Peter Laird is an internist who also happens to be a dialysis patient. He writes regularly about the plight of dialysis patients from a unique perspective. In his most recent article, The dialysis industrial complex, he draws the parallel between Eisenhower’s military industrial complex and the current relationship between the US government and dialysis providers. “Despite the best intentions of the 1973 ESRD program, gross deficiencies in quality are rampant throughout the industry where profits continue to soar,” writes Laird.
Dialysis in the US started as a grand experiment to keep kidney failure patients alive, productive, and well but has devolved into the worst treatment program in the developed world. How that happened, as Laird notes, is subject to debate, but the fact it has is not in dispute.
As the provision of dialysis services in the US was commercialized, quality went down and mortality and morbidity rose in proportion to corporate profits. “Today, Davita and Fresenius dominate the American market with the most expensive dialysis population and the world’s worst outcomes,” Laird reports. Laird traces the qualitative shift in provision of dialysis services to the 1978 congressional testimony of Edmund G. Lowry, then vice president of National Medical Care, condemning “an entire generation of dialysis patients to short, violent sessions coupled with daily nausea, vomiting, severe fatigue, cramping and bouts of syncope.”
The dialysis community has known for quite a while that longer sessions combined with lower blood flow rates yields higher quality dialysis with fewer problems. But it’s not economically feasible in a system that rewards only the shortest treatment cycles.
Laird goes on to note the rarity of an academic nephrology study that makes an actual recommendation (other than that additional study is needed).
0 responses. Comments closed for this article.