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"God help you. You're on dialysis."
- aheilbut 16y agoIt would seem that the ultimate solution to this problem would be an implantable artificial kidney. Given that the technology for dialysis has been around for so long, it's surprising that there hasn't been more progress in miniaturization over the last 40 years.
- CapitalistCartr 16y agoMuch of these problems with artificial organs revolve around the power supply. An artificial heart is pretty easy with modern technology compared to how to power it. Same for most organs.
- RodgerTheGreat 16y agoWell, the heart, lungs and to some extent kidneys are pretty simple to emulate, but the full suite of chemical functions performed by, say, the liver are actually pretty tough. That said, the power concerns are indeed another serious obstacle.
- cdavid 16y agoDialysis also requires expensive medicine, like e.g. EPO, which contributes to a non negligeable part of the cost. The 77000 $ / patient surprised me a little because the figures I have heard in France (family members involved in dialysis treatment)are actually higher, not lower.
- arn 16y agoAs much as this seems like a solution, its distant science fiction for now. The kidney is not a simple organ and once you start implanting foreign material into people you run into some major issues. Clotting and infection for example. In comarison, artificial heart (a mechanical pump) seems a simpler task and I don't remember hearing much on widespread applications of that lately.
- icegreentea 16y agoThere are multiple implantable artificial hearts in use right now. They're really only good in cases of near total heart failure, and generally only work to extend life by ~year at most (for now). Crank High Voltage has one of these as a plot device. Did anyone actually watch that movie?
- Jach 16y agoHow distant would you personally estimate? Close enough that it's worthwhile to pump some funds into it so it's achievable in, say, a decade or two?
- noonespecial 16y agoThey have a rediculouls hard time just maintaining access to the patients' blood supply. A machine that can do the filtering is actually the easy part. Getting fluids in and out of the body continuously and on a long term basis is actualy a very difficult problem.
- cstross 16y agoAs a Brit, I'm fascinated by the lack of discussion of CAPD here -- that's Continuous Ambulatory Peritoneal Dialysis (see: http://en.wikipedia.org/wiki/Continuous_ambulatory_peritoneal_dialysis http://en.wikipedia.org/wiki/Continuous_ambulatory_peritonea... ). Back in the late eighties when I was working in clinical pharmacy practice, it was the big new thing -- cheaper than haemodialysis (CAPD fluid is dirt cheap, so cheap that hospitals had to brew it up themselves in their pharmaceutical manufacturing units because no commercial supplier could be arsed selling the stuff), more convenient for the patient (they could walk around while on CAPD, rather than being stuck in a chair), somewhat lower risk of infection when it was done right, no need for an expensive perfusion machine with blood filters, and so on. It's still used extensively in the NHS, and in some other countries -- but seems to be unheard-of in the USA.
- rendezvouscp 16y agoI wouldn’t say it’s unheard-of; perhaps my mom is an outlier, but she’s been doing Automated Peritoneal Dialysis for about 3.5 years.
- stretchwithme 16y agoThe pattern with the government is the same from situation to situation. 1) They make something free 2) The market for private delivery of the same thing dries up. Those few that still want to pay must pay much more than they would have before the government started giving it away for free because the market has shrunk so much 3) The same thing happens to alternatives to the thing they made free 4) Decisions are now made by those delivering the process instead of the person choosing between the alternatives. Costs and benefits are no longer weighed together or by the person that cares about the outcome the most. 5) The corporations and unions move in and start influencing the decision makers, carving out expensive niches for themselves 6) Things that truly matter but aren't profitable for the politically connected fall by the wayside 7) People getting something free put up with it because ditching the free thing for same thing done right is now a super expensive alternative 8) Delivering the free thing grows more expensive, much faster than the rate of inflation 9) Eventually the tax payers fight back and the costs of delivering the thing are slashed, along with quality. The corporations and unions have to spend and/or threaten more to hang on to their protected positions. 10) Those getting the service for free now have to spend all their time at rallies and fine tuning the stories about how badly they're being treated. Happens with health care. Happens with roads. Education. City services. Anything they give away for free or heavily subsidized.
- T_S_ 16y agoGod help us. You are so right.
- deleted 16y ago[deleted]
- knowtheory 16y agoI'm not going to claim that undergraduate education in the US is perfect or anything, but we do have a world class education system which rivals or bests all other nations'. And on top of that, i would say that my publicly subsidized education was just as good if not better than many private educational experiences, and it was a whole hell of a lot cheaper. And i grew up in a city with one of the best public library systems in the country. You'll still notice that it was populated with plenty of Barnes & Nobels and Borders book stores. Oh, and i'll note that the Ambassador Bridge, the Blue Water Bridge and basically any bridge in and out of Ontario to the US are privately owned toll bridges, which charge you to travel over them. [edited to remove pointless but cathartic ad hominem]
- arn 16y agoAs a former nephrologist I feel obligated to comment on this article. So, much of what is written is true, but much is also a bit slanted too. So, mortality rates on dialysis do suck. It's not necessarily a reflection of bad care, though that certainly happens. Once you require dialysis, that means your kidneys are trashed. They don't work well enough to function, so you need kidney replacement therapy. This generally doesn't happen in isolation. If your kidneys are that damaged, you generally have serious underlying health problems (diabetes, high blood pressure) that have also affected your brain and heart... so it's only a (short) matter of time before you have a devastating event. There are diseases which only affect the kidneys in isolation, and those people tend to live a long time on dialysis. The comparisons to foreign countries is always important but I feel like the article dismisses some of the country-specific factors "Yet Italy spends about one-third less than we do per patient. These results reflect lower overall health-care costs and a __patient population with lower rates of diabetes and heart disease__, but also important divergences in policy and practice." Less diabetes and heart disease would be a huge factor in the difference in spending and mortality rates. Those are massive implications, and also indicate that their dialysis patients might be due to different (less systemic) diseases. In the end, it's probably only one factor. I think it's likely that underlying U.S. cultural differences are another. I believe expectations and beliefs about death and elderly may be different abroad, though I don't have any citations for that. In the U.S., it's seems hard to deny people dialysis. I'd be curious what the average age of people on dialysis in the U.S. vs abroad are. I expect the U.S. average age would be much higher. I think american families tend to want dialysis and are more reluctant to accept that it's simply the end of the line. To be fair, it's a hard decision to not accept what seems to be a life extending treatment. And it's incredibly hard as a physician to refuse dialysis to anyone, especially if the family wants it. I also expect these same attitudes pervade u.s. trained physicians who may skirt these subjects of death more apprehensively because they also share those attitudes. The cover your ass mentality also tends to mean people err on the side of doing more, when doing less may be more appropriate.
- robryan 16y agoWould you support some minimum standards to qualify for government support dialysis, taking away the need for the individual physicians to have to make a tough call? I wouldn't think they would even need to be placed to high, just used to identify when a patient is coming to the end of the line and the benefit of the dialysis would be minimal.
- jdietrich 16y agoDialysis is a proxy issue. The majority of renal failure in the US is the result of diabetes or hypertension. The huge increase in the number of dialysis patients is overwhelmingly attributable to these two causes. In the vast majority of these cases, renal failure can be prevented with relatively inexpensive intervention to better manage the primary condition. In most other developed countries, it is politically straightforward to spend $20,000 a year on coaxing and cajoling a patient into managing their diabetes better in order to prevent them from becoming a $70,000 a year dialysis patient. Needless to say that the benefits to this approach are greater than just a cost saving. The United States has a quite peculiar set of popular attitudes to healthcare. It is clear that a large number of US citizens believe that healthcare ought not be a universal right, but most also find it unpalatable to simply allow people to die of preventable diseases. Consequently, cheap early intervention to preserve health is often shunned in favour of expensive, late intervention to prevent death. To my mind the most egregious example of this is drug abuse and alcoholism - huge amounts are spent on ER care for disastrously ill addicts, but little is spent on basic social work and rehabilitation. I can't honestly say that I understand the mindset that completely opposes government involvement in healthcare, but it seems obvious to me that the current situation is the worst of all worlds - the worst outcomes and the highest costs. I don't know how healthcare became such an ideological battleground, but it's not doing anyone any good - not patients and certainly not the taxpayer. I really don't want to be negative, but I have no idea how this stalemate can be broken.
- kleinmatic 16y agoThis project was done by ProPublica, the nonprofit reporting outfit where I work. There's more from the same investigation at http://www.propublica.org/dialysis http://www.propublica.org/dialysis including a leaked P.R. plan drawn up by an industry group to respond to our investigation -- and there's lots more to come in the next few weeks.
- knowtheory 16y agowhat's it like working at ProPublica, and what do you do there? I've liked everything i've ever read/heard that's been produced there, and i know they've got good taste in terms of the journalists they poach from other orgs.
- kleinmatic 16y agoThanks for the kind words about ProPublica. It's exciting to be around so many talented journalists and to get to work on great projects with them. I run a small team (five of us) of developer/journalists. We're in a new-ish field of journalism called "news applications." Essentially it means we make software instead of using words or pictures to tell journalistic stories. There are crews like ours (some bigger, some smaller) at the New York Times, LA Times, Chicago Tribune, the Guardian in the U.K., and elsewhere. Our work includes the Recovery Tracker http://projects.propublica.org/recovery http://projects.propublica.org/recovery and the recent "Docs for Dollars" project http://projects.propublica.org/docdollars http://projects.propublica.org/docdollars that analyzes payments from pharmaceutical companies to doctors. You can see pretty much all of our work at http://www.propublica.org/tools http://www.propublica.org/tools
- jfb 16y agoI worked IT for the University of Chicago hospitals for a while in college, and was responsible for the systems at the dialysis center on 55th street. It was utterly heartbreaking to me; the stoicism of the patients (the vast, vast majority of whom were locals in the UofC parlance -- read, "black and poor"), the genuine hard work of the nurses and nurses aides; and just the overall sense of agony in the building. It was rough, and only made rougher because I could leave.