Scrib, born in Chicago in 1921, was a sickly child suffering from allergies, and this may have contributed to his ambition to become a physician. He studied at the University of California, Berkeley, and Stanford University School of Medicine, San Francisco, where his mentor was Thomas Addis. After holding a fellowship at the Mayo Foundation, Scrib moved to Seattle to the faculty of the University of Washington Medical School in 1951, and soon persuaded the hospital to buy a SkeggsLeonards haemodialyser. He was appointed the first head of the Division of Nephrology in 1958, Professor of Medicine in 1962, and Professor Emeritus of Medicine in 1992.
The shunt, developed with the collaboration of Wayne Quinton, was first used to treat a patient with chronic renal failure in March 1960. The patient, Clyde Shields, lived for 11 years before dying from cardiovascular disease. For several years after Scrib's first report on the shunt in the Transactions of the American Society for Artificial Internal Organs, dialysis for chronic renal failure was regarded with suspicion by many physicians interested in renal disease, but this began to change following his presentation to the International Society of Nephrology in Prague in 1963. Today, many more than a million patients around the world have been treated for what is now called end-stage renal disease.
Over the next 43 years, Scrib and his team were involved in many more of the developments that have benefited dialysis patients. These included working out the management of many of the complications associated with dialysis, including severe hypertension, peripheral neuropathy, gouty arthropathy, metastatic calcification, renal anaemia and renal bone disease. Early on, he saw the potential of peritoneal dialysis, and recruited Fred Boen and Henry Tenckhoff who developed peritoneal dialysis equipment for use in the home and the catheter that made long-term peritoneal dialysis feasible.
Because of his concern that dialysis should be available more generally, in 1962 he and Dr James Haviland established the Seattle Artificial Kidney Center, now the Northwest Kidney Centers, as the first out-of-hospital, non-profit, community-supported dialysis unit. In turn, this led to development of an anonymous lay selection committee to decide who should receive this expensive treatment. The description of this committee in an article in Life Magazine in 1962 stirred discussion among ethicists, philosophers and nephrologists that has been cited as the origin of bioethics as a discipline. Scrib was president of the American Society for Artificial Internal Organs in 1964, and his presidential address dealing with patient selection and related issues is still pertinent today. He felt strongly about the importance of patient autonomy and of justice in access to care. In 1986, at an international meeting of bioethicists in Seattle, he was given the honorary title of the original bioethicist.
In 1963, Scrib developed a productive relationship with Les Babb, Professor of Nuclear Engineering at the University of Washington. Their cooperation led to development of the first proportioning system to make dialysate and to a single patient-monitored proportioning machine for home haemodialysis that became the prototype for most of the dialysis machines in use in centres around the world today.
Scrib had always been interested in adequacy of dialysis. He originally based this on sufficient dialysis to avoid peripheral neuropathy, but with Babb he went on to develop the concepts of the square metre hour hypothesis and the middle molecule hypothesis. Because of his belief in the important role of middle molecules in uraemia, Scrib was always sceptical about the use of Kt/V as a measure of dialysis adequacy. Rather, he believed strongly in the importance of both the duration and frequency of dialysis. Thus, he was not surprised by the results of the recent HEMO study. He stressed his views on these subjects as recently as March of this year in a message sent to the Annual Dialysis Conference in Seattle.
Scrib was also interested in long-term parenteral nutrition and the use of blood access as a route for thiswhat he called the artificial gut. This work led to the development of the Broviac catheter and the Hickman catheter that is now widely used to administer chemotherapy and other drugs, as well as for parenteral nutrition.
He was always a patient advocate and helped play a role in getting the legislation leading to the Medicare End-Stage Renal Disease Program and in the implementation of this endeavour. He always believed in encouraging as much patient autonomy as possible, the importance of patient education and of rehabilitation, and the benefits of self-dialysis.
Over the years, Scrib trained many fellows from the USA and around the world, and Seattle was visited by many other nephrologists interested in dialysis. However, in addition to educating nephrologists and patients, he was also a superb teacher of medical students. While working with Addis and at the Mayo Foundation, he had developed a bedside kit to measure chloride, bicarbonate and urea. At the University of Washington, he combined this with a syllabus for teaching the principles of fluid balance in a simplified fashion that benefited thousands of medical students.
Throughout his career, Scrib acquired many honours. He was a president of both the American Society for Artificial Internal Organs and the American Society of Nephrology, and held honorary degrees from the University of Göteborg and the Postgraduate Medical School of London. Together with Pim Kolff, he was the recipient of the 2002 Albert Lasker Award for Clinical Medical Research, the USA's highest award in the field and regarded as second only to the Nobel Prize. However, he was also very delighted shortly before he died to receive the Distinguished Alumnus Award from Williams College in Massachusetts where he went to school.
For many years, Scrib lived on a houseboat across the lake from the University of Washington Medical School and canoed to work. He is survived by his wife Ethel, whose hospitality and charming personality are known to many, and by their seven children and their grandchildren.
Scrib was a warm, generous and rather modest person with a great many friends, especially among nephrologists and patients. While his intellect was important, his professional success was also due to his ability to focus completely on any problem that interested him, medical or otherwise, and to patiently persevere until he found a solution. He was one of the great men of medicine, and will be sorely missed by all who knew him.
A memorial tribute for Dr Scribner was held at the University of Washington on June 30. Remembrances can be sent to the University of Washington Scribner Dialysis Fund, in the care of UW Medicine, 1325 Fourth Avenue, Suite 2000, Seattle, WA 98101, USA
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