The G-d Committee
Recently, I've come across several discussions of medical ethics taking this post
http://m-p.livejournal.com/454176.html
at its face value. It is amazing what arguments people would concoct to justify the sacred right of federal bureaucracy to make life-and-death decisions in the name of the greater public good. The claim is that the only way to avoid medical rationing or to do it the "right way" is to leave it all to the feds, in the most centralized way possible. The early history of hemodialysis is distorted to illustrate this dubious proposition. We are told that if the government officials (aka death panels) would not decide such matters, then - o, horror - people will organize themselves, or the rich will be paying to save their filthy, useless lives. Wrong people might be saved!
m_p's post has been lifted entirely from
http://www.brighthub.com/science/medical/articles/13108.aspx
crude factual errors included (that's why Time magazine is given instead of Life).
This rendition of the events of fifty years ago is incorrect. For example, Shana Alexander's article "They Decide Who Lives, Who Dies" was published in 1962; the outcry that followed had nothing to do with the hemodialysis entitlements introduced and signed by Nixon in 1972, full ten years later. These entitlements were not part of Medicare when it was enacted in 1965, at the hight of the dialysis trials. Furthermore, ESRD covers only stage-5 uremics, whereas stage-4 is already life threatening, so life-and-death decision did not go anywhere. One out of four ESRD patients are denied dialysis once it is decided by - who else - a committee that they are terminal; this decision is made according to federal guidelines,
http://www.lahey.org/NewsPubs/Publications/Ethics/JournalSpring2004/Journal_Spring2004_Harvard.asp
http://www.ncbi.nlm.nih.gov/pubmed/12709469?ordinalpos=&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.SmartSearch&log$=citationsensor
People who make this life-or-death withdrawal decision are more-or-less the same people that once were in the G-d Committees. It is sheer delusion to believe that such programs eliminate the need for making hard decisions.
As for the "notorious" G-d Committees, these existed during clinical trials. Dialysis was a new, untested technique, and it was extremely expensive and labor intensive, the equipment was primitive, and it required absolute commitment to the regimen from the patient, which was the main concern of the committee. They did not want to compromise their trials by increasing the mortality through including irresponsible people. It took about a decade to develop expertise and go through three generations of dialysis equipment to be at the point when ESRD entitlements became a financial possibility. Even now, when the costs are beaten way down, it is $18b/yr program. In the 1960s, it was not affordable. What made it possible was the development of hollow fiber technology, at the end of the 1960s, chiefly at Dow Corning.
http://www.fmcag.com/internet/fmc/fmcag/neu/fmcpub.nsf/AttachmentsByTitle/2004_Dialysis_Compact_History_en/$FILE/Dialysis_Compact_2004_HD_History_english.pdf
and the shunting technique that was developed and tested in Seattle by the physicians during the clinical trials maligned in the post.
The impression is carefully created that journalistic hysteria and changed public opinion led to supplant these admission committes with a political solution. In fact, most of these committees where instituted by local Medical Societies well after Alexander's article. It is also claimed that these committees were "tired" of making such decisions. This is absurd. These committees were no more tired of making painful decisions than their modern equivalents. At no stage of ESRD enactment the activity of these admission committees has been questioned or found to be unethical. Very different considerations were taken into account, see Oberlander's "The political side of Medicare", p. 41. ESRD was rolled together with the disabled entitlements as part of Social Security amendments. The G-d committees were not an issue in deliberations. The only immediate result of Alexander's exposition was that the Hartford Foundation that supported the Seattle group abruptly withdrew its support, leaving the patients to die. That's when Seattle Times (!) run the article "Will These People Have to Die?" The grant from Boeing's Good Neighbor Fund saved their lives. Then the US Public Health Service chipped in, the NIH chipped in, there was also massive public support. Then the Hartford Foundation had returned.
All of these details have been omitted. That without such screening committees the trials required to develop the method (to the point when ESRD could've been enacted) would be impossible is not even registered. The very people who made ESRD for everyone possible have been mired with dirt.
PS: R Fox, JP Awazey, The Courage to Fail: A Social View of Organ Transplant and Dialysis; Ch. 7
also http://www.aei.org/article/28156 (other committees, brief overview)
Scribner's memories http://www.nature.com/nm/journal/v8/n10/full/nm772.html
Here is how the person who organized the first such committee is remembered in Seattle
http://seattletimes.nwsource.com/html/localnews/2004032252_havilandobit24m.html
He was the president of American College of Physicians. Another person in this committee was Scribner himself.
http://m-p.livejournal.com/454176.html
at its face value. It is amazing what arguments people would concoct to justify the sacred right of federal bureaucracy to make life-and-death decisions in the name of the greater public good. The claim is that the only way to avoid medical rationing or to do it the "right way" is to leave it all to the feds, in the most centralized way possible. The early history of hemodialysis is distorted to illustrate this dubious proposition. We are told that if the government officials (aka death panels) would not decide such matters, then - o, horror - people will organize themselves, or the rich will be paying to save their filthy, useless lives. Wrong people might be saved!
m_p's post has been lifted entirely from
http://www.brighthub.com/science/medical/articles/13108.aspx
crude factual errors included (that's why Time magazine is given instead of Life).
This rendition of the events of fifty years ago is incorrect. For example, Shana Alexander's article "They Decide Who Lives, Who Dies" was published in 1962; the outcry that followed had nothing to do with the hemodialysis entitlements introduced and signed by Nixon in 1972, full ten years later. These entitlements were not part of Medicare when it was enacted in 1965, at the hight of the dialysis trials. Furthermore, ESRD covers only stage-5 uremics, whereas stage-4 is already life threatening, so life-and-death decision did not go anywhere. One out of four ESRD patients are denied dialysis once it is decided by - who else - a committee that they are terminal; this decision is made according to federal guidelines,
http://www.lahey.org/NewsPubs/Publications/Ethics/JournalSpring2004/Journal_Spring2004_Harvard.asp
http://www.ncbi.nlm.nih.gov/pubmed/12709469?ordinalpos=&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.SmartSearch&log$=citationsensor
People who make this life-or-death withdrawal decision are more-or-less the same people that once were in the G-d Committees. It is sheer delusion to believe that such programs eliminate the need for making hard decisions.
As for the "notorious" G-d Committees, these existed during clinical trials. Dialysis was a new, untested technique, and it was extremely expensive and labor intensive, the equipment was primitive, and it required absolute commitment to the regimen from the patient, which was the main concern of the committee. They did not want to compromise their trials by increasing the mortality through including irresponsible people. It took about a decade to develop expertise and go through three generations of dialysis equipment to be at the point when ESRD entitlements became a financial possibility. Even now, when the costs are beaten way down, it is $18b/yr program. In the 1960s, it was not affordable. What made it possible was the development of hollow fiber technology, at the end of the 1960s, chiefly at Dow Corning.
http://www.fmcag.com/internet/fmc/fmcag/neu/fmcpub.nsf/AttachmentsByTitle/2004_Dialysis_Compact_History_en/$FILE/Dialysis_Compact_2004_HD_History_english.pdf
and the shunting technique that was developed and tested in Seattle by the physicians during the clinical trials maligned in the post.
The impression is carefully created that journalistic hysteria and changed public opinion led to supplant these admission committes with a political solution. In fact, most of these committees where instituted by local Medical Societies well after Alexander's article. It is also claimed that these committees were "tired" of making such decisions. This is absurd. These committees were no more tired of making painful decisions than their modern equivalents. At no stage of ESRD enactment the activity of these admission committees has been questioned or found to be unethical. Very different considerations were taken into account, see Oberlander's "The political side of Medicare", p. 41. ESRD was rolled together with the disabled entitlements as part of Social Security amendments. The G-d committees were not an issue in deliberations. The only immediate result of Alexander's exposition was that the Hartford Foundation that supported the Seattle group abruptly withdrew its support, leaving the patients to die. That's when Seattle Times (!) run the article "Will These People Have to Die?" The grant from Boeing's Good Neighbor Fund saved their lives. Then the US Public Health Service chipped in, the NIH chipped in, there was also massive public support. Then the Hartford Foundation had returned.
All of these details have been omitted. That without such screening committees the trials required to develop the method (to the point when ESRD could've been enacted) would be impossible is not even registered. The very people who made ESRD for everyone possible have been mired with dirt.
PS: R Fox, JP Awazey, The Courage to Fail: A Social View of Organ Transplant and Dialysis; Ch. 7
also http://www.aei.org/article/28156 (other committees, brief overview)
Scribner's memories http://www.nature.com/nm/journal/v8/n10/full/nm772.html
Here is how the person who organized the first such committee is remembered in Seattle
http://seattletimes.nwsource.com/html/localnews/2004032252_havilandobit24m.html
He was the president of American College of Physicians. Another person in this committee was Scribner himself.