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How to Make a Killing

Blood, Death and Dollars in American Medicine

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1 of 1 copy available
1 of 1 copy available

"Inspiring and deeply distressing." —Ezekiel J. Emanuel, author of Which Country Has the World's Best Health Care?

How did a lifesaving medical breakthrough become a for-profit enterprise that threatens many of the people it's meant to save?

Six decades ago, visionary doctors achieved the impossible: the humble kidney, acknowledged since ancient times to be as essential to life as the heart, became the first human organ to be successfully replaced with a machine. Yet huge dialysis corporations, ambitious doctor-entrepreneurs and Beltway lobbyists soon turned this medical miracle into an early experiment in for-profit medicine—and one of the nation's worst healthcare catastrophes.

With powerful insight and on-the-ground reporting, New York Times best-selling author Tom Mueller introduces an unforgettable cast of characters. Heroic patients, including a Hollywood stuntman and body double, risk their lives to blow the whistle on how they've been mistreated. An unpaid activist living in a south Georgia trailer park fights to save patients from involuntary discharge from their lifesaving care. Industry insiders put their careers on the line to speak out about the endemic wrongs and pervasive inequality they've witnessed—and about dialysis executives who dress as musketeers and Star Wars characters to exhort their employees to more aggressive profit-seeking.

Mueller evokes the scientific ingenuity and optimism of the 1950s and 1960s, when the burgeoning field of organ transplant and early dialysis machines offered long-awaited hope for lifesaving care. That is, until a New York salesman had himself dialyzed on the floor of the House, and Congress made renal disease the only "Medicare for All" condition—opening the financial floodgates for Big Dialysis. Of the thousands caught in a web of corporate greed, a disproportionate number are Black and Latino, highlighting the stark racial divides already endemic to American medicine.

How to Make a Killing reveals dialysis as a microcosm of American medicine and poses a vital challenge: find a way to fix dialysis, and we'll have a fighting chance of fixing our country's dysfunctional healthcare system as a whole, restoring patients, not profits, as its true purpose.

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    • Library Journal

      December 1, 2022

      In the 1950s, transplants and dialysis made kidney failure a manageable condition. But as explained here by Mueller, author of the multi-starred Crisis of Conscience, the profit motive then intervened, especially when Congress extended Medicare coverage to those with chronic kidney failure. Now, he says, the drive to maximize profits has led to a below-the-threshold quality of care.

      Copyright 2022 Library Journal, LLC Used with permission.

    • Kirkus

      August 1, 2023
      A dispiriting look at the replacement of the Hippocratic oath by a PIN number that centers on the big business of kidney dialysis. Basing his account on interviews with hundreds of constituents of the "dialysis community," journalist Mueller, author of Extra Virginity and Crisis of Conscience, describes a health care industry that is seemingly entirely focused on profit. Most dialysis takes place at clinics where a premium is placed on getting patients in and out quickly, with the withdrawal and reinsertion of blood occurring more rapidly than the body can comfortably accommodate--even though in many instances, "when administered this way, dialysis may shorten patients' lives by stripping off bodily fluids too fast, triggering sudden drops in blood pressure that can damage the heart, brain, gut, and lungs and lead to stroke, congestive heart failure, and cardiac arrest." If you complain, you're likely to be denied care--and, worse, far too many nephrologists are disinclined to fight on behalf of their patients. One nephrologist recounts that a colleague told her he had developed "techniques for goading undesirable patients into acting out, in order to eject them from his facility." Most of these patients are insured by Medicare or Medicaid, a system that pays less than private insurance. Against the American system of "bazooka dialysis," most advanced countries use a slower, more frequent program of dialysis. Furthermore, many of them place the locus of dialysis at home, with patients self-administering their care, a method that the American medical system lobbied hard to discourage. Some American physicians are bucking the system, Mueller writes, and the Trump administration issued an executive order demanding improved care--likely only because, Mueller ventures, Health and Human Services Secretary Alex Azar's father "had been on dialysis for several years." Even so, the system remains a mess, and bad actors are seldom punished. An indignant, urgent indictment of the for-profit American way of medical care.

      COPYRIGHT(2023) Kirkus Reviews, ALL RIGHTS RESERVED.

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