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wierdscience
08-07-2008, 11:34 PM
http://www.dailymail.co.uk/news/article-1041430/Doctor-saves-babys-life-making-homemade-kidney-dialysis-machine.html


Helluva good idea!:)

torker
08-07-2008, 11:48 PM
Geez. Darin.. I thought you meant you! A few days after I broke my ribs.. I DID go to the doc. SHE...chewed me out also. Took a whack of pics to see if I'd punctured my liver. I guess I was pretty lucky by the sounds of it.
Thanks hey!

ptjw7uk
08-08-2008, 04:56 AM
Nice to hear that DIY is not dead in Uk, only hope his garage was cleaner than mine!
Are you better now Torker!
Havent had many posts from you laetely!

peter

Evan
08-08-2008, 05:47 AM
A touching story. Very inventive doctor. This of course appears to represent the best possible outcome. Unfortunately the National Health Service is forced to make choices that result in placing a price on human life, it's unavoidable.

In the case of infants with severe liver disease the resulting buildup of toxins (conjugated bilirubin) commonly results in serious brain damage. This is not an unusual outcome, it is the nearly inevitable outcome if the baby is somehow saved. The child in this story may yet face some serious problems.

Using the good doctor's invention to save potentially thousands of brain damaged infants is misguided at the least and will, in the cold light of limited resources, deny treatment for others that could better benefit by it.

JCHannum
08-08-2008, 08:06 AM
Aside from the question of whether the Government should decide which infants should live and which should die, there is a basic difference between the liver and the kidneys.

Methinks you are off base on both accounts.

oldtiffie
08-08-2008, 08:27 AM
Let's keep the machine and emotive issues seperate.

Moral and ethics issues can be debated or decided elsewhere.

Lets just deal with and stay with the concept and manufacture of the machine.

Evan
08-08-2008, 09:01 AM
Aside from the question of whether the Government should decide which infants should live and which should die, there is a basic difference between the liver and the kidneys.

Methinks you are off base on both accounts.

Acute renal failure in an infant is accompanied by hepatic failure. The liver is also responsible for processing bilirubin. In this case especially the entero-hepatic circulation was obviously impaired because of the birth defect. Hepatic distress was a given especially considering that hepatic stress occurs in all newborns as they switch to the adult hemoglobin form to process oxygen from air.

As for the government deciding who lives and dies, there are only two other options. Treat everyone under all circumstances at a cost that is unaffordable by the taxpayer or treat no one. Triage is an established part of medicine and reflects the inevitable necessity of distributing limited resources in a manner that provides the greatest benefit.

JCHannum
08-08-2008, 10:25 AM
In this case, it was not an infant with renal failure at birth, but later in development following another life saving procedure. In any case, treatment of renal failure before it leads to hepatic failure could potentially save many infants who would otherwise die or suffer serious side effects. Developing the means to provide this is called medical progress.

Triage is used in disaster situations, to decide who receives treatment first, not the government deciding who should live or die based on economics.

Evan
08-08-2008, 11:37 AM
Triage is used in disaster situations, to decide who receives treatment first, not the government deciding who should live or die based on economics.



Hospital triage systems in the United States

For a typical inpatient hospital triage system, a triage physician will either field requests for admission from the ER physician on patients needing admission or from physicians taking care of patients from other floors who can be transferred because they no longer need that level of care (i.e. intensive care unit patient is stable for the medical floor). This helps keep patients moving through the hospital in an efficient and effective manner.

This triage position is often done by a hospitalist. A major factor contributing to the triage decision is available hospital bed space. The triage hospitalist must determine, in conjunction with a hospital's "bed control" and admitting team, what beds are available for optimal utilization of resources in order to provide safe care to all patients. A typical surgical team will have their own system of triage for trauma and general surgery patients. This is also true for neurology and neurosurgical services.

The overall goal of triage, in this system, is to both determine if a patient is appropriate for a given level of care and to ensure that hospital resources are utilized effectively.
http://en.wikipedia.org/wiki/Triage


In any case, treatment of renal failure before it leads to hepatic failure ...

The two conditions are usually concomitant (in infants).

JCHannum
08-08-2008, 12:02 PM
Triage in that context is vastly different than what is being discussed, but it is nonetheless based on facilities available, not taxpayer's dollars.

A good example of governmental driven triage is that same Tiffiepedia link under Triage in North Korea, where food was allocated to the military and high officials and denied to the population who were left to "scrounge for food or die."

While renal failure may, in some cases, lead to hepatic failure, they do not necessarily occur together, and the potential for these problems often can be diagnosed well before birth, which is when the problem becomes manifested. In those cases, early treatment will be quite effective in reducing or eliminating future problems.

mwechtal
08-08-2008, 12:15 PM
Regardless of if any random baby would be a good candidate for the procedure:

1) This doctor whacked the machine together pretty fast, and it worked.
2) There must be many situations where babies are a good candidate, and "gee we don't have a machine that small" is NOT a good excuse.
3) Let's see if we can get him to write an article for HSM!

Evan
08-08-2008, 01:56 PM
Triage in that context is vastly different than what is being discussed,

No, triage in that context is exactly what is being discussed. Government health systems depend on the taxpayer to fund health care. Those funds are not unlimited. The NHS made a decision based on likelihood of survival and the cost of providing care. That is triage.


While renal failure may, in some cases, lead to hepatic failure

Once again, they are are normally concomitant. That means they occur together. Infants have trouble processing bilirubin as soon as they are born which results in jaundice caused by the liver being put under sudden stress. Add to that the stress of the operation and especially the anesthetics used and the liver was under even greater stress. Most likely this contributed to the renal failure as well as the requirement to process the anesthetic chemical and the at best poor functioning intestines.

At any rate, infants that require dialysis immediately after birth and have a similar history of surgical intervention and birth defects are poor candidates for expensive and possibly very prolonged interventions. Apparently the NHS agrees.

heidad01
08-08-2008, 01:58 PM
One thing at a time. All medical inventions are experimantal and always questioned at first as to if this or that makes it worthwhile or justified. We fix this one now and a few years or months (hopefully) later we will have the solution to another part of the problem. I do not know about NHS or what that is, but I do beleive that the entire world is indebted to people like this Dr for doing what they do.
As to wheather it was right to save that little girl's life knowing the possibility of future problems, You go and ask her mother!! Think about her as your own baby, and then think again. DavidH.

Evan
08-08-2008, 02:01 PM
Ask her mother in a few years when it becomes clear whether the child has serious developmental problems.

Evan
08-08-2008, 02:10 PM
BTW, the linked article isn't telling the entire story. This rare birth defect is linked to the mothers use of alcohol, amphetamine and cocaine in particular as well as possible exposure to solvents.

JCHannum
08-08-2008, 02:15 PM
Ask her mother in a few years when it becomes clear whether the child has serious developmental problems.

I am sure the mother will be greatful that her child was saved. Ask any parent of a child with disability that question, and I have little doubt that the overwhelming response will be that it was worth whatever it took to save the child's life.

The NHS is the Canadian National Health Service, and has nothing to do with the US hospital triage system described. That system is how bed space is determined, and if not available, the patient may well be diverted or moved to another hospital, not turned out in the hall to expire.

heidad01
08-08-2008, 02:15 PM
According to the originally posted article and the opinion of the doctors, she is a fit and normal 2 year old child. DavidH.

Evan
08-08-2008, 02:24 PM
The NHS is the Canadian National Health Service, and has nothing to do with the US hospital triage system described. That system is how bed space is determined, and if not available, the patient may well be diverted or moved to another hospital, not turned out in the hall to expire.

No, it isn't. It's the UK National Health Service. We don't have a national health service, it's a provincial responsibility.

The mention of the availability of beds also determines the availability of treatment options in a hospital. This is apparently entirely outside of your expertise Jim. It most certainly isn't outside of mine. I am far too well acquainted with the medical system and with medicine than I wish to be.

The age of 2 isn't old enough to diagnose many developmental disorders. [edit] Especially those that result from brain damage.

pcarpenter
08-08-2008, 03:22 PM
BTW, the linked article isn't telling the entire story. This rare birth defect is linked to the mothers use of alcohol, amphetamine and cocaine in particular as well as possible exposure to solvents.


So this child should not be saved because you apparently have some intimate knowledge that the mom must have been a crack addict or sniffing glue? Mom was bad so baby must die...die evil baby die!:rolleyes: ????

I recall a similar discussion in that it involved the lives of the innocent and your position was that yard darts should be eliminated because someone's poor child might be killed or maimed because they don't follow their parent's instructions. Now we have a child that did nothing to deserve her condition (not even any disobedient behavior) and she should have been allowed to die rather than have this guy fabricate a machine? She is not dead, she is not even known to be developmentally disabled...you are just pretty sure she could be.

Any child *could* end up being developmentally disabled. What is the threshold (the percentage liklihood for developmental disability) among the population at large at which you would be willing to kill all children to prevent someone else developing a disability you don't think they should live with?

I am pretty practical, but I understand the value of human life, as it appears this doctor did, and I can't be cold enough to borrow trouble that does not even exist--and suggest that letting folks die is a good move.

To me, if this doctor invented a machine that may even be able to be made cheaply, he did a favor to the nations afflicted with socialized medicine. Perhaps fewer will be denied life saving medicine because governments run their healthcare systems.

Paul

MCS
08-08-2008, 03:45 PM
Maybe you're all making a bigger issue of it than it really is.

The doctor sees a problem as it presented. A child is ill.

He grabs a few things from the laboratory and turns them into a miniature machine. As nobody knows anymore how things are made, he is an instant hero.

Which he is, off course. He sees a problem, he fixes it with thinking outside of his box and comes out with a working fix.

So he is not part off this world, where ignorance is wisdom, where shaking off responsibilities is normal behaviour.

You all, we, are all slapping and stalling the problem with circumstantial evidence.

Some people act.

kap pullen
08-08-2008, 03:50 PM
Well heck Paul,

These libs want to kill babies for the
convenience of the mother, born or not!

What's better than some half cocked
excuse to finish the job.

And we need "CHANGE", for change's sake in
our health care system?

Kap

macona
08-08-2008, 04:02 PM
I think the issue of NHS deciding not to use a dialysis machine on the infant was a technical issue. A dialysis machine takes about 1 pint of blood out of the body through the extracorporeal circuit during the procedure, I would think this is most of the blood in an infant that small and probably would kill it. What the doctor did, i think, it make a smaller machine that dosnt pull out so much blood.

Dialysis machines are pretty simple, I got to take one apart for the goodies recently (All bodily fluids are external of the machine.)

bruto
08-08-2008, 04:12 PM
It's not made clear in the article whether the unavailability of the machine was due solely to NH policy or because such a machine simply didn't exist or could not be obtained at all. Without a little background to insure that we're not dealing with sloppy reportage, we should probably not jump to too many conclusions, except for the obvious one: that's one helluva doctor and one lucky little girl!

pcarpenter
08-08-2008, 04:54 PM
I am certainly in agreement with these statements. I am having a problem with Evan's assumptions.

1. There's a good chance that this girl will be developmentally disabled and therefore perhaps should have been allowed to die.

2. That a great doctor like this, took the initiatave to save a life and perhaps develop something that will save more. Evan's view on this would appear to be that saving the lives of those who may not end up as sharp as he is is somehow a waste of resources in a nation with socialized medicine. I see the root of the problem as having socialized medicine in the first place.

How many of the rest of us make stuff in our shops that so very clearly saved a life? That ought to have been what came out of this...I am astounded at some of the statements that followed.

To me, folks who are willing to let someone die because that someone will have a disability or live a life that does not meet their standards are right up with the kind of peole who torture small animals. Lack of respect for life comes in lots of forms but its still the same line of thinking. In this case, Evan seemed to be implying that she should have been allowed to die because she *might* be developmentally disabled...something that no one knows yet. So far its an assumption based on Evan's Kmart medical degree. If being developmentally disabled is so awful, then why don't we just kill all the retarded folks as the Nazis did? Anyone who didn't fit their mold was treated as less than human. If disabled people are so sub-human as to not merit care then why not just be clear about one's position?

I am concerned for our future and its this sort of statement that leads me there.

Paul

MCS
08-08-2008, 05:37 PM
The doctor acted in true spirit of his Hippocrates oath.

He saved a life. Once you go into the discussion if a life is worth saving, you are moving to an undefendable position.

Then everything can be held against you, then everybody can be sentenced, the moment he/she needs urgent medical attention, for habits and latent diseases.

The discussion can be extended to a point where you don't need emergency care anymore, because emergencies are Darwinistic in nature.

Every life is a life, even mine.

Evan
08-08-2008, 06:33 PM
There's a good chance that this girl will be developmentally disabled and therefore perhaps should have been allowed to die.

That unfortunately is the way the health care system works. It doesn't mean I agree with it but it is how it MUST be. We don't have a choice.

Now, let this sentence be rephrased slightly:

There's a good chance that this girl will be developmentally disabled and therefore cost the health care system tens of thousands of dollars that could have been used to save many other lives.

That is how the health care system decision makers must view the issue as they cannot fund every technical procedure for every patient that could benefit from it. Modern technology has produced some amazing medical miracles but along with that have been some astonishing costs for those miracles.

All the appeals such as "you can't put a price on a life" are seriously ignoring the real issue which is exactly that must be done and is done daily. There is no other option and ignoring that fact serves no good purpose.


The discussion can be extended to a point where you don't need emergency care anymore, because emergencies are Darwinistic in nature.

That is the classic "slippery slope" argument. There is no justification for thinking it to be the case.


He saved a life. Once you go into the discussion if a life is worth saving, you are moving to an undefendable position.

That isn't the question though. The question is "Can we afford to save this life?" Not "Is this life worth saving?".

Evan
08-08-2008, 06:40 PM
I recall a similar discussion in that it involved the lives of the innocent and your position was that yard darts should be eliminated because someone's poor child might be killed or maimed because they don't follow their parent's instructions.

I never took a position on that. The position I defended was the right to ban certain products that are proven dangerous to the public.

sconisbee
08-08-2008, 07:16 PM
I find some of the comments here shocking, but at least the large majority does see sense. It is plain to see that it wasnt a financial choice made by the NHS that said we cant give her dialysis, it was the fact that no machines exist or available to provide the treatment hence why one was made. As for it being a monetary thing the NHS whilst it has its faults strives to treat everyone regardless of past history or disability. it is staffed by the most devoted people one can think of and they have to put up with an immense amount of pressure from all directions. The fact this doctor went above and beyond the call of duty is outstanding and he deserves as much praise as is possible. Just because a baby grows up disabled does not mean they have no right to treatment and very rarely means that "other" people don't get treated thats not how priority is done here it is all based on case by case basis, triage is done in our hospitals to determin best course of action and which department or hospital is best to treat the problem in hand it is not there to decide who lives who dies, that is the difference between disaster triage and every day triage. No single person other than the parent can take the choice as to whether their child gets treated or not and the NHS always does its best to provide the care needed even if it means paying *alot* out to private facility's and hospitals to get said treatment and this happens very often over here.

I find Evans comment about "ask the mother 5 years from now" to see her point of view on things and even though the child maybe severely handicapped i almost garuntee that she will still say that she would not have done anything different if she had the time over again.

Its easy to look back and say oh well we should have let that person die to save this one... but that is not how things work. Belittle me all you like but i have been around the NHS and its workers long enough to know just what they have to put up with and I would not be here today if it was not for the NHS and its staff striving to treat everyone equally.

So to those who are looking at the doctors actions and thinking it might not have been for the best or not financially sound etc then you have some issues. ALL life has value and merit and a childs life always should be viewed to be saved as they are truly the only innocent and unprotected of us all.

So on a last note Good on you Doc for thinking outside the box and providing a new avenue for treatment.


Edit: The device is still in use saving as many baby's as is possible with similar problems to the girl from the article, if it was a case of "Can we afford to save this life?" said device would not still be in use simple as that.

Second Edit: the times goes into more detail here in a related article http://women.timesonline.co.uk/tol/life_and_style/women/body_and_soul/article4485140.ece

Evan
08-08-2008, 07:47 PM
So to those who are looking at the doctors actions and thinking it might not have been for the best or not financially sound etc then you have some issues. ALL life has value and merit and a childs life always should be viewed to be saved as they are truly the only innocent and unprotected of us all.

That isn't the issue and isn't in question. Statements like that are deflecting attention from the real issue: How to best distribute limited resources.

As for the machine the doctor assembled, it can't have been too difficult or unobvious. He only had a very short time to do it (measured in hours) so I would guess that he simply took off the shelf parts and fitted it with smaller more appropriately sized tubing etc. He is not the only person involved in the design and use of dialysis units and I am sure the matter has come up frequently in the past. Clearly a decision had already been made previously not to pursue this line of development. The reason for such a decision would be cost effectiveness, like it or not.


A dialysis machine which takes blood from the body, filters it and then returns it, was unavailable on the NHS for children under a certain weight

That is clearly a decision made in advance not to provide such a service.

sconisbee
08-08-2008, 07:56 PM
well how can one argue against a mind reader like yourself Evan. A statement like "That is clearly a decision made in advance not to provide such a service." is your opinion so its not clear, if it is so clear then state your sources and evidence. Had it been a prior decision trust me there would have been a whole lot more uproar about the lack of machines on the NHS cause of said decision. that and the way you talk your sounding like you think everything thats ever been thought of has been done already so why bother doing anything more.

Just because it hasn't been done before doesn't mean that it was a choice not to do it. I mean come on thats like the wright brothers saying "oh well nobody's flown before, we better not try it as theres obviously a reason why we cant" Advancements arent always obvious and its possible that the two people that designed the micro machine had been working on a design before hand and its also possible that they simply had an idea that nobody else did. thats how life works.

So state your proof of decision making on this machine.

JCHannum
08-08-2008, 08:17 PM
This is apparently entirely outside of your expertise Jim. It most certainly isn't outside of mine.

You are in no position to judge my expertise in this, or any matter. As a matter of fact, it is entirely within my expertise and educational background as well as my personal experience.

The original birth defect can be caused by drug usage, but it can also be caused by several other problems during the pregnancy which are not the fault of the parents. It is also a congenital defect, it can be inherited.

A dialysis machine was not used by the NHS, because none was available in the small size required for babies of this weight. The good doctor fabricated a smaller unit which was used to good effect to save the child. The technology, undoubtably will be used to save many more lives, and he is to be applauded for his efforts.

It is unfortunate that you feel that the saving of human life comes down to a dollar and cents evaluation. Mankind can rejoice that you chose to go into Xerox service rather than medicine or politics with that set of values.

Evan
08-08-2008, 08:22 PM
The proof is simple. The machine and techniques have been available for over 25 years.



Clinical Pediatrics, Vol. 21, No. 3, 166-169 (1982)
DOI: 10.1177/000992288202100306
© 1982 SAGE Publications
Successful Peritoneal Dialysis in an Infant Weighing Less Than 800 Grams
Keith S. Kanarek

Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida

Edward Root

Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida

Richard A. Sidebottom

Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida

Paul R. Williams

Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida

This paper describes the technical feasibility and successful outcome of peri toneal dialysis in the management of a 710-gram, 25-week-gestation infant.



It is unfortunate that you feel that the saving of human life comes down to a dollar and cents evaluation. Mankind can rejoice that you chose to go into Xerox service rather than medicine or politics with that set of values.

They aren't my values. They are reality in the medical system.

This is a case of shoot the messenger because you don't like the message.

sconisbee
08-08-2008, 08:53 PM
considering that your proof is of Peritoneal Dialysis said proof is rendered null and void as Dr Coulthard's machine is for Haemodialysis which is totally different.

http://www.journallive.co.uk/north-east-news/todays-news/2008/08/04/mum-wants-daughter-s-life-saver-to-go-on-nhs-61634-21458997/

JCHannum
08-08-2008, 09:05 PM
They aren't my values. They are reality in the medical system.

This is a case of shoot the messenger because you don't like the message.
They are not yet the reality of the medical system in this country. They are unfortunately becoming the reality in countries that have socialized medicine because people like yourself are willing to accept them.

Evan
08-08-2008, 09:08 PM
It serves the same purpose. There are numerous references to various dialysis techniques for newborns including very low birth weight newborns that far predate this story. Also, at birth weight of 6 lbs 2 oz the girl in this story was not a very low birth weight newborn and conventional dialysis would have been available had it not been against policy.

sconisbee
08-08-2008, 09:13 PM
It serves the same purpose. There are numerous reference to various dialysis techniques for newborns including very low birth weight newborns that far predate this story. Also, at birth weight of 6 lbs 2 oz the girl in this story was not a very low birth weight newborn and conventional dialysis would have been available has it not been against policy.


hmmm so when were you appointed as policy making staff in the NHS? i mean you have yet to prove that it is in-fact policy not to offer conventional dialysis to an infant that young. and it doesn't serve the same purpose because the two types of dialysis is totally different and has different risks and techniques. I have yet to see you produce evidence of NHS policy on this.

If the NHS policy was to place a dollar value on any life including infants then i would be paying for the medication i receive to stay alive as would my sister, but alas we are not.

Evan
08-08-2008, 09:16 PM
They are not yet the reality of the medical system in this country. They are unfortunately becoming the reality in countries that have socialized medicine because people like yourself are willing to accept them.

No, it isn't the same in the US. You can have the best care money can buy if you pass the credit check.

I certainly don't accept the limitations of our health care system. I have two significant medical conditions that went undiagnosed by the doctors for years despite numerous tests and visits to specialists as well as several hospitalizations. I finally made a concerted effort to educate myself in the related fields and then proceeded to conduct my own testing and trials to narrow the possibilities. In both conditions I correctly diagnosed what my medical issues were and that was later confirmed by the doctors after I presented my evidence and conclusions. Also, the treatment that I currently take for fibromyalgia was researched and suggested by myself to my doctor and she agreed to my suggested course of action. It has been remarkably effective in the face of a condition with virtually no effective treatments.

oldtiffie
08-08-2008, 09:30 PM
This has devolved into an emotive issue with too much "polarisation", talking "AT" instead of "WITH" or "TO" each other, and people taking and defending intractable positions.

It has all the ear-marks of descending into "politics and religion" and associated issues.

It has been hi-jacked from a HSM issue - the machine and the development of it - so lets get back to and stay with the HSM issue/s.

Perhaps those that have "ethics" and "triage" issues might like to read these links as well as other relevant and/or informed/credible sources.

http://en.wikipedia.org/wiki/Ethics

http://en.wikipedia.org/wiki/Ethicist

http://en.wikipedia.org/wiki/Triage

Evan
08-08-2008, 09:43 PM
Abstract


In the United Kingdom and as in all other countries, health care professionals ration access to diagnosis and treatment. Throughout its history there has been a reluctance to acknowledge the existence, let alone the nature of rationing processes and public opinion about them. Several health policy reforms are discussed with reference to their approach to dealing with the scarcity of health care resources. Data taken form the 1998 Eurobarometer Survey are analysed to examine public opinion regarding rationing issues, such as funding for health care, the need to set limits in health coverage, the role of stakeholders in setting priorities, and the use of age, and other factors, as a criteria for setting priorities.

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V8X-3YC0FJ2-3&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_version=1&_urlVersion=0&_userid=10&md5=300c285f395331442bd1170d2360d762


Clearly a budgetary issue:


Value for Money Delivery Agreement 2008 to 2011
This document sets out the Department of Healthís agreement with HM Treasury on how*it expects to support delivery of the Value for Money requirements of the 2007 Comprehensive Spending Review.**It continues to build on the progress made as part of the Gershon efficiency programme. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_081547


And this:

http://www3.telus.net/metalshopborealis/uknhs.jpg

Evan
08-08-2008, 09:51 PM
It has been hi-jacked from a HSM issue - the machine and the development of it - so lets get back to and stay with the HSM issue/s.

There isn't likely any machining in the machine done by the good doctor. It is composed of a standard neonatal dialysis unit with modifications according to various sources. It has virtually nothing to do with home shop machining in the first place.

JCHannum
08-08-2008, 09:55 PM
No, it isn't the same in the US. You can have the best care money can buy if you pass the credit check.

Not the case. You can walk into any emergency room in any hospital in the US and you must be treated. It is the law.

Evan
08-08-2008, 10:08 PM
Not the case. You can walk into any emergency room in any hospital in the US and you must be treated. It is the law.

Only for emergent conditions such as a heart attack or stroke, trauma etc. Even then the treatment may have options where a more expensive option exists. You won't be getting that unless you can afford it. You won't be treated if you walk in with a chronic condition that isn't immediately life threatening unless you pick a public hospital.

JCHannum
08-09-2008, 06:22 AM
Emergency rooms are more and more being used as the number of primary care physicians decline. In many cases, if you try to contact your doctor in off hours, you are told by the answering service to go to the ER for attention. Any illness can be considered as emergent, headaches, colds and traumas such a hangnails are all reasons for emergency room treatment.

Laws regarding reducing length of stay in ERs before treatment are in part a reason for the type of triage desccribed in your Tiffiepedia link.

Rustybolt
08-09-2008, 09:02 AM
Cute kid. To drag this back ontrack; I'd like to see the detailed machine and hear his story, the dr.s on how he made it.

Hey! Alistair. Isn't your son a dr?

plastikosmd
08-09-2008, 09:08 AM
Lord Evan, I respect your HSM knowledge...but please stop with the "medical fact arguing" Google is wonderful but it only provides you with a snapshot of what you are looking for. I respect your research ability, like when you treated your ear infection but to sum up the issues as simply as you think you have...phew

Back to basics;
gastroschisis is often felt to be an absolute contraindication to PD
birthweight is not the issue when your peritoneum is not intact....now if the renal failure was post-surgical...phew maybe open the abdomen in hopes that the failure was secondary to intra-abdominal compartment pressure and hope to live to fight another day (and the child would most likely die, infection, metabolic issues with renal failure and massive fluid shifts with exposed bowel, bag or no bag..and the list goes on. As far as attempting PD post repair..shiver..Good luck stickin a PD cath into a tight abdomen with swollen bowel, there is no space..I would put your chances at 100% at cannulating the small bowel or something worse! Even if you did get in..I would question the exchange ability. Maybe it has been done, try googling it, most everything has...once...that is why a HD option is ideal. Regarding your renal failure argument....wow...not gonna even step into that one, you missed about 8 other more likely senarios and made one heck of an assumption......"when you hear hoofbeats think horses not zebras"

Evan
08-09-2008, 03:57 PM
gastroschisis is often felt to be an absolute contraindication to PD


I am aware of that. The point is that dialysis has been available in various forms for a very long time and more particularly that the Doctor in this story did not make some sort of discovery or novel leap forward. What he did do is buck the system to provide help for his patient and that is comendable by itself but there is a better than 50% chance at the beginning that it won't work and a high possibility of further problems, possibly severe, in the future.

Gastroschisis is associated (among other things) with the mother's exposure to teratogenic substances and there is a strong possibility of other problems existing. The mean IQ of those that survive treatment is a full 11 points below normal.

Some who have commented on the stance taken by the health service don't seem to be aware that the mother was twice offered an abortion according to the story. Obviously the NHS didn't think much of the chances of the baby surviving with a reasonable quality of life.

sconisbee
08-09-2008, 04:10 PM
Gastroschisis is associated (among other things) with the mother's exposure to teratogenic substances and there is a strong possibility of other problems existing. The mean IQ of those that survive treatment is a full 11 points below normal.

Some who have commented on the stance taken by the health service don't seem to be aware that the mother was twice offered an abortion according to the story. Obviously the NHS didn't think much of the chances of the baby surviving with a reasonable quality of life.

Fully aware that the mother was offered an abortion and its often an "option" however its often an option that is not taken. At least in this country most mothers to be wish to give their child a chance no matter what. So what if the kids mean IQ level is going to be 11 points below normal, besides define "normal". Just cause the kid might not be a genius doesn't mean that she has nothing to contribute to society, and so what if the kid has risk of further troubles and consequences later on in life shes been given a chance to live and to contribute to life as a whole even if she decides she wants to grow up as a road sweep, IQ isn't everything

JCHannum
08-09-2008, 04:50 PM
The cause of this particular infant's birth defect is not discussed, like many it could have been due to multiple reasons. Some people do prefer to have their babies rather than abort them. It is not a selective process like choosing a head of lettuce.

Once again, it is not a decision that some quasi-governmental organization has any right to make.

The device was made by the doctor some two years ago as those in the NHS system were too large. The device is still in use two years later, proof of it's effectiveness and the need for it.

http://news.bbc.co.uk/2/hi/health/7542404.stm

Gastroschisis does have a minimal association with use of teratogenic substances, which are aspirin and related analgesics, but the potential of lowered IQ scores is related to the substance use, not the gastroschisis, and even then it is not well substantiated.

http://depts.washington.edu/terisweb/teris/aspirin.htm

aboard_epsilon
08-09-2008, 04:57 PM
Fully aware that the mother was offered an abortion and its often an "option" however its often an option that is not taken. At least in this country most mothers to be wish to give their child a chance no matter what. So what if the kids mean IQ level is going to be 11 points below normal, besides define "normal". Just cause the kid might not be a genius doesn't mean that she has nothing to contribute to society, and so what if the kid has risk of further troubles and consequences later on in life shes been given a chance to live and to contribute to life as a whole even if she decides she wants to grow up as a road sweep, IQ isn't everything

yup, if every one was born clever ...you'd have no road sweepers...no trash collectors ...no car park attendants ...no super market shelf stacker's ...no chicken plucker's ..on and on etc ...because they would think of it as below their capabilities.

TOO THE REST ...
And the Americans lack of health service is not so brilliant as you make out ...
Not when, i read here about ...people super gluing their wounds together ...pulling their own teeth ...or letting them rot in their mouth.

all the best.markj

Swarf&Sparks
08-09-2008, 05:02 PM
My best wishes to mother and child (no father was mentioned in the article).

The Doctor is a balls-out HERO!

Why?
Because, in the face of increasing litigation in all fields, he chose to give em the fingers V.

He assembled a few luer lock fittings and a peristaltic pump (this is not to denigrate the man's efforts).
He demonstrated that life saving equipment can be assembled at short notice with stock components.

The difference?
The equipment was not assembled and tested by ISO 9001/9002 audit trail companies, appropriately insured!

Do insurance companies contribute anything to anyone except their shareholders?

Like Evan, I have been involved with the medical industry for many years, involuntarily. The main costs of those (mainly) dedicated people, is insurance.

Regardless of the state and status of mother and child (and, as I said, I wish them the best) that doctor has put his neck on the block of litigation.

[edit for ISO numbers]

JCHannum
08-09-2008, 05:48 PM
And the Americans lack of health service is not so brilliant as you make out ...
Not when, i read here about ...people super gluing their wounds together ...pulling their own teeth ...or letting them rot in their mouth.

all the best.markj

This report on NHS hospitals was in the news this week.

http://news.bbc.co.uk/1/hi/health/7542718.stm

Rustybolt
08-09-2008, 07:24 PM
In the US emergency room dr.s are used more and more as physicians of choice for less than emergency medical care.


The reason infant mortality is higher in the US is because our dr.s here will risk treating high risk babies that are routinely denied care in other countries. It skews the stats.

Evan
08-09-2008, 10:31 PM
There is a major inconsistency in the story. They refer to the use of the device as being devised for very low birth weight babies yet the girl in the story was not such. In fact she was at the low end of what is considered normal birth weight here. It is for that reason that numerous dialysis options were available to her if they were permitted by the NHS.

The only logical reason the doctor needed to fabricate the device is because he wasn't permitted to buy one.

bhjones
08-09-2008, 10:34 PM
Using the good doctor's invention to save potentially thousands of brain damaged infants is misguided at the least and will, in the cold light of limited resources, deny treatment for others that could better benefit by it.

Hey Evan, do you take any blood pressure medications? How about something for high cholesterol? Do you know anyone you care about that's a diabetic?


Treat everyone under all circumstances at a cost that is unaffordable by the taxpayer or treat no one.

Or Allow for profit within a socialized health care system. The number of stories one reads about people from CA heading south for relatively common but urgently needed treatments is shocking.


Once again, they are are normally concomitant. That means they occur together.

Do you treat people like this in your everyday life? Either use the big word and let people look it up who need to, or just dumb it down if you think we're to stupid to understand what you're saying. The vocabulary lesson is the defining trait of every know-it-all I've ever met.


BTW, the linked article isn't telling the entire story. This rare birth defect is linked to the mothers use of alcohol, amphetamine and cocaine in particular as well as possible exposure to solvents.

Classy Evan, real classy.


That unfortunately is the way the health care system works. It doesn't mean I agree with it but it is how it MUST be. We don't have a choice.

There's a good chance that this girl will be developmentally disabled and therefore cost the health care system tens of thousands of dollars that could have been used to save many other lives.

Why is it socialists care more about the system than the people the system was intended to serve.

bhjones
08-09-2008, 10:41 PM
Also, the treatment that I currently take for fibromyalgia was researched and suggested by myself to my doctor and she agreed to my suggested course of action. It has been remarkably effective in the face of a condition with virtually no effective treatments.

So can we assume you did double blind studies in order to confirm it's effectiveness?

Can we say psychosomatic? That big word means it's all in your head Evan....

Evan
08-09-2008, 11:08 PM
So can we assume you did double blind studies in order to confirm it's effectiveness?


Not I but a Doctor in Seattle who achieved remarkable results never seen before in any treatment for fibromyalgia. The drug is Pramipexole and was recently approved for restless leg syndrome which is what gave a clue to the effectiveness in fibromyalgia. Normally the drug is used to treat Parkinsons Disease but through certain pathways in the brain that are in common with PD it restores the proper nerve impulses that permit the large muscle groups to be mobilized properly in fibromyalgia. The drug in not yet approved for the condition in the US or Canada but a doctor may prescribe it off lable if they wish. I have to pay for it myself as it isn't covered by our health care system and I have no benefits from other sources.


Can we say psychosomatic?

I can since I was a child.


That big word means it's all in your head Evan

So is your heart rate, your breathing, pain, pleasure and appetite. In fact virtually every part of your body's function and responses are at least to some extent controlled from your brain.


Do you treat people like this in your everyday life? Either use the big word and let people look it up who need to, or just dumb it down if you think we're to stupid to understand what you're saying. The vocabulary lesson is the defining trait of every know-it-all I've ever met.


What's the matter? Did you have to look it up?


Hey Evan, do you take any blood pressure medications? How about something for high cholesterol? Do you know anyone you care about that's a diabetic?


No, no, and no.


The number of stories one reads about people from CA heading south for relatively common but urgently needed treatments is shocking.



The number of people, mostly seniors, who come to Canada to buy drugs that they cannot afford in the US is really appalling. You should start reading a higher class of tabloid.


BTW, the linked article isn't telling the entire story. This rare birth defect is linked to the mothers use of alcohol, amphetamine and cocaine in particular as well as possible exposure to solvents.


Classy Evan, real classy.


Also true.


Why is it socialists care more about the system than the people the system was intended to serve.

Is that a rhetorical question or were you expecting an answer from me? I wouldn't know, I vote conservative.

plastikosmd
08-09-2008, 11:36 PM
"The only logical reason the doctor needed to fabricate the device is because he wasn't permitted to buy one"

Sure but he seems to have added something beneficial to the system, maybe a shorter circuit, less filters, better exchange

From the article
"Very low birth weight newborn babies are usually unable to be haemodialysised effectively and may not be saved.

But Dr Coulthard's development could ensure their survival.


He came up with the idea in conjunction with senior children's kidney nurse Jean Crosier."

If you ever visited a NICU and maybe observed HD you would understand. HD in the first year of life is rare, fraught with difficulty and major complications. We donít even offer it at our institution you have to be shipped 2 states away. Just use your trusty google most centers are in the single digits per year...then check the survival numbers...from the wording of the article key words effectively and development, it seems he improved the basic HD...maybe better exchange with less volume in the extra-corporal circuit, who knows.

Evan
08-10-2008, 12:05 AM
From the article
"Very low birth weight newborn babies are usually unable to be haemodialysised effectively and may not be saved.

But Dr Coulthard's development could ensure their survival.


But he wasn't dealing with a very low birth weight newborn. Equipment for hemodialysis for 6 lb 2 oz babies has been available for a long time regardless of the possible complications, which I pointed out are possibly severe. The medical establishment tends to look at these cases in two ways, what they call a "good outcome" meaning the patient survived, and what they call "a less than good outcome" usually meaning the patient died. While there are no shades of meaning surrounding death, a "good outcome" could be anything from full health to profound retardation.

By your own admission the chances of a truly "good outcome" are slim. Obviously there is a good reason your institution doesn't offer it. And, unfortunately because of the poor success rate it will be seen by the decison makers as not a cost effective use of resources.


He came up with the idea in conjunction with senior children's kidney nurse Jean Crosier."


The question of what the idea was is not addressed. I find it likely that the idea was a way to get around the lack of equipment because of policy, not a new way to do dialysis on infants. It's hardly likely that he and an assistant thought of something new in the space of 24 hours or so, built it as well and then applied it successfully without any sort of testing or trials in advance. It just doesn't work that way for something as delicate as dialysis on a newborn. In fact, if that were really the case the doctor would probably be in front of a board facing a license revocation for taking such a chance even though the child was eventually doomed. There are other treatments as well including exchange transfusions that can at least prolong survival until appropriate equipment is obtained. Transplant is also an option in such a case unless contraindicated by the recent surgery.

The other question I have about this story is why it is in the news now? This event took place two years ago. Was it not big news then? If not then why not? There don't seem to be any stories of this from two years ago.

plastikosmd
08-10-2008, 12:29 AM
well i will agree with you that it doesnt seem to have changed the market for HD machines in the past couple of years....I would like to know what was unique about the machine

oldtiffie
08-10-2008, 12:43 AM
Thanks plastikosmd.

I had just about despaired of the topic getting back to the machine and the processes of its development and manufacture.

JCHannum
08-10-2008, 08:06 AM
The article you cite states "Very low birth weight newborn babies are usually unable to be haemodialysised effectively and may not be saved." Note the word effectively. While equipment was available, it is usually not effective.

You might care to read and understand this article;

http://news.bbc.co.uk/2/hi/health/7542404.stm

It quite clearly states that the reason for it's fabrication was that none was available in a suitable size, not that the Doctor was somehow denied the use of one due to an NHS policy as you seem to think.

This is a direct quote:
"During an operation to correct the problem, her kidneys started to fail, and her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used.

Rebecca was warned that Millie was unlikely to survive.

However, Dr Coulthard, together with senior children's kidney nurse Jean Crosier, devised a smaller version, then built it away from the hospital. Millie was connected to the machine over a seven day period, allowing her own kidneys to recover. "

This further quote addresses the availability of similar machines, they do not exist, and are needed.

"The machine is still in use, helping babies in similar circumstances to Millie, but Dr Coulthard told the Newcastle Journal newspaper that an official version was needed.

'This machine is only being used on the tiniest, earliest babies where there is nothing else that can be done.' "

Evan
08-10-2008, 09:57 AM
'This machine is only being used on the tiniest, earliest babies where there is nothing else that can be done.' "

That does not describe the baby in the story.


This is a direct quote:
"During an operation to correct the problem, her kidneys started to fail, and her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used.


That quote simply proves my point. 6 lbs 2 oz is a low normal birthweight. All it shows is that the NHS isn't willing to fund the appropriate equipment. Note the reference to "existing NHS dialysis machines", not "newborn dialysis machines".


This further quote addresses the availability of similar machines, they do not exist, and are needed.
While there are indeed needed they do also exist. It's up to the NHS to provide them.

JCHannum
08-10-2008, 10:17 AM
That quote simply proves my point. 6 lbs 2 oz is a low normal birthweight. All it shows is that the NHS isn't willing to fund the appropriate equipment. Note the reference to "existing NHS dialysis machines", not "newborn dialysis machines".

It would seem that "existing NHS dialysys machines'" pretty much rules out dialysis machines of any type.

At no point in any of the stories concerning the machine and it's development is there any statement that supports the premise that the NHS is unwilling to provide the equipment for any of the reasons you put forward.

Evan
08-10-2008, 10:37 AM
Perhaps you missed the internal letter that I posted regarding dialysis equipment in the NHS. My server was down from Friday to yesterday morning on account of thunderstorms.


It would seem that "existing NHS dialysys machines'" pretty much rules out dialysis machines of any type.

At no point in any of the stories concerning the machine and it's development is there any statement that supports the premise that the NHS is unwilling to provide the equipment for any of the reasons you put forward.

No, they certainly don't mention it do they? Rather poor reporting I would say.

Norman Atkinson
08-10-2008, 11:31 AM
As I have it, Doctors and Dentists from the UK have to re-pass their qualifications before being let loose on Canadians.

Now we have an unqualified Canadian pontificating on the NHS and British qualified doctors.

Just a thought- bearing in mind that I have three members of the family who are Fellows of the Royal Colleges of Surgeons.
And ,of course, not forgetting Matron who looks after the rest of us who repose in this fine edifice for the mentally disturbed which is just around the corner from Newcastle's RVI.

Norm

JCHannum
08-10-2008, 11:32 AM
Perhaps you missed the internal letter that I posted regarding dialysis equipment in the NHS. My server was down from Friday to yesterday morning on account of thunderstorms.



No, they certainly don't mention it do they? Rather poor reporting I would say.
I did read that letter, and I cited your other reference stating that such devices are not always effective.

I do not feel that excluding your unsubstantiated premise is poor reporting.

Norman Atkinson
08-10-2008, 11:48 AM
Unfortunately, I read of the contribution which nurse Jean Crozier made in this.
So are we really sure of the truth?

Evan
08-10-2008, 12:23 PM
Jim,

I see you aren't willing to do your own research. Apparently you are content to just sit back and take random snipes at whatever you see that doesn't fit your perception of how "things should be".


Some cancer treatments are not available

The NHS cannot, and never has been able to, offer every treatment to everyone who needs it.
The NHS is funded from taxes, and it spends more than £42bn every year - £779 for every person in the UK. But it is not a bottomless pit of funds and some treatments have to be restricted.

Raising taxes to pay for every possible need is politically unthinkable, as it would require a massive increase in income tax to raise enough revenue to make a significant difference to spending.

This means some treatments have to be restricted, or rationed.

http://news.bbc.co.uk/1/hi/health/251988.stm




Hospital and Health Care
Rationing

SECTION 1: INTRODUCTION
In 1997 HOPE published a book entitled “On Solidarity in Changing Healthcare
Systems: Europe in Search of a New Balance” (de Gooijer, W J). This book
addressed the roles and responsibilities of the evolving Welfare State, and its
individual components, in caring for the less advantaged members of society.
In so doing, it stu-died the interaction of altruism and self-interest, ethics and
economics, with political values and systems. For HOPE, it seemed a logical
next step to look at one of the most emotive topics arising from that
interaction – rationing.
The presence of rationing is recognised throughout Europe, albeit more readily
in some countries because, as others have found before us, it is at the very
centre of healthcare policy making. By whatever method, and in whatever
system, choices have to be made, implicitly or explicitly, leading to the
questions how, where, when, and by whom, the decisions are made.
...
Because of the sensitivity of the issues, the language of rationing tends to be
softened by euphemism. Terms such as “prioritisation”, ”competing
demands”, and “finite resources” are commonplace. Behind this language, as
we will see, “rationing” takes on many different forms. It can happen at the
macro level as, for example, a matter a policy in seeking to reduce morbidity
and mortality in regard to a particular disease; or it can happen at the micro
level in, for example, a clinician’s decision in a particular hospital to place a
patient on a waiting list. It can be explicit, on a declared national policy
decision, or it can be implicit, where the reasons for a decision (which may be
multiple) may not be immediately evident.
...

Rationing at the National Level
Let us look now more closely at what happens once the national government
has determined its limits for health care expenditure. For example, the UK
Government White Paper on the NHS acknowledged, in 1996, that rationing
was part of the system.
...
One of the best known therapeutic interventions developed in recent years has
been the treatment of renal failure using the technique of transplantation, and
dialysis equipment. The dispersal/availability of transplantation, haemodialysis
and peritoneal dialysis shows wide variations. In the former case, the
availability of donor organs is the main limiting factor although Spain, unique
in the European Union, has succeeded in achieving a high rate of donation
through the creation of a nation-wide network of co-ordinators backed up by
an efficient and professional transplantation service. As far as dialysis is
concerned, the choice between the two techniques may not be wholly a clinical
one. It is claimed, for example, that in Belgium the payment system
discriminates against peritoneal dialysis, while in the UK the government-
controlled budgets and nephrologists’ support of peritoneal dialysis have
helped to shift the emphasis away from haemodialysis.38
http://www.hope.be/05eventsandpublications/docpublications/58_hc_rationing/58_hc_rationing_2000.pdf


Once again I repeat, it was clearly a decision made by the health authorities that resulted in appropriate equipment not being available.

Norman Atkinson
08-10-2008, 12:47 PM
Evan,
As far as I am aware, you have no connection whatsoever in the affairs of the NHS- and Newcastle Hospitals Trust in particular.

Recently, as a referee in the affairs of the Trust, I scanned the list of would be members. Unless I am mistaken your CV did not appear.

Again, you still have to answer a question which was deliberately aimed at Canada's own health service.

Physician, heal thy self!

Norman

ScottM
08-10-2008, 12:51 PM
All,

I'm sorry I know this is at OT post but do any of you ever do any metal work?

I realize from the number of replies in the threads on this site that it's a health care/politics/religion site but I just thought I would ask.

I'm gona go out to the shop and dill random holes in a piece of scrap, it got to be more fun that this.

Maybe I'll make a "tang it all" tool holder - anybody get that reference :-}

- Scott

dockrat
08-10-2008, 12:55 PM
All,
I'm gona go out to the shop and dill random holes in a piece of scrap, it got to be more fun that this.- Scott

High 5 Scott!!!!!
.
.

Evan
08-10-2008, 12:58 PM
Again, you still have to answer a question which was deliberately aimed at Canada's own health service.


What question was that? (edit ) What was it's relevance?


As far as I am aware, you have no connection whatsoever in the affairs of the NHS- and Newcastle Hospitals Trust in particular.

Recently, as a referee in the affairs of the Trust, I scanned the list of would be members. Unless I am mistaken your CV did not appear.

Nor have I claimed such. It is however a public agency and it's affairs are open to public scrutiny.

Norman Atkinson
08-10-2008, 01:03 PM
The question was why are UK medical and dental staff obliged to take Canadian examinations?

The question was plain enough. The next question is what is your authority in this? Or do we have duplication?

As you are altering replies, might I suggest that you are not 'Public' in this sense. Have you actually been part of the British National Health Service? If you answer 'Yes', you got the service for nothing.
The money could have gone to more deserving causes. If your answer is 'No', you are merely accessing the internet. For what purpose, I am too polite to comment

Evan
08-10-2008, 02:15 PM
Norman wrote:


As I have it, Doctors and Dentists from the UK have to re-pass their qualifications before being let loose on Canadians.


That isn't a question Norman, that is a statement.


The question was plain enough. The next question is what is your authority in this? Or do we have duplication?


What is my authority in what? Canadian medical licensing requirements? Duplication of what?


As you are altering replies, might I suggest that you are not 'Public' in this sense.
Altering what replies? I cannot make sense of what you are writing.

If you answer 'Yes', you got the service for nothing.
The money could have gone to more deserving causes. If your answer is 'No', you are merely accessing the internet. For what purpose, I am too polite to comment


Sorry, that is what is called a "complex question", also known as a "loaded question". Therefore I shall not answer it. It is like asking someone "Do you beat your wife and if not then how long has it been since you stopped beating your wife?"

dp
08-10-2008, 02:26 PM
That quote simply proves my point. 6 lbs 2 oz is a low normal birthweight. All it shows is that the NHS isn't willing to fund the appropriate equipment. Note the reference to "existing NHS dialysis machines", not "newborn dialysis machines".

Twins at birth weigh even less as a norm. Triplets weigh even less. Hopefully the NHS doesn't withhold funding for them and is proactively equipped to work with these newborns.

Norman Atkinson
08-10-2008, 03:12 PM
Perhaps I am the only person here who has contributed to the British NHS since it started in 1948. I stopped paying 'contributions' at the age of 65 but my money still goes in quietly from the greatest charity in the world.
OK, I was asked to 'stand' for NHS thing but I am becoming progressively deafer and although the RVI examined me and shook its head- in 1935, I'm still here. I have two hands- one of which I owe to a young senior registrar in the RVI. Next day, he was off to East Grinstead and following the footsteps of Archie McIndoe- who helped so many of our terribly burned aircrew.
That day, I had no hesitation in thinking that my contributions had only paid for a minute portion of what I got from him.

There was no Hype, no Press, no Ballyhoo. A man going home with two hands and a bandage.

I have no criticisms. Niggles, yes, but we can all run the show better.
And from such a distance and in such real ignorance!

Paul Alciatore
08-10-2008, 03:39 PM
First, may God bless this man.

What strikes me about this is the fact that the entire health care industry is not capable of making a solution to a problem that a single man can solve in his garage, apparently with limited funds.

We have an endless spiral between the health care professionals, the insurance campanies, and the lawyers. And the only result is ever higher costs for the patient. And situations like this where nothing is available when the solution is so simple that one man can cook it up in a limited amount of time and on a shoe string budget.

Is there no way of taking all the greed out of our health care?

MCS
08-10-2008, 04:25 PM
Slightly rebuild quote, but this is a global problem. Looking over the fence, box, whatever.


All,

I'm sorry I know this is at OT post but do any of you ever do any medical work?

I realize from the number of replies in this hospital that it's all health care/politics/religion/budget problems but I just thought I would ask.

I'm gona go out to the shop and build a miniature dialysis machine, it got to be more fun that this.

- Scott

Norman Atkinson
08-10-2008, 05:11 PM
deleted,

norm

ScottM
08-10-2008, 06:01 PM
imitation is the sincerest for of flattery - right? :-}

Too funny - of course you laugh when it hurts too much to cry.

dp
08-10-2008, 06:28 PM
Is there no way of taking all the greed out of our health care?

We need to write a law that says the patient is also the primary customer and has fiscal management if his/her care. When that relationship was lost to a workplace benefit the rest went with it.

JCHannum
08-10-2008, 06:50 PM
Jim,

I see you aren't willing to do your own research. Apparently you are content to just sit back and take random snipes at whatever you see that doesn't fit your perception of how "things should be".

Once again I repeat, it was clearly a decision made by the health authorities that resulted in appropriate equipment not being available.

There is nothing in any of the articles concerning the device indicating the NHS denied the use of dialysis equipment, only that existing equipment was not suitable.

The articles further state that the device has been used in the two years subsequent to its development which would indicate that they are quite willing to use such equipment if it is available.

Evan
08-10-2008, 10:32 PM
There is nothing in any of the articles concerning the device indicating the NHS denied the use of dialysis equipment

Yes there is. The available devices were only permitted to be used on children above a certain weight. The use for children under that weight was denied. While the weight limit wasn't mentioned it obviously is high enough to exclude even normal birth weight children.

However, whether the NHS actively denied the use of the machine or not has nothing to do with my points. My points are about the reasons the technology wasn't available and the risks the doctor was taking. This story is a clumsy "feel good" and "Genius goes beyond the call of duty" story. It is riddled with inconsistencies and bad reporting.

Evan
08-10-2008, 10:40 PM
What strikes me about this is the fact that the entire health care industry is not capable of making a solution to a problem that a single man can solve in his garage, apparently with limited funds.


What is apparent is that the doctor was blessed with incredible good luck more than anything else. If the story title was the far more likely "Doctor kills baby with home made medical contraption" everyone would be decrying his callous disregard for human life and medical incompetence.

wierdscience
08-10-2008, 11:02 PM
The fact that surgery on unborn children is now becoming more common means that someone sometime made the conscious choice to TRY.

gmatov
08-10-2008, 11:46 PM
ScottM ScottM is offline
Member

Join Date: Mar 2008
Location: Portland OR
Posts: 38
Default OT machining
All,

I'm sorry I know this is at OT post but do any of you ever do any metal work?

I realize from the number of replies in the threads on this site that it's a health care/politics/religion site but I just thought I would ask.

I'm gona go out to the shop and dill random holes in a piece of scrap, it got to be more fun that this.

Maybe I'll make a "tang it all" tool holder - anybody get that reference :-}

- Scott

38 posts and you bitch that people who have been here for a couple thou CAN argue whether we have affordable healthcare in the US or not!

You have every right in the world to ignore threads that may be related to this stuff.

You have no right in the world to chastise them of us who speak of these issues.

Some issues ARE a bit more important than YOUR edification or profit, whether it be this Forum or a Forum dedicated to reducing health care costs.

You want to read machining ONLY stuff, go to the MACHINING ONLY STUFF.

Down arrow skips the posts that are begun as "OT".

Snoops will read and bitch.

Cheers,

George

JCHannum
08-11-2008, 06:55 AM
Yes there is. The available devices were only permitted to be used on children above a certain weight. The use for children under that weight was denied. While the weight limit wasn't mentioned it obviously is high enough to exclude even normal birth weight children.

However, whether the NHS actively denied the use of the machine or not has nothing to do with my points. My points are about the reasons the technology wasn't available and the risks the doctor was taking. This story is a clumsy "feel good" and "Genius goes beyond the call of duty" story. It is riddled with inconsistencies and bad reporting.

This statement negates your first statement;
"During an operation to correct the problem, her kidneys started to fail, and her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used."

Your second statement is not true also. Throughout the entire discussion, your premise is that, if saved, the child could have a low IQ, and was not worthy of saving.

If the "feel good" nature of the story; the saving of that child's life and the development of a machine that is continuing to save infants lives; goes against your grain, that is your problem, and your position is not one I would be proud to maintain. That is, of course, your choice.

Evan
08-11-2008, 07:42 AM
This statement negates your first statement;
"During an operation to correct the problem, her kidneys started to fail, and her birthweight, at just over 6lb, meant existing NHS dialysis machines, even those designed for children, were too large to be used."


It negates nothing. Existing NHS dialysis machines does not mean ALL dialysis machines. Did you not read the analysis I posted explaining that the NHS prefers not to fund haemodyalysis equipment for infants?


It is claimed, for example, that in Belgium the payment system
discriminates against peritoneal dialysis, while in the UK the government-
controlled budgets and nephrologists’ support of peritoneal dialysis have
helped to shift the emphasis away from haemodialysis.



Your second statement is not true also. Throughout the entire discussion, your premise is that, if saved, the child could have a low IQ, and was not worthy of saving.

You grossly oversimplify and misrepresent what I have said. You cannot seem to separate the message from the messenger. I have not expressed a personal view on this topic. It isn't my premise, it's the stance taken by the medical authorities in the UK and elsewhere as well. Health care procedures and equippment are rationed by all health care systems in one manner or another. It means some will die that may have lived. It also means that more will live that may have died. It's a tradeoff measured in human lives. That is how medicine works. There isn't any other option.

It is flatly impossible to provide all services to all comers all the time, needed to save life or not. Some will die that could have been saved. It's not a popular idea and many refuse to acknowledge it but nevertheless it is true.

Health care providers are charged with making these decisions. They must balance available funding with need that can be filled to provide the best lifesaving value for the dollar. That isn't open for debate. How well they do it is.

oldtiffie
08-11-2008, 07:44 AM
I can appreciate the righteous indignation and "feel good" aspects of the discussion.

This is the article and comments (10).
http://www.dailymail.co.uk/news/article-1041430/Doctor-saves-babys-life-making-homemade-kidney-dialysis-machine.html

This is the result of a search for any other articles on this topics in this "tabloid" newspaper as of now - there are none.

http://www.dailymail.co.uk/home/search.html?searchPhrase=homemade+kidney+dialysis+ machine

So it seems that the topic did not gain any traction in the UK or from anywhere else where that paper is read.

So pragmatism triumphs over sympathy - again - both in the press and the public arenas.

Comments (10 only) are pretty bland and not from anyone with influence or "clout".

If there is no public out-cry there will be no "political solution". Tough yes - but that's how it is.

Sorry.


'Now she is fit as a fiddle and just like a normal two-year-old. She is a really lovely child.'

Rebecca is now backing Dr Coulthard's bid to make the device available on the NHS nationwide.

Very low birth weight newborn babies are usually unable to be haemodialysised effectively and may not be saved.

But Dr Coulthard's development could ensure their survival.

He came up with the idea in conjunction with senior children's kidney nurse Jean Crosier.

That is a direct quote from the newspaper article.

It is two years since the machine was made/used. It appears that there are no others. So two years effort to convince either the Health authorities or perhaps manufactures or entrepreneurs etc. has been to no avail.

To take the article at face value, it seems that the only supporters or proponents of the machine even yet are the doctor/inventor and the mother.

If it was as good a deal as some might say, I wonder why it has not been taken up in the US or Europe or Japan etc?

Anyone here still feel strongly enough to "start something" and write to the Editor or to petition someone in authority - both in the US and the UK?

If not - why not?

Evan
08-11-2008, 08:14 AM
I find it surprising that anybody on this board is undiscriminating enough to take a story such as this at face value with absolutely no references or other evidence to back it up or substantiate it.

Statements such as this one in the story should be sufficient to raise the BS alarm to maximum.

"But Dr Coulthard's development could ensure their survival."

You cannot ensure the survival of a gravely ill infant. You can't even give a reasonably good chance in a newborn that requires dialysis. For an underweight newborn that requires dialysis there isn't even a reasonable prospect of survival no matter what technique may be available.

Now I will express my own personal view on this. It is a matter of education. If people would take it upon themselves to educate themselves in matters of their own health then health would improve for the large majority. Knowing even a few simple facts would reduce the burden on the health care system to the point that many more lives could be saved. Knowing that you cannot treat a cold with antibiotics and that a cold isn't the flu would by itself diminish the number of doctor and ER visits dramatically. Knowing how to treat minor injuries and infections and having the right supplies on hand would decrease the burden even more. Taking responsibility for your own health and actively doing something about it (losing weight perhaps) would make it possible to save the ones that need saving instead of forcing health care providers to deal with a never ending stream of ignorant and careless people that effectively are denying treatment to those who need it most.

JCHannum
08-11-2008, 09:54 AM
It negates nothing. Existing NHS dialysis machines does not mean ALL dialysis machines. Did you not read the analysis I posted explaining that the NHS prefers not to fund haemodyalysis equipment for infants?




You grossly oversimplify and misrepresent what I have said. You cannot seem to separate the message from the messenger. I have not expressed a personal view on this topic. It isn't my premise, it's the stance taken by the medical authorities in the UK and elsewhere as well. Health care procedures and equippment are rationed by all health care systems in one manner or another. It means some will die that may have lived. It also means that more will live that may have died. It's a tradeoff measured in human lives. That is how medicine works. There isn't any other option.

The cited article is a letter written in 2000 concerning a book published in 1997 and refers to dialysis and the equipment used in general. It is not an NHS policy statement.

Your initial statement was; "Using the good doctor's invention to save potentially thousands of brain damaged infants is misguided at the least and will, in the cold light of limited resources, deny treatment for others that could better benefit by it." That is the direct quote. It sounds pretty much like a personal view to me.

Evan
08-11-2008, 11:06 AM
I grant that is does sound like a personal view but it is the view taken by the medical authorities in their decision making. I should have made it more clear. I have a very good friend who is a retired doctor of long experience whose services have been in demand across this country. We have had many discussions on this and similar topics in the past and what she has told me directly supports the similar information that I have related in this topic.

It remains that the way to assure treatment for those who need and deserve it is to reduce the voluntary demand on the system. That is something that everyone can contribute to and it costs little or nothing to accomplish. The main benefit is improved health for everyone and reduced expenses as well as much better allocation of limited resources.

This is rapidly going to become the overriding issue of the day for the foreseable future as the enormous "baby boom" population bulge moves into retirement. If people don't take responsibility for their own health they will find that there won't be anyone else to do it either.

JCHannum
08-11-2008, 12:02 PM
If people don't take responsibility for their own health they will find that there won't be anyone else to do it either.

Exactly how would you propose the infant in this case would accomplish that?

Evan
08-11-2008, 04:37 PM
Exactly how would you propose the infant in this case would accomplish that?

Since that isn't a valid question I will ask you one. What do you propose should be done to make sure all such infants are treated appropriately with the correct equipment and who will pay for it?

Norman Atkinson
08-11-2008, 05:05 PM
Enough of me. Now other people have to be counted

JCHannum
08-11-2008, 07:46 PM
Since that isn't a valid question I will ask you one. What do you propose should be done to make sure all such infants are treated appropriately with the correct equipment and who will pay for it?

The question is perfectly valid.

You made the statement that everyone should take responsibility for their own health. Quite obviously, in many cases that is not possible. That is why a responsible medical establishment is necessary. Decisions as who does or does not receive treament should never be made by some outside organization based on the future "worth" of the patient.

In a perfect world, all infants would receive appropriate treatment with the correct equipment. It is not a perfect world, but strides are being taken to attain that. To dismiss those accomplishments out of hand as "misguided" and state that they serve no purpose other that to "deny treatment for others that could better benefit by it", is a pretty sorry comment on one's values. If your doctor friend holds these views, I would suggest that you find another physician, as I can assure you that is not a typical viewpoint.

As far as payment, those who see the need will see that it is provided. Norm's post is just one example. You have no idea of how people will rise to the need until you have the opportunity to experience it yourself.

oldtiffie
08-11-2008, 10:12 PM
Has anybody actually had the fore-thought (and good manners) to ask the British Health system administrators or the Doctor of the Infirmary in which he worked/works whether they actually want or need anybody else to provide these things?

Or to keep it "local", have you addressed this matter in a similar manner in your own "back yard"?

If not - why not?

This may well be an example of sticking your collective noses in where they are not needed - perhaps not - but asking might be a good start.

Who are we to decide what is needed and perhaps worse to "know best" and provide it anyway?

Or is it one of those "it seemed like a good idea at the time" or "everybody says" efforts/events? It sure seems like it.

How would you or yours feel if you were "on the receiving end" like this?

Not too pleased? If so, why impose your will or decisions on others.

Just charging in and "making the things" without plans and specifications etc. and checking that the design you use is the current version would be a good start may be one thing - but assuming or presuming that it is needed may well be another.

Or are we just going to decide "what's best" there too?

Just have another look at the web page in question and see where the emphasis is and what the topics of interest are:
http://www.dailymail.co.uk/news/article-1041430/Doctor-saves-babys-life-making-homemade-kidney-dialysis-machine.html

It must have been a "slow news day" and this was used as a "filler" or "padding piece". It is a classic "Tabloid" ploy to get readership and circulation. The Brits have this down to a fine art.

This is another - "The News of the World". A classic "Murdoch Press" approach - but it sure does sell papers though - world-wide.

These papers are aimed at the "lower classes" and certainly not the "intelligentsia", or "literati" that some here may see themselves as being but who may instead may in effect just part "chattering class/es".

http://en.wikipedia.org/wiki/Special:Search?search=lower+classes&fulltext=Search
http://en.wikipedia.org/wiki/American_lower_class
http://en.wikipedia.org/wiki/Intelligencia
http://www.answers.com/topic/literati
http://www.google.com.au/search?hl=en&q=literatti&btnG=Google+Search&meta=
http://en.wikipedia.org/wiki/Chattering_Classes

The "Daily Mail" sure seems to have scored a "bulls-eye" here beyond its wildest expectations.

It might be interesting or embarrassing if the link to this thread is posted to the "Daily Mail", the more so if it chooses to "follow-up" some of the leads and addressed here!!!

Surely no one would do THAT!!

(Or) would they??

Norman Atkinson
08-12-2008, 12:42 AM
Tiff,
You have hit the nail on the head. One of yesterdays E-Mails was an invite from a Chinese 'brother' inviting us- masons and other halfs and friends, to a charity function next month. I had no idea what the Bubble Foundation meant as the Good Cause.

The cause is yet again children and the local centre or co-ordinator is the adjoining hospital which is Newcastle General Hospital which is part of the group but built up after the RVI became too small to cover the needs of an expanding population. The Freeman Hospital is again part of the group following the subsequent expansion. So this points, again to availability of cash for children's needs and outside the 'normal funding' by the Government and NHS. Has Coulthard approached the voluntary bodies such as Bubble Foundation? We simply dpo not know!

This is now a bitter issue with a critic who is outside the country but who claims to have consulted a doctor who is also 'out of the country'
Whether the doctor mentioned is 'au fait' with the British NHS is also unclear.
What is patently obvious is a possible breach of medical etiquette. No doctor worth his or her Hippocratic Oath will discuss an individual case. This little mite is regarded as an individual.

As most know, I do spend a lot of energy on charitable causes. It is one way of trying to thank others for my life. I can say that I have a lot of friends who have funds expressly for needs. I am not a Rotarian but I am in close weekly contact with many. Again, I have wide masonic connections and know that needs regardless of whether they are masonic are quickly answered. On 9-11, I was at a meeting when the news broke. I think that we all know where we were then. The Provincial Grand Master left us to our evening. Within hours, £500,000 was in the hands of the New York masons to spend on whatever relief that they deemed necessary. There was more. They only had to ask.World governments were still dithering but the money was there. And rightly so!

Money is always available from one source or another. I have tried to explain just how generous the North East of England is. I have explained what happens in my small corner.

We all bellyache about things- but many very ordinary people respond postively as well.

I bid you all well!

Norman

Norman Atkinson
08-12-2008, 02:16 AM
Tues 7.13 AM BST Breakfast News om the BBC
It's there. The brief news is that we now have


A bedroom

Await the next gripping instalment


No more on this by 7.30 but we are now advised to eat kangaroos.

Even the news is jumping about!

Norman Atkinson
08-12-2008, 02:59 AM
7.40 and little Millie has really taken the BBC Studio to pieces!
The builder of the machine was NOT Dr Malcolm Coulthard.
The first baby which prompted the ideas sadly died.
Millie's mother's comments are that the present machine- looks as if it was made in a garage.
The second machine is being built-- in the Royal Victoria Infirmary.
Where was the first one built?

At that point, I cannot help but it does point to a lot of lies from the Press.
As the day wears on, more news from 'the builder' will definitely come.

With my non-engineering inquisirive nature, there is 'something' which I have also unearthed.There is actually a separate charity for kidney sufferers on Tyneside. I have more but - not here.

It would a shame to spoil Millie's Day

Norm

Evan
08-12-2008, 05:16 AM
This is now a bitter issue with a critic who is outside the country but who claims to have consulted a doctor who is also 'out of the country'
Whether the doctor mentioned is 'au fait' with the British NHS is also unclear.
What is patently obvious is a possible breach of medical etiquette. No doctor worth his or her Hippocratic Oath will discuss an individual case. This little mite is regarded as an individual.


Don't be an arse Norman. I never said we discussed this case or that anybody I spoke to was familiar with it in any way. I haven't spoken to my doctor friend in several days. What is "patently obvious" is that I have touched a nerve and you are not at all comfortable with it.

oldtiffie
08-12-2008, 05:51 AM
Thanks Norm for doing the "hard yards" and the "leg-work" and for getting the facts straight and keeping us informed.

Well done



.................... noble truth the Scottish peasant told
That rank is but the guinea's stamp, the man himself's the gold ...................

Norman Atkinson
08-12-2008, 06:02 AM
Evan,
As far as I am concerned, the nerve was the fact that you stuck your arse in! Yet again, you googled or whatever to get publicity. Other people here have much the same opinion.

I freely admit that more than an interest in the UK NHS and I have made that clear from the beginning.

Emerging evidence suggests that the Daily Mail reporting was 'crap' and that your interference was no better.

Keep your opinions of what goes on in the UK to yourself- until you have first hand evidence.

Norman

Evan
08-12-2008, 07:35 AM
I said the reporting was crap. At least we agree on something.


Yet again, you googled or whatever to get publicity

There you go again. I have strong opinions regarding the medical system both here and elsewhere. The UK system is a public system as is Canada's and there is a lot to be learned from examining how they work, or fail to work. It isn't your private benefit plan and there is no reason why I should refrain from commenting on how it does or doesn't fulfill it's function. We have serious problems with our system too, most notable is a lack of doctors in rural areas. It is possible to learn from the mistakes of others. In fact, that is usually the preferred method.

oldtiffie
08-12-2008, 07:43 AM
Well Norm.

It seems that you and I have PhD's in tact and diplomacy from the same old school. Definitely PM's at it!! but a total failure in panache' (me anyway).

Perhaps I'd better do a re-hash on the liberal arts and sciences.

Do you think that a course in "Fine Arts" and etiquette would get me into a garden party at Buck House?

Keep up the good work.

Swarf&Sparks
08-12-2008, 08:14 AM
"we are now advised to eat kangaroos"

don't knock it til you've tried it ;)

Norman Atkinson
08-12-2008, 09:24 AM
There's a young man-German and I have been friends with them all these many years. How I wish that I could do something. He was born with only one kidney which was only discovered when he fell off a sledge. There has been more than one rejection and his Mum and Dad are looking for a miracle.
Life or whatever you want to call it, is like that for some.

I don't knock the Germans or the Spanish- he's been to both.

That's only one. Millie was lucky, the other little boy wasn't. Life or death is like that.

One of my friends- a PM- spent all his free time working in operating theatres- for free. I won him a War Pension but it took 39 years. Life is like that.
In one of those moments he asked me why. I simply related to a time when a young lad used to strao me into the back of an aeroplane. The plane did its thing and returned safely. He was its engine fitter. A lot of our aircraft were old but this boy had only 6weeks of training. Johnnie's always came home for tea- and Australian jack rabbit. It was a way of saying 'Thank you'
I was lucky. Life or death is like that.

I was thinking of doctors and Myford lathes. There was one.In Newcastle and in the RVI! Another great honour for me to have been his friend.

C'est tout

Norm