An APAP Shootout (sort of) on Academic Journal

dsm · Post by **dsm** » Tue Jan 16, 2007 6:42 pm

WillSucceed wrote:
<snip>
OK, you have made your snotty shot, "please do confirm that you have read it." Fine. Do you feel better now?

<snip>

Will

Might I venture that your reply gets this qualifiaction.

I was given this report by a highly regarded professional and I am more than happy to debate it with him seeing as he gave it to me.

I am also willing to read any counter reports that give a credible analysis of why this particular report was flawed. This report is what this thread is about - you say it is flawed but offer me no publications or reports or any evidence I can use to take the matter up with Dr Joffe. He is not someone I would debate this matter with without some intelligent material.

The reason I asked if you had read this report is that you said words to the effect that you have read 'these reports' but didn't mention this one. Again your reply above said you have read 'these' reports. If you hadn't read this one I might understand your dismissing it so swiftly.

So rather than taking offence as you have, steer me to some credible reports or documents that counter this report then I will have what I need to take the matter up with Dr Joffe.

Thanks

DSM

Goofproof · Post by **Goofproof** » Tue Jan 16, 2007 9:31 pm

-SWS wrote:I didn't know Jane Fonda was a lawyer.

I always considered her to be the CPAP of actresses.

You must have missed the vacation, in Viet Nam, Hanoi Jane, made quite a impression on me. Jim

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

Guest · Post by **Guest** » Tue Jan 16, 2007 9:40 pm

Goofproof wrote:
-SWS wrote:I didn't know Jane Fonda was a lawyer.

I always considered her to be the CPAP of actresses.
You must have missed the vacation, in Viet Nam, Hanoi Jane, made quite a impression on me. Jim

I think SWS misspelled that word CPAP, he meant to replace that first P with an R

WillSucceed · Post by **WillSucceed** » Tue Jan 16, 2007 9:41 pm

dsm wrote:

The reason I asked if you had read this report is that you said words to the effect that you have read 'these reports' but didn't mention this one. Again your reply above said you have read 'these' reports. If you hadn't read this one I might understand your dismissing it so swiftly.

dsm , forgive me, PLEASE, for sloppy grammar! A thousand apologies!

Now, get over yourself. Your condescending attitude stinks. I have very little interest in debating the methodology of ANY studies with you and, I'll bet that "Dr. Joffe M.B., B.S(hons), PhD.F.R.A.C.P (try a google on any of this - he is an Australian)" finds you just as tedious as I do. I suspect that you drive the man screaming for a hot bath and a rusty blade!!

Seriously, enough is enough. You think the studies are stellar and I think they are crap. I vote that we agree to disagree. Further, that I disagree with your take on the studies in no way obligates me to offer something that you can take to your Dr. for discussion. Your name-dropping and holier-than-thou attitude impresses me not! 'nuff said?

-SWS · Post by **-SWS** » Tue Jan 16, 2007 10:44 pm

Anonymous wrote:
Goofproof wrote:
-SWS wrote:I didn't know Jane Fonda was a lawyer.
I always considered her to be the CPAP of actresses.
You must have missed the vacation, in Viet Nam, Hanoi Jane, made quite a impression on me. Jim
I think SWS misspelled that word CPAP, he meant to replace that first P with an R

You guys both missed what I mistakenly thought was an obvious metaphor: they both move volumes of air. Speaking of slight redemption there was that Barbarella movie... .

GoofyUT · Post by **GoofyUT** » Tue Jan 16, 2007 11:14 pm

Wish I was a Kellogg Cornflake

Floatin' in a bowl a takin' movies!!!!

S&G

Cheers!

Chuck

-SWS · Post by **-SWS** » Tue Jan 16, 2007 11:16 pm

Doug, why not just point Dr. Joffe to the arguments in this thread? I especially like the point I made about the methodology inadvertently evoking the Respironics non-responsive (NR) patient routine, then the study implicitly depicting that designed response as if it were a comparative failure. I would personally welcome Dr. Joffe's or anyone's comments about that argument in particular.

Is Dr. Joffe the same physician who told you that your high AHI with that wide IPAP/EPAP spread was definitely attributable to expiratory-end-phase apneas? If so, you might also want to point out the following thread, where I mention to you that central dysregulation was really at fault. I based that comment on my having observed your AHI decrease significantly after first lowering IPAP (while holding EPAP steady) in your experiments with Frequenseeker. Regardless of my initial observation-based comment in that thread, you go on to reprove central dysregulation a second time: viewtopic.php?t=16375&start=0

Of course, Doug, you know the members of this message board: more high IQ's and advanced degrees than you can shake a CPAP hose at. The persistent people on this message board are going to continue thinking and analyzing for themselves... thank goodness. .

dsm · Post by **dsm** » Wed Jan 17, 2007 12:04 am

WillSucceed wrote:dsm wrote:
The reason I asked if you had read this report is that you said words to the effect that you have read 'these reports' but didn't mention this one. Again your reply above said you have read 'these' reports. If you hadn't read this one I might understand your dismissing it so swiftly.
dsm , forgive me, PLEASE, for sloppy grammar! A thousand apologies!

Now, get over yourself. Your condescending attitude stinks. I have very little interest in debating the methodology of ANY studies with you and, I'll bet that "Dr. Joffe M.B., B.S(hons), PhD.F.R.A.C.P (try a google on any of this - he is an Australian)" finds you just as tedious as I do. I suspect that you drive the man screaming for a hot bath and a rusty blade!!

Seriously, enough is enough. You think the studies are stellar and I think they are crap. I vote that we agree to disagree. Further, that I disagree with your take on the studies in no way obligates me to offer something that you can take to your Dr. for discussion. Your name-dropping and holier-than-thou attitude impresses me not! 'nuff said?

WS
You bought into this thread - I asked you for why the study was flawed.
If providing some sort of backing is too much then say so but please don't
resort to ad hominem comments at me as it looks so much like an attempt to
cover up your inability to back up your statement on the research.

All you are saying that it is your humble opinion that the study is flawed
you offer nothing else. That fine by me.

The reason I even mentioned Joffe was because of who he is and that he gave me the
report and I would take it up with him if I had something do so with. At least
SWS is polite enough to offer material to start with rather than smokescreens &
personal comments.

Cheers

DSM

dsm · Post by **dsm** » Wed Jan 17, 2007 1:59 am

-SWS wrote:Doug, why not just point Dr. Joffe to the arguments in this thread? I especially like the point I made about the methodology inadvertently evoking the Respironics non-responsive (NR) patient routine, then the study implicitly depicting that designed response as if it were a comparative failure. I would personally welcome Dr. Joffe's or anyone's comments about that argument in particular.

Is Dr. Joffe the same physician who told you that your high AHI with that wide IPAP/EPAP spread was definitely attributable to expiratory-end-phase apneas? If so, you might also want to point out the following thread, where I mention to you that central dysregulation was really at fault. I based that comment on my having observed your AHI decrease significantly after first lowering IPAP (while holding EPAP steady) in your experiments with Frequenseeker. Regardless of my initial observation-based comment in that thread, you go on to reprove central dysregulation a second time: viewtopic.php?t=16375&start=0

Of course, Doug, you know the members of this message board: more high IQ's and advanced degrees than you can shake a CPAP hose at. The persistent people on this message board are going to continue thinking and analyzing for themselves... thank goodness. .

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, hose, CPAP, AHI

Steve,

Yes this is the same respiratory specialist I have been going to since 2005. Interestingly it was my posting in this thread that brought home to me just how prominent he is. I knew he had good quals. I was certainly not name dropping as WS accuses me. Joffe is my RT & he gave me a copy of this report. He is the person I will discuss these reactions with. I also recall posting here that he said to me, go buy a Remstar Plus as that will suit you fine I like my PB330 A/C that machine is working very well once I tuned the settings with the help of FreqenSeeker & yourself.

His comment re my results of those high AHI Vpap tests you are referring to (epep=8 ipap=15 AHI = 40-50) was that the epap of 8 was plainly too low (I think I said his comment was 'I could have told you that'). He then said that bit about epap should be equal to titration (and I am sure he would have added 'unless you are doing a bilevel titration').

He has me scheduled for a split night study end of feb.

I appreciate you putting forward some material I can follow through with and I will & I am confident you know I will - understand though that I will not be inviting him to join this thread - I am sure if I asked god to join in he would say 'not with those types of responses - I have enough trouble with blasphemers & agnostics already'

Cheers

DSM

-SWS · Post by **-SWS** » Wed Jan 17, 2007 7:48 am

Doug, I actually agree about the comfort and respect factors involved in asking Dr. Joffe to join this thread. Patient message boards are all about people like us trying to solve our own highly frustrating issues. That often includes plenty of subtle undertones, overt ranting, and even displaced/well-placed rage against the medical system.

If I was a doctor, I very likely wouldn't have the necessary interpersonal skills or even nerve to openly join these discussions, despite having the compassion to do so. In the half-decade or so that I have been following the apnea message boards, there has only been one doctor, at least that I am aware of, who made the extraordinarily brave and kind gesture to come on board to compassionately interrelate with us, as a genuine peer among peers. I don't know about you, Doug, but I feel a little less alienated by the medical system because of that rare, wonderful gesture. We also have plenty of nurses, therapists, RTs, DME's, and other health professionals posting here that I am also extremely grateful to have among us.

I hope that one day the overall tone on these patient message boards is placated enough, by compassion and medicine, that more and more medical doctors will feel comfortable coming here to relate to us as the thinking and feeling human beings that we genuinely are deep down inside, rather than the justifiably frustrated lot of patients we occasionally portray.

Please give Dr. Joffe my blessings for the immense help he has already provided those of us who have been granted our special lot in life.

WillSucceed · Post by **WillSucceed** » Wed Jan 17, 2007 11:31 am

dsm scribbled:

You bought into this thread - I asked you for why the study was flawed.
If providing some sort of backing is too much then say so but please don't
resort to ad hominem comments at me as it looks so much like an attempt to
cover up your inability to back up your statement on the research.

dsm, here is what I said in the thread:

"dsm, I think the salient point here is that testing with the iron lung is essentially useless because it does not approximate closely enough the real person. I don't see Rested Gal's comments as "apples and oranges" at all"

AND

"dsm... I did not get the impression that RG is saying that the tests are flawed because they can't emulate ALL human responses. It seems to me that she is saying that the tests are flawed because they can't emulate ANY human responses due to the lack of response loop."

AND

"Yes, I HAVE read these studies and yes, before you suggest it, I'm NOT a respirologist or scientist in any way. I HAVE, however, done research (had to write a thesis based on original research when I completed a Master's degree in 1989, and continue to be involved in research in my workplace. So, to answer your question, while I would not in any way consider myself a "researcher" and I am in no way qualified to suggest how to design a better study regarding APAP machines, I am qualified to look at the studies presented and say that I think they are flawed based on design. If the design is bad, so too is the study."

I've been clear that my objection to the study has to do with it's not accurately emulating a real person.

I've been clear and upfront that I'm not a researcher and have little to offer on how to redesign an APAP study.

I've made no effort, as you suggest, to "cover up [my] inability to back up [my] statement on the research" as I've told you what I think is wrong with the research.

dsm scribbled further:

All you are saying that it is your humble opinion that the study is flawed
you offer nothing else. That fine by me.

You have me figured out, with one exception... I've never suggested that my opinion is "humble."

dsm went on to scribble:

At least SWS is polite enough to offer material to start with rather than smokescreens & personal comments.

SWS is a better man than I, no argument about this from me. However, the "smokescreen" to which you refer is your own... namedropping and holier-than-thou attitude. Further, the "personal comments" started with your condescending, smarmy "(I am making one assumption here and that is that you have read this report and thus feel justified in saying what you have about it being flawed. Before I go any further, please do confirm that you read it - thanks )" crack. You intended that as a smart-mouthed way to shut me up, seemingly because I dared agree with RG.

dsm FINALLY finished scribbling:

Cheers

Are you kidding me? Smarmy to the end... dsm, if you don't want to swim in the pool with other folk, GET YOUR OWN POOL. Disagreement is healthy. Collectively, we find the RIGHT answers by challenging the existing answers; don't be so quick to dismiss the comments of others just because they don't agree with your own opinion.

So, go ahead, scribble a rebuttal and have the last word (I KNOW you will)... I'm going back behind my smokescreen, my lack of scientific acumen, my woefully inadequate use of grammar and, most embarrassingly, my utter inability to measure up to the great minds that surround me. I am a misery, mock me and my sarcasm.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): APAP

Guest · Post by **Guest** » Wed Jan 17, 2007 1:41 pm

I have three solutions to this problem, one funny and two serious. Funny:

(1) just use CPAP; the algorithm is the same for every brand and can be summed up in one word: "blow". Problem solved!

Serious:

(2) Make an APAP machine with a memory card slot (or even a mini CD reader). The machine has NO algorithm, it's just a general-purpose piece of hardware, so you essentially CAN'T "waste your money" buying it. You then purchase an algorithm on a memory card (or a mini CD-R) and insert it. It loads into firmware, you try that algorithm for a week or two. Now buy and load another card/disc with a different algorithm, try it for a week or two. Lather, rinse, repeat until you find the best algorithm for you. Memory cards would be cheapish to make ($10 each?), but mini CD-R's would literally cost pennies to make. Isn't that a great way to try many algorithms, nearly risk-free?

(3) Make an APAP machine that learns and custom-designs, over time, an idealized personalized algorithm that's designed just for you. Give it feedback (how do you feel this morning, 1-10 scale, kind of like that FOSQ questionnaire thing today), and it combines that with last night's detailed sleep data it recorded (what did I try, and how well did it work out?) to continually try new things and different approaches and eventually "learn" exactly what's best for you.

These two ideas aren't impossible or even impractical. So why aren't they being done? Idea #2 is great, but #3 would be spectacular, given enough time for the personalized algorithm to develop itself.

dsm · Post by **dsm** » Wed Jan 17, 2007 3:37 pm

WillSucceed wrote:dsm scribbled:
You bought into this thread - I asked you for why the study was flawed.
If providing some sort of backing is too much then say so but please don't
resort to ad hominem comments at me as it looks so much like an attempt to
cover up your inability to back up your statement on the research.

dsm, here is what I said in the thread:

"dsm, I think the salient point here is that testing with the iron lung is essentially useless because it does not approximate closely enough the real person. I don't see Rested Gal's comments as "apples and oranges" at all"

AND

"dsm... I did not get the impression that RG is saying that the tests are flawed because they can't emulate ALL human responses. It seems to me that she is saying that the tests are flawed because they can't emulate ANY human responses due to the lack of response loop."

AND

"Yes, I HAVE read these studies and yes, before you suggest it, I'm NOT a respirologist or scientist in any way. I HAVE, however, done research (had to write a thesis based on original research when I completed a Master's degree in 1989, and continue to be involved in research in my workplace. So, to answer your question, while I would not in any way consider myself a "researcher" and I am in no way qualified to suggest how to design a better study regarding APAP machines, I am qualified to look at the studies presented and say that I think they are flawed based on design. If the design is bad, so too is the study."

I've been clear that my objection to the study has to do with it's not accurately emulating a real person.

I've been clear and upfront that I'm not a researcher and have little to offer on how to redesign an APAP study.

I've made no effort, as you suggest, to "cover up [my] inability to back up [my] statement on the research" as I've told you what I think is wrong with the research.

dsm scribbled further:
All you are saying that it is your humble opinion that the study is flawed
you offer nothing else. That fine by me.

You have me figured out, with one exception... I've never suggested that my opinion is "humble."

dsm went on to scribble:
At least SWS is polite enough to offer material to start with rather than smokescreens & personal comments.

SWS is a better man than I, no argument about this from me. However, the "smokescreen" to which you refer is your own... namedropping and holier-than-thou attitude. Further, the "personal comments" started with your condescending, smarmy "(I am making one assumption here and that is that you have read this report and thus feel justified in saying what you have about it being flawed. Before I go any further, please do confirm that you read it - thanks )" crack. You intended that as a smart-mouthed way to shut me up, seemingly because I dared agree with RG.

dsm FINALLY finished scribbling:
Cheers

Are you kidding me? Smarmy to the end... dsm, if you don't want to swim in the pool with other folk, GET YOUR OWN POOL. Disagreement is healthy. Collectively, we find the RIGHT answers by challenging the existing answers; don't be so quick to dismiss the comments of others just because they don't agree with your own opinion.

So, go ahead, scribble a rebuttal and have the last word (I KNOW you will)... I'm going back behind my smokescreen, my lack of scientific acumen, my woefully inadequate use of grammar and, most embarrassingly, my utter inability to measure up to the great minds that surround me. I am a misery, mock me and my sarcasm.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): APAP

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): APAP

Will Succeed.

There is nothing I can say here that will make you look or seem stupid any more than there is anything you can say here that can make me look the same. It is what we post ourselves that does that more effectively than anything.

You & I disagree on this report. That is obvious. But turning your disagreement into accusations of snot & smarm & all the other Ad Hominem epitaphs just takes us away from the debate.

I apologize for hurting your feelings. I did not intend that. I did intend debating the real issue, the report. If my style offends you then do what SWS occasionally does, say what offended you & let me respond, but don't destroy any chance of apology or further reasonable discourse with repeated ad hominems. Disagreement can be very healthy but keeping it healthy takes character & effort. Please let us debate the report & not our impressions of each others personalities or styles.

In General
========

I am more than happy to gather anyone's comments about the report and to pass these back to the Author (assuming I can get through to him). I believe it would be very good value to have them answer any issues & concerns raised.

Any takers ?

Thanks

DSM

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): APAP

drbandage · Post by **drbandage** » Wed Jan 17, 2007 11:30 pm

-SWS wrote:
If I was a doctor, I very likely wouldn't have the necessary interpersonal skills or even nerve to openly join these discussions, despite having the compassion to do so.

CPAPopedia Keywords Contained In This Post (Click For Definition): DME

-SWS is astonishingly intelligent, cordial, diplomatic, insightful, open minded, analytical, humble, not to mention remarkably generous in sharing his very considerable wisdom.

That is why I cannot believe he could be so wrong in suspecting that he would not make an absolutely wonderful physician!

Oh well, just goes to show that even -SWS isn't always right! ' '

rested gal · Post by **rested gal** » Thu Jan 18, 2007 1:00 am

drbandage wrote:-SWS is astonishingly intelligent, cordial, diplomatic, insightful, open minded, analytical, humble, not to mention remarkably generous in sharing his very considerable wisdom.

Add and possesses a great sense of humor to that list and you've described the man so many of us admire, drB!

-SWS wrote: Speaking of slight redemption there was that Barbarella movie...

drbandage wrote:That is why I cannot believe he could be so wrong in suspecting that he would not make an absolutely wonderful physician!

Oh well, just goes to show that even -SWS isn't always right! ' '

You're right, drB. btw, you share the same traits...including a sense of humor.

An APAP Shootout (sort of) on Academic Journal

Punky's dilemma