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Daniel Kochis

Throughout its history, the government of the United States has traditionally expanded services to veterans after the outbreak of a major conflict. Whereas individual states initially carried the majority of the burden of caring for wounded soldiers, the federal government has gradually expanded its responsibility in this arena. During the Revolutionary War, disabled soldiers received pensions from the Continental Congress (although Congress did not have money to provide for many of them); however, hospital medical care was the responsibility of an individual soldier’s home state. During the Civil War, some states began to establish centers specifically designed to care for

Daniel Kochis
Part I: A Historic Retrospective

The National Institute of Arthritis and Metabolic Diseases, predecessor of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), was founded in 1950 under the already established National Institutes of Health (NIH). The end of World War II and the subsequent economic boom shifted dollars and scientific brainpower into medical research as never before. The decade after World War II saw the establishment of no fewer than six divisions of the NIH, including the future NIDDK and the National Heart, Lung, and Blood Institute. The research undertaken by the NIH and its new

Daniel Kochis

The year 2007 was a challenging one for researchers. The National Institutes of Health (NIH) funded only 24 percent of proposals (down from 32 percent in 1999) (1), and additional funding for research seemed miles away. Clinical practice, private industry, and foreign countries all threatened to poach valuable talent from the ranks of researchers at U.S. research institutions. After a funding boom earlier in the decade, willingness to devote new dollars for NIH had dried up in Congress. The economy, increased spending for other sectors, and a lack of political urgency drove the trend.

Tight funding at NIH

Daniel Kochis

You could spend a lifetime trying to understand the Congressional appropriations process. Some do: Senators, House members, and their staff make navigation of a multifaceted appropriations process their hallmark. The influence at stake and numerous bodies involved make the appropriations process inherently complex. As the 2011 Congressional appropriations continues to play out this winter following the November election, you may wonder, how does this whole process work?

Article I of the U.S. Constitution creates the legislative branch and with it the power to raise revenue—a power given to the House of Representatives exclusively. However, the Constitution does not address which

Daniel Kochis

In order to temporarily avoid drastic cuts to Medicare physician payments, Congressional leaders agreed to a bipartisan compromise that would maintain the current set of Medicare payments through the end of 2011. While the yearlong “doc fix” is only an interim solution, the compromise allows the incoming Congress time to consider implementing a permanent solution to the flawed Sustainable Growth Rate (SGR), the basis of Medicare physician payments. The SGR has been a recurrent problem for the better part of the past two decades, and ASN has led advocacy efforts to replace it with a new formula that fairly and

Daniel Kochis

The workforce crisis hitting the field of nephrology extends beyond physicians to nurses, nurse practitioners, and physician assistants (PAs), who are often on the front lines in the battle against kidney disease. Nurses and nurse practitioners provide essential services to patients with kidney disease, working in hospitals, dialysis centers, and homes. They help bridge the growing gap between the number of patients with kidney disease and the availability of nephrologists.

Despite the essential role of nurses in caring for patients, the future of nursing is less than certain. In 2008, the average age for nurses reached 46, reflective of an

Daniel Kochis

To facilitate the matching of internal medicine residents with nephrology fellowship training programs, nephrology first participated in the Electronic Residency Application Services (ERAS) in 2006 and the Medical Specialties Matching Program (MSMP) in 2007. MSMP—part of the larger National Residency Matching Program—is a service that pairs residents with available fellowship positions. Currently, 10 internal medicine specialties participate in MSMP (Table 6.1).

In 2011, continuing the downward trend that has plagued the nephrology fellowship match in recent years, the fewest number of residents applied for positions than in any year since the ASN first joined the MSMP (1

Daniel Kochis

Acompromise budget bill passed by Congress on April 14 and signed by President Obama cuts federal spending by $38 billion for the remainder of fiscal year (FY) 2011, including a 1 percent cut to the National Institutes of Health (NIH). The compromise bill, the result of a last minute deal between the House of Representatives and Senate, avoids the first government shutdown since 1995 and funds the federal government through September 30, 2011. By avoiding a government shutdown, the research community avoided disruption of vital ongoing research projects funded through the NIH, but must now grapple with reduced funding pools

Daniel Kochis and Rachel Shaffer

Representatives convened at a crucial Food and Drug Administration (FDA) meeting of the Cardiovascular and Renal Drugs Advisory Committee (CRDAC) recently to determine the future of darbepoetin. ASN Public Policy Board member Wolfgang Winkelmayer, MD, ScD, FASN, presented testimony on the currently available evidence regarding erythropoiesis-stimulating agents (ESAs).

FDA convened the CRDAC meeting to discuss the risks and benefits of the use of ESAs to treat anemia in patients with chronic kidney disease (CKD) based on results from the recent “Trial to Reduce Cardiovascular Events with Aranesp® Therapy” (TREAT). CRDAC reviews and evaluates available data concerning the safety

By Daniel Kochis

A newly proposed rule on conflict of interest in medical research would reduce the monetary amount that qualifies as a conflict for researchers from $10,000 to $5000. Issued by the National Institutes of Health (NIH) in May, the rule is designed to help strengthen the current rules governing conflicts of interest between researchers and industry.

In addition to changing the definition of “significant financial interest” by reducing it to a total of $5000, the rule supports creating a website for public reporting of significant financial interests among researchers and placing increased responsibility on individual institutions to monitor potential