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How Corporate Health Care Leaders Maintain Their Impunity: The Case of Purdue Pharma's Funding of the Washington Legal Foundation to Attempt to Weaken the Responsible Corporate Officer Doctrine

The ongoing epidemic of narcotic (opioid) abuse, and the resulting rise in the deaths due to overdoses, has focused attention on pharmaceutical companies' aggressive promotion of these drugs which minimized their substantial risk. A recent article in the Intercept showed how the leadership of one such company tried to insulate itself from responsibility for such actions even while such promotions were continuing. Background: Impunity of Top Leaders of Big Health Care Organizations For years, we have railed against the impunity of top leaders of health care organizations.  We have noted that despite numerous legal settlements made by health care organizations of alllegations like fraud , bribery , and kickbacks , almost never do top leaders who presided over these actions face any negative consequences.  Lack of deterrence caused by such impunity appears to be a major cause of  the epidemic of continuing unethical behavior, crime and corruption on the part of large health car

Health Care and Sleep Apnea

One of the most challenging aspects of sleeping soundly is a health issue known as sleep apnea. It is a common disorder that causes interruptions in breathing during sleep, preventing oxygen from reaching the brain. Sufferers wake hundreds of times per night, each time normal breathing is interrupted and the brain is depleted of oxygen.

As a result, they never feel rested and experience excessive daytime grogginess. It is not a disease but increases risks of contracting other diseases and conditions. There are three types: obstructive, central and complex, which is a combination of the first two, according to SimpleSleepSolutions.com.

Central Sleep Apneais caused when the brain fails to properly signal the muscles to breath. It is very uncommon and snoring is generally not a symptom.

Obstructive sleep apnea (OSA) is the most common form of sleep apnea, with some estimates at 1 in 7 people in the U.S being afflicted with some form of OSA. In OSA, the muscles around the throat and airway relax, causing the airway to collapse. Sometimes the tongue falls back and obstructs the airway. The brain can no longer receive oxygen and sends a signal to the muscles to open, often causing the person to wake up with a gasp or a snort. Most of the time, sufferers do not recall waking up during these episodes.

More than 18 million adults have sleep apnea, according to the National Sleep Foundation. It is very difficult at present to estimate the prevalence of childhood OSA because of widely varying monitoring techniques, but a minimum prevalence of 2 to 3% is likely, with prevalence as high as 10 to 20% in habitually snoring children. More information is located at this website: https://sleepfoundation.org/sleep-disorders-problems/sleep-apnea/page/0/1.

Sleep apnea can make you wake up in the morning feeling tired or unrefreshed even though you have had a full night of sleep, according to the American Academy of Sleep Medicine. During the day, you may feel fatigued, have difficulty concentrating or you may even unintentionally fall asleep. This is because your body is waking up numerous times throughout the night, even though you might not be conscious of each awakening.

The lack of oxygen your body receives can have negative long-term consequences for your health. This includes:
·         High blood pressure
·         Heart disease
·         Stroke
·         Pre-diabetes and diabetes
·         Depression

If you sleep on your back, gravity can cause the tongue to fall back. This narrows the airway, which reduces the amount of air that can reach your lungs. The narrowed airway causes snoring by making the tissue in back of the throat vibrate as you breathe. Obstructive sleep apnea in adults is considered a sleep-related breathing disorder. Causes and symptoms differ for obstructive sleep apnea in children and central sleep apnea. More info is available at this site: http://www.sleepeducation.org/essentials-in-sleep/sleep-apnea.

Anyone can develop it, regardless of gender or age, and even children can be afflicted, according to Simple Sleep Solutions. The most common risk factors include:
·         Excess weight, especially obesity – about half of all OSA sufferers are overweight
·         Male, although recent research has indicated that women’s risk increases to about the same level as men once they reach post-menopausal age
·         Over the age of 60
·         Smoking
·         Enlarged tonsils and adenoids, one of the most common factors for children with OSA, particularly overweight children
·         Having certain anatomical features such as a thick neck, narrowed airway, deviated spectrum or a receding chin
·         Using alcohol, sedatives and tranquilizers, all of which relax the muscles in the airway
·         Having asthma, in adults and children, particularly if they are overweight
·         Race and ethnicity can play a part as well – some studies have indicated African Americans, Hispanics and other races have a slightly higher risk
·         Allergies and chronic nasal congestion

Only a doctor or sleep specialist can confirm if you or a loved one is suffering from sleep apnea. More information is available at this website: http://www.simplesleepservices.com/what-is-sleep-apnea/.

According to the National Institutes for Health (NIH), Doctors diagnose sleep apnea based on medical and family histories, a physical exam, and sleep study results. Your primary care doctor may evaluate your symptoms first, and will then decide whether you need to see a sleep specialist. Sleep specialists are doctors who diagnose and treat people who have sleep problems. Examples of such doctors include lung and nerve specialists and ear, nose, and throat specialists. Other types of doctors also can be sleep specialists.

If you think you have a sleep problem, consider keeping a sleep diary for 1 to 2 weeks. Bring the diary with you to your next medical appointment. Write down when you go to sleep, wake up, and take naps. Also write down how much you sleep each night, how alert and rested you feel in the morning, and how sleepy you feel at various times during the day. This information can help your doctor figure out whether you have a sleep disorder.

Sleep studies are tests that measure how well you sleep and how your body responds to sleep problems. These tests can help your doctor find out whether you have a sleep disorder and how severe it is. Sleep studies are the most accurate tests for diagnosing sleep apnea. There are different kinds of sleep studies.

If your doctor thinks you have sleep apnea, he or she may recommend a polysomnogram (also called a PSG) or a home-based portable monitor. Testing can show patterns and symptoms that can help lead to a diagnosis and treatment options. More information is available at this site: https://www.nhlbi.nih.gov/health/health-topics/topics/sleepapnea.

According to HelpGuide.org, if your sleep apnea is moderate to severe, or you’ve tried self-help strategies and lifestyle changes without success, a sleep doctor may help you find an effective treatment. Treatment for sleep apnea has come a long way in recent times, so even if you were unhappy with sleep apnea treatment in the past, you may now find something that works for you.

Treatments for central and complex sleep apnea usually include treating any underlying medical condition causing the apnea, such as a heart or neuromuscular disorder, and using supplemental oxygen and breathing devices while you sleep. Treatment options for obstructive sleep apnea include:
·         CPAP
·         Other breathing devices
·         Dental devices
·         Implants
·         Surgery

Medications are only available to treat the sleepiness associated with sleep apnea, not the sleep apnea itself. Much more material on this health care issue can be found at this website: http://www.helpguide.org/articles/sleep/sleep-apnea.htm.

According to this website: http://vjpillow.com/sleep-health-benefits-science/, there are at least 8 reasons why sleep is important to you. Check out how you benefit from getting good sleep; it's important to your health.  

Since so many people suffer from sleep apnea, it is perceived as a very common problem, but not that many take steps to deal with the problem. As sleep apnea can result in long term more severe health issues, it is advisable to see your doctor for a solution that is to your benefit. If you have it, or think you do, get help. You’ll sleep better for it.


Until next time. 

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