3 ms·

Using throw-away as this sounds dismal, BUT: who makes money from this and who loses money? That will tell you whether this can happen or not. Dialysis is big

Using throw-away as this sounds dismal, BUT: who makes money from this and who loses money? That will tell you whether this can happen or not. Dialysis is big business. Technicians. Consumables. Doctors. Repeated Vi$it$. Real estate (often owned by the Nephrologist $.) More saliently, Nephrologist also control the standard of care. Do they stand to gain more from artificial kidney surgery/maintenance, or do they stand more to lose from dialysis going away?

DennisP 3y ago
On the other hand, the government spends a huge amount on dialysis. Medicare pays for it regardless of your age. Removing the need for dialysis simplifies life for politicians by putting off the day they need to raise taxes or cut Medicare services. Dialysis is also a lot crappier than this would be. My mom was on dialysis and quality of life is not great. Neither is the expected lifespan. Free markets have their flaws but their big advantage is competition. If the government approves this device, and it provides significantly better outcomes, then nephrologists who use it will take patients from those who don't.
- tialaramex 3y ago
  My understanding is that the firms who provide Medicare patient dialysis are very loathe to have patients exit their system, if they spend say $1000 on patient care and bill Medicare, the US government, for $1200 that's $200 of very safe profit. If that patient gets a transplant that's $200 of lost profits, regardless of how much healthier the patient is, and so they have no incentive to help patients get a transplant. So for technologies, either xenotransplantation (GM pig kidneys) or artificial kidneys which eliminate dialysis, expect some push back from those firms, certainly expect them to have a more negative outlook on any safety studies etc. than you might expect if you think of them as neutral health professionals who are focused on patient outcomes. Which of course doesn't magically mean these alternatives end up safer and healthier, they might turn out cheaper but worse, whereupon pushing to keep dialysis makes sense and you'd find yourself on the same side as the profiteers, but this happens, just like if you thought Prohibition was wrong and you found yourself alongside people whose businesses prey on problem drinkers...
  - DennisP 3y ago
    There are about 1300 transplant nephrologists in the US: https://www.kidneynews.org/view/journals/kidney-news/13/7/article-p14_11.xml https://www.kidneynews.org/view/journals/kidney-news/13/7/ar... They make their money from transplants, not from dialysis. If you want an artificial kidney, a transplant surgeon is what you need, and for them, artificial kidneys are just more business.
- Gibbon1 3y ago
  Kidney failure is something the rich as well as the poor suffer from. A good comparison is a work friend had a heart valve replaced. That's way expensive, takes a top line cardiac team to do it safely. And big picture she's a nobody important. Yet they did it. I think what the powers that be care about more than anything is the system exists to provide that kind of care as a routine thing. Which you won't have if you're just treating super wealthy people.
- brokenmeds 3y ago
  >> Free markets have their flaws but their big advantage is competition. Medicine is not a "free market", it is tightly controlled. The standards of care are determined by doctors. Doctors also happen to control the supply of care and hence the price of care. Doctors also happen to rake in money doing all this. You cannot just release a medical device or medicine like you release code into github.
  - SamoyedFurFluff 3y ago
    Doctors do not go generally into medicine the way devs go into startups. It’s a generally garbage approach if your goal is to make money, nephrology included. Doctors generally want better patient outcomes and better patient lives but are too squeezed by insurance, student debt, and other bullshit. You can bet your ass that if there’s a transplant that radically improves outcomes, nephrology will be all for it. It’s extremely frustrating and deeply demoralizing to tell someone they will need to be on dialysis, which you know all the nuances of the suckitude of, a task nephrologists need to do more and more often as Americans age with worse health due to lifestyle issues. I don’t doubt there won’t be a minority of doctors who are just money grubbing but the vast majority of doctors would rather be able to say, “hey, I have a solution for you which relieves you from the permanent life quality burden of dialysis”.
  - DennisP 3y ago
    I said "if the government approves this device." And if it does, there are about 1300 transplant nephrologists in the US who make their money from doing transplants, not from dialysis.
zamadatix 3y ago
What does it matter who loses money? This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} and they get all of the pie while these stagnant people now get none. If there is some grand conspiracy of how they have enough power to prevent anybody from coming in and doing it better/cheaper to steal the larger volume then why do they need to protect this oddly specific set of jobs to get money? Basically, how does who from the past will lose expected income prevent someone who wants to become rich now? Dialysis is indeed big business, but that means it's more attractive to upset - not less. The sad reality is it's just hard to upset. That's not as cool, it doesn't catch your attention, it doesn't give you anyone to blame for why things are shitty... but it's also a lot better supported as an explanation.
- brokenmeds 3y ago
  >> This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} This isnt an iOS app where 10,000 developers compete to bring prices down. This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice. Funny, they also benefit when there isnt progress. Lets tackle it another way -- if medicine is a perfect competition, how is are hospital bills one of the leading causes of bankruptcy in the US? Shouldnt programmers have made it all efficient and made everything free like in software?
  - skissane 3y ago
    > This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice The “Nephrology Board” is only one country. Even supposing US medical institutions decided to block a treatment being developed in the US, they have no authority to stop its development in other countries. If it was seen to be working in other countries, they’d find it very hard to justify refusing to allow it in the US. But politically I think the scenario you are describing is very unlikely - the US medical system justifies its “uniqueness” (such as extreme expensiveness) on the grounds that “we have the best medical technology on the planet”. Blocking medical advances would undermine that justification, and hence is not in the best interests of the people who control the US medical system
standardUser 3y ago
Cynicism can be useful component of critical thought, but using it like a bludgeon and assuming it explains everything usually leads to conspiracy theories and wrong answers.
bobmaxup 3y ago
The world is a big place, and not everything is driven by commonsense demand and supply economics.

DennisP 3y ago

On the other hand, the government spends a huge amount on dialysis. Medicare pays for it regardless of your age. Removing the need for dialysis simplifies life for politicians by putting off the day they need to raise taxes or cut Medicare services. Dialysis is also a lot crappier than this would be. My mom was on dialysis and quality of life is not great. Neither is the expected lifespan. Free markets have their flaws but their big advantage is competition. If the government approves this device, and it provides significantly better outcomes, then nephrologists who use it will take patients from those who don't.

tialaramex 3y ago
My understanding is that the firms who provide Medicare patient dialysis are very loathe to have patients exit their system, if they spend say $1000 on patient care and bill Medicare, the US government, for $1200 that's $200 of very safe profit. If that patient gets a transplant that's $200 of lost profits, regardless of how much healthier the patient is, and so they have no incentive to help patients get a transplant. So for technologies, either xenotransplantation (GM pig kidneys) or artificial kidneys which eliminate dialysis, expect some push back from those firms, certainly expect them to have a more negative outlook on any safety studies etc. than you might expect if you think of them as neutral health professionals who are focused on patient outcomes. Which of course doesn't magically mean these alternatives end up safer and healthier, they might turn out cheaper but worse, whereupon pushing to keep dialysis makes sense and you'd find yourself on the same side as the profiteers, but this happens, just like if you thought Prohibition was wrong and you found yourself alongside people whose businesses prey on problem drinkers...
- DennisP 3y ago
  There are about 1300 transplant nephrologists in the US: https://www.kidneynews.org/view/journals/kidney-news/13/7/article-p14_11.xml https://www.kidneynews.org/view/journals/kidney-news/13/7/ar... They make their money from transplants, not from dialysis. If you want an artificial kidney, a transplant surgeon is what you need, and for them, artificial kidneys are just more business.
Gibbon1 3y ago
Kidney failure is something the rich as well as the poor suffer from. A good comparison is a work friend had a heart valve replaced. That's way expensive, takes a top line cardiac team to do it safely. And big picture she's a nobody important. Yet they did it. I think what the powers that be care about more than anything is the system exists to provide that kind of care as a routine thing. Which you won't have if you're just treating super wealthy people.
brokenmeds 3y ago
>> Free markets have their flaws but their big advantage is competition. Medicine is not a "free market", it is tightly controlled. The standards of care are determined by doctors. Doctors also happen to control the supply of care and hence the price of care. Doctors also happen to rake in money doing all this. You cannot just release a medical device or medicine like you release code into github.
- SamoyedFurFluff 3y ago
  Doctors do not go generally into medicine the way devs go into startups. It’s a generally garbage approach if your goal is to make money, nephrology included. Doctors generally want better patient outcomes and better patient lives but are too squeezed by insurance, student debt, and other bullshit. You can bet your ass that if there’s a transplant that radically improves outcomes, nephrology will be all for it. It’s extremely frustrating and deeply demoralizing to tell someone they will need to be on dialysis, which you know all the nuances of the suckitude of, a task nephrologists need to do more and more often as Americans age with worse health due to lifestyle issues. I don’t doubt there won’t be a minority of doctors who are just money grubbing but the vast majority of doctors would rather be able to say, “hey, I have a solution for you which relieves you from the permanent life quality burden of dialysis”.
- DennisP 3y ago
  I said "if the government approves this device." And if it does, there are about 1300 transplant nephrologists in the US who make their money from doing transplants, not from dialysis.

zamadatix 3y ago

What does it matter who loses money? This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} and they get all of the pie while these stagnant people now get none. If there is some grand conspiracy of how they have enough power to prevent anybody from coming in and doing it better/cheaper to steal the larger volume then why do they need to protect this oddly specific set of jobs to get money? Basically, how does who from the past will lose expected income prevent someone who wants to become rich now? Dialysis is indeed big business, but that means it's more attractive to upset - not less. The sad reality is it's just hard to upset. That's not as cool, it doesn't catch your attention, it doesn't give you anyone to blame for why things are shitty... but it's also a lot better supported as an explanation.

brokenmeds 3y ago
>> This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} This isnt an iOS app where 10,000 developers compete to bring prices down. This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice. Funny, they also benefit when there isnt progress. Lets tackle it another way -- if medicine is a perfect competition, how is are hospital bills one of the leading causes of bankruptcy in the US? Shouldnt programmers have made it all efficient and made everything free like in software?
- skissane 3y ago
  > This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice The “Nephrology Board” is only one country. Even supposing US medical institutions decided to block a treatment being developed in the US, they have no authority to stop its development in other countries. If it was seen to be working in other countries, they’d find it very hard to justify refusing to allow it in the US. But politically I think the scenario you are describing is very unlikely - the US medical system justifies its “uniqueness” (such as extreme expensiveness) on the grounds that “we have the best medical technology on the planet”. Blocking medical advances would undermine that justification, and hence is not in the best interests of the people who control the US medical system

standardUser 3y ago

Cynicism can be useful component of critical thought, but using it like a bludgeon and assuming it explains everything usually leads to conspiracy theories and wrong answers.

bobmaxup 3y ago

The world is a big place, and not everything is driven by commonsense demand and supply economics.