The Center for Chronic Disease Research and Policy is proud to feature a talk by Michelle Josephson, “Kidney Care Education and Policies: A National View from American Society of Nephrology,” at our 12th Annual Symposium: Intersections of Policy, Innovation, Healthcare, and Financialization for Kidney Disease: Where Are We in America Today? on October 16, 2024. REGISTER HERE.
Michelle A. Josephson, MD, FASN, is Professor of Medicine and Surgery at University of Chicago. She is the Medical Director of the University of Chicago Kidney and Pancreas Transplant Program as well as the Program Director of the Transplant Nephrology Fellowship. Dr. Josephson completed both her undergraduate and medical school training at the University of Pennsylvania. She completed her residency in internal medicine and a clinical and research nephrology fellowship at the University of Chicago. Dr. Josephson is an active member of the American Society of Nephrology (ASN) and has previously served as President. She chaired the American Society of Transplantation (AST) Cutting Edge of Transplantation 2020 and 2021 meetings. From 2007 to 2010m she served as a Councilor at Large on the AST Board of Directors. She serves on the editorial boards of JASN and AJN. Dr. Josephson has authored over 100 articles and 5 book chapters and has presented over 100 invited lectures nationally and internationally. She has particular interest in the live kidney donor, post-transplant bone disease, BK virus, and pregnancy in the transplant recipient. She is deeply committed to education in the realm of kidney transplantation.
How did you become interested in kidneys and chronic kidney disease?
I had exposure to the field of nephrology early in my life. I grew up in Brooklyn, New York. My dad had been an allergist immunologist. He worked at Downstate Medical Center and was friends with a nephrologist at his institution named Eli Friedman. Dr. Friedman pioneered nephrology and more specifically dialysis care, having started his career in the 1960s. During college, I spent some school breaks working in Dr. Friedman’s lab. I also worked with his team on a project in which they were trying to develop a portable dialysis machine. They thought of it as a “kidney in a suitcase.” Although I thought the work they did was all very interesting, I decided I would not become a nephrologist. I stuck with that decision all the way through medical school and internship. After I spent some time in a bush hospital in Liberia during medical school, I decided that I would pursue the areas of infectious disease and international health. However as a resident at University of Chicago, I had 3 wonderful nephrology attendings: Fred Coe, Susan Fellner, and Marshall Lindheimer as well as a terrific chief resident, Mark Richter (who was going into nephrology). These individuals reignited my interest in nephrology, and I applied for the nephrology fellowship. During my first year of fellowship I found myself drawn to issues related to kidney transplant: the immunology, the ethics, the nephrology, and the connection to infectious disease. I decided to dedicate my career to improving the care of patients with kidney transplants. Along the way I got involved in policy work related to kidney transplant, which provided another approach to improving the care of patients with kidney disease and transplants.
What do you think are the greatest problems in kidney health today?
To start, most people with kidney disease don’t know they have it. This is because there is no routine screening for it, even for patients who are high-risk. Then there are issues of disparities in access to care across the continuum of kidney disease, along racial/ethnic, as well as socioeconomic, and in some cases geographic lines. Fortunately, in part thanks to advocacy efforts to raise awareness about these disparities, they are receiving more attention today, from both scientists and policymakers who are looking to develop innovative solutions and tackle root-cause drivers. Insufficient education of patients about how to manage or slow their kidney disease, or to support them in making the most informed choices about what kind of therapy is best for them, is another challenge the organization I was recently president of, the American Society of Nephrology (ASN), is also advocating to overcome.
For a long time there was little in the way of interventions to help slow kidney disease. Fortunately now several effective options have emerged, such as SGLT2 antagonists and GLP1 agonists. Now the issue is whether people who need these interventions can get access to them.
Could you share an abstract or a few sentences on your talk?
The best therapy for kidney failure is kidney transplantation, but there are major issues with access to kidney transplant. Our current system has outgrown the demands and is not optimally supporting people with kidney diseases. Recognition of the gaps in the system have prompted the past several administrations to propose substantial changes, in part due to the kind of advocacy efforts I had the privilege to work on during my time as ASN President. These changes are simultaneously difficult and also offer an opportunity for improvement for individuals afflicted by kidney diseases. I’ll provide a historical perspective of the development of treatment of kidney disease that both makes clear how much the field has evolved and explains how the government became involved with payment and policies for kidney care in ways that are unique to the American healthcare system.
My goal is for the audience to leave both having learned something new about kidney care and transplantation as well as to be inspired to get engaged in advocacy efforts in their area of medicine.
What are you looking forward to at the CDRP symposium this year?
I’m looking forward to hearing what the other speakers present and discuss. It is a phenomenal line up of speakers. I am also looking forward to the opportunity to exchange ideas as well as learn what the audience has further questions about, during the question-and-answer session.