4 ms·

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

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.

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.