Commentary - Dr. Peter Laird
In the December 2010 Atlantic Magazine article, Robin Fields published her investigative report of the American dialysis industry in an attempt to understand our uniquely poor clinical outcomes despite the highest per capita expenses when compared to Europe, Japan , New Zealand and Australia America are unchanged over several decades of public funding and are double that of Europe and Japan
Robin Fields follows in the footsteps of Kurt Eichenwald who authored Death and Deficiency in Kidney Treatment in the widely circulated NY Times investigative report of 1995 (1). Sadly, the two reports are essentially identical showing the lack of any real change in dialysis practices over a 15-year period of time despite these known deficiencies that persist. In fact, Jack Anderson reported much the same in his own editorial in 1982 where he simply stated: “Of all the corporate Scrooges in the world, none is lower than one that would squeeze profits from the sick and debilitated.” (2)
There is a better way to do dialysis than turning over the trust of the American people to an industry focused on profits much more so than the pain and suffering of their patients. In fact, we did dialysis better before the start of public funding when patients dialyzed thrice weekly for 8-9 hours at night. Four decades later, no one questions the current standard of care with it’s lack of credentials, yet going back to the original 24-27 hours of weekly dialysis is ironically held back by the call for randomized and controlled trials instead.
In America Japan
The dialysis industry contends that these clinical differences reflect higher co-morbid conditions but decades of studies in DOPPS instead shows that the shorter dialysis times and higher ultrafiltration rates are the largest contributors to these international disparities. Robin Fields gained the attention of not only the dialysis community, but that of the nation with widespread media coverage of her series much as Kurt Eichenwald and Rita Rubin of US Today did in 1995 and 2009. Outside investigators over and over again reach the same conclusions that profit before patients is at that heart of our adverse outcomes when compared with international data sources. The Mortality rate is essentially unchanged from the 1995 investigative report. Kurt Eichenwald laid the blame for our outcomes squarely on the for-profit dialysis industry shortsighted quest for wealth.
Death and Deficiency in Kidney Treatment
“The investigation found an industry that uses equipment and procedures that cut costs and raise profits, often at the expense of patients' health; that operates with few rules to assure high-quality care, and that has induced doctors to play along by giving them a share of the cash.”
The allegations against the dialysis industry as a whole of placing greed and profits above patient outcomes are not new. Belding Scribner, the inspiration behind chronic hemodialysis spoke out against the for-profit dialysis practices that have resulted in the developed world's worst patient outcomes. Dr. Scribner selflessly gave up the riches of his shunt invention and instead focused on simply saving lives when he donated his shunt freely to the world, lending his criticism more relevance.
The response by the for-profit dialysis industry to quotidian dialysis is not as surprising as that of academic nephrology, which labeled more frequent and longer duration dialysis as “controversial” despite extensive studies showing better outcomes. The quest for evidence based medical practices in dialysis requiring a large randomized and controlled study that shows a significant mortality benefit is the greatest hindrance to adopting daily dialysis modalities here in America
Bill Peckham summed up well in his interview with Robin Fields the prevailing attitude toward dialysis patients in America
References
1) Death and Deficiency in Kidney treatment, Kurt Eichenwald, NY Times, December 4, 1995.
2) Clinics Pad Kidney Dialysis Costs, Jack Anderson, Sarasota
