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January 02, 2010

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Miriam Lippel Blum

Eloquently stated, Peter. It is really the time for an end to quixotic medicine. But we probably dream the impossible dream when it comes to optimal dialysis in this country as long as profit is the only thing that matters to insurance companies and nephrologists aren't willing to challenge the status quo.

Dori Schatell

Bravo, Peter! This is exactly the point I was trying to make to CMS. IMHO, Bleyer's work showing the 50% higher rate of sudden cardiac death on the day after the 2-day no-treatment "weekend" is enough to show that what we are doing now with 3 treatments per week is not only not optimal, but, in fact, LETHAL.

You didn't mention Carl Kjellstrand's work on the "Unphysiology hypothesis" which he summarizes for Home Dialysis Central here: http://www.homedialysis.org/pros/abstracts/20050617/. In essence, he says that treatment that is more like healthy kidneys (such as transplant or longer/more frequent HD) will cause fewer symptoms and extend survival. Sure looks like he was right. Now if CMS would just get on board...

Peter Laird, MD

Dear Miriam, it is to dream the impossible dream of optimal dialysis here in America, but since the rest of the world has accepted this basic concept, hopefully America can become less dense and do the same some day. Until then, it gives incentives to DSEN to continue on.

Peter Laird, MD

Dear Dori, as always, you steal my thunder of future posts. You did teach me well since it was our conversations nearly two years ago where I first heard of Dr. Kjellstrand's unphysiology and the two day death trap of conventional incenter dialysis on the long weekend without treatment. In fact, there is very little I have gained outside of what you taught me in those emails and phone converstation and I am thankful for that gift you gave to me.

I am in fact just getting revved up on the issue of optimal dialysis in America and it really goes right back to whether the unphysiology theory is correct which I know you are convinced as I am as well. I had already planned a post on both of those issues in the near future. Thank you for all that you do for our community.

Lydia

Thanks for such a well written post. I stumbled across your site via Google alerts. Glad that I did.

Christopher Blagg

Dear Peter

Perfect! It seems that as with many things everything has to be relearned 40 or 50 years later.

Chris

Peter Laird, MD

Dear Chris, thank you for the many years of dedicated study and care to people such as myself. Perhaps the "new and novel" treatments offered today will someday be recognized for the treatments that you and Dr. Scribner and many others already offered and promoted nearly 50 years ago. The only problem is America still hasn't remembered where it came from which blinds its path to the future.

Linda Gromko, MD

Peter,

Well stated. I, too, tend to find myself "looking for logic in all the wrong places!" In the quest for good evidence based medicine, I find myself practicing "anecdotal medicine." It's wonderful to be backed up in what you do my a large multi-centered RCT, but in the end, good medicine involves doing the right thing. It requires that most elusive quality: common sense.

Peter Laird, MD

Dear Linda, you have summed up well the entire issue of doing the right thing. Perhaps one day, America shall learn to do the right thing as we once did during the pioneering days of dialysis. May it be soon.

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