Michael Farrell
Management
So on this one, I won't characterize a response. I'll read out the response from the American Journal of Respiratory and Critical Care Medicine, which is the journal of the American Thoracic Society. Let's read two paragraphs out. This is four authors from University of British Colombia, Johns Hopkins, Brown and others. The title of the paragraph is What Should we do with Patients Being Treated with ASV for Other Indications? And I'll just quote this. "It is important to note that survey chest study only included patients with heart fail, with reduced ejection fraction and predominantly central events, and the findings should not be extrapolated beyond the study population. Patients who have been given ASV for other indications, such as narcotic injuries, central sleep apnea, heart failure, preserved ejection fraction or complex sleep apnea, can likely continue ASV safely as we see no compelling reason to withdraw, especially if there is a beneficial impact on their symptoms." And they go on further to say, "We believe that newly diagnosed patients with obstructive sleep apnea should be treated on CPAP as a first-line treatment of obstructive sleep apnea if clinically indicated as there is no compelling reason to believe that CPAP is harmful in any way with heart fail, with reduced ejection fraction patients." So they're just two quotes directly from publication in mid-July from APS. What we've seen out in the market is exactly that. The sleep physicians and the cardiologists are working together to look for patient groups where they can double-down on treatment with, I would say, bi-level, oxygen and ASV, and they're looking for areas where there might a safety signal, but as we delve further and further into the SERVE-HF data, our chief medical officer said at a session at APSS that when you get ejection fraction above 30%, the safety signal goes away. So these data are going to get out there. There's going to be public, and there's going to be a lot of follow on, but the dust has sort of settled on these last two months, and it's sort of what we predicted, as I said earlier, in the numbers, and as adjusted earlier, they're from the peer-reviewed press that we're starting to see articles concerning that and certainly in the numbers we're seeing in sales and the channel. We're seeing that we're all moving forward, and a great thing about this is that we've done some great scientific research. We have the data on Kern-Loin [ph] showing a 60% reduction in mortality in severe COPD, and we had a safety signal in heart failure. But our reputation at ResMed in our clinical community only goes up by these large, randomized controlled trials that we publish in the peer-reviewed press and will continue to do that.