"please keep me updated about oximeters "
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don't forget to register for the free interview tonight, when I'll be interviewed as part of Dr. Park's "Expert Interview" Series: http://doctorstevenpark.com/expert-interview-michael-goldman-of-sle...
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Replies to This Discussion
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Permalink Reply by RockRpsgt on
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I believe that he will be somewhere in line behind Banyon and Rooster. Not sure how much of my job will be left to wipe when they are done.
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Permalink Reply by Mike on
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here's the link to Mike Goldman Unplugged! (audio file from Expert Interview with Dr. Park)
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Permalink Reply by Judy on
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Everybody just has to keep in mind that there is more to Sleep Disordered Breathing AND to Sleep Disturbances than "just" OSA. And I think that the GOOD sleep doctors and RPSGTs such as our Rock Hinkle and Dr Park will always keep that in mind and stay on top of that. Rock Hinkle picked up on both my high leak rate AND my likely cardiac arrhythmias long before my medical team (excepting my family doctor).
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Good lord Mike what did you say?
Judy said:Everybody just has to keep in mind that there is more to Sleep Disordered Breathing AND to Sleep Disturbances than "just" OSA. And I think that the GOOD sleep doctors and RPSGTs such as our Rock Hinkle and Dr Park will always keep that in mind and stay on top of that. Rock Hinkle picked up on both my high leak rate AND my likely cardiac arrhythmias long before my medical team (excepting my family doctor).
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Permalink Reply by Rooster on
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Mike said:thanks. it's definitely something I've come around to based on the totality of my experiences. my views have evolved over time.
Banyon said:Good job, Mike. Glad to see you have such a strong libertarian viewpoint on this topic.
I propose what Mike has "come around to" is the idea that health care works better when patients are self-educated and free to make decisions while unencumbered by government regulations. And that it is better to have health care providers who are not heavily restricted by government regulations and are therefore free to partner with patients for the best outcome.
Maybe OT, it is also true that people, including people with low incomes, are capable of managing, not only their health care, but also their retirement investments, their banking, their investments and loans for housing, their credit card contracts, all of their dealings in the consumer market, their choice of education providers, etc., as long as the markets are not significantly restricted by governments. In fact, free individuals in free markets can do this much better than government does it for them.
This is the "libertarian viewpoint" that Banyon refers to. It is the viewpoint that gives the individual his inalienable rights to make his own choices in life.
Good job on the interview Mike!
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the main thrust of what i said was that the diagnosis and treatment of Obstructive Sleep Apnea should not require the intervention of the health care "system," but only permit the intervention of the health care system at the election of the patient. by the health care "system," i mean the requirement of a doctor's prescription to be tested for OSA, to get a CPAP machine, to get a CPAP mask, to have pressure settings adjusted -- the whole 9 yards. if you lifted all these regulations on the market, what you'd have in the year 2010 is a CPAP machine that is more than just a CPAP machine -- today's CPAP machine is a relic of our regulatory regime that is a "dumbed down" version of what should and CAN be on the market today: a machine that not only will diagnose OSA, but will determine the ideal pressure setting on a breathe-by-breathe basis and auto-titrate in real time. the only reason we don't have such a machine is that such a machine would be illegal and its makers would be thrown into federal prison because it would be deemed a "dangerous medical device" by the FDA. the only way the thing would be a "dangerous medical device" in my opinion is if you took it off its shelf at Walmart or Target (where it should be sold), and threw it at someone.
now, there's all sorts of shades of grey and nuance i would and could add to that, but for the sake of clarity and summary, that is the main thrust of what i said.
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I just wrote a very long addendum to this that got wiped out somehow by accident. but what i wanted to add is that putting a regulatory regime in the way of patients access to diagnosis and treatment of OSA is unconscionable. it takes away our control over the best the world has to offer to help us breathe easy and live longer, healthier lives, and puts control over that in the hands of others who have disincentives to give us what we need: i.e., the insurance companies and the doctors. the insurance companies obviously want to keep their costs to a minimum and the doctors get paid by doing procedures and tests, not by troubleshooting mask and machine issues.
Mike said:the main thrust of what i said was that the diagnosis and treatment of Obstructive Sleep Apnea should not require the intervention of the health care "system," but only permit the intervention of the health care system at the election of the patient. by the health care "system," i mean the requirement of a doctor's prescription to be tested for OSA, to get a CPAP machine, to get a CPAP mask, to have pressure settings adjusted -- the whole 9 yards. if you lifted all these regulations on the market, what you'd have in the year 2010 is a CPAP machine that is more than just a CPAP machine -- today's CPAP machine is a relic of our regulatory regime that is a "dumbed down" version of what should and CAN be on the market today: a machine that not only will diagnose OSA, but will determine the ideal pressure setting on a breathe-by-breathe basis and auto-titrate in real time. the only reason we don't have such a machine is that such a machine would be illegal and its makers would be thrown into federal prison because it would be deemed a "dangerous medical device" by the FDA. the only way the thing would be a "dangerous medical device" in my opinion is if you took it off its shelf at Walmart or Target (where it should be sold), and threw it at someone.
now, there's all sorts of shades of grey and nuance i would and could add to that, but for the sake of clarity and summary, that is the main thrust of what i said.
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by the way, i don't identify as libertarian or any other label. what i'm espousing might sit well with libertarians. but that's not the point. the point is this is the truth as i see it based on the totality of my experiences. if it happens to be a libertarian viewpoint, so be it.
Mike said:I just wrote a very long addendum to this that got wiped out somehow by accident. but what i wanted to add is that putting a regulatory regime in the way of patients access to diagnosis and treatment of OSA is unconscionable. it takes away our control over the best the world has to offer to help us breathe easy and live longer, healthier lives, and puts control over that in the hands of others who have disincentives to give us what we need: i.e., the insurance companies and the doctors. the insurance companies obviously want to keep their costs to a minimum and the doctors get paid by doing procedures and tests, not by troubleshooting mask and machine issues.
Mike said:the main thrust of what i said was that the diagnosis and treatment of Obstructive Sleep Apnea should not require the intervention of the health care "system," but only permit the intervention of the health care system at the election of the patient. by the health care "system," i mean the requirement of a doctor's prescription to be tested for OSA, to get a CPAP machine, to get a CPAP mask, to have pressure settings adjusted -- the whole 9 yards. if you lifted all these regulations on the market, what you'd have in the year 2010 is a CPAP machine that is more than just a CPAP machine -- today's CPAP machine is a relic of our regulatory regime that is a "dumbed down" version of what should and CAN be on the market today: a machine that not only will diagnose OSA, but will determine the ideal pressure setting on a breathe-by-breathe basis and auto-titrate in real time. the only reason we don't have such a machine is that such a machine would be illegal and its makers would be thrown into federal prison because it would be deemed a "dangerous medical device" by the FDA. the only way the thing would be a "dangerous medical device" in my opinion is if you took it off its shelf at Walmart or Target (where it should be sold), and threw it at someone.
now, there's all sorts of shades of grey and nuance i would and could add to that, but for the sake of clarity and summary, that is the main thrust of what i said.
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Permalink Reply by Mary Z on
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Enjoyed your interview last night Mike. I would like to hear a follow up with Dr. Park on patient education.
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I agree with all that except 1 thing: none of this is "obvious." It's not obvious that are doctors and health care system are working against the OSA patient. Far from it. I'm sure many of them would disagree. But it's the truth I've arrived at after a lot of things happening to me in the time since I was diagnosed.
j n k said:Don't let Rooster's political statements bother you, Mike. You believe, as I do, that sick people need access to what makes them well, and that it is not the job of doctors, manufacturers, or other businesses to get in the way of that.
Different people have different ways of getting at that concept politically, religiously, and philosophically, but I consider it obvious common-sense love for fellowman, myself.
Thank you for expressing it so well in your interview.
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Right. I get thrown in jail if i sell a CPAP machine or a OSA test to a patient because that would be the "unauthorized practice of medicine." However, when the insurance companies refuse to pay a doctor for running a home test or for prescribing a CPAP machine, are they prosecuted? Far from it. They are given bonuses by their Boards of Directors for showing quarterly earnings growth.
j n k said:Well said. I only meant that it is an obvious concept, or belief, that they shouldn't get in the way, that they shouldn't attempt to harm. For the doctors, it actually breaks their oath. But, yes, I agree that it is insidiously evil how often they do.
If a prison official makes a decision that harms a prisoner's sleep and breathing, he is prosecuted. If a DME employee does the same thing, in essence, to a patient, the employee gets a raise.
And that's the world we live in.
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A little off the subject, but there is a home sleep apnea monitpring test for $80 which may be useful as a screening test. It is called the Item# 1825Sleep Strip - Sleep Apnea Syndrome (SAS) At Home Screen Test Kit
■Accurate & Reliable
■FDA and CE approved
■Professional use only
■CPT Code
■Results in 30+ minutes
■CPT Code 95806 Modifier 52
Sales Price: $79.95
Available from
The results are available on awakening, not 30 minutes after starting the test
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