Short film from 1963 showing dialysis

[okarol]

Not much has changed?
THIS SHORT VIDEO SHOT IN 1963 SHOWS THE FIRST PATIENT IN THE WORLD TO PERFORM SELF DIALYSIS - THIS PERMITTED US TO DEVELOP HOME DIALYSIS OVERNIGHT FOR THE FIRST TIME IN THE WORLD

http://www.youtube.com/watch?v=dJ3m6TK2vvY

[Hemodoc]

Most of the advances in dialysis happened in the 1960's.  Greed and financial gain sent it into hybernation for decades.

[Stoday]

Most of the developments happened in the USA where greed and financial advantages were the key force to bring about developments and improvements. Without that greed dialysis might still be where we were in the 1960's and I'd be dead by now.

[Phil]

Talking about dialysis in a movie....the other day I was watching Star Trek 7 (I think it was 7)...the one where they go back into the past to 'our days' to save a whale.....well anyway...at a certain point they go into a hospital and Dr.McCoy sees this old lady and asks her whats wrong with her...she says 'I'm on dialysis'....and he answers 'Dialysis? What is this the middile ages?' then gives her a pill and says 'you'll be fine with this! lol Got to love Star Trek!

[MooseMom]

Phil, I can't tell you how often I have thought of that scene!  They were trying to find Chekov in a hospital, and this woman was lying in a bed in the hallway.  I didn't know at the time I had CKD (maybe I didn't...I don't know), but that scene always stuck in my head!  And all these years later, I'm about to go on D and marvel at the irony of it all.

[natnnnat]

Re footage from 1963:  I guess at some point the nurses stopped bringing patients cups of tea and the newspaper? 

Gregory told me about that Star Trek scene on our walk just last week! 
Internet says its from Star Trek VI, the Voyage Home, and  my dear nerdy husband agrees.  But I can't find a clip of it, ah well.

McCoy: [McCoy, masked and in scrubs, passes an elderly woman groaning on a gurney in the hallway] What's the matter with you?
Elderly patient: [weakly] Kidney... dialysis.
McCoy: [geniunely surprised] Dialysis?
[musing to himself]
McCoy: What is this, the Dark Ages?
[he turns back to the patient and hands her a large white pill]
McCoy: Here... you swallow that, and if you have any more problems, just call me!
[he pats her cheek and leaves]

Elderly patient: [dialysis patient being wheeled down the hall after being given the pill by McCoy... joyfully] The doctor gave me a pill and I grew a new kidney!
Intern #1: [in disbelief walking ahead of patient] Fully functional?
Intern #2: [incredulous] Fully functional!
(from http://www.imdb.com/title/tt0092007/quotes)

[natnnnat]

Gregory said to me patronisingly while patting me kindly on the back:  "you want anything, just ask me.  Don't try it yourself".
Ridiculous man.  Nonetheless, he found the clip first go.
http://www.youtube.com/watch?v=MMaGnpVaSGQ

That was a big talking point in the dialysis community when that came out in 1986, says Gregory.  Everybody was talking about it, how good would it be.  They were doing 6 hour sessions 3 days a week.

[Hemodoc]

Most of the developments happened in the USA where greed and financial advantages were the key force to bring about developments and improvements. Without that greed dialysis might still be where we were in the 1960's and I'd be dead by now.

Forgive me for not expanding such a provocative statement.  By the time that Medicare opened its doors to essentially all dialysis patients in 1973, 90% of those on dialysis dialyzed at home for 6-8 hours, three times a week.  Once Medicare began to pay, dialysis times became shorter and more violent in a peculiar dialysis American style not seen elsewhere in the developed world.  If you go and study the major aspects of dialysis came into play during the 1960's.  Today, we are trying over throw decades of profiteering at the hands of dialysis providers. 

This isn't simply my view, it was Dr. Belding Scribner's view as well as that of many of the Seattle dialysis pioneers such as Dr. Blagg and  Dr. Kjellstrand. Dr. Kolff, the inventor of the first clinically effective dialysis machine freely gave his invention away.  Dr. Scribner likewise freely gave his advancements away.  He spent the remainder of his long life decrying greed and financial gain in an industry that he nearly single handedly established.  He was ignored by his peers and colleagues.  Some conjecture that in his dispare he may have taken his own life at the end, but no one knows for sure.  Daily dialysis, nocturnal dialysis, fistula placement and so many of the central features of "optimal" dialysis occurred in the 1960's.  In many ways, we have lost ground since then and it is greed and financial gain and profiteering such as the scandelous overuse of EPO for instance that we find ourselves today.

[MooseMom]

Hemodoc, for those of us not as au fait with the financial ramifications/reasonings behind dialysis as practiced today, what should the patient new to dialysis try to do for him/herself to make D as optimal as possible within today's constraints?  Is home dialysis our best protection?

[Hemodoc]

If you are at Davita where re-uses is the norm, perhaps so since they have access to NxStage.  My take on NxStage is it is a great idea, but a little low on actual clearance, that is why I doubled my dose from 20L to 40L with appropriate modifications and precautions.

FMC does not do re-use which is a big plus.  You need a MINIMUM of 4 hours, 3 X a week.  Many only get 3-3.5 which is not enough dialysis to prevent the multitude of complications.  ANZDATA from Australia and NZ shows people that get over 20 hours of dialysis/week had a 2% mortality, raw figures waiting for further evaluation.  Historically, when a patient was not doing well in the 1960s for one of many reasons, often the solution was MORE dialysis and in many cases it worked.  Longer dialysis and more frequent dialysis are the norm of this experiment.  We have lost that edge that we had when it was in its first baby steps due to financial and business decisions on the length and frequency of dialysis.

So, if you can get incenter nocturnal 3 times a week, you are better than conventional incenter dialysis.  Not everyone is eligible health wise to do home dialysis for various reasons, but at least 30% in America could by many estimates. That would be over 100,000 patients in America alone.  This would over night improve access to care, reduce morbidity, mortality, ER and hospital stays as well as significantly reduce the overhead costs of doing dialysis.  Dialysis when it started WAS a home treatment option.  We now call these options new, go figure.

[RightSide]

Talking about dialysis in a movie....the other day I was watching Star Trek 7 (I think it was 7)...the one where they go back into the past to 'our days' to save a whale.....well anyway...at a certain point they go into a hospital and Dr.McCoy sees this old lady and asks her whats wrong with her...she says 'I'm on dialysis'....and he answers 'Dialysis? What is this the middile ages?' then gives her a pill and says 'you'll be fine with this! lol Got to love Star Trek!

It was "Star Trek IV: The Voyage Home."

When McCoy hears from the old lady that she's on dialysis, he mutters, "What is this, the Dark Ages?"  So he gives her a pill to take instead.

Later in the movie that old lady is walking around feeling great, telling everybody "A doctor gave me a pill and I'm growing a new kidney!"

[Stoday]

It seems to me that Hemodoc and I can look at the same story and reach diametrically opposite conclusions. Such is the basis of healthy debate.

Forgive me for not expanding such a provocative statement.  By the time that Medicare opened its doors to essentially all dialysis patients in 1973, 90% of those on dialysis dialyzed at home for 6-8 hours, three times a week.  Once Medicare began to pay, dialysis times became shorter and more violent in a peculiar dialysis American style not seen elsewhere in the developed world. 

What Hemodoc is saying is that dialysis was better for taking 6-8 hours at home rather than the current 3-4 in center, that the change was for the worse for the patient and was a consequence of the drive for profit and the greed of big business.

I think there is a better explanation. Dialysis machines and membranes in particular were vastly improved from the mid 60's. The improvement meant that the patient on newer machines needed less time to achieve the same result. For instance, the twin coil dialyser used by the Bringham group in the 1960's needed 1500 ml of blood in the coil, which had to be saved between sessions.

The reason for the large proportion on home dialysis was that Dr. Scribner was turned down by the hospital administration when he applied to expand his unit. He could only add more patients by modifying his procedures so that they could dialyse at home.

Dr. Kolff, the inventor of the first clinically effective dialysis machine freely gave his invention away.  Dr. Scribner likewise freely gave his advancements away.

Those assertions are misguided.

Dr Kolff was professor of surgery and research professor of engineering at the University of Utah. Dr. Scribner was employed by the University of Washington. It is normal for inventions made in the course of employment to belong to the employer, not the employee. Their inventions were not theirs to give away. Since the employers were public organizations, the public, in effect, already owned the inventions. I am certain that if the two good men were employed in the private sector, their inventions would never have been given away.

Of course, Hemodoc's main point , that some dialysis developments were not initiated by profit and greed motives, is still valid, but for some, not all developments. But I never said it was.

My point it that the development of production quantities of machines and membranes could only take place where finance is available. It's only available where profits can be made. That's why without it, dialysis would still be stuck in the 1960's and 70's.

[Hemodoc]

It seems to me that Hemodoc and I can look at the same story and reach diametrically opposite conclusions. Such is the basis of healthy debate.

Forgive me for not expanding such a provocative statement.  By the time that Medicare opened its doors to essentially all dialysis patients in 1973, 90% of those on dialysis dialyzed at home for 6-8 hours, three times a week.  Once Medicare began to pay, dialysis times became shorter and more violent in a peculiar dialysis American style not seen elsewhere in the developed world. 

What Hemodoc is saying is that dialysis was better for taking 6-8 hours at home rather than the current 3-4 in center, that the change was for the worse for the patient and was a consequence of the drive for profit and the greed of big business.

I think there is a better explanation. Dialysis machines and membranes in particular were vastly improved from the mid 60's. The improvement meant that the patient on newer machines needed less time to achieve the same result. For instance, the twin coil dialyser used by the Bringham group in the 1960's needed 1500 ml of blood in the coil, which had to be saved between sessions.

The reason for the large proportion on home dialysis was that Dr. Scribner was turned down by the hospital administration when he applied to expand his unit. He could only add more patients by modifying his procedures so that they could dialyse at home.

Dr. Kolff, the inventor of the first clinically effective dialysis machine freely gave his invention away.  Dr. Scribner likewise freely gave his advancements away.

Those assertions are misguided.

Dr Kolff was professor of surgery and research professor of engineering at the University of Utah. Dr. Scribner was employed by the University of Washington. It is normal for inventions made in the course of employment to belong to the employer, not the employee. Their inventions were not theirs to give away. Since the employers were public organizations, the public, in effect, already owned the inventions. I am certain that if the two good men were employed in the private sector, their inventions would never have been given away.

Of course, Hemodoc's main point , that some dialysis developments were not initiated by profit and greed motives, is still valid, but for some, not all developments. But I never said it was.

My point it that the development of production quantities of machines and membranes could only take place where finance is available. It's only available where profits can be made. That's why without it, dialysis would still be stuck in the 1960's and 70's.

Dear Stoday, it is not my opinion only on this.  Perhaps you would want to spend more time reading about the last 3 decades of Dr. Scribner's life and what he had to say about this issue.  I have accurately reflected his views.  If you wish to argue about this or any subject, you will have to do it without me.

Cheers,

[Hemodoc]

It seems to me that Hemodoc and I can look at the same story and reach diametrically opposite conclusions. Such is the basis of healthy debate.

Forgive me for not expanding such a provocative statement.  By the time that Medicare opened its doors to essentially all dialysis patients in 1973, 90% of those on dialysis dialyzed at home for 6-8 hours, three times a week.  Once Medicare began to pay, dialysis times became shorter and more violent in a peculiar dialysis American style not seen elsewhere in the developed world. 

What Hemodoc is saying is that dialysis was better for taking 6-8 hours at home rather than the current 3-4 in center, that the change was for the worse for the patient and was a consequence of the drive for profit and the greed of big business.

I think there is a better explanation. Dialysis machines and membranes in particular were vastly improved from the mid 60's. The improvement meant that the patient on newer machines needed less time to achieve the same result. For instance, the twin coil dialyser used by the Bringham group in the 1960's needed 1500 ml of blood in the coil, which had to be saved between sessions.

The reason for the large proportion on home dialysis was that Dr. Scribner was turned down by the hospital administration when he applied to expand his unit. He could only add more patients by modifying his procedures so that they could dialyse at home.

Dr. Kolff, the inventor of the first clinically effective dialysis machine freely gave his invention away.  Dr. Scribner likewise freely gave his advancements away.

Those assertions are misguided.

Dr Kolff was professor of surgery and research professor of engineering at the University of Utah. Dr. Scribner was employed by the University of Washington. It is normal for inventions made in the course of employment to belong to the employer, not the employee. Their inventions were not theirs to give away. Since the employers were public organizations, the public, in effect, already owned the inventions. I am certain that if the two good men were employed in the private sector, their inventions would never have been given away.

Of course, Hemodoc's main point , that some dialysis developments were not initiated by profit and greed motives, is still valid, but for some, not all developments. But I never said it was.

My point it that the development of production quantities of machines and membranes could only take place where finance is available. It's only available where profits can be made. That's why without it, dialysis would still be stuck in the 1960's and 70's.

After World War II ended, Kolff donated the five artificial kidneys he’d made to hospitals around the world, including Mt. Sinai Hospital in New York. Because of this unselfish act, doctors in many countries were able to learn about the practice of dialysis.

http://www.davita.com/dialysis/motivational/a/197

Kolff and Scribner freely gave their inventions away.  You are looking at issues in our greed filled academic centers of today and completely fail to understand that times were different in the 1960s in medicine.  People were actually motivated by altruistic values to save peoples lives.  My statements about Scribner and Kolff stand.

If you wish to argue with me simply because you personally oppose my views, that is fine, but it would be behoove you to know your facts.  Kolff donated his machine, Scribner did likewise.  You truly do not know what you are talking about.

In any case,

Cheers,

[Hemodoc]

It seems to me that Hemodoc and I can look at the same story and reach diametrically opposite conclusions. Such is the basis of healthy debate.

Forgive me for not expanding such a provocative statement.  By the time that Medicare opened its doors to essentially all dialysis patients in 1973, 90% of those on dialysis dialyzed at home for 6-8 hours, three times a week.  Once Medicare began to pay, dialysis times became shorter and more violent in a peculiar dialysis American style not seen elsewhere in the developed world. 

What Hemodoc is saying is that dialysis was better for taking 6-8 hours at home rather than the current 3-4 in center, that the change was for the worse for the patient and was a consequence of the drive for profit and the greed of big business.

I think there is a better explanation. Dialysis machines and membranes in particular were vastly improved from the mid 60's. The improvement meant that the patient on newer machines needed less time to achieve the same result. For instance, the twin coil dialyser used by the Bringham group in the 1960's needed 1500 ml of blood in the coil, which had to be saved between sessions.

The reason for the large proportion on home dialysis was that Dr. Scribner was turned down by the hospital administration when he applied to expand his unit. He could only add more patients by modifying his procedures so that they could dialyse at home.

Dr. Kolff, the inventor of the first clinically effective dialysis machine freely gave his invention away.  Dr. Scribner likewise freely gave his advancements away.

Those assertions are misguided.

Dr Kolff was professor of surgery and research professor of engineering at the University of Utah. Dr. Scribner was employed by the University of Washington. It is normal for inventions made in the course of employment to belong to the employer, not the employee. Their inventions were not theirs to give away. Since the employers were public organizations, the public, in effect, already owned the inventions. I am certain that if the two good men were employed in the private sector, their inventions would never have been given away.

Of course, Hemodoc's main point , that some dialysis developments were not initiated by profit and greed motives, is still valid, but for some, not all developments. But I never said it was.

My point it that the development of production quantities of machines and membranes could only take place where finance is available. It's only available where profits can be made. That's why without it, dialysis would still be stuck in the 1960's and 70's.

The preponderance of short dial-
ysis in the U.S. is one of the major factors explaining the
higher mortality for hemodialysis patients compared with
those in Australia, New Zealand, many European coun-
tries, and Japan (48). Short dialysis has also resulted in
acceptance that patient symptoms during and between
hemodialyses are normal phenomena and why almost all
U.S. dialysis patients need drugs for control of hyperten-
sion. It is forgotten that these were not issues until the late
1970s. The program in Tassin, France, which continued
long dialysis three times weekly, has the best long-term
survival results and more than 95% of the patients there
no longer require antihypertensive drugs after six months
on this regime (48).

http://www.aami.org/publications/hh/home.blagg.pdf

Dear Stoday, you may wish to consult with Dr. Blagg on the reason for the short violent dialysis and his opinion of why we have gone backwards since the 1960's in many ways in American dialsyis.

Stoday, simply because you oppose my views on evolution and religion, you bring up a worthless accusation against my simple statements that only reflect the views of the pioneers of dialysis that developed this for all of us.  Once again, please get your facts correct before you jump into an argument that is not necessary.  I have only represented accurately historically relevant facts about the growth and development of American style dialysis that kills their patients at a rate 2.5 times that of any other nation.  The entire growth of nocturnal dialysis tells the story but it was developed in the 1960's by Shaldon in London.  We have gone backwards in the development of this technology that was given freely by its devolopers.  You simply don't know what you are talking about.

Cheers,

[Stoday]

Stoday, simply because you oppose my views on evolution and religion, you bring up a worthless accusation against my simple statements

That’s not true. I have made no accusations; I have merely suggested that improvements in machines and membranes could allow for faster dialysis. I’m not opposing your views; I just see things differently from you.

You opposed my suggested motivating force for most (not all) developments. That’s fine by me. I don’t object to anyone expressing contrary views to mine. Bit of a shame though when rather than answer my points you throw your toys out of the pram saying “If you wish to argue about this or any subject, you will have to do it without me”.

You imply that I suggested that Kolff and Scribner gained financially from their inventions. Just to be clear, I said no such thing, nor do I believe they made any financial gain from them. Kolff took his machine to the Mt Sinai Hospital in 1947, very much as an experimental machine for acute dialysis. This is a long time before the developments in which US companies became involved in mass production and a long time before the procedure could be seen to be potentially profitable. I never intended to suggest that these early pioneers were motivated other than by altruism.

Blagg’s paper is interesting. Yes, home hemodialysis would not have been possible for the numbers undergoing it if the profit motive had not encouraged manufacturers to develop affordable machines.