Who is John Galt?
Greetings, Acumen blog readers. I hope each of you are navigating the many challenges we face today as best as can be expected. In close to a decade of writing this blog, I don’t recall ever starting with a question, particularly not a question like this. For those of you not familiar, “Who is John Galt?” is the opening line in Ayn Rand’s most famous work, Atlas Shrugged. In her novel, Rand weaves a tale about a dystopian society where productive and profitable private companies are continuously assaulted by government organizations and bureaucracies until they ultimately just walk away. Atlas shrugs and the world comes tumbling down.
I was reminded of this fiction when I came across yet another misguided comment recently published in the Journal of the American Society of Nephrology (JASN). The Acumen blog is no stranger to comments from academia throwing dialysis organizations and their colleagues under the bus. In fact, one of our most widely read posts addressed one such unfounded criticism from academia. While it’s easy to sit on one’s hands and ignore these issues, every once in a while, a response is in order. But where to start? There are so many misleading statements in this perspective, it will be tough to tackle in a single blog post.
The 2-page “perspective” published in the recent issue of JASN is entitled, “A Modest Proposal to Spur Innovation in Chronic Dialysis Care.” The author proposes what amounts to a tax on for-profit dialysis companies to fund research. I call this a tax as the proposal is aimed squarely at the profit status of the company. The author attempts to form an analogy between this tax and the funding mechanism for the ESRD network, which is applied to all dialysis providers. Perhaps his focus on for-profit companies is a nod to the author’s employer?
Of additional interest is how quickly this moves from innovation to funding research. As a member of academic medicine, I suspect the author is quite familiar with the challenges involved with grant writing and the constant treadmill necessary to keep one’s lab open. Taxing successful for-profit companies to keep the lights on in what may well be an inefficient lab operation sounds like a splendid idea, no?
In this perspective, the author tosses around some large dollar figures regarding the combined profits of the two largest dialysis organizations, and then he states, “but their annual reports hardly note research expenditures.” Interesting. A Google search and about 60 seconds of effort allowed me to learn that the large dialysis organization that I work for spent $168 million Euros on research and development last year. I don’t know about you, but that sounds like a very big number to me. And of course, those are only the funds reported in our annual report. The substantial amount of research we sponsor and fund in other ways is rarely publicly recognized, but I suspect those funds would certainly disappear if we were subject to the proposed tax. And unlike most academic institutions, for-profit dialysis companies pay millions of dollars in tax today, some of which is ultimately allocated to the NIH.
Then there is this quote, “Dialysis provider charitable activities are typically directed at maintaining goodwill for affiliated physicians and patients with little or no application to research that could improve care and quality of life for those patients or all patients with chronic kidney failure.” The subtle accusations that lie in this perspective are mind boggling. The author is clearly not familiar with the fine work the Fresenius Medical Care Foundation has performed. To date the foundation has donated almost $2 million to advance several transplant-facing organizations. And let’s not forget the $10 million Ben Lipps Research Endowment, which has successfully supported a number of renal-related research inquiries in the past and continues to do so today.
But I cannot stop there. As a clear example of the author’s lack of connection with what is happening in dialysis clinics across the country, there’s this:
“Currently, dialysis care in centers is virtually industrialized; if certain bath compositions benefited certain patients, then individualizing them would confound the smooth running of such units. Indeed, dialysis care must be one of the least ‘personalized‘ sectors of current health care.” The sodium, potassium, bicarbonate, and calcium are easily adjusted to meet individual patient needs without “confounding” the operations of the unit. And anyone who has spent time on a dialysis treatment floor would immediately recognize compassionate, dedicated care teams that provide highly personalized care—and they do so bravely in the midst of a global pandemic.
At the end of the day, all of us believe the prevention, diagnosis, and treatment of renal disease would benefit from innovation, as would every other aspect of medical care. Taxing profitable companies as a means to fund academic research labs is not the solution. What we need is meaningful policy change. Until someone has the courage to make the necessary changes in health care policy, we will remain in catch up mode.
So, who is John Galt? Look around and you will see him everywhere. Let’s hope Atlas never has to shrug.
Terry Ketchersid, MD, MBA, practiced nephrology for 15 years before spending the past seven years at Acumen focused on the Health IT needs of nephrologists. He currently holds the position of Chief Medical Officer for the Integrated Care Group at Fresenius Medical Care North America where he leverages his passion for Health IT to problem solve the coordination of care for the complex patient population served by the enterprise.
Image from canstockphoto.com.