Friday, October 29, 2010

Iatrogenic Problems in End-Stage Renal Failure

In Section 5.7 of the 4th edition of Intermediate Physics for Medicine and Biology, where Russ Hobbie and I discuss the artificial kidney, we say
The artificial kidney provides an example of the use of the transport equations to solve an engineering problem… The reader should also be aware that this “high-technology” solution to the problem of chronic renal disease is not an entirely satisfactory one. It is expensive and uncomfortable and leads to degenerative changes in the skeleton and severe atherosclerosis

The alternative treatment, a transplant, has it own problems, related primarily to the immunosuppressive therapy. Anyone who is going to be involved in biomedical engineering or in the treatment of patients with chronic disease should read the account by Calland (1972), a physician with chronic renal failure who had both chronic dialysis and several transplants.
The paper by Chad Calland, in the New England Journal of Medicine (“Iatrogenic Problems in End-Stage Renal Failure,” Volume 287, Pages 334–336, 1972), was published on the same day that Calland took his own life. Wikipedia defines “iatrogenic” as “inadvertent adverse effects or complications caused by or resulting from medical treatment or advice.” It is a problem we must constantly be aware of as we seek to improve medical care through technology. Calland wrote
The physician is more often a voyeur than a partaker in human suffering. I am a physician who has undergone chronic renal failure, dialysis and multiple transplants. As a physician-partaker, I am distressed by the controversial dialogue that separates the nephrologist from the transplant surgeon, so that, in the end, it is the patient who is given short shrift. I have observed that both nephrologist and transplant surgeon work alone in their own separate fields, and that the patient becomes lost in a morass of professional role playing and physician self-justification. As legitimate as their altruistic but differing opinions may be, the nephrologist and the transplant surgeon must work together for the patient, so that therapy is tailored to suit the individual patient, his circumstances, his needs and the quality of his life.

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