NBC Commentator Dr. Arthur Caplan Calls Dialysis Cruel and Lousy Care
By Peter Laird, MD
NBC news followed it’s recent series on dialysis with a commentary online by Arthur Caplan, Ph.D., director of the Center for Bioethics at the University of Pennsylvania where he called he characterized dialysis as lousy care and cruel:
Dialysis payment program is costly in too many ways
The End-Stage Renal Dialysis program was an act of noble compassion. But ripping off the American people by allowing too many people to receive lousy or unnecessary care is not compassionate at all. It is cruel.
Once again, in the short space of a few days, NBC news has gone down the path of what I consider to be biased reports that casts a shadow over all dialysis patients who benefit from the 1972 ESRD Medicare program. While there are many patients who develop renal failure as a part of a terminal illness, Dr. Caplan should be well aware that the mortality for such patients is greater than 50-60% during that hospitalization alone which persists for those that survive and are discharged especially to nursing homes after such an acute illness. Proper informed consent with patients and family members keeps many patients who truly will not benefit from acute renal dialysis in this situation from becoming chronic patients.
If we return to the true history of the Medicare ESRD program, the fact that government officials and industry leaders are responsible for the uniquely America poor outcomes. Data supplied by Richard Rettig,(page 3) a Rand Corporation scholar, shows that in 1972, in-center dialysis costs were between $27,600 - $30,500 while at the same time home dialysis costs were only $14,900 for the first year of therapy and only $7000 for each year there after. Similar cost differentials by magnitude of differences still prevail today between in-center dialysis and home based dialysis modalities, yet the outcomes are as much as 60% better with the home programs.
Nevertheless, in 1978 congressional hearings, led by what in my opinion was false or at the very least incorrect testimony by Dr. Edmund G. Lowrie, a high ranking official at that time in the National Medical Care Inc., the large for profit dialysis corporation, congress paradoxically adopted in-center, ultra-short dialysis as the standard treatment of choice. Shortly thereafter, the NCDS led once again by Dr. Lowrie cemented the standard of care for dialysis in America in-center as ultra-short, fast paced, “efficient” hemodialysis that is now responsible for the 2.5 times higher mortality than with a similar elderly population with many diabetic patients in Japan.
If NBC news wishes to continue what are in my opinion biased reports, I am not in a position to do any more than report these facts. My largest concern is that any future actions by congress and CMS would take a clearer picture of the dialysis industry than NBC has certainly demonstrated in the last few day on any future considerations for the Medicare ESRD program. If cuts are to be made in the program, let it be due to improvements of care and economies of scale taking advantage of the home dialysis option before any politician or physician fails to prescribe care to elderly and infirm patients who may benefit as much as younger and more fit patients when dialysis is done in a compassionate and caring manner, longer, slower and gentler.
I invite NBC news to interview patients such as Bill Peckham and and Dan Larabee and review their videos on the Rogue River last summer setting up portable dialysis units all the way down this wilderness river that is a challenge to young and healthy people let alone, a “dialysis” patient.
It is time to tell the truth about dialysis as the noble experiment it truly is as the first real gift of life to thousands of uremic patients instead of what is, in my opinion, continued media and political lies about how dialysis truly impacts the lives of dialysis patients. Perhaps instead of perpetuating the myths of dialysis, NBC and Dr. Arthur Caplan would add more to the commentary by exploring the corruption of congressional actions by dialysis industry insiders that reaped the huge profits that make the American dialysis experience the most expensive in the world with the worlds worst outcomes.