Features
Preferential treatment?
During a time of record low highway deaths, the sleep study and CPAP industries are zeroing in on truckers. Could it be a case study in big bucks buying…

By Charlie Morasch
staff writer

 

The black and white advertisement oozes with fear.

A little girl sadly stares at the camera while donning a T-shirt with a scare tactic. “Daddy used to drive for a living; then he fell asleep.”

In the United Kingdom, the ad aims to inform the public about supposedly “drowsy lorry drivers.”

Such is the world of transportation safety campaigns, where an emotional image or simple anecdotal story about a crash can be projected onto millions of drivers – potentially creating a boon for industries that produce electric on-board recorders or CPAPs.

Why the interest in trucking?

Do any statistics show an increase in commercial vehicle wrecks? Is there any evidence that truckers are too tired to drive safely?

No.

Two years after the Federal Motor Carrier Safety Administration’s Medical Review Board proposed that all drivers with a Body Mass Index of 30 or greater undergo expensive overnight sleep exams, pressure is mounting for more regulation on truckers.

Some of that pressure is now coming from the CPAP manufacturers (an estimated $2.4 billion in revenue) and sleep study labs (an estimated $4.5 billion in revenue), which appear to have trained their eye on trucking’s 6 million CDL-holders.

The industries – led by publicly traded companies such as ResMed, Respironics, Sleep Solutions and others – seem to have reached a simple yet powerful conclusion:

Trucking is a target-rich environment for certain medical testing and treatment.

Given that CDL privileges hinge on medical standards set by FMCSA, it may make the agency a natural target for special-interest lobbying.

“I think we will do a lot of business (in the trucking industry),” one representative of CPAP-manufacturing Battery Power Solutions said in a company statement, after attending a truck show in Las Vegas last year.

The facts
Sleep apnea occurs when a person has partial or total airway obstruction during sleep, resulting in interrupted breathing.

Americans have increasingly been diagnosed with apnea, leading to a push to diagnose even more individuals. Some have used anecdotal scenarios to make unsupported claims in an effort to link wrecks involving trucks to tired truckers who may have untreated sleep diseases.

“If you listen to them, the highways are full of nothing more than a bunch of sleep-deprived truckers,” said Tom Weakley, director of OOIDA’s Foundation. “Well, why is the total number of fatalities dropping year after year? Hello! It’s not happening out there.”

Weakley makes three main points.

First, there’s no data showing more drivers are tired, or that drivers with sleep conditions are causing any large number of wrecks on U.S. highways. Actually, fatal wrecks that include commercial trucks have continued to drop.

Second, federal regulations already require physicians to examine commercial drivers for sleep apnea.

“It’s already on the books,” Weakley said. “What you’re saying is, doctors today aren’t doing their job. Well, that’s possible, but a regulation mandating certification of medical examiners for DOT physicals is pending this year. Shouldn’t that solve the problem?”

Third, Weakley said truckers who may have brought up sleep issues with their physicians normally won’t do so if the threat of a $2,000 to $5,000 sleep study hangs over them.

“One of our main concerns is this will make a lot of drivers who would have gotten treatment avoid telling their doctors about sleep problems,” Weakley said. “So then what do you do? Are you going to force them to take a sleep lab just because they’re a certain weight?”

 The billions of potential revenue for the sleep lab and CPAP industries can spell disaster for truckers already struggling to make it through the ongoing recession.

Weakley is also concerned that those promoting sleep testing don’t realize the serious financial impact it could have on truckers.

Most truck drivers don’t work for major trucking companies. Many owner-operators are either self-insured or lack any health insurance. Others work for small to mid-size motor carriers that may not offer insurance benefits that cover $2,000 to $5,000 sleep lab bills.

“Truck drivers are struggling to bring home a good paycheck,” Weakley said. “These kinds of costs could very easily put them out of business.”

In addition to facing the exorbitant costs of sleep testing, drivers may avoid mentioning sleep problems to their doctor if their livelihood could be affected by the potential scarlet letter of an apnea diagnosis.

“It’s more likely now that he’d then withhold that information because he’s afraid he’ll lose his job,” Weakley said. “Now you’ve created a health problem.”

Follow the money
Groups like the National Sleep Foundation consistently beat the drum about Americans’ lack of adequate sleep these days. These groups are supported by sleep labs and CPAP makers, which obviously stand to profit when people think they aren’t getting enough sleep.

Flip through lists of industries that lobby Congress enough, and it’s clear that few industries spend like the medical industry. According to the watchdog Web site opensecrets.org, CPAP giant Medtronic Inc., spent $4 million politically through lobbyists last year.

What CPAP makers spend in the beltway pales, however, in comparison with what they pay doctors and researchers.

That flow of money hasn’t gone unnoticed. The medical profession has been increasingly scrutinized by Capitol Hill.

Sen. Charles Grassley wants the public to know when physicians make more money from consultant contracts than they do from teaching or treating patients.

Grassley, R-IA, has worked since 2007 on the passage of the “Physician Payments Sunshine Act,” that would require pharmaceutical and medical device manufacturers to report money they give to doctors. The bill has 11 co-sponsors, all Democrats.

“People rely on medical advice, and taxpayers spend billions of dollars on prescription drugs and devices through Medicare and Medicaid,” Grassley said late last year.

Grassley’s investigations have revealed several expensive relationships between CPAP and pharmaceutical makers and doctors, including millions of dollars that weren’t previously reported.

For example, Thomas Zdeblick, chairman of orthopedic surgery at the University of Wisconsin, received $2 million from royalties on inventions and from working eight days as a consultant for Medtronic, a major CPAP manufacturer. He received nearly $20 million in payments from Medtronic from 2003 through 2007, reporting only $80,000.

Because of such revelations, Harvard and the University of Wisconsin are among 40 universities nationally that are revising their disclosure policies after Grassley’s staff revealed major ethical lapses regarding physicians and drug/medical device manufacturers.

Limiting options?
Dr. Arnold Relman has testified before Congress on the issue of health care costs. Relman, professor emeritus of medicine at Harvard Medical School and former editor of the New England Journal of Medicine, said in a 1995 paper that competition among doctors and medical suppliers and drugmakers leads to fewer choices for patients.

In a 1995 paper titled “Health-care financing: profit and commercialism,” Relman said physicians began taking on investments in associated facilities such as sleep labs during the 1980s.

Before that, most physicians believed referring their own patients to a product or service that tied financially to that doctor was a breach of ethics.

“The investor-owned part of the system has converted the whole (health care) system into a system that’s driving to make more money, driving for more income. There is competition now, but the competition is for patients, for market share and for income.”

Free market competition in the medical community is vastly different than in other portions of the economy, Relman wrote.

“Consumers can make relatively few independent and informed purchasing decisions because they must rely so heavily on advice from their physicians.

A closer look
In mid-May, hundreds of physicians, scholars and salesmen will meet in Baltimore to discuss how professional drivers spend their days and especially their nighttime hours.

The biggest conference yet exploring the prevalence of sleep disorders in the trucking industry will be the “Sleep Apnea & Trucking Conference” scheduled for May 11-12. The conference, organized by the American Sleep Apnea Association, is co-sponsored by FMCSA and the American Trucking Associations.

OOIDA’s Weakley, who drove truck for more than 20 years, will attend and said he’s been asked by the conference’s organizers to detail the problems, including expenses and privacy concerns, that small-business truckers have regarding sleep apnea.

“Our guys are struggling,” Weakley said. “I appreciate everyone giving us the opportunity to participate. My fear is that this conference will be a rally saying, ‘Let’s get more support behind this need for sleep apnea testing.’ I’ll be the voice saying, ‘Wait a minute.’ ”

Weakley has attended past apnea conferences and said he is glad the event’s organizers invited OOIDA to participate.

He said not everyone is just interested in selling a product and pushing a mandate. There are those who really want to hear from all sides.

Can Big Sleep shift gears?
Though sleep labs and CPAP manufacturers will likely always view potential patients as growth markets first, a medical journal editorial hinted that some in the industry could change and adapt.

A 2008 editorial published in the National Institutes of Health Web site, the president of the American Academy of Sleep Medicine addressed the change, all while keeping an eye on growth for the future.

“The past decade has seen explosive growth in our field,” said Alejandro Chediak, president of the American Academy of Sleep Medicine. “If sleep medicine is to continue its unprecedented growth, we need to be prepared to develop and embrace disease management paradigms with greater focus on chronic care and less emphasis on facility-based testing.” LL

 

charlie_morasch@landlinemag.com