CPAPtalk.com

-SWS wrote:I presented a hypothetical case, which is known to be common.

Huh?

Known to who to be common?

Certainly not scientists in the field.

Please show me one—just one—study that demonstrates that what you assert is true.

Again, sir, I fear you live in your head.

-SWS wrote:I think that's an entirely distorted interpretation of the future for sleep apnea patients.

I repeat: Huh?

How do you distort your own interpretation of your own musings about the future?

Plain English, man. Just say you disagree with my vision of the future.

You'd still be wrong, but at least people would read your posts and not say:

Huh?

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-SWS wrote: I have had discussions with murderers and drug dealers both before and during incarceration

Yeah, chating up a guy during incarceration, that'll give you a heart to heart.





Also:

That a person is accused of a crime and then incarcerated means zero, nothing.

In our society, a defendant is innocent until convicted.

Equally, as a legitimate researcher, you would never assert that you conducted an interview with a murderer when that person hasn't been convicted of that crime.

And even if convicted, he may vehemently assert his innocence, making your interview an outlier.

If I was a crueler man, I'd let my wife reply to this post.

But she's better served by enjoying her morning coffee undisturbed by my internet postings, trust me on this.



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-SWS wrote:I'm through discussing nonsense about totalitarian sleep medicine.

Again, sir, I fear you live in your head.

Not a single poster in this thread asserted a totalitarian model of sleep medicine.

Harsh, jungle-level capitalism, yes.

But only you, in a completely closed loop with yourself, have been talking about totalitarianism.

You're clearly an intelligent, accomplished person.

Please, step out of your head, and engage us on what we're actually saying.


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OK, nuff. Basta. Enjoy your morning.

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Mr Bill wrote:

rocklin wrote:SWS, let me ask you this:

What were you doing when the towers collapsed and 2,752 people died?

Do you remember?

We quickly called our friends next door, we were all geologists.

I remember seeing the tower start to collapse and saying those people on the ground had better start running, that's going to produce a ground surge cloud like a pyroclastic eruption, and it did.

Pyroclastic eruption?

Classic geologists: the towers are falling, humanity is spinning . . . and you guys are talking shop.



Good to see your nick, Mr. Bill, as always.




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Mr Bill wrote:Hmmm, for the $4000 they cost to the DME they only have to sell a couple thousand of these ASV's if they have any sort of decent markup which I am sure they do.

Don't know how much bearing this has on outfits like Resmed, but here's what I observed 30+ years ago. I had a small print shop and one of guys I did printing for made wooden plaques sold as souvenirs. The retail price was $2.00. The price the retailer paid the wholesaler was the usual 60%, or $1.20. The wholesaler bought them from the jobber at about $0.75 each. The jobber bought them from the manufacturer for about $0.45 each. Taking out the cost of production the manufacturer cleared maybe 20 to 25 cents each. Of the entire chain of distribution, the manufacturer made the least amount of money. There is always more money in selling than in making something!!

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Hi rszasz!

I see this is your first post. Welcome to CPAPtalk.

rszasz wrote:I'm still going through the thread, but once you include regulatory compliance , bringing a new device to market probably cost 5 million dollars or so.

The approximate time and costs for bringing a new medical device (emphasis on new, and on device, not upgraded software, which much of ASV is) is as follows:

- Europe: six months to two years: $2,000,000 (approx)

- Japan and China: three to five years: $3,000,000 (or less, approx)

- United States: two to seven years: 50,000,000 to $100,000,000 (approx)

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But I don't believe that Resmed (or Respironics) introduced the ASV as a new device in any of those markets.

That isn't a statement of fact, just my guess at the moment.

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rszasz wrote: What I don't understand is why there are base level CPAP devices from manufacturers of higher level devices(Bipap, auto pap, etc..) The cost savings of having just two lines, CPAP+, and Ventilator, should allow the prices to come down almost to where the lowest end model is.

Excellent question, rzasz.

But keep in mind, R&R want the highest prices the market will bear, not the lowest.

Since they each own an exclusive franchise on their flavor of ASV, they can dictate terms to the marketplace.

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Mr Bill wrote: If ASV users are ~1 in 500 then that would be ~80,000 ASV users. Lets see times $4000 (DME discount) that would be sales of ~$320 million with a further DME markup of ~$320 million.

But the ~40 million CPAP users at $400 each could generate ~$16 billion in sales.

So, they stand to make 50 times as much money with the less expensive CPAP. I guess we should be glad our ASV's only cost 10-20 times as much.

Hi Bill.

Again, it's only in ASV that R&R have an exclusive franchise.

With standard CPAP the market is much more fragmented.

So, no, they don't stand to make that kind of money.

Unless ordinary CPAP users are hot for ASV and willing to pay R&R a premium for it

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Do I know that this is their marketing strategy?

No.

But it sure as hell would be mine.

You can be damn sure they didn't spent the bucks developing ASV just to serve a tiny fraction of the sdb marketplace.

That would be stupid.

An neither company is stupid.

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IMHO, we here at CPAPtalk, are, in essence, an excellent sampling of the early adopters in the US, unwittingly forming a living, breathing, day-to-day "focus group" for the R&R sisters.

Nothing wrong or nefarious about that, it's just the way our cookie has crumbled.


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Doctors like Barry Krakow (and some very satisfied users) pound out the message that ASV is the sh*ts.

They do so without any controlled studies, or studies so poor / unfocused / meaningless that they are rejected by Chest, which accepts a wide range of papers.

Other, more cautious professionals (Lund & Gassabi at SDI, our own DeltaDave) are saying: "Where's the beef?"

And people like you and me are stuck in the middle.

- Is an ASV worth seven grand?

- Will a trip to New Mexico give me that Oh So Fresh Feeling Down There?

Inquiring minds want to know.

Stay tuned.

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An ASV is worth 7 grand if it provides therapy that works, when other devices don't work. I tried two other machines, carefully chosen based on the way their algorithms worked. They did not work for me. in fact, one machine responded opposite the way its algorithm was reported to work, because there is something unusual about my SDB. My doctor did a 3 way sleep study (CPAP/BiPAP/ASV), ant it confirmed my theory that the ASV was the way to go.

The first set of settings for the ASV were just right, and I have had no need to tweak the machine since (and I thoroughly understand all the settings, and their implications, thanks in part to -SWS). And as of late, I am beginning (finally!) to see some real improvement in my sleep quality. I am also finding I am able to lose weight for the first tie since beginning xPAP.

If Resprironics hadn't started price-fixing just before I needed to buy my ASV, I would have bought it outright. (They have since gone back to allowing discounts on this machine) But because of the artificially high price, I went through a DME. It took a month to get it, a lot of phone calls, and almost threatening some people to get their act together. Then, I had to bite my tongue while being taught like some sort of invalid how to set up the machine, even though I had all the manuals (even the service manual). Had I paid the inflated price, I could have had the machine in a week, no hassles.

As Morpheul said in 'The Matrix', "It's all about control". And money.

Oh, by the way, I once helped produce a TV show that was shot on Wall Street in NYC (they ran bulls up and down the street as a publicity stunt. This was pre-9/11. Wouldn't be allowed today ). The people there were so focused on rectangular portraits of presidents that you had to get out of their way if they were walking down the street. They did not know you were there. So much for 'excitement from your friends on the 'street!

Rocklin wrote:Suzy Creamcheese, this is the silliest question you've asked in gym class all year. Do 15 squat thrusts and then get back in line.

And spit out that damn bubblegum!

I am subscribed to this topic, yet haven't received notifications of new posts. I am apparently two days late in receiving my insults from you!

rocklin wrote:

SleepingUgly wrote:Let's each of us ask ourselves what we can do to make CPAP seem less dorky/more cool, and even sexy

Decide you want to be rid of the little beast.

OK, done!

Do what ever is necessary to accomplish that goal.

Actually investigate alternative solutions.

Like what? Surgery? Done (at least all I would consider doing). Dental device? Considering, but not ready to do yet. Positional therapy? Not relevant enough for me. My big problem is REM, not solely on my back. Medication? I've read about REM-suppressing agents and they don't work particularly well, and I've been on them and the side effects are not worthwhile. What else is there?

It's well and good to keep saying "reject CPAP", but it has to be replaced with an effective alternative. Please list effective alternative treatments in your next post.

Then, when CPAP is history, when the units are sold in antique stores, people may find it cool.

I was going to suggest a swimsuit+CPAP calendar. I tentatively had you down for Mr. April, when the weather is extremely unpredictable and one day it can be hot and sunny and the next day cold and dreary.

rocklin wrote:

-SWS wrote:I think that's an entirely distorted interpretation of the future for sleep apnea patients.

I repeat: Huh?

How do you distort your own interpretation of your own musings about the future?

Plain English, man. Just say you disagree with my vision of the future.

You'd still be wrong, but at least people would read your posts and not say:

Huh?

How can one be "wrong" when they "disagree" with your vision for the future? I gotta' say, Rocklin, this really makes me scratch my head and say, "Huh?" I guess there's two ways of analyzing that sentence: (1) You wrongly think disagreeing means something other than a difference of opinion, with no one "right" and no one "wrong" or (2) anyone who disagrees with your vision is obviously wrong because it is YOUR VISION!

What's fascinating here is that you actually think that much of what you say makes sense, and you berate others for not being as articulate and eloquent in expressing their thoughts as you think you are at expressing yours. Except I'd bet that you can't find anyone on this board (not even among NotMuffy's Top 3 Most Intelligent CPAPtalk.com Members) who understands much of what you write. I'm sure that in your own mind, it's all brilliant, relevant, and coherent, and you just want to share with the world (and Columbia and NYU) all the amazing ideas you have.

Anyway, I thought you'd appreciate a little Insight to go with your Insomnia.

Your BFF,
Suzy Creamcheese

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SleepingUgly wrote: I am apparently two days late in receiving my insults from you!

Think of me as that little girl in kindergarten who had a crush on a boy and expressed it by running up to him, and punching him in the arm, then running away.

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SleepingUgly wrote:It's well and good to keep saying "reject CPAP", but it has to be replaced with an effective alternative.

Please list effective alternative treatments in your next post.

Sure.

But I require a nominal fee of $1.00 first, refundable if you aren't 100% satisfied.

Like Dr. Krakow, but vastly less expensive, and uh, refundable.

Oh, and you have to call me on the phone, I don't do diagnostics by email, PM or post: just basic HIPPA privacy rules and all that..

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SleepingUgly wrote:I was going to suggest a swimsuit+CPAP calendar.

Brilliant idea. Funny, sexy, strange.

With the right exposure, it could get national publicity, help a lot of people.

If you want to do that project, and donate the proceeds to a very worthy cause, I will do it.

This is a dead serious offer.

Ball's in your court.

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SleepingUgly wrote:I tentatively had you down for Mr. April, when the weather is extremely unpredictable and one day it can be hot and sunny and the next day cold and dreary.

Yeah, I can be a complete a$$hole sometimes, and today I was in fine form.

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So here's a public apology to SWS, and I'll send him / her a private one too.

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SleepingUgly wrote:What's fascinating here is that you actually think that much of what you say makes sense,

And you know what I actually think exactly how, my dearest Madam Kreskin?

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Basically, I sleep-post.

Like sleep-walking, three-quarters of my posts are made in a semi to full dream state, when my unconscious rules.


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If I made anyone smile or laugh, then that's all I can ask for.

Sheesh, my guess is that 99.9% of CPAPtalk members had figured that out already . . .



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rocklin wrote:

Mr Bill wrote:

rocklin wrote:SWS, let me ask you this:

What were you doing when the towers collapsed and 2,752 people died?

Do you remember?

We quickly called our friends next door, we were all geologists.

I remember seeing the tower start to collapse and saying those people on the ground had better start running, that's going to produce a ground surge cloud like a pyroclastic eruption, and it did.

Pyroclastic eruption?

Classic geologists: the towers are falling, humanity is spinning . . . and you guys are talking shop.



Good to see your nick, Mr. Bill, as always.




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Yes, experts notice things in the field of their expertise, even while sharing the same shock as other people.

Mr Bill wrote: Yes, experts notice things in the field of their expertise, even while sharing the same shock as other people.

Agreed.

Mr Bill wrote:

rocklin wrote:

Mr Bill wrote:

rocklin wrote:SWS, let me ask you this:

What were you doing when the towers collapsed and 2,752 people died?

Do you remember?

We quickly called our friends next door, we were all geologists.

I remember seeing the tower start to collapse and saying those people on the ground had better start running, that's going to produce a ground surge cloud like a pyroclastic eruption, and it did.

Pyroclastic eruption?

Classic geologists: the towers are falling, humanity is spinning . . . and you guys are talking shop.



Good to see your nick, Mr. Bill, as always.




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Yes, experts notice things in the field of their expertise, even while sharing the same shock as other people.

Absolutely, Mr. Bill. I think most of us experienced a mix of reactions. Shock and worry were among mine as well.

rocklin wrote:.



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Being popular on cpaptalk.com is like sitting at the cool table in the cafeteria at a mental institution.

Keep up the good work rocklin. Very clear what you are saying. Hopefully in the near future I will have time to move up to your table. We will have a blast!

All the best for 2012,

rocklin wrote:

SleepingUgly wrote: I am apparently two days late in receiving my insults from you!

Think of me as that little girl in kindergarten who had a crush on a boy and expressed it by running up to him, and punching him in the arm, then running away.

You must have a crush on a lot of us here!!

So here's a public apology to SWS, and I'll send him / her a private one too.

I must have missed the public apology. Or by that do you mean if you say "here's a public apology", that's the apology? My 6-year-old says you have to say what you're sorry for, and something about how you're not going to do it again, and you have to mean it.

Basically, I sleep-post.

Like sleep-walking, three-quarters of my posts are made in a semi to full dream state, when my unconscious rules.

It's a very rare form of REM Behavior Disorder, where the person types insults while asleep.

If I made anyone smile or laugh, then that's all I can ask for.

Sheesh, my guess is that 99.9% of CPAPtalk members had figured that out already . . .

Well, THAT made me laugh!

So Well wrote:Being popular on cpaptalk.com is like sitting at the cool table in the cafeteria at a mental institution.

And you would know that exactly how, good buddy?



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So Well wrote:We will have a blast!

All the best for 2012,

Anybody who visits me gets the white glove treatment!

(no, don't ask)

Great seeing your nic, So Well, my best to you and yours.



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SleepingUgly wrote: You must have a crush on a lot of us here!!

Yeah, I'm easy.

Easy like Sunday Morning.

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SleepingUgly wrote: My 6-year-old says you have to say what you're sorry for, and something about how you're not going to do it again, and you have to mean it.

SU, would you mind asking your adorable 6-year-old this question:

"Do sincerely you want to make it to 7, kid?"



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Oh, I think I'm going to run with your fantastic idea for a Swimsuit CPAP Calender.

Starting a new thread.

Be there, or be . . .



viewtopic/t72920/Armies-Of-The-Night-Th ... ender.html

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rocklin wrote:

So Well wrote:Being popular on cpaptalk.com is like sitting at the cool table in the cafeteria at a mental institution.

And you would know that exactly how, good buddy?

Been there. Done that. T-shirt too small.

Love ya,

If I may kindly suggest that everyone here please follow this link: viewtopic/t72921/A-call-for-inaction.html