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Arnold Berns,
MD, FASN, head of the Renal Division at Saint Francis Hospital Arnold Berns, MD, FASN, has practiced
nephrology in Chicago, IL, for more than 30 years He heads
the Renal Division at Saint Francis Hospital in Evanston and is a
Clinical Professor of Medicine at the University of Illinois College of
Medicine. A member of the Nephrology Board of the American Board
of Internal Medicine (ABIM) Dr. Berns co-chairs the ASN Practicing
Nephrologist Advisory Group and serves on the Society’s Board of
Advisors. He has graciously agreed to answer 10 questions for this
edition of Renal Express. RE: The role of nephrologists as de facto primary care providers for dialysis patients is of increasing interest. What are your thoughts on this matter? In many instances, the nephrologist is the de facto primary care physician, but unfortunately, even after all these years, this remains a poorly defined and non-standardized area of nephrology practice. Certainly, the nephrologist is responsible for all issues directly related to dialysis, however, overlap areas, such as diabetes care and routine preventative health issues are often left to the discretion of the various providers. The recent initiation of universal foot care initiatives is an excellent example of adding real value to the patients while they visit the dialysis unit. As practice patterns and areas of clinical responsibilities become better defined, and they need to be, the governing dynamic must remain the continuous improvement of patient care. RE: How do you feel about the current scenario wherein nephrologists train for many years in several different aspects of renal physiology and pathophysiology, but the majority of them take care of patients without functioning kidneys? I didn’t give renal physiology much thought prior to my fellowship, but it rapidly became my "favorite subject" during training. Renal physiology is the foundation of clinical nephrology and continuously informs the thinking and decision making of the nephrologist. It is not possible to successfully function as a clinical nephrologist without a thorough understanding of all aspects of renal physiology. To do so would be tantamount to going to sea without a compass, hoping not to get lost. Therefore, it is incumbent upon the training programs to maintain a strong commitment to physiology education as an important component of the fellowship curriculum. RE: The ABIM, with the input of its Nephrology Board, has recently established and defined a set of core procedural competencies that are required for initial board certification in Nephrology. Please tell us about this. ABIM and ASN agree that there is a requisite intellectual and procedural core of competencies that must be mastered in order to achieve the status of a board certified nephrologist. For example, such proficiencies include acute and chronic dialysis, percutaneous renal biopsy, and expertise in continuous renal replacement modalities. The goal is to educate and certify nephrologists capable of consistently delivering the highest quality patient care. RE: A young nephrologist comes to you and asks for advice on how to be a good nephrologist. What do you tell him/her? Be prepared to work hard, embark upon a life-long personal learning curve, and never stop deeply caring about the well being of your patients. My career has taught me that excellence is a process, not a destination. RE: What frustrations have you experienced as a practicing nephrologist? As nephrologists, we routinely take care of very seriously ill patients. In spite of our best efforts, outcomes are often not as good as we would like. The disappointments can be quite discouraging and at times, overwhelming. The creation of new knowledge is a laborious process and important and meaningful scientific advances come ever so slowly, especially for someone as impatient as me. However, when I compare the average dialysis patient of the 70s and 80s to the patients of today, I see a much healthier group of people with a higher level of rehabilitation and a markedly improved quality of life. This evolving improvement serves as an excellent emotional counter weight to the disappointments and failures that are an integral part of clinical medicine. As a practicing nephrologist for more than three decades, I am sustained by the fact that it has been my privilege to care for some of the bravest and most courageous men and women that I will ever have the honor of knowing. RE: What are your thoughts on interventional nephrology? To me, this is a very exciting new area of nephrology. Clearly it is not for everyone, but for those talented individuals who are interested and willing to complete the necessary additional training, it will likely be a gratifying career choice. I predict that interventional nephrologists will make a significant positive contribution to our specialty. Nobody is in the position to understand the access needs of a patient and execute optimal procedural decision making better than another nephrologist. In my opinion, it’s the perfect amalgam of form and function. RE: Which of the recent ASN initiatives for clinical nephrologists do you find most useful? Quite happily, this is a tough question to answer. In the past four years, the ASN has rolled out several new products, all geared to the clinical nephrologist. The two that come to mind immediately are the introduction of CJASN and the creation of Renal WeekEnds, both of which add substantial value to the practitioner. The formation of the Practicing Nephrologist Advisory Group and the sustained contribution of practicing nephrologists to many of the ASN committees, advisory groups, and ad hoc projects and task forces are other examples of the growing synergy between our society and the practice community. RE: Renal Express heard a rumor that you were a Boy Scout. How did this experience influence your success as a nephrologist? This particular rumor is actually true, back when Dwight Eisenhower was president. As a result, I became proficient in Morse Code, but I don’t get to use it much these days. Seriously, what I did learn was the personal value of setting and accomplishing goals and the importance of being honest at all times. RE: Who is your favorite writer? Why? I am an avid reader and have had a life long love affair with literature, and much like foods and movies, I have many favorites. However, there will never be another Shakespeare. His canon expresses the full range of human emotions and explores the joys and sorrows in life that we all will experience. To read Shakespeare is to understand the human condition. RE: What has been the biggest disappointment in your career? In 2005, I offered to the ASN education leadership an unsolicited suggestion that we change the name of the "Renal Week Mini-Review" to "Renal WeekEnd." The penetrating logic and sheer brilliance of my proposal was immediately appreciated and the change was initiated the very next year. Unfortunately, I failed to copyright the term "Renal WeekEnd" and, therefore, do not receive royalties whenever the name is used. |
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 ASN Submits NIH
Common Fund Proposal, NIH Announces Changes to Peer ReviewIn response to a National Institutes of Health (NIH) request for information, ASN submitted a proposal earlier this month for new initiatives to be funded by the NIH Common Fund. ASN recommended NIH develop clinical and translational research infrastructure that supports interconnected specialized disease databases, large-scale studies and disease-related analyses, and clinical trial patient recruitment. "ASN encourages NIH to develop the infrastructure to allow data-consolidation among the specialized databases which would require common data dictionaries and algorithms," the proposal states. "The data-connected networks would assure timeliness in protocol development, maintain Health Insurance Portability and Accountability Act compliance, and could include a common IRB for increased expertise and facilitation of institution interaction with the reposited materials." According to NIH, the Common Fund "supports programs that address fundamental knowledge gaps, develop transformative tools and technologies, and/or foster innovative approaches to complex problems." To best fit a proposal to this interdisciplinary model, ASN purposely proposed an initiative that would benefit kidney disease research without excluding other diseases and disciplines. "By storing and coordinating patient data, opportunities increase for large-scale studies and disease-related analyses that can uncover the etiologies and appropriate therapy for the [kidney] disease." NIH plans to review the submitted proposals to ensure they fit within the context of the NIH Roadmap for Medical Research. They may then be used as the framework for new Common Fund initiatives starting in fiscal year 2011. In related news, NIH Director Elias A. Zerhouni, MD, announced Friday, June 6, 2008, that the year-long process to assess the agency's system of peer review has led to a number of critical changes that will be implemented during the next 18 months. According to an NIH press release, the four major priorities for enhanced peer review are to recruit the best reviewers by increasing reviewer flexibility, compensation, and training; improve the quality of review by shortening grant application length, highlighting scientific impact, and altering the rating system; provide fair review by supporting early stage investigators, funding transformative research, and reducing multiple application submissions; and improve the process for continuous peer review. Along with these changes, Dr. Zerhouni announced the agency will commit $1 billion during the next five years for investigator-initiated, innovative research. For more information about ASN's Common Fund proposal, the NIH Common Fund and Roadmap for Medical Research, or NIH's peer review changes, please contact ASN Research Policy Coordinator Allison L. Haupt at (202) 659-0599 or ahaupt@asn-online.org. Senate Fails to Reach Consensus on Medicare Legislation Containing ESRD Reforms During the past several weeks, congressional leaders, medical societies, and numerous other organizations have worked to develop a proposal to prevent pending cuts to physician payment rates under the Medicare program. Without congressional action, Medicare will reduce payments to physicians by 10.6 percent on July 1, 2008, and by an additional five percent on Thursday, January 1, 2009. Unable to reach consensus on this key provision, Senate Finance Committee Chair Max Baucus (D-MT) and Ranking Minority Member Charles Grassley (R-IA) introduced competing proposals. The physician payment piece is not the only provision of interest to ASN members included in this legislation. In fact, both the Baucus and Grassley proposals include reforms to the Medicare end-stage renal disease (ESRD) program. For more information about both proposals’ ESRD provisions, read the Kidney Care Partners (KCP) Democratic and Republican summaries. ASN is supporting advocacy efforts that would cancel the July 1, 2008, Medicare payment cuts to physicians. Specifically, the Society supported the American Medical Association (AMA) and the American College of Physicians (ACP) efforts on a reasonable sustainable growth rate (SGR) fix. Working closely with KCP, ASN served on the coalition’s working groups to develop ESRD reform measures that are part of both the Baucus and Grassley bills. ASN advocated for and strongly supports provisions for chronic kidney disease (CKD) education sessions, a phase-in of a (proposed) bundled payment, acceptable oral drug language, an annual update, measure development and the requirement that the General Accountability Office (GAO) report back to Congress on bundling. The Society also advocated for keeping (renal) physician fees for service out of the bundled payment. Recent ASN advocacy efforts have focused on communicating with key congressional and committee staff, meeting with senior staff to discuss provisions of the Medicare bill and ESRD reform measures, and providing feedback about these key provisions prior to the introduction of both bills. On Thursday, June 12, the struggle to reach consensus on this legislation resulted in the Senate failing to invoke cloture on the Medicare Improvement for Patients and Providers Act of 2008 (S 3101). Senator Baucus’ bill fell six votes short of the 60 required for passage. Despite the setback, the medical community is optimistic that Democratic and Republican leaders will come together and resume negotiations on the scope and size of a final Medicare bill. ASN will work in coordination with KCP and the rest of the renal community to ensure ESRD reform provisions are part of the final compromise bill and reflect the interests of its members. For more information about Medicare or this legislation, please contact ASN Director of Policy and Public Affairs Paul C. Smedberg at (202) 416-0646 or psmedberg@asn-online.org. |
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Postgraduate
Education Committee Planning for Renal Week is a collaborative
process
between the Program Committee and the Postgraduate Education (PGE)
Committee. The PGE Committee is responsible for developing the one- and
two-day PGE courses that take place during the first two days of Renal
Week; the Clinical Nephrology Conferences, which are held from 10:00
a.m. to 12:00 p.m. and 2:00 p.m. to 4:00 p.m. during the third, fourth,
and fifth days of Renal Week; and the Official Symposia that occur
during the meeting's breakfasts, lunches, and dinners. The committee is
also responsible for the Clinical Pathologic Conference, Dialysis
Outcomes and Practice Patterns Study, United States Renal Data Systems,
Kidney Disease: Improving Global Outcomes sessions, and two public
policy forums.Members of the PGE Committee serve staggered three-year terms and represent a number of different organizations, content areas, and ASN advisory groups. The committee reviews potential topics in nephrology with an emphasis on integrating current information into the existing knowledge base. Strengthening this separation between content development and industry sponsorship has been a high priority for the committee and the Society. To ensure the educational programs meet the standards set forth by the Accreditation Council for Continuing Medical Education, ASN has developed strict policies to govern the relationship between the Society and industry. Moving forward, the PGE Committee is committed to soliciting broad input from ASN members into the planning of Renal Week 2009, which will take place October 27 to November 1, in San Diego, CA. The process will involve formal solicitation of program suggestions from the Society's committees and advisory groups as well as from the ASN membership. A major long-term goal is to repackage the excellent programs presented at Renal Week to allow for multiple opportunities for asynchronous learning. Mark E. Rosenberg, MD University of Minnesota Medical School Chair, Postgraduate Education Committee |
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JASN Hidden
Heart Condition Increases the Risk of Death in Patients Waiting for
Kidney Transplants An often asymptomatic condition—systolic dysfunction, or decreased pumping of the heart—poses an increased risk of death for patients on kidney transplant waiting lists. Study findings reveal that a clinical indicator beyond well-known risk factors for cardiovascular mortality should be considered when caring for patients waiting for kidney donations. The study also suggests that changes in organ allocation policies may be warranted. TOC; Full Study Medical
Research is Essential to Improving The Economy and Bettering Lives: Now
is Not the Time to Stifle the Funding of Science Health care in the United States is expensive, but its funding is crucial because it also is a major contributor to the economy and can better lives. This editorial asserts that the rising costs of health care should not result in a shrinking of the budget at the National Institutes of Health, which funds medical research that leads to potentially curative therapy. TOC; Full Study Evidence
Lacking on Health Benefits of Drinking Lots of WaterA recent look at what is known about the health effects of drinking water reveals that most supposed benefits are not backed by solid evidence. The findings indicate that most people do not need to worry about drinking eight glasses of eight ounces ("8x8") of water per day. TOC; Full Study |
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| ASN Reminders Abbott Accepting Research Proposals Deadline: Monday, June 30, 2008. Abbott is accepting research proposals for "ExtenD to explore additional therapeutic benefits of VDRA in areas including cardiovascular disease, cardiac and vascular function, metabolism disorders, inflammation, and chronic kidney disease progression." To learn more, please click here. ASN Member Login Change The ASN member login structure will change Monday, June 17, to require your email address and a user-generated password. This change allows ASN members to utilize the Society’s online benefits while enjoying increased security and enhanced customization. For more information about this change, please contact Hal Nesbitt at hnesbitt@asn-online.org. 2008 ASN Resident's Program To nominate a resident for the 2008 ASN Residents Program, please visit the ASN Training Program Directors Page. ASN Seeks Education Director ASN seeks an Education Director for the ASN Board Review Course and Update. Click here to learn more about this position.
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