No filibuster

Tuesday, August 31, 2004

I am writing in response to your article published in the June issue of HME News, “Davey and Goliath: Doc slings doubt at sleep academy.” The article suggests that the position of the American Academy of Sleep Medicine (AASM), the American Thoracic Society and the American College of Chest Physicians, as represented in the position statements published last year, represents a “filibuster” against the use of portable monitoring. This view is both inaccurate and, I believe, poorly informed. The development of this paper was based on carefully designed and well-accepted evidence-based processes. Members of the task force were chosen as representative experts from the three societies and were screened for conflict of interest to the greatest extent possible. If participation as a specialist in the field is considered by some to represent a conflict of interest, then it will be necessary to preclude cardiologists from asserting which diagnostic studies are most suitable for heart patients, or surgeons from deciding, in an evidence-based fashion, which surgical procedures are most likely to benefit their patients.

The article focuses extensively on the profit motive of sleep centers. It is certainly the case that many sleep centers support their operations and the salaries of both technologists and professionals, in part, by income from laboratory studies, just as thousands of other medical professionals support programs and salaries by means of diagnostic testing. But to suggest that these societies, in a purely calculated and self-serving fashion, are attempting to systematically thwart the use of portable monitoring is simply incorrect. In the spirit of fairness, it might be worth noting that neither physicians with a vested interest in the home monitoring business, nor the home medical equipment industry, which constituites much of your readership, are immune from profit motive. Furthermore, there seems little question that Dr. Davidson’s clear ties to industry, as a member of ResMed’s Medical Advisory Board, constitue a very clear conflict of interest.

The American Academy of Sleep Medicine is not opposed to development and application of effective technologies that will improve patient care - even those technologies that would supplant, in part, the existing standard of in-lab evaluation. What we do oppose are shortsighted and premature “solutions” to problems that may or may not exist, and that are suspect with respect to their reliability and application. We believe that it is our responsibility to apply whatever technology will be in the best interest of our patients and public health, in general. We continue to actively study the use of portable monitoring and methods of application that will produce maximum benefit for patients in the most efficient fashion.

- Michael J. Sateia, M.D., is president of the American Academy of Sleep Medicine.