Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?

How good are we doctors in conveying the concept of risk to our patients and our community?

I recently met someone who donated a kidney to a person who was not a relative. My impression was that the recipient was previously a stranger, but I did not press that issue. I was overwhelmed by the staggering generosity of that gift. I am embarrassed to say that I do not know how I would respond if I were asked to donate.

Shortly afterwards in the impossibly large volume of medical journals that crosses the desk of even a retired physician, and proving the hypothesis that a person only sees what they are prepared to find, I noticed a research paper estimating the risk of kidney failure in a donor following the removal of one of the normal pair. The risk does not appear to be zero. I want to use that paper as a base to continue writing about conveying the results of medical studies and of risk to the public.

Why did Mother Nature Give Us Two Kidneys?
In medical school, and in common public wisdom, it is universally recited that we only need one of our two kidneys to live. That is true. As it happens though, there is little or no information about whether we would live as long or as well! It is known that as people age, there is an expected gradual decline in kidney function. It happens sooner and faster in people with hypertension, diabetes, and so on. It is reasonable to speculate that if starting out from a half-normal position, that a single remaining kidney might run out of steam sooner without it’s helpmate. The best way to definitively settle the matter would be to randomly divide in half a group of people who had committed to donate, only allow one group to do so, and then follow the lives of both groups to see if the donors develop kidney failure more frequently than the donor wanna-bees. I do not see that experiment happening, but the information would be relevant to a person deciding whether or not to donate. Continue reading “Does Donating a Kidney Increase the Risk of Kidney Failure For a Living Donor?”

How Much Information Is There In Informed Consent at UofL?

A Retraction.research-man

Is informed consent being censored?

I take some pride that I have not, until now, had to retract anything of factual substance that I have written in these pages despite the fact that I have always invited others to offer corrections or to point out misinterpretations. I freely admit to offering a healthy amount of speculation about matters that turned out otherwise. However, I always identify speculation as such and do so in the interest of bringing a variety of issues into the arena of public discussion. However, I must now retract my earlier article congratulating KentuckyOne Health and the Catholic Church for joining the 21st century with respect to their apparent changing views on justified contraception and termination of pregnancy. I was wrong.

Continue reading “How Much Information Is There In Informed Consent at UofL?”

KentuckyOne Health Confronts Legitimate Role of Contraception and Abortion in Healthcare.

Catholic Church enters 20th century on reproductive health by passively accepting justifiability of contraception and abortion in its institutions.

See Partial Retraction

Background.
The Roman Catholic Church, Catholic Health Initiatives (CHI), and KentuckyOne Health (KOH) most certainly had only an incomplete understanding of what they were getting into when they assumed management earlier this year of a secular University of Louisville Hospital and also effective control of the academic medical practices of the University’s faculty and trainees. These religious organizations must now also learn how to deal with contemporary academic research standards. KentuckyOne is promoting its intention to participate in the University’s clinical research enterprise. Indeed, Jewish Hospital has been doing so for many years. Increasing clinical research is also a prominent part of the UofL’s commercial research enterprise.

As Catholic organizations, CHI and KentuckyOne expect University employees, physicians, trainees, and patients to accept its religious tenants with respect to medical care. Indeed, trainees are now required to attest that they have received training about those religious directives. I suspect these faith-based organizations were unaware of the extent to which the Church itself was going to have to, in turn, confront and modify some of its traditional dogma in order to participate in the clinical practices and research of a modern, science-based University and Medical School. By entering the contemporary world of research; CHI, KentuckyOne, and their supervising Catholic Church have tacitly acquiesced to the reality that contraception and abortion are integral to scientific and medical standards of honest and ethical clinical research. Even if unintended, this is a break-through of historic proportions in the history of religion. I congratulate the Catholic Church for allowing its medical mission to enter the 21st Century. Allow me to explain how the Church is being forced to confront and partially alter its previously sacrosanct medieval dogma. Continue reading “KentuckyOne Health Confronts Legitimate Role of Contraception and Abortion in Healthcare.”

Why Do We Physicians Still Practice So Much Ineffective Medicine?

How Not to Treat Idiopathic Pulmonary Fibrosis.

One of the first things I wrote about on these pages was the importance of having good evidence backing up what we doctors do to people, and how commercial editorial policies of medical journals have at least the potential of denying doctors and their patients timely knowledge of information that might inform their medical choices. I thought of that article again when I looked at one of the several email news summaries I get from various organizations.

One of the highlighted items that caught my eye was a report that “Combination therapy for pulmonary fibrosis appears to increase risk of death [and] hospitalization.” Several of the diseases I used to treat included pulmonary fibrosis and were notoriously difficult to manage. I clicked the “More…” button and was led to this week’s New England Journal of Medicine. The article provides a stunning example of how we physicians still allow ourselves to be led down the garden path of ineffective medical care. Continue reading “Why Do We Physicians Still Practice So Much Ineffective Medicine?”