February 13, 2009

Peter Klatsky '98 on octuplets, public health

My classmate, Peter Klatsky, M.D.,M.P.H., in addition to his own medical practice, has set up shop at Huffington Post with a regular column on public health issues. While Pete specializes in women’s reproductive health, his writings cover a broader scope of topics.

His latest entry at HuffPo is a different take on the Nadya Suleman octuplets story. While the media have amplified certain themes around the story, Klatsky takes a different angle:

[Suleman’s physician] has appropriately come under professional scrutiny. While I share concerns that he may not have followed the guidelines of our professional society and performed procedures that were outside of our standard practices, I have yet to hear anyone asking critical rather than judgmental or voyeuristic questions. How did this happen? Have we done anything to encourage this? And how can we prevent this from happening again? I want to examine the circumstances that could permit and even encourage this?

[emphasis in original]. Klatsky notes the structural factors of our health care system that encourage multiple embryo placement during in vitro fertilization (IVF), including pressure on clinics to report high success rates and issues surrounding insurance coverage of the procedure. Noting the tension between government regulation of public health issues and the privacy rights of patients, Klatsky offers suggestions for reform:

For starters, clinics should only be mandated to report births or pregnancies per embryo transferred. Patients should be encouraged to transfer no more than the recommended number of embryos (as determined by professional guidelines and the specific history and conditions of each patient). If patients demand to transfer more embryos, perhaps they could be asked to bear part of the economic burden of that choices. A surcharge could be added if patients transfer more than the recommended number of embryos (as the ensuing obstetric and pediatric costs to society will be higher. Such economic risk sharing might encourage patients to be more conservative about their embryo transfer strategies.

I am not sure our system can afford to universally cover IVF or that people would accept the restrictions that would likely follow, but in the absence of clear regulatory jurisdiction or mandates, an appropriate first step would be to reduce irrational incentives when healthier alternatives exist.

Dave Nardolillo '98 | February 13, 2009 07:29 AM | Alumni

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