I believe there is a way for kidney function to return.
I believe the truth about that is held back from mainstream.
These are lines from a recent email asking about treatment options for their loved one who has been miserable on dialysis for two years. This email served as fodder for my latest Real Kidney Talk with The People’s Nephrologist YouTube video. I hope you’ll check it out, like, subscribe, share, and let me know what you think. 😉
Because folks often wonder about treatment options for kidney failure and the likelihood their kidneys will come back, this is the focus of the video. But I also know the sentiment expressed about truth being withheld is common too. It stings a bit to see the doubt in some eyes, even if they don’t say outright that we physicians are giving them treatments or cures because they are poor or Black or foreign-born or whatever, when I know for sure that I am giving the best information, best advice, and best treatment I know how to give for every patient I encounter.
And yet I get it.
America as a whole has earned the distrust. Our health care system demonstrably prioritizes profits over patients, from the price gouging of pharmaceutical companies to the bankruptcy-inducing charges of hospitals to the coverage denials of insurance companies. Even our electronic medical records (EMR) are designed for billing, not communication. No doubt EMR systems could be connected to allow patient information to be viewed if they happen to be seen a different state or even county with a different EMR. But doing so might make it harder for them to lure organizations or hold them hostage.
And then there is the unethical, downright evil shit that litters our history. Like the (alleged) mass hysterectomies being performed at an immigrant detention site early on in the pandemic; the experiments conducted on prisoners and the mentally ill; the infamous Tuskegee experiment in which the US Public Health Service withheld penicillin from Black men being ravaged by syphillis; and the multitude of surgeries J. Marion Sims, the so-called “father of modern gynecology”, performed on enslaved women without anesthesia—just to name a few.
In the nephrology world, many a patient would say our recommendations to start dialysis are because we want to make money off them or we’re trying to kill them. Some believe both—that we are trying to make money off them and kill them at the same time. I found this one very puzzling—until I thought about how the government denies Medicare coverage for transplant medications three years after transplant if kidney failure was the patient’s only eligibility for Medicare, even though (1) Medicare pays for transplant and dialysis; (2) transplant is much more cost-effective than dialysis after the first year; (3) people who can’t afford their transplant medications will reject the transplant and have to go back on dialysis; and (4) people on dialysis don’t live as long as those who have a transplant. It’s almost as if they are banking on the fact that dead patients are less less expensive than living ones. (Read my free editorial on this topic here.)
Like I said, we have collectively earned the distrust.
I don’t know how we overcome the distrust. Honestly, I don’t even think it’s possible as long as greed, racism, sexism, homophobia and xenophobia abound. I just hope the sincerity in my words, eyes, and actions come through in my one-on-one encounters with patients and in all my videos.