Healthy Debate, Healthy Industry
By Franklin A. Holman
It is better to debate a question without settling it than to settle a question without debating it.”—Joseph Joubert, French essayist and moralist
The debates leading to the presidential election are a key factor in Americans’ decision of who will lead our country for the next 4 years. When opposing views are presented in a public forum, voters are better able to settle their stance on the issue at hand. Similarly, when issues are debated in the sleep industry, sleep medicine professionals can better determine the optimal outcome for the profession and the patients they serve. Debate is the instrument that allows well-researched, evidence-based opinions to prevail. Currently, in sleep medicine, a number of topics are being debated. While some may say this is a sign of an industry in disarray, ultimately, these debates will strengthen the field of sleep medicine.
The most discussed issue among sleep medicine professionals at the moment is home testing. While many are advocating for the implementation of home testing, there are scores of opponents to unattended portable monitoring. One quick look at the CMS comment page and you will find strong opinions on both sides. One commenter said, “As a sleep medicine professional, I strongly urge rejection of the proposed Medicare policy regarding home diagnostic testing and empirical CPAP titration for obstructive sleep apnea (OSA).” Another stated, “I am in support of the decision of the Coverage and Analysis Group as articulated in the proposed Decision Memo for Continuous Airway Pressure that was posted December 14, 2007. The analysis was exhaustive; evidence-based and took into consideration… a better standard of care for Medicare beneficiaries.” It’s comments like these that will sway CMS in one direction or another and that will ultimately lead to the determination about what is best for the future of sleep medicine professionals and the patients they serve. I hope you were among those who voiced their opinion during the open comment period.
Not only does debate exist in the political realm of sleep medicine, but also in the research community. Researchers Adam G. Elshaug, BA, BSc(Hons), MPH, PhD; John R. Moss, MSocSci, BEc, MB BS, FCHSE; Janet E. Hiller, Dip Soc Studies, BA, MPH, PhD; and Guy J. Maddern, MB BS, PhD, MS, MD, FRACS concluded in an article in the January 5, 2008, issue of the British Medical Journal (BMJ) that sleep apnea surgery yields inconsistent clinical effectiveness and should be restricted to clinical trials. But in a posted comment on the BMJ Web site, Dr Sam Robinson said, “While I agree with Elshaug et al that upper airway surgery should not be first line treatment for obstructive sleep apnoea in adults, I do not agree that surgery should be restricted to controlled clinical trials.” Such debates explore new ideas and spawn new research that can in turn bolster sleep medicine.
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In order to accommodate the rising prevalence and awareness of sleep-disordered breathing, the field of sleep medicine will continue to change. Along with updated policies and standards, new forms of diagnosis and management of sleep disorders will emerge. The changes are bound to be debated. Keep in mind as you take your stance on current and future debates that you are the voice not only of your industry, but also of patients suffering from sleep disorders. It’s your voice that will ultimately mold the industry and empower you to best care for the patients you serve.
—Franklin A. Holman