Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

Can an artificial kidney finally free patients from dialysis?

ucsf.edu

Post reply on HN
Print view View original

71–80 of 97 posts

Re: Can an artificial kidney finally free patients from dialysis?

#71

Post by skissane »

brokenmeds wrote: post #67
zamadatix wrote: post #45

Earlier quoted context omitted.

What does it matter who loses money? This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} and they get all of the pie while these stagnant people now get none. If there is some grand conspiracy of how they have enough power to prevent anybody from coming in and doing it better/…

>> This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} This isnt an iOS app where 10,000 developers compete to bring prices down. This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice. Funny, they also benefit when there isnt…

> This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice

The “Nephrology Board” is only one country. Even supposing US medical institutions decided to block a treatment being developed in the US, they have no authority to stop its development in other countries. If it was seen to be working in other countries, they’d find it very hard to justify refusing to allow it in the US.

But politically I think the scenario you are describing is very unlikely - the US medical system justifies its “uniqueness” (such as extreme expensiveness) on the grounds that “we have the best medical technology on the planet”. Blocking medical advances would undermine that justification, and hence is not in the best interests of the people who control the US medical system

Re: Can an artificial kidney finally free patients from dialysis?

#72

Post by iancmceachern »

This would be awesome. I helped architect and design the Outset Tablo hemodialysis machine, have designed several LVAD/Artificial hearts and a few other dialysis related systems. This is the ultimate goal, would be amazing improvement for patient quality of life. God speed to this team!!

Re: Can an artificial kidney finally free patients from dialysis?

#73

Post by justinclift »

robbiep wrote: post #31
blorenz wrote: post #10

Earlier quoted context omitted.

As someone totally unqualified to make an assessment about this, I feel selectively forgetting is much harder than generalized forgetting. This would make the person vulnerable to multitudes of vectors.

You’re basically right, we have no idea how to do this - we can help the immune system remember new things (ie we’ve started teaching it how to attack cancers that it has been ignoring) but when the body wants to go at something, the only way we’ve been able to get it to sort it’s shit out is to wipe out all the agents of the adaptive immune system and implant a new one (give someone a bone marrow transplant). This h…

Doesn't catching measles somehow reset the immune system as well?

As per articles a while ago like this:

https://www.bbc.com/future/article/20211112-the-people-with-...

Re: Can an artificial kidney finally free patients from dialysis?

#74

Post by jacquesm »

iancmceachern wrote: post #72

This would be awesome. I helped architect and design the Outset Tablo hemodialysis machine, have designed several LVAD/Artificial hearts and a few other dialysis related systems. This is the ultimate goal, would be amazing improvement for patient quality of life. God speed to this team!!

That's a whole pile of progress right there, thank you so much for this. I hope to never be the recipient of any of your work but those are some very solid 'improve the world' marks right there.

Re: Can an artificial kidney finally free patients from dialysis?

#75

Post by shkkmo »

skissane wrote: post #71
brokenmeds wrote: post #67

Earlier quoted context omitted.

>> This isn't a 3 person scam, there are 10s of thousands of people capable and it only takes a single company getting a single practice in the area to start doing ${RADICALLY_MORE_EFFECTIVE_THING} This isnt an iOS app where 10,000 developers compete to bring prices down. This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice. Funny, they also benefit when there isnt…

> This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice The “Nephrology Board” is only one country. Even supposing US medical institutions decided to block a treatment being developed in the US, they have no authority to stop its development in other countries. If it was seen to be working in other countries, they’d find it very hard to justify refusing to allow it i…

You say this as if the only way this happens is through a big top down conspiracy. In reality it's several separate actors with aligned incentives that create unnecessary headwinds to the adoption of cost saving medical advances

To pretend that there aren't groups who will work to delay and limit the rollout of industry shattering technology like this is naive at best.

Re: Can an artificial kidney finally free patients from dialysis?

#76

Post by jacquesm »

esotericsean wrote: post #13

This probably isn't a viable solution for my father who has been on dialysis for 2 years and is in ESRD. I am a candidate for a kidney transplant for him (I went through the whole process), but he has other issues that have been preventing him from having another surgery. I'm pretty scared to do the procedure, too. But really glad to see progress being made here. Hopefully, also, the world works toward improving diet…

I've looked at this from a fathers perspective and have made the decision that no matter how much my kids may be a good match I would never want to be a donor recipient from them. That short-circuits a lot of ethical dilemmas around such a decision and making that decision well before it would ever come into play makes it a lot easier. My eldest one day said he'd gladly give up a kidney for me and it caused me to think about that at a time when it wasn't even on the horizon (fortunately it still isn't). That doesn't mean I do not appreciate the sentiment (and that I think you are tremendously brave) but it wouldn't sit right with me as a parent.

A big part of that is that they would be giving up something that they may very well need later in life and I may be condemning them to a reduced quality of life at some point in the future (possibly long after I've passed away but that doesn't really matter). Another part is that I don't want to see my children in any way diminished or at risk because of me, they're not 'spare parts'. On the reverse I would do in a heartbeat. These are tricky problems.

Re: Can an artificial kidney finally free patients from dialysis?

#77

Post by skissane »

shkkmo wrote: post #75
skissane wrote: post #71

Earlier quoted context omitted.

> This is medicine. You cant just compete, the Nephrology Board has to approve these standards of practice The “Nephrology Board” is only one country. Even supposing US medical institutions decided to block a treatment being developed in the US, they have no authority to stop its development in other countries. If it was seen to be working in other countries, they’d find it very hard to justify refusing to allow it i…

You say this as if the only way this happens is through a big top down conspiracy. In reality it's several separate actors with aligned incentives that create unnecessary headwinds to the adoption of cost saving medical advances To pretend that there aren't groups who will work to delay and limit the rollout of industry shattering technology like this is naive at best.

> You say this as if the only way this happens is through a big top down conspiracy. In reality it's several separate actors with aligned incentives that create unnecessary headwinds to the adoption of cost saving medical advances

I didn’t intend my comment as saying anything about whether this suggested phenomenon is “top-down” or “bottom-up”. I think my two counterarguments-“other countries exist” and “contrary to collective political self-interest” have about as much force in either case.

> To pretend that there aren't groups who will work to delay and limit the rollout of industry shattering technology like this is naive at best.

I never claimed such groups don’t exist - I’m sure there are some individuals and groups who (consciously or not) possess the agenda you describe. The real question is whether they will succeed in achieving that goal-I’m sceptical they will make any significant difference to whether or when these advances are achieved

Re: Can an artificial kidney finally free patients from dialysis?

#78

Post by kelnos »

hotstickyballs wrote: post #63
DennisP wrote: post #40

Earlier quoted context omitted.

The article says it "does not trigger the recipient’s immune system to go on the attack." I've read elsewhere that the biological stuff inside is sealed off from the immune system.

It’s pretty hard to seal off the kidney from the immune system since the immune system is in the blood and kidneys filter blood

And yet, they seem to have accomplished this, in pigs at least.

Re: Can an artificial kidney finally free patients from dialysis?

#79

Post by kelnos »

ma55ypi3 wrote: post #16

Will this be abused whereby peoples are coerced into trading their kidney for an artificial one for a price?

Why would that be desirable, though? The artificial kidney would likely be superior just because it doesn't require immune-suppressant drugs. I don't think there'd be much of a market for that sketchily-obtained real kidney.

Re: Can an artificial kidney finally free patients from dialysis?

#80

Post by SamoyedFurFluff »

brokenmeds wrote: post #68
DennisP wrote: post #41

Earlier quoted context omitted.

On the other hand, the government spends a huge amount on dialysis. Medicare pays for it regardless of your age. Removing the need for dialysis simplifies life for politicians by putting off the day they need to raise taxes or cut Medicare services. Dialysis is also a lot crappier than this would be. My mom was on dialysis and quality of life is not great. Neither is the expected lifespan. Free markets have their fla…

>> Free markets have their flaws but their big advantage is competition. Medicine is not a "free market", it is tightly controlled. The standards of care are determined by doctors. Doctors also happen to control the supply of care and hence the price of care. Doctors also happen to rake in money doing all this. You cannot just release a medical device or medicine like you release code into github.

Doctors do not go generally into medicine the way devs go into startups. It’s a generally garbage approach if your goal is to make money, nephrology included. Doctors generally want better patient outcomes and better patient lives but are too squeezed by insurance, student debt, and other bullshit.

You can bet your ass that if there’s a transplant that radically improves outcomes, nephrology will be all for it. It’s extremely frustrating and deeply demoralizing to tell someone they will need to be on dialysis, which you know all the nuances of the suckitude of, a task nephrologists need to do more and more often as Americans age with worse health due to lifestyle issues.

I don’t doubt there won’t be a minority of doctors who are just money grubbing but the vast majority of doctors would rather be able to say, “hey, I have a solution for you which relieves you from the permanent life quality burden of dialysis”.

Post reply on HN