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April 15, 1974

Chronic Dialysis and the Tower of Babel

JAMA. 1974;228(3):317-318. doi:10.1001/jama.1974.03230280019022

FROM the earliest days of chronic dialysis (1960), the problem that would not go away was lack of beds and money. The formation of "life or death" committees who chose patients to be treated or rejected was one result. Quotas on the number of indigent patients to be treated was another. The word "indigent" had a very special meaning in dealing with treatment programs that cost up to $25,000 per year, per patient.

Americans customarily deal with important issues by passing 50 sets of laws. Thus, chronic dialysis joined some strange bedfellows such as divorce, gambling, and alcohol in that it became a matter of great importance as to which state of the union you chose in which to become uremic: New York, California, and Illinois were good places to lose your kidney function.

A great many nephrologists worked long and hard to achieve support for all who needed dialysis.