By Bill Peckham
With regard to the letter (see WORD document or web page and RenalWEB discussion) from the Steering Committee of the April 23-26, 2009 conference “ESRD: State of the Art and Charting the Challenges for the Future”, (the conference was held in Boston and was sponsored by the Harvard Medical School Department of Continuing Education).
Dr. Blagg's note to RenalWEB should be read before reading Renal Business Today's followup on the lack of response from the letter's recipients, Nancy-Ann DeParle, director of the White House Office of Health Reform, and Barry Straube, MD, chief medical officer of the Centers for Medicare & Medicaid Services. The RBT article makes clear that the docs who wrote the letter expected their support would have immediate effect and that they are disappointed that people don't seem interested in making the provision of dialysis better.
I'm glad the new docs are not the same as the old docs. Still let us remember. Scribner was booed. Scribner's ideas were ridiculed. Scribner was disparaged by the docs who preceded the authors. I think Scribner is owed an apology. However, I agree with the larger point, that the Obama administration should act on the letter's message. Scribner would not give a wit who got the credit and Scribner would undoubtedly be as charitable as Blagg in welcoming all comers to his point of view. Clearly, Scribner and Blagg are better men than I.
It's too bad this letter wasn't written 30 years ago. It's too bad that 30 years ago docs from National Medical and the esteemed Harvard Medical institutions were disparaging home dialysis and the need for more dialysis. It is too bad that they were doing this back in the late '70s when their support would have made a huge difference. It is too bad that when it mattered 30 years ago the east coast medical establishment came to a very different conclusion about volume control and instead focused on hemodialysis adequacy as measured by urea removal.
I have an urge to hold the East coast establishment in a headlock and force them to admit Scribner was right. I agree with everything in their letter and I am delighted that the conventional nephrology point of view is moving away from Gotch and towards Scribner. Hopefully, it's not too late.