Rhesus Pieces posted:Do patients see it as a win? Were their opinions surveyed or consulted prior to development or deployment of these things? What happens when these “smart bottles” detect noncompliance? Do they report to the doctor or to insurance? The goal is to contain costs. The patients may not like it similarly how people may not like doing a month of physical therapy before an MRI or surgery. But even PT is more burdensome or potentially harmful than being told by the HCP that you aren't following your treatment or being denied a new monthly TRx for a 10k/month therapy because data shows the patient should already have 60 day supply given historical non compliance. The alternative is those pills are flushed down the toilet or sit in a cabinet and the cost is distributed via insurance premiums or taxes. Would you be as opposed to the policy if we had single payer and all pharma companies were nationalized? If not, can you at least understand why others wouldn't like paying for other's inability to set an alarm in their phone to take a pill? I don't disagree with the big brother concerns, but even the dream healthcare distribution system will have require trade-offs to contain costs. KingNastidon fucked around with this message at 21:43 on Nov 21, 2018 |
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Nov 21, 2018 21:40
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Flesh Forge posted:"Those insurance companies are garbage." - Ok good to see we are now discussing more topical matters than healthcare reform in the healthcare reform megathread, such as how you feel disrespected by the arguments of forums poster Yeowch!!! My Balls!!!
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Nov 21, 2018 21:41
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Yeowch!!! My Balls!!! posted:good to see we are now discussing more topical matters than healthcare reform in the healthcare reform megathread, such as how you feel disrespected by the arguments of forums poster Yeowch!!! My Balls!!! I mean you ether the gently caress out of people, I'm glad you've never turned your ire on me tbh. Also I feel like we're just assuming that people using CPAP machines incorrectly is just this immutable fact of life and not something we could address with education and compassionate healthcare doctrine?
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Nov 21, 2018 21:42
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Sundae posted:Edit: ^^^ Okay, so there's one answer. Your doctor can refuse you treatment if he thinks you're not compliant. Pretty much, yeah. If you're not using the machine and/or it's not working for you, your doctor is the person who should make the determination on the next steps for treatment, whether that is changing it up so that it works for you or trying to find an alternative therapy that will work.
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Nov 21, 2018 21:46
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Lightning Knight posted:Also I feel like we're just assuming that people using CPAP machines incorrectly is just this immutable fact of life and not something we could address with education and compassionate healthcare doctrine? There are several factors with it. There are multiple mask types, some of which work better than others for different people, and there are also multiple different types of things we all more or less lump under CPAP (APAP, CPAP, BIPAP, etc etc). Depending on why you need it and the intensity of your symptoms, also, your usage patterns / requirements may differ as well. The biggest drawback I've seen from people using them is (1) either ignoring treatment and only using them when they've had a bad night before, or (2 and more common) not making it through the initial month of adjustment period before you give up. It almost always feels "weird" at the beginning, and it may be uncomfortable dealing with the mask especially if the ideal airflow settings aren't known yet. Beyond that, some of the more complicated machines (APAP/BIPAP) have additional breathing control settings which may be perfect for you while you're asleep, but are uncomfortable as loving hell while you're awake. Now take that and add in the human elements. Not all patients are forthcoming about problems, not all patients know what to even ask, and a lot of doctors loving suck at patient interaction. The end result is a complicated mess of set-up, patients and doctors who don't like talking to each other, stuff with a lot of trial-and-error even when you put sleep studies into place, and an insurance industry doing everything in their power to minimize the amount they cover for it. Sure, you can get them using it correctly. It's just a big, stupid task filled with stupid people every step of the way.  Edit: There are also even dumber factors which shouldn't play into it but you know do, such as people grumbling about not being able to get the hose to reach from location X to their bed, plug locations, variable temperatures causing your starting humidification settings to become a torrential waterfall of condensate around 4AM, etc etc. About the only thing I've seen that is mostly not a factor is noise. Those things are QUIET when they're on your face. quote:I actually really wanted to take this moment to talk about CPAP experiences, even though it's outside the spirit of the thread somewhat, because I have one and it's done me no good at all. Sadly, I can see that that isn't going to happen given the current tenor of the thread. VVVVV My post is for you then! 
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Nov 21, 2018 21:49
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I actually really wanted to take this moment to talk about CPAP experiences, even though it's outside the spirit of the thread somewhat, because I have one and it's done me no good at all. Sadly, I can see that that isn't going to happen given the current tenor of the thread.
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Nov 21, 2018 21:50
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I would assume non-use is due to comfort or upkeep:
edit: JustJeff88 posted:I actually really wanted to take this moment to talk about CPAP experiences, even though it's outside the spirit of the thread somewhat, because I have one and it's done me no good at all. Sadly, I can see that that isn't going to happen given the current tenor of the thread. Just don't touch the poop. Also, sorry to hear that! Out of curiosity, is it an automatic machine? I've heard that fixed pressure are usually set to 5 cmH20 then adjusted up as needed. Mine's an automatic and the default range was set to 5 to 15; it gets up to ~14.5 for treatment. Accretionist fucked around with this message at 21:55 on Nov 21, 2018 |
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Nov 21, 2018 21:50
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Sundae posted:Sure, you can get them using it correctly. It's just a big, stupid task filled with stupid people every step of the way. Right, I understand this. My dad has a CPAP machine and it was a struggle to get him to use it consistently. I'm just saying, some of these factors could be addressed with doctor training and better doctor-patient relationships, we shouldn't just assume that it's an unchangeable reality I think.
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Nov 21, 2018 21:52
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Lightning Knight posted:I mean you ether the gently caress out of people, I'm glad you've never turned your ire on me tbh. I gotta come out and ask, do you have any experience at all with obtaining a CPAP machine and getting health insurance/medicare coverage for it? Because you sound like very much not. e: Lightning Knight posted:Right, I understand this. My dad has a CPAP machine and it was a struggle to get him to use it consistently. I'm just saying, some of these factors could be addressed with doctor training and better doctor-patient relationships, we shouldn't just assume that it's an unchangeable reality I think. Ok fine, did you go with your dad to those doctor visits, did you assist with any of the paperwork and compliance monitoring?
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Nov 21, 2018 21:57
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JustJeff88 posted:I actually really wanted to take this moment to talk about CPAP experiences, even though it's outside the spirit of the thread somewhat, because I have one and it's done me no good at all. Sadly, I can see that that isn't going to happen given the current tenor of the thread. I have one for central sleep apnea (where your brain just doesn't send the signals to breathe, basically). You clean the mask roughly weekly, the tubing monthly, change the filters roughly quarterly. You need space near your bed and an adequate number of plugs. You need the space to also be conducive to having a hose lying around, or size the hose correctly. I sleep on the floor, so there's no hose drag issue for me. I know a lot of people complain about that, though. Sleeping position is really only restricted either by hose length or if you're wearing one of the full-cup masks with yours, and even then it's not too bad. I use one of the nose-pillow styles and roll back and forth pretty constantly without issues. You do need to be good with the water tank and in particular using only distilled water in it. My largest problem has been temperature change. When I go to bed, my room is typically around 70*F and will drop to 45*F or so during the night. That difference is significant enough that the humidification controls that work great in the early night will result in condensation pooling once it gets colder, and sometimes that condensate decides I need a good old-fashioned drowning around 3-4AM once it's accumulated enough that the air pressure pushes it into my lungs. Doesn't happen often, but I'd say 4-5 times in the last six months it's done it. What kinds of problems are you having with yours? When you say "no good" what were you trying to solve? quote:Right, I understand this. My dad has a CPAP machine and it was a struggle to get him to use it consistently. I'm just saying, some of these factors could be addressed with doctor training and better doctor-patient relationships, we shouldn't just assume that it's an unchangeable reality I think. Agreed. Sundae fucked around with this message at 22:04 on Nov 21, 2018 |
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Nov 21, 2018 21:58
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Sundae posted:My largest problem has been temperature change. When I go to bed, my room is typically around 70*F and will drop to 45*F or so during the night. That difference is significant enough that the humidification controls that work great in the early night will result in condensation pooling once it gets colder, and sometimes that condensate decides I need a good old-fashioned drowning around 3-4AM once it's accumulated enough that the air pressure pushes it into my lungs. Doesn't happen often, but I'd say 4-5 times in the last six months it's done it. You make $1 Hojillion dollars Heat your house
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Nov 21, 2018 22:00
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Flesh Forge posted:I gotta come out and ask, do you have any experience at all with obtaining a CPAP machine and getting health insurance/medicare coverage for it? Because you sound like very much not. He got it a few years ago and I was still in high school, so no. I know that my dad historically has had issues with doctors, because he's stubborn and forgetful but they're also patronizing and treat him poorly because he didn't graduate high school and is a middle aged Latino man. He's certainly not blameless, but I've been with him at doctor's visits where they've openly condescended to him and treated him like poo poo.
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Nov 21, 2018 22:04
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Lightning Knight posted:Right, I understand this. My dad has a CPAP machine and it was a struggle to get him to use it consistently. I'm just saying, some of these factors could be addressed with doctor training and better doctor-patient relationships, we shouldn't just assume that it's an unchangeable reality I think. But the monitoring encourages patient/MD interaction leading to better health outcomes. Patients, and especially men, are notorious for not being forthcoming with MDs and other HCPs about adherence/compliance or acknowledging symptoms/side effects. The doctor should have significant influence and override ability on how treatment is administrated, which the CPAP/insurer example appears to lack. But is the better alternative a complete lack of information? HCPs are busy and aren't directly affected by the economic costs of non-compliance or the secondary health issues arising from non-compliance.
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Nov 21, 2018 22:12
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I wasn't about to crap on your dad, I would say if you're a patient of any doctor and they're not explaining things to your liking and treating you with condescension you should find another doctor if that's at all possible. On the topic though, you're shooting from the hip at people explaining how the twitter guy's anecdote has some problems and maybe should not be taken 100% at face value. When you're prescribed a CPAP machine (if you're insured) you have 1-3 months to get your usage figured out, with some interaction with your doctor at short intervals to address any issues like pressure and fit and whatever. It just does not work the way the twitter guy describes, not at all. Obviously, loving DUH, people should be given the medical treatments their doctors prescribe and when good-intentioned patients are screwed out of that it is wrong. Cost control and the avoidance of waste are still good things though 
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Nov 21, 2018 22:19
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Insurance companies have the exact wrong incentives and can't be trusted to control costs in a way that benefits anyone but insurance companies.
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Nov 21, 2018 22:40
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Speaking of c-paps, this is a scary anecdote.Adenoid Dan posted:Insurance companies have the exact wrong incentives and can't be trusted to control costs in a way that benefits anyone but insurance companies. The Annals of Internal Medicine has published the results of a new study showing that high deductibles lead to people deferring diagnosis and care for complications from diabetes: quote:During follow-up, the delay for the high-deductible group was 1.5 months (95% CI, 0.8 to 2.3 months) for seeking care for the first major symptom, 1.9 months (CI, 1.4 to 2.3 months) for the first diagnostic test, and 3.1 months (CI, 0.5 to 5.8 months) for the first procedure-based treatment. Another data point that "the bending of the cost curve" in the increase of medical spending is due to sick people not being able to afford using private insurance they're mandated (for another month) to carry.
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Nov 21, 2018 23:26
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Well, since there was interest, here's what happened with my CPAP experience; Back in the spring of '15 I had a sleep study done of whose results I am fairly dubious. Reason being: All of the tubes that were hooked up to me forced me to sleep on my back, which I haven't been able to do since childhood, and I didn't get any sleep. I was diagnosed with severe apnoea (more than 30 incidents per hour, I believe) which wasn't that surprising, but that night was hardly representative of how I sleep. I have always been uniquely a side-sleeper and, even with CPAP, I cannot sleep on my back, period. I simply cannot doze off. Here has always been my sleeping problem: I sleep perfectly well when I don't need to. I have no problem sleeping at all when I don't have to get up early in the morning; when I do have to wake up at even a moderately early hour, I almost always struggle. I don't doubt that I have sleep apnoea as I have been a moderate to severe asthmatic my whole life and may have COPD despite never smoking or the like. As an example of how bad I could get, shortly before the sleep study I had a job where I had to be in at 10 AM, Monday through Friday. Not terribly early, but not having a day off in mid-week to get a decent sleep was brutal on me. One week, I hadn't slept in four nights running and, on a Thursday, I nearly fainted from exhaustion during my late lecture, which was utterly terrifying. Nevertheless, when I don't have to wake up at a specific hour I sleep perfectly well and wake up feeling refreshed and rested even though I snore like a chainsaw. In the previous example, I always slept very well on the weekend after being miserable all week. I was given a CPAP machine in the autumn of 2015. I tried this CPAP machine for 4 months, and it didn't help in the slightest. At the time that I received the CPAP machine, I had to be at work at 9 AM on Mondays, Wednesdays and Fridays. I would sleep very well four nights of the week and badly the other three; there's no prize for guessing which three. My difficulty sleeping would take many forms: I would have a hard time getting to sleep, I would wake up intermittently all through the night for no reason, or I would wake up at 5:30 AM for no reason and eventually get up because I knew that further sleep was impossible. The end result was always the same in that I would be exhausted all day. What is frustrating about this is that I gave the machine a proper try - I was looking for anything to help me rest better - and it didn't work, but every doctor I see acts as if I did something wrong and that a CPAP machine is a magic bullet. I've gotten very tired of looking for help with my sleeping problems because nobody listens. It seems to me that I have some kind of mental issue that causes anxiety and stops me from sleeping under stress, but doctors just keep blathering on about CPAP and I've kind of given up. The other problem is that I have very bad sinuses dating back from my childhood and, unless I take a shot of Afrin or the like, I cannot reliably breathe through my nose. My left nostril is bad but my right nostril, most of the time, is a no-passing zone. Because of that, the only CPAP mask I can wear is the huge one that covers my mouth and nose. Since I can only sleep on my side, it's almost impossible to contort my body in such a way that I can comfortably sleep while still maintaining the pressure seal around the mask. I also roll over often in the night, which exacerbates the problem. After months of fighting with that and not sleeping better nor feeling more rested come the morning, I gave up. I even bought one of those pillows that has the cut-out bits on each side for CPAP patients, but I'm guessing that it was designed for someone with a head the size of a grapefruit and a swan neck, because it didn't work for me and I wasted a fortune on it. I ended up donating the pillow to the sleep clinic. So, that's my CPAP story. I'm sad because I really hoped that it would help me and frustrated/bitter because doctors keep insisting that it will make my life better when it didn't.
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Nov 21, 2018 23:37
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Compulsory licensing must be a factor in granting patent license but only India really has the balls to do that since the generic industry is big there Also ban drug ads
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Nov 22, 2018 00:03
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High deductible plans are the perfect example of how rational economic incentives do not apply to east African plains apes who have documented lizard brain tendencies around rewards
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Nov 22, 2018 00:06
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That is, how economics as an explanatory method for human behavior is basically junk past basic analysis
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Nov 22, 2018 00:06
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Malcolm XML posted:Also ban drug ads Ads for psychoactive meds are the most insanely unethical thing 
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Nov 22, 2018 00:12
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Adenoid Dan posted:Insurance companies have the exact wrong incentives and can't be trusted to control costs in a way that benefits anyone but insurance companies. Exactly. For a good example see their fondness for rescissions pre-ACA, when they could legally get away with retroactively cancelling your insurance as soon as you came down with an expensive disease they didn’t feel like paying for. Flesh Forge posted:Ads for psychoactive meds are the most insanely unethical thing At least tv drug ads usually mention what the drug treats. Ads I’ve seen online lately don’t even mention what the drug is used for. Who the hell are these even aimed towards? Rhesus Pieces fucked around with this message at 00:57 on Nov 22, 2018 |
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Nov 22, 2018 00:55
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Malcolm XML posted:Also ban drug ads *Puts on devil's advocate fedora* Well Actually... Direct to consumer marketing increase patient awareness about conditions they may be reticent to discuss with their doctor. A mass-market TV ad empowers patients to discuss the issue with their HCP without outright acknowledging they proactively researched the issue. It also helps patients be aware of better novel therapies that their doctor may not recommend due to familiarity and/or laziness. It also encourages family/caregiver discussion under the safety of "it's not just you..." (Disclosure: I work in pharma marketing / market research)
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Nov 22, 2018 01:07
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JustJeff88 posted:Well, since there was interest, here's what happened with my CPAP experience; *snip* I also had a cpap thrown at me. Not quite that dramatic but how it got there was kind of dubious. The sleep test itself had a bunch of issues that I suspect lead to a false positive result, but I just went with it because medicaid paid for the whole thing.
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Nov 22, 2018 01:33
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Rhesus Pieces posted:At least tv drug ads usually mention what the drug treats. Ads I’ve seen online lately don’t even mention what the drug is used for. Who the hell are these even aimed towards? I like the ads that don't even mention the name of the drug, the "Non 24" drug ad e.g. https://www.statnews.com/2016/05/04/sleep-drug-blind-advertising/ quote:Fewer than 1,000 patients in the United States take the drug, which is aimed at completely blind people with the disorder. e: just wanted to add, the drug name Hetlioz is like some 9th circle of hell devil's name The first generation of ads for Lyrica were written like "you have pain somewhere, you want drugs for it, tell your doctor you have fibromyalgia because no one can prove you don't have it, here's a free helpful pamphlet to teach you how to convince your doctor" Flesh Forge fucked around with this message at 01:48 on Nov 22, 2018 |
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Nov 22, 2018 01:45
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Do you not have follow ups with your sleep physician about these concerns? Ongoing symptoms would surely require a full monitored sleep study that could find what issues you have when your apneas are under control.
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Nov 22, 2018 01:58
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hobbesmaster posted:Do you not have follow ups with your sleep physician about these concerns? Assuming that you mean me, yes, of course. The basic response seemed to be that I would be better off using it because I would get more oxygen during sleep and it's easier on my internal organs and so on. My concerns about not sleeping better and actually being able to wear the bloody thing were mostly ignored. Now you know why I became so frustrated.
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Nov 22, 2018 02:05
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Assumedly he saw apneas on your sleep study then saw reduced apneas on the machine at your follow up so that problem is solved - he got the right pressure! The mask, tubing and humidifier is the DME provider’s problem. Need a new appointment to follow up on your real issues though. Different billing code you see. 
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Nov 22, 2018 02:38
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Malcolm XML posted:Also ban drug ads Flesh Forge posted:Ads for psychoactive meds are the most insanely unethical thing You need to flip at least the DC Circuit and probably SCOTUS on that, KingNastidon posted:*Puts on devil's advocate fedora* Well Actually... Bullshit. Discendo Vox fucked around with this message at 07:10 on Nov 22, 2018 |
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Nov 22, 2018 02:44
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quote:(Disclosure: I work in pharma marketing / market research) Just want to let you know, down here in the R&D basements we all hate you. 
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Nov 22, 2018 02:52
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If people aren't using a device they need to use, the correct therapeutic approach is to determine why they aren't using it and then address those roadblocks, not assume they don't really need it and then automatically deny further coverage. But that would increase care costs, and you can save money by throwing hurdles under the feet of sick people and cutting their care when they can't make the jumps.
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Nov 22, 2018 03:02
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It’s not like dentists take away your floss when they see through your lie that you’re regularly flossing
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Nov 22, 2018 03:39
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A ban on drug ads would get overturned so fast by SCOTUS and I suspect it would be closer to unanimous than 5-4
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Nov 22, 2018 03:40
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Note that providers are not taking anything away - your insurance is threatening to stop paying for it. So yes if you get a monthly subscription of dental floss from your insurance they probably wouldn’t be too happy about paying for it if you won’t use it. It’s an important distinction in the US. With something like a CPAP machine there are at least 3 separate companies that are trying to profit off you involved and they have very different interests.
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Nov 22, 2018 03:43
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Regarding the CPAP thing, it seems like the issue isn't so much the monitoring itself, but the monitoring being used by insurance to deny coverage. That should be something only controlled by the doctor; insurance should have no input.
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Nov 22, 2018 03:50
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Terror Sweat posted:It’s not like dentists take away your floss when they see through your lie that you’re regularly flossing Just keep those little floss picks everywhere. It ain't that hard.
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Nov 22, 2018 04:45
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Nissin Cup Nudist posted:A ban on drug ads would get overturned so fast by SCOTUS and I suspect it would be closer to unanimous than 5-4 Not really. The FTC and FDA have and have always had strong ability to regulate and limit DTC ads for prescription and nonprescription drugs (I got confused, it was offlabeling where the WLF has already shanked the government). There was an outright ban on the practice in a bunch of media until the 1980s, and the rules were majorly relaxed in 97. The crucial issue is really the membership of the DC circuit, regulatory capture, and the fact that FDA is increasingly in a financial regulatory stranglehold. Discendo Vox fucked around with this message at 07:20 on Nov 22, 2018 |
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Nov 22, 2018 07:08
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KingNastidon posted:*Puts on devil's advocate fedora* Well Actually... Somehow every other country except for new Zealand gets by. Why not have public health bodies educate the public about health instead of companies with an incentive to push pharmaceutical spending? Pharma spends most of their money on sales and marketing over r and d so let's start by removing the costs to """"educate"""" consumers by enforcing a tax to fund educational services.
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Nov 22, 2018 07:25
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Discendo Vox posted:You need to flip at least the DC Circuit and probably SCOTUS on that, Yeah with the current conservative majorities and the idiotic novel interpretation of any sort of speech as permissible it's unlikely. Thanks democrats for approving a conservative bench you guys are really stellar
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Nov 22, 2018 07:30
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Malcolm XML posted:Yeah with the current conservative majorities and the idiotic novel interpretation of any sort of speech as permissible it's unlikely. I want to emphasize it's not really SCOTUS that's the issue here- it's a combination of 1. the WLF, which is a decades-old, terrifyingly competent Koch litigation entity, 2. decades of funding strangulation and capture and brain drain at FDA (which is still actually a really clean agency when all's said and done) and 3. the DC circuit, which has had this issue with libertarian judges since the 80s. Ultimately, if this went to SCOTUS, I think that even now it's quite possible a ban would be upheld.
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Nov 22, 2018 07:36
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