Georgetown forum; Kidneys, lives, dollars

Kidneys lives dollars a topic for the Eleven Hundred and Sixty seventh consecutive broadcast of the Georgetown University radio forum. Another in a series of educational and informative programs from Washington D.C. The Georgetown forum was founded in 1946. This is Wallace Manning speaking to you by transcription from the Raymond Rice studio on the campus of Georgetown University historic Jesuit seat of learning in the nation's capital. Today's discussion will be kidneys lives dollars participating are Dr. George Shriner president of the National Kidney Foundation and Professor of Medicine at Georgetown University's School of Medicine. Mr. Charles plant consultant to the foundation and two kidney transplant recipients. Mr. Rudolph Oh Devore Cheli and Mr. Arthur mock. Today we have these two people who are quite unique. Both recipients of kidney transplants 10 years ago they would not have been alive to tell their

story. Today the successful transplant is a reality. But Mr. Markey Mr. Devant Chely are still among a lucky minority they have kidneys thousands of others have died before matched kidneys were available they might have been saved if there were enough artificial kidney machines. But there aren't. You may have seen an advertisement that's been running in newspapers and magazines. I'll read it to you. How do you tell a man you know how to save his life but he's going to die anyway. Bob Martino is suffering from what doctors call a chronic renal shutdown. To put it in plain English his kidneys have stopped working. Of course it's serious very serious but it's not necessarily fatal. The artificial kidney machine has been saving people like Bob for over 10 years now. Two or three treatments a week and he could even go on living on normal life. He could

but there are over 10000 people in America today who need this machine and the way it looks now 9000 of that 10000 will never get to use it. There just isn't money enough for machines or for personnel or facilities. So Bob Martino is going to die. It's like some kind of bad dream you want to pinch yourself and wake up to think we could keep Bob alive. We could keep all these people alive indefinitely or at least until we can provide them with new kidneys kidney transplants are no longer something out of the year 2001 they're a reality. We don't have all the answers yet but we're well on our way. Scientists tell us that within a few years we may actually be able to manufacture a life sized plastic kidneys when our real kidney goes bad outcomes than in would go the plastic one just like that. They're even working at growing kidneys with cells taken from the human

body in the middle of the 20th century. There's no end to what we could do if we just had enough money. That's all money. When people die it's always sad but when 9000 people die because of a stupid thing like money it's prophetic. Well that's the way the advertisement reads and we're going to begin our discussion by asking Dr. Shriner if that is just more Madison Avenue or is it for real. Well I think Mr. Fanning that we sometimes get over a condition my the drama of Madison Avenue and become hardened to appeal such as the one you read which is being made all over the nation this month as part of March which is a national kidney month. But I think the presence here today in the studio of two individuals who have actually gone through this experience from beginning to happy conclusion are three dimensional

real life examples and proof of the fact that this is not simply a Madison Avenue and but this is a real life situation. I wonder if we could chat for a few moments with these patients to see what their reactions have been to this dreaded disease and its consequences. Part of your first patient on mile after Mr. Adolfo never Charlie. Known to us as a roadie since we have been with him for so long really how long now have have you been. L. your first bout with a disease called chronic nephritis or chronic Bright's disease began as I recall around one thousand fifty nine. Yeah it would discover a day in the beauty of 15 or so that's about 10 years ago and you're now how 31 years. So you were 21 just just turned the voting age in this country when you were stricken

with this very serious disease I might say that yesterday which I was a very active person a jet pilot at this point in his life and it was quite a transition to to go to complete an activity with his severe uranium. Then you managed to get on with what we call conservative therapy until about 1964. Is that here right. Begin at me through 64. Could you tell us a little bit about how your life was changed by your e-mail at that point how you felt. Well I tell you I was told that there was going to that in three weeks if I didn't get to be helped by the kidney machine. We make every effort to come to your country because it was just about the only played the dialysis brother. Well this is actually what happened to Mr. Dove a child he came to Washington went on the artificial kidney machine in

1964 in September and then had a very serious complication of kidney disease which is quite frequent and that is severe. High blood pressure or hypertension. Actually this may be difficult to explain to our audience but there is a type of hypertension so severe that the only way to treat it is to remove the kidneys in order to treat the hypertension this was done in Mr. Debra Charlie. It isn't as radical as it sounds because at that particular point his kidneys weren't really functioning. And after the removal of his kidneys his blood pressure improved markedly. And in fact his hypertension been so severe that at one point you were born with it. You know I would linger for a month and his eyesight has been restored after the improvement in the hypertension. Obviously patients without any kidney tissue at all. Are

becoming increasingly difficult to manage in terms of diet and fluid requirements and so much of that which I was considered as a transplant candidate from me. Beginning of the serious part of his illness and in October 965 he was given a kidney from a person who had died and this transplantation was done and the kidney has function now for going on and so forth here are harvested. Do you have any sensations or thoughts really about having a kidney from another person working for you at this point. Well not really because you think that did this your own you were told that it was donated by somebody else and then you realize how good it could be for some other people to be given these other talents. If other people would understand. What what constitutes your routine now really you've been going to computer school

Einstein and what sort of life do you leave in terms of what you actually do and also what sort of medicines you take and how much medical care is involved in the care of a transplant. Well you mentioned that they was blind in math but we forgot to mention that I was also paralyzed for two years after that transplant. It took me six months to learn to stand up and walk a little bit again with braces and gains. So it was a slow process that they have to learn how much could I don't. Anyway I went to school and they made 27 credits in data processing. Bad working in data processing is very hard to stand long hours so you try working and they could work I know wait six hours push a little bit is a little too much. You have to come to a clinic at intervals to receive your malice and

the issue of Kenya that they will seem prone to these strange to my body so I try to reject it. I have am under immunosuppressive drugs which prevent rejection of these dishes but these drugs have to be controlled very carefully because they have side effects so I have to be checked at least every 3 weeks or every two weeks. Thank you very much we've asked really to explain this in his own words so that I think he understands and can communicate it remarkably well. This kidney function is sufficient that you are not restricted anymore greatly in your dietary intake No not at all. I don't drink and eat anything. So this is considerable for your life and you and your obviously while you are under very careful restrictions from half a glass of water when you were you wouldn't it's a big difference.

Well let's turn to Arthur now author you're about 27 years. And as I recall you became uremic in 1962. Now Mr. Mark had a concern. A completely different cause for his his renal failure. He has had a small kidney probably all his life from birth this is a congenital or a birth defect in the growth of the kidney. And this coupled with bladder infection led to a decline in his kidney function and he finally had not sufficient function to handle his daily metabolism. And you went on the artificial kidney when it was in 65 when I first went on it. I came in hospital here doing stand University in 64 when I was admitted here and they ran test on me for about a year and then they decided my kidneys but they had almost completely quit. And they said if I had gotten the OTC base your

kidney which would give me hope for a while. And so I was on the artificial kidney for a year and say I'm not here. And then at the end of this time boss Mr. Mark was an active person also and had volunteered as a transplant recipient when a kidney could become available. I'm sure the audience realizes that this is still a great problem to get suitable cadaveric kidney and it requires communication with the families of patients who are dying often accident victims and requires a great deal of medical investigation of the prospective kidney donor after the patient had died. Arthur received his kidney you know any transplant that was done by not Charles Hufnagel at Georgetown. And this has been functioning since.

October one thousand nine hundred sixty six. No going to Nov. 19 overly severe. He remembers that day very well. Can you tell us a little bit about what you're doing now and how you feel. Well I feel wonderful. Very successful with my kidney the last two years and I work at those open steel come in for the role of a genie and I've been working on now a little over four months. And so for if they've been going real good what sort of work do you do it still operate a car press. It cuts up cars smashing them up and cuts them up and I grab on deliveries deliver steel or something like it and I work five and a half days a week which is good. And of course you're checking in and our transplant regularly to follow on your medications are you restricting your diet I don't know so I can drink or eat anything else. I wonder if you'd mind my telling the story Arthur. On his way to

the operating room to get his transplant bought a new car to illustrate his confidence in the procedure even though at this time it was somewhat of a quasar experimental procedure. These two gentlemen bring up a very important point I think and it is probably the most neglected or on answered problem in American medicine today and it hits us in the fall of the particular way because this is such a rapidly developing field. The problem I referred to is the moving front here that exists between the development of either tool diagnostic tool or therapeutic procedure. On a research basis where it can be developed to a very fine degree and successful degree in an investigational setting in the university hospital. And they from the frontier that exists when the time comes for the translation of

that research fruit to actual delivery to a larger group of people who need it. We have of course excellent facilities and excellent organization for the conduct of research through research foundations such as the National Kidney Foundation and through many government agencies the most notable of which of course is the National Institutes of Health. We also have an excellent hospital system in the United States and we have both private now and to some extent government assisted insurance from medical care. We do not have a specific organization however. To handle this gray zone in between the development of a research success and it's our ability to deliver it to the community at large. And the only analogy to this that exists in the industrial world is the pilot plant concept that as when for example a chemical

procedures developed in a company before it goes into mass production it goes through a pilot plant operation which serves to take out some of the difficulties and also to train people. There really isn't any national organization in America capable of organizing the resources and the facilities for this grey area. We happen in kidney disease to be extremely fortunate to have developed in the last few years not one but two successful treatments for end stage renal failure. One is chronic analysis and the other is of course transplantation of the kidney which can be done either from live donors or from recently deceased persons the so-called cadaver donor. The problem is however that these fruits are really not being delivered to the community at large and the basic delivery is a simple matter of ABC. We would list

as an organisation a structure and a concert a will on the part of the people to actually have this delivery take place. We would list as the be the funds which are which have been emphasized by Mr Fanning which are of course necessary to begin this whole process and see the training and the manpower that must be gone through the training programme that must be completed. If we are to have the manpower to deliver these fruits of research to our community self ABC in this case organisation funds and manpower adds up to the D of delivery and for this purpose the Kidney Foundation has has appealed to the American public in what is essentially a crisis because this year by the strictest medical criteria 10000 persons will die of end stage renal failure who are judged to be ideal candidates for dialysis or

transplantation. Are there another. 40 to 50000 at least. Who are less idea about potential candidates for further research work in this area. It seems almost pointless to continue further research work in this area when we're not delivering the fruits of our recent research to the to the people who need it. And I wonder if at this time we could ask Mr. Plant to make some comments about what is being done on the legislative scene what what bright clouds are there on the horizon is there any chance that there will be legislation to correct this in a needed area. Dr Shriner I think that there are a number of points both in the legislative area and also in the area of the executive branch. That indicate that there is some hope on the horizon. Members of

Congress are becoming increasingly more aware. Of this great delivery gap. For instance senators Jackson and Magnussen of the state of Washington have introduced legislation and have over 20 co-sponsors. This legislation is primarily designed to offer a comprehensive approach to the problem of kidney disease. It has a numerous parts but the most significant aspects of the legislation are number one the establishment of a transplantation commission which would look into the medical social economic ramifications of transplantation in our society this would not only by the way be for kidneys but would cover the whole spectrum of transplantation. Heart

and other organs it would also set up a kidney commission. This commission's primary responsibility would be to look into the the general area of kidney disease to offer advice and counsel to the executive branch. The National Institutes of Health. Department of Health Education and Welfare. In the distribution of funds the cons set some priorities and try to marshal the total forces of the country to meet this very very serious problem. This commission then possibly could act as a coordinator body to set up or at least build the kind of structure that I talked about that was needed to put together in many cases resources that already exist but simply aren't being intern digits that aren't being used in a proper way with each other. Yes I think that's a very significant point if I can just go on for a minute Doctor and fill out the the titles of the Jackson Magnussen bill and

go back to that very point because I do think it is significant in the total picture of the federal establishment and what it's trying to do to meet the problem. The Jackson Bill also sets up a series of kidney centers both in the private and public sector. It asks for an authorization of a hundred and forty million dollars over a five year period. This is a very large amount of money but. People like you and others in the field feel that it's it's a necessary amount in order to meet the problem. It also amends the Social Security Act the Medicare aspects of it to include for patients on dialysis or transplant patients an opportunity regardless of age an opportunity to covered in hospitalization aspects of the Medicare program. Now in addition to the Jackson Magnussen Bill

there are many other members of Congress who have introduced bills and have contacted the National Kidney Foundation in an effort to get more facts more figures. About the seriousness of the problem Sen. Jacob Javits of New York for instance at this very moment is drafting legislation somewhat different than the Jackson Magnussen bill but directed at the problem now going back to your earlier reference to the the total picture in the federal establishment for instance vocational rehabilitation as a program for dialysis the Veterans Administration. The Kidney Disease Control Program at the National Institutes of Health the Children's Bureau has some small amount of money for this kind of work. A doctor there. The real unfortunate part about it is that number one there is no cohesion. Secondly there's not enough money there. It's just

a drop in the bucket. And in reference to the need. I think this is really the important point we haven't had anywhere in the in the health picture. Someone that or some structure that could be appealed to even the start planning in this area even though the possibility of doing it has been present for almost nine years. It's only actually in the last month or two that the blue plan's Blue Shield and Blue Cross have finally gotten together their local affiliates into the prospect of offering a uniform national plan. We haven't had uniform coverage in the various jurisdictions even for these techniques of dialysis. And I point out that this is not a unique problem. This is simply dramatic because it's a life and death problem but it also occurs in the diagnostic side of kidney disease. If I might just cite one example

of one of the tests that's used to diagnose the type of kidney disease in fact this was done on Mr. Devore jelly What is a kidney biopsy which is the taking of a small piece of the kidney through a needle. Now the the local Blue Shield. Compensation for this is $35. We have developed in a research laboratory a method of handling this tissue in a very complicated way. Call him you know fluorescents when we do a cost analysis and what it costs us to process one piece of tissue it comes to over three hundred dollars. Now the temptation you save for hospital administrators is to continue to call this a research item because its simply too costly to deliver on the firing line to the consumer of medical care. And yet obviously there has to come a time for translation as this if this information can

save lives and may save in the long run thousands of dollars worth of hospitalization and drugs to make an early diagnosis. So we have to have a way of quickly introducing these developments into when theyre ready scientifically into. The community at large in a way that's economically feasible and no really coherent plan has has been done for the US that has universal application. The only thought that I have constructed on this problem is that if commissions such as you talked about in that bill could convene on each specific procedure and decide that the transition period let's say it would be four years that perhaps then one could have a moving front Taher and for the first year have a 75 percent supported by research funds and 25 percent by service funds and then in the fourth year vice versa 25 percent by our research

funds and 75 percent by service ones only by some orderly fashion like that where we regularly make this transition and this problem is going to come up over and over again in other fields of medicine as progress goes on. I think Doctor that. An interesting aspect of the Jackson Magnussen bill is the wide range of co-sponsorship Edwin Muncie Muskie of Maine Alan Cranston of the state of California Sen. Irwin from North Carolina. Ma'am like Senator Byrd from North Dakota it covers the pretty much the full breath and length of our country this this growing awareness in the Congress of this problem of kidney disease. It's gratifying to see so many people in the Congress interested in helping out there. You have one minute remaining I wonder if you have talked about the legislation and so forth but what what can people in the meantime do to

help. Well certainly the first thing is to find out all we can about the forms of kidney disease in this requires further work on the diagnostic side of Nephrology the specialty of kidney disease. This can be fostered by people getting literature from the National Kidney Foundation and we hope by contributing to the Kidney Foundation so that its work can continue at a much higher pace than has been possible in the past due to financial restrictions. Secondly. I hope the audience will encourage their own legislators to sponsor and back the legislation that Mr planets talked about and I'm sure that patients like Mr. Debra chali and Mr. mouth would be very enthusiastic about sharing their good fortune with their less fortunate fellow sufferers from kidney disease.

Thank you very much Dr. Georgie Shriner president of the National Kidney Foundation and professor of medicine that they Georgetown University School of Medicine and to Mr. Charles plant consultant to the National Kidney Foundation and to our two guests who are kidney transplant recipients. Mr. Adolfo Deborah Kelley and Mr. Arthur Moore. You have attended the weekly discussion program in the Georgetown University radio forum broadcaster which was transcribed in the Raymond Rice studio on the campus of historic Georgetown University in Washington D.C.. Next week you'll hear discussed Latin America student dissent. Our panel at that time will can sift that consist of Dr. Thomas Dodd assistant professor of history at Georgetown Mr. front's von Sauer from Mexico a graduate student at Georgetown. Dr. Harold E. Davis professor of Latin American Studies at the American University and Mr. Holm mando man from Argentina. This program has been presented in the

interest of public education by Georgetown University your moderator. WALLACE banning this program was distributed by the national educational radio network.