Pharmaceutical industry coverup responsible for increased rates of incarceration

Obstructive sleep apnea, characterized by severe or disruptive snoring, despite being a widely prevalent condition, is rarely suspected or diagnosed. In children, it causes learning disorders. This is because it interrupts both sleep and oxygenation during sleep. In adults, in its more extreme form, it is a major diagnosis leading to behavior that society will not tolerate. Pharmaceutical control of physicians' education is so pervasive that even physicians may have obstructive sleep apnea, complain of symptoms, but go unsuspected and undiagnosed by their own comrades. This happened to me, a practicing physician. Subsequently, at a Texas State Board of Medical Examiners meeting, a Board member, a practicing forensic psychiatrist, stated that she knew almost nothing about sleep apnea. Oops, this would mean that those individuals that she consulted on would not have the fact they had a medical condition affecting their daytime behavior explained to the court. Also, it would mean that an opportunity to get control of an easily diagnosed and treated medical disorder had been missed. It would seem that none, or almost none, of the forensic experts who evaluate individuals accused of criminal conduct are evaluating for this disorder. Many of the forensic experts are not even physicians but have been allowed to give an opinion on these individuals anyway, since the diagnosis was never established. While most physicians, when they think of sleep apnea, usually associate it with extremely obese individuals, this is not accurate. British studies published years ago established that up to 50% of individuals with clinically significant sleep apnea are of normal weight. The sleep apnea, itself, is known to sleep medicine physicians as a cause of undesirable weight increase. Please see my letter to Barbara Boxer that I have redacted of my snail mail address and home phone #. Please find a way to advocate for a Department of Justice review of this situation. Please give the information about sleep apnea to anyone you know who has behavioral issues, including depression and schizophrenia, hypertension, heart disease, and, of course, all prisoners. One of the most responsible websites about sleep apnea is a commercial one, Sleep Quest, since they retained an eminent and responsible physician, Dr Dement, as their physician consultant. While the cause of sleep apnea in most individuals is not known (mine was caused by a rare craniofacial defect), I believe it is the end result of neurological damage in susceptible individuals exposed to synthetic compounds, mercury, mold, pesticides, etc.)






Cynthia Lee, MD

Current resident: Texas

June 24, 2005
Via fax (to Sacramento office on June 25, 2005)

Barbara Boxer
United States Senator
1700 Montgomery Street, Suite 240
San Francisco, CA 94111

Dear Senator Boxer,

Late last year, I brought to your San Francisco office information I believed useful in regards to the pending battle over alterations to class action suit legislation. The information was accompanied by a book, The Promise of Sleep, by William Dement, MD., one of the eminent men of science of our day. I outlined how the pharmaceutical industry has hidden the true epidemic of obstructive sleep apnea from practicing physicians. Thus, physicians were taught to mislabel the symptoms of this disorder as other disorders that are commonly treated with prescription products. Since obstructive sleep apnea is not halted with prescription products, but rather it is stabilized by the use of an assistive breathing apparatus at night, undiagnosed these patients would have a progressive disorder resulting in early morbidity and mortality. I believe this is comparable to the tobacco industry’s cover-up of the health consequences of the use of their products. At this time, I am requesting that you advocate for a Department of Justice review of this issue much like they pursued the tobacco corporations.

While the high cost of prescription products is receiving much publicity, this issue is actually more important. This is because obstructive sleep apnea affects fully 1/4th of our middle aged white male population. Unbelievably, current estimates for the Black and Hispanic population are two to three times this rate. These men are at a higher risk than average for domestic abuse, criminal behavior, divorce, unemployment, cardiovascular complications like stroke and myocardial infarction, and most importantly, automobile accidents that endanger the others on the road. Obstructive sleep apnea patients cost a minimum of 150% of the average patients’ costs. You will find specialists in medicine who, after a cursory review of the available information, will state that I am mistaken. They will assert that middle aged white male patients with obstructive sleep apnea patients constitute only 4% of the population because this is what it states in textbooks. Unfortunately, this is not true. The original study that I am referring to was performed in Wisconsin and published in 1993 in the Journal of the American Medical Association. The 4% figure resulted from a survey questionnaire of the 24% of the patients with the minimum apnea results for the diagnosis. Only 1 out of 6 patients with enough apnea to carry the diagnosis of obstructive sleep apnea believed that they experienced sleepiness during the day. These patients have Sleep Apnea Syndrome; hence, the 4% figure was published. Since that study appeared , it has been clarified that the other 5 out of 6 patients who did not complain of sleepiness were, in fact, neurologically impaired for activities of daily living such that they have behavioral disorders, medical complications, and risky driving. Not counting these patients who do not complain of day time drowsiness is comparable to ignoring elevations of cardiac enzymes if the patient does not complain of chest pain bringing them to the physician’s attention.

While I understand the above discussion is a little bit to wade through, it underscores the importance of a core issue. State and federal governments have allowed the pharmaceutical industry to control physician education. The lectures and medical education information we physicians receive on behavioral issues leaves out information on sleep disorders. Since this is classified as CME units, I maintain that this has been an illegal behavior on the part of this industry. Many of our highly placed and influential physicians have been taken in by this pharmaceutical industry attempt to sway our education. Other have benefited from their largess so that they are unlikely to speak out. It is up to our legislators to intervene since the government has deliberately cut back physician educational funding, leaving the medical faculty and educational system vulnerable. Never the less, the behavior of pharmaceutical industry, in deliberately leaving out this clinical information, should occasion review for criminal behavior since it has resulted in early morbidity and mortality for many citizens. In others, it has created behavioral crises such that their judgment was so impaired that their conduct was criminal. Such may be the case for our Black and Hispanic population since their middle aged men carry 2 to 3 times the risk of having obstructive sleep than the Anglo middle aged male populations. On the issue of incarceration of persons with a diagnosis of obstructive sleep apnea, unsuspected, undiagnosed, and untreated, the Americans with Disability Act may be invoked to protect their right to experts unbiased by commercial education promoted by the pharmaceutical industry. Since these patients’ physicians never received the information timely to help them avoid antisocial behavior, the current system of allowing the pharmaceutical industry de facto control of physician education may render the current criminal justice system illegal.

Therefore, I urge you to advocate for a Department of Justice review utilizing the most knowledgeable experts. Since pharmaceutical industry influence over physician behavior may have caused the huge costs that our society bears, possibly as high as twice what other Western nations experience, this issue needs to be explored before physician independence is threatened by single payer system issues. By bringing the true diagnoses to light, we may be able to decrease the cost of all kinds of insurance affected by human behavior, from health, to worker’s comp, to automobile insurance. The savings may be able to allow an equitable single payer system to be considered favorably.

While I did not hear back from your office after my December 2004 submission, this may be because much of my U. S. mail has been delayed or never received at all since filing an Americans with Disability Act case in Texas. The phone number listed at that time was 512 XXX XXXX. If your office tried to call, I never received the call. If they believe they did speak with me, the call actually was handled by another not authorized to do so. I would be willing to volunteer with additional time and materials on this issue if desired. This information will also be sent registered mail to your office since it is so timely and I wish to document receipt.

Respectfully submitted,


Cynthia Jeanne Lee, MD