good medical and business sense. Rock, I hope your Drs continue to have patience with you so that you get the help you need. SU and jnk make obviously good points.Sounds simple to me. I'm also not fond of your use of the "salesman" description but the heading sure got a lot of attention which I'm sure was your intent, right?

[-SWS]

They think you are an ideal candidate for ASV based on WHAT?

Based on my nighly ResScan reports (and the centrals that I am having), based on their own testing, based on their clinical judgement.

I don't even know how his protocol for ASV is different than others', in the presence of centrals. Admittedly, I don't know much about what his protocol is, but I thought he was using ASV for other uses besides the typical central sleep apnea.

Dr. Krakow's posts here were about using BiLevel to address high upper-airway resistance. His ASV work for that type of SDB is thus off-label. By contrast on-label conditions for ASV include complex SDB, central SDB, and certain types of cardiac SDB.

If you have primarily UARS type problems, then Dr. Krakow's experimental ASV protcol might be a good alternative to consider. But if you are presenting with complex SDB, central SDB, and/or heart issues, then I would think standard ASV titration protocol makes a lot more sense.