CMS and Preventing Kidney Disease

COMMENT:
Whatever happened to this? CMS Considering GenoMed’s Treatment to Prevent End-stage Kidney Disease

RESPONSE:
Amazingly, nothing.

This press release was from October, 2004, when a group of people from GenoMed met with Sean Tunis, MD, then the Chief Medical Officer for CMS, and Sandra Foote, his assistant. CMS spends $35 billion a year on dialysis and kidney transplantation; the cost is rising by at least 10% a year. Part of this is due to the 7% increase in patients every year, which means that there is a true epidemic of end-stage renal disease. (An epidemic is defined as a greater than 5% rise per year).

Incredibly, CMS had no interest in eliminating 90% of ESRD. Neither did the CDC, the AHRQ, the NIDDK, the National Kidney Disease Education Program within the NIDDK, the National Kidney Foundation, the American Society of Nephrology, the International Society of Nephrology, the American Kidney Fund, etc., etc.

The reaction wasn’t peculiar to Americans, but, indeed, was the same for everybody in the First World. The National Health Service in Canada, the UK, Australia, New Zealand, as well as nephrologists in Israel, Italy, and Austria all had a similar disinclination to preventing dialysis. The WHO never answered my emails.

The bottom line is that nobody in the First World wants to eliminate their salary. The glory days when medicine was happy to get rid of diseases and, with them, entire hospital wards (think TB, polio, rheumatic fever, syphilis) are long gone.

Which is why I’m now focusing on the Third World. They can’t afford dialysis or kidney transplantation, and they’re excited about preventing ESRD. There’s little vested interest in preserving chronic diseases in the Third World. That’s why I think the Third World will leapfrog ahead of the First in terms of clinical outcomes. I think the First World will never report clinical outcomes data, but just keep repeating the mantra that medicine is best in the First World because they spend the most money on it.

The truth, of course, is that In medicine, the healthier you are, the less you have to spend.

First World residents, though, are used to getting snookered by their governments. Look what they still spend on defense!