Using throw-away as this sounds dismal, BUT: who makes money from this and who loses money? That will tell you whether this can happen or not.
Dialysis is big business. Technicians. Consumables. Doctors. Repeated Vi$it$. Real estate (often owned by the Nephrologist $.)
More saliently, Nephrologist also control the standard of care. Do they stand to gain more from artificial kidney surgery/maintenance, or do they stand more to lose from dialysis going away?
What does it matter who loses money? This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} and they get all of the pie while these stagnant people now get none. If there is some grand conspiracy of how they have enough power to prevent anybody from coming in and doing it better/cheaper to steal the larger volume then why do they need to protect this oddly specific set of jobs to get money? Basically, how does who from the past will lose expected income prevent someone who wants to become rich now?
Dialysis is indeed big business, but that means it's more attractive to upset - not less. The sad reality is it's just hard to upset. That's not as cool, it doesn't catch your attention, it doesn't give you anyone to blame for why things are shitty... but it's also a lot better supported as an explanation.
>> This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING}
This isnt an iOS app where 10,000 developers compete to bring prices down. This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice. Funny, they also benefit when there isnt progress.
Lets tackle it another way -- if medicine is a perfect competition, how is are hospital bills one of the leading causes of bankruptcy in the US? Shouldnt programmers have made it all efficient and made everything free like in software?
> This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice
The “Nephrology Board” is only one country. Even supposing US medical institutions decided to block a treatment being developed in the US, they have no authority to stop its development in other countries. If it was seen to be working in other countries, they’d find it very hard to justify refusing to allow it in the US.
But politically I think the scenario you are describing is very unlikely - the US medical system justifies its “uniqueness” (such as extreme expensiveness) on the grounds that “we have the best medical technology on the planet”. Blocking medical advances would undermine that justification, and hence is not in the best interests of the people who control the US medical system
You say this as if the only way this happens is through a big top down conspiracy. In reality it's several separate actors with aligned incentives that create unnecessary headwinds to the adoption of cost saving medical advances
To pretend that there aren't groups who will work to delay and limit the rollout of industry shattering technology like this is naive at best.
> You say this as if the only way this happens is through a big top down conspiracy. In reality it's several separate actors with aligned incentives that create unnecessary headwinds to the adoption of cost saving medical advances
I didn’t intend my comment as saying anything about whether this suggested phenomenon is “top-down” or “bottom-up”. I think my two counterarguments-“other countries exist” and “contrary to collective political self-interest” have about as much force in either case.
> To pretend that there aren't groups who will work to delay and limit the rollout of industry shattering technology like this is naive at best.
I never claimed such groups don’t exist - I’m sure there are some individuals and groups who (consciously or not) possess the agenda you describe. The real question is whether they will succeed in achieving that goal-I’m sceptical they will make any significant difference to whether or when these advances are achieved
Research is controlled by separate IRBs, not the ABIM.
In regards to "tackling it in another way", more than market efficiency goes into play of how expensive something is. Lots of people can build houses, that doesn't mean houses are now $10 it means houses aren't 500,000,000 dollars because one guy can build them and wants to make 1,000x margin each time. I'm not sure what programmers or software has to do with it, billions are spent on that as well it's not just free. FWIW I come from a healthcare background, not a software one.
Cynicism can be useful component of critical thought, but using it like a bludgeon and assuming it explains everything usually leads to conspiracy theories and wrong answers.
On the other hand, the government spends a huge amount on dialysis. Medicare pays for it regardless of your age. Removing the need for dialysis simplifies life for politicians by putting off the day they need to raise taxes or cut Medicare services.
Dialysis is also a lot crappier than this would be. My mom was on dialysis and quality of life is not great. Neither is the expected lifespan.
Free markets have their flaws but their big advantage is competition. If the government approves this device, and it provides significantly better outcomes, then nephrologists who use it will take patients from those who don't.
My understanding is that the firms who provide Medicare patient dialysis are very loathe to have patients exit their system, if they spend say $1000 on patient care and bill Medicare, the US government, for $1200 that's $200 of very safe profit. If that patient gets a transplant that's $200 of lost profits, regardless of how much healthier the patient is, and so they have no incentive to help patients get a transplant.
So for technologies, either xenotransplantation (GM pig kidneys) or artificial kidneys which eliminate dialysis, expect some push back from those firms, certainly expect them to have a more negative outlook on any safety studies etc. than you might expect if you think of them as neutral health professionals who are focused on patient outcomes.
Which of course doesn't magically mean these alternatives end up safer and healthier, they might turn out cheaper but worse, whereupon pushing to keep dialysis makes sense and you'd find yourself on the same side as the profiteers, but this happens, just like if you thought Prohibition was wrong and you found yourself alongside people whose businesses prey on problem drinkers...
They make their money from transplants, not from dialysis. If you want an artificial kidney, a transplant surgeon is what you need, and for them, artificial kidneys are just more business.
Kidney failure is something the rich as well as the poor suffer from. A good comparison is a work friend had a heart valve replaced. That's way expensive, takes a top line cardiac team to do it safely. And big picture she's a nobody important. Yet they did it.
I think what the powers that be care about more than anything is the system exists to provide that kind of care as a routine thing. Which you won't have if you're just treating super wealthy people.
>> Free markets have their flaws but their big advantage is competition.
Medicine is not a "free market", it is tightly controlled. The standards of care are determined by doctors. Doctors also happen to control the supply of care and hence the price of care. Doctors also happen to rake in money doing all this.
You cannot just release a medical device or medicine like you release code into github.
Doctors do not go generally into medicine the way devs go into startups. It’s a generally garbage approach if your goal is to make money, nephrology included. Doctors generally want better patient outcomes and better patient lives but are too squeezed by insurance, student debt, and other bullshit.
You can bet your ass that if there’s a transplant that radically improves outcomes, nephrology will be all for it. It’s extremely frustrating and deeply demoralizing to tell someone they will need to be on dialysis, which you know all the nuances of the suckitude of, a task nephrologists need to do more and more often as Americans age with worse health due to lifestyle issues.
I don’t doubt there won’t be a minority of doctors who are just money grubbing but the vast majority of doctors would rather be able to say, “hey, I have a solution for you which relieves you from the permanent life quality burden of dialysis”.
I said "if the government approves this device." And if it does, there are about 1300 transplant nephrologists in the US who make their money from doing transplants, not from dialysis.
Dialysis is big business. Technicians. Consumables. Doctors. Repeated Vi$it$. Real estate (often owned by the Nephrologist $.)
More saliently, Nephrologist also control the standard of care. Do they stand to gain more from artificial kidney surgery/maintenance, or do they stand more to lose from dialysis going away?