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Monday, December 27, 2010

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MooseMom

OK. So, what do we do TODAY and TOMORROW to change tack? I don't know when exactly I will be starting dialysis, but when it comes time, what can I, MooseMom, do to change the status quo? Tell me where to begin, and I'll begin.

Peter Laird, MD

Dear MoosMom,

The first place to start is as you have already done, learning about the different dialysis options. I would think that the second task would be to find which centers offer home dialysis or nocturnal in-center options and see if they are available in your health plan. If so, seek a second opinion by the nephrologist at that center and begin to plan with a cooperative health team your dialysis strategy. Since nephrologists are the only doctors that prescribe dialysis treatments, you must work through the system with them. Finding the right nephrologist and health care team is not often easy, but they do exist here in America. Home Dialysis Central has information on which dialysis centers offer these alternative treatments.

Bill Peckham

Another example would be Les Babb who in an astounding example of rising to a challenge invented the proportioning system that became the standard in dialysate delivery. He tells the story in this oral history:

I wrote up an invention disclosure and took it up to the business manager, Ernie Conrad, who was a good friend. In those days one could go from A to B without going through a mountain of bureaucracy. I said, “Ernie, I think we have something here that might generate millions if not billions of dollars. Do you think we ought to patent it?” And he sort of patted me on the head and said, “No. We’re an institution of higher education and in no way interested in commercialization. It’s university policy that if anyone asks for drawings or anything, we give them to them.”

A lot of people made a lot of money when medical ethics were replaced by business ethics.

Peter Laird, MD

Bill, thank you for the link to Les Babbs. It was once a matter of professional integrity to distribute widely any new information to colleagues on how to improve outcomes. I find it maddening today to pay up to $35.00 for studies that are 30 years old as is the case often. It was a different era and we now suffer greatly at the hands of the business model of medical care.

Thank you also for the links that made the basis of this article that you sent to me a few weeks ago, without such I would not have been able to place this post today.

Bill Peckham

Those Rettig reports were are real eye openers. There has been a whole series of them - reading them together is pretty amazing.

For profit, incenter dialysis manipulated the process each time the question of dialysis funding was at issue. They easily out gunned doctors who were naively presenting their data without spin.

Christopher Blagg

Thanks Peter.It was a different world in the 1960s. In 1962 the Seattle Artifical Kidney Center was developed as the world's first out-of-hospital dialysis unit because the University of Washington Hospital would not allow Dr. Scribner further expansion for the dialysis program beyond the first 4 patients. Scrib and the King County Medical Society never thought of making their new center anything other than a community supported non-profit operation.
In similar circumstances a few years later the Brigham group developed an out-of-hospital unit that became for-profit and led to National Medical Care. When the Medicare progam began the potential profit margin was large and so dialysis flourished and led to what we see in the US today. As Dr. Scribner commented to a Congressional hearing and on 60 minutes, what began as a noble experiment degenerated into a a multi-million dollar money-making enterprise. Opposition by NMC to home hemodialysis - it was unsafe and the cost savings were exagerated - was one of the main reasons home hemodialysis withered throughout the 70s and 80s.

roberta mikles

Thank you all for continuing to educate me...and increase my own knowledge base. Although I am focused on incenter care, I can say that I have and will continue, even moreso, to refer those who contact me e.g. dialysis patients, or pre-dialysis patients, to home dialysis.
Thank you all,

Roberta

MooseMom

I don't know how many of you follow the Renal Fellow Network blog, but this entry regarding the top ten neph stories of the year caught my eye as it addresses some of the issues presented by this blog.

http://renalfellow.blogspot.com/2010/12/top-nephrology-related-stories-of-2010.html

Peter Laird, MD

Thanks MooseMom, yes, RFN is one of our Renal Links on this site and they likewise have placed HemoDoc on their Renal links as well. The RFN started by the late Nathan Hellman is now overseen by a group of renal fellows. The top 10 news stories for 2010 listed the ProPublica article as number 7, and the FHN as the number 5 story with bundling as the number one story in nephrology for the year. Obviously, dialysis and its connected issues are one of the most important topics of nephrology and the Renal Fellow Network has so noted this connection.

MooseMom

I was fairly sure I was stating the obvious, that RFN was well known in these parts, but I thought that with the holidays, some might have missed this particular top ten list. I was particularly interested in the IDEAL trial. What I found, cynically, to be particularly glaring was that the top story in nephrology had to do with the financial side of practice, ie bundling...not optimal dialysis or some new amazing technology, but how dialysis providers will be paid. How illustrative of the mindset of dialysis in the US today.

Peter Laird, MD

Dear MooseMom, unfortunately, that is exactly the issue when it comes to dialysis, patient outcomes are not at the forefront of many decisions made in the last 40 years. It has long since been all about money and profits, something Dr. Scribner spent the last 3 decades of his life fighting, quite sadly without overcoming the American dialysis profiteering. That remains our largest challenge today.

MooseMom

It remains our largest healthcare challenge today...it's not confined just to dialysis.

me.yahoo.com/a/hu57zewOivbeMNTseFyzrkoimA--

We should be honest and agree that Hemodialysis is about THE ALMIGHTY DOLLAR.It started out as an option to keep a patient alive until a kidney transplant occured.We have allowed companies from across the water D & F TO MAKE BILLIONS OFF OF SICK PATIENTS that we pay for..

MooseMom

Hey Peter! I've been looking out for some posts from you re the conference in Phoenix (I figured you'd remove the spam..haha). I'm glad to hear that you didn't "kill the Bill" (I'm so funny, I know); I know how much you two love to talk politics! I'm really looking forward to your thoughts about the conference! Post soon!

Peter Laird, MD

Thank you Moosemom, had some other pressing things in the last two weeks on top of the conference. I was only there for a day but what a day. Great conference especially the Home Dialysis conference on Saturday where the gathering of the advocates for home dialysis is at it's highest, talk about being able to preach to the choir. Bill is doing well and great to see him back in the saddle blogging again in his rightful "throne." LOL

Will try to get some posts out soon.

Take care,

Peter

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