it's not just cultural -- it's all about the money

[walkitout]

Doctors get paid for procedures. Just keep repeating that. That's what's really wrong here.

I posted a link to a bioethics blogger. In that article was a link to this article:

http://virtualmentor.ama-assn.org/2008/10/pfor2-0810.html

Which starts out really bad (I don't currently know where it ends because I can't get there yet.
It's too painful.). It's all over the we're better at taking care of preemies because of
surfactant therapy and blah blah bleeping blah. Never mind this:

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2133345

I mean, some people down south figured out about kangaroo care 30 years ago and beat our preemie rates hands down with it. But that's not okay in our medical system. Nooooo. That might lead to co-sleeping and we know how the AMA feels about that.

*sigh*

Anyway. Back to virtual mentor, they do not include the standard disclaimer on comparing preemie rates internationally.

[Start quote]Do U.S. hospitals want to decrease NICU stay? While in most areas of pediatrics, frequency and duration of hospitalization have decreased over several years, NICU admissions have gone up mainly because of the increase in prematurity. According to pediatrician and ethicist John Lantos, "NICUs have become the economic engine that keeps children's hospitals running [10]." Lantos adds, "It almost seems as if society, by some mechanism, is working against health to produce more and more low-birth-weight babies, and that medicine is then working against society, desperately trying to patch the wounds caused by some nameless thing that is forcing our babies from the womb too soon [11]."[End quote]

Okay, it's not "society" or "some mechanism", it's basic accounting. You said NICUs are where they're making all the money. You could have perfect births of perfect babies 100% of the time. They'd just set the bar for sticking the kid in the NICU in a different place if they need kids in the NICU to pay the bills. Duh. Of course, normally we only do drastically evil stuff if we're really desperate, e.g. have to feed a kid who will otherwise go hungry. Hospital administrators, clearly, are made of sterner stuff.

The article has some merit, but I really think they missed the point. Yeah, sure. Limit number of embryos transferred. Whatever. But if you want to fix that NICU problem, that won't do it. Other countries don't have overuse of NICUs because in other countries NICUs aren't a profit center.

I should quit reading about this. It's just upsetting me. But I _really_ think I'm right that there's a completely screwy missing component to the Making a Perfect Baby rhetoric. People should be talking a lot more about the technical risks associated with IVF and other ARTs. And no one is.

Comments

[ethelmay.livejournal.com]

Totally agree. Plus, the part in the first article where they said women should be encouraged to have babies in their early twenties really ticked me off. Um, yeah, let's just revamp all of society, putting women even further behind economically, rather than stick to running our hospitals appropriately. Not to mention that putting the generations closer together is irresponsible given the burgeoning population. I mean, duh, if your average first birth is at 20, you have five generations in a century, at 25, four generations, 33, three generations. Delayed childbearing is a reasonably earth-friendly thing to do: each generation that's *here* gets to have its babies, but you still have fewer total born over the course of a century. And if we really have a lot of people being infertile by 33, gee, couldn't be that was a public health problem, could it? No, you're just too ooooold.

"encouraging" people to do something

[walkitout]

In general, whenever there's a whole tilt to society to get people to do something (like, say, smoke) and then a group of other people go around "encouraging" people to do another thing (like, say, not smoke), I get a little suspicious. Yes, people should not smoke. I agree. I've really always felt that way (even now, when I have a much more detailed and nuanced understanding of how many people are anxious more or less a lot of the time, and how effective nicotine is at alleviating that anxiety, and how cheap a delivery system cigarettes are for that anxiety relief). However, the "encouraging" bit is the problem. What we really need to do is re-tilt society to make it harder to do that thing than not. By, say, banning smoking in public places and taxing the shit out of the stuff. Now no one needs to go around saying, "No, I'd prefer you didn't smoke around my baby", much less, "Please don't burn the house down by smoking in bed, dear."

Taking the issues in order, women could have their babies earlier in their childbearing years (when, let's face it, some women would prefer to do so, but do not for economic reasons) if we made a series of adjustments to the way we handle pregnancy and parenting while parents are in school and working. These are adjustments that need to be made anyway. It also helps a lot when it isn't mothers getting special treatment, but rather parents. The standard array of goals applies: more/better/subsidized/nearby child care, maternity leave, support for breastfeeding, parental leave, flexible hours, telecommuting, part-time work with benefits, blah, blah, bleeping blah.

Next, the earth-friendly, number of generations on the planet at once question. Ignoring, for the moment, the it's-nice-to-see-your-grands issue (particularly since younger grands can help with child care and older grands probably less so), there are a variety of ways to reduce earth-impact without resorting to average age at first childbirth being over 35 (not that it is, yet). There's the fewer children thing. And there's the don't have them so damn close together thing. I, personally, am partial to the idea of having the kids 10-20 years apart -- one while in college, approximately, and one after the career is going great guns. Then you have a shot at seeing grands, the older sibling is genuinely old enough to be useful with the younger sibling and so forth. I cannot imagine anyone else signing off on this as an idea, but I will note that it solves the gosh I'm one of those people who hits menopause early problem -- at least you got to have one kid. Really, to make this solution fly, we'd probably have to normalize having the two kids by different fathers. I mean, I'm just saying. That actually would have some real benefits, in that if we played it right, everyone would get to reproduce at least once (so their genes get a shot at immortality) but we could have fewer kids in each ensuing generation (if each mother had two children, but each father only had one). There's at least one fantasy series out there with this as the premise. Which is where I got it from.

I have mixed feelings about the infertile at 33 thing. I agree that it's probably a public health issue. I suspect smoking, and too many hormones in the food supply. But I don't really know.

Re: "encouraging" people to do something

[ethelmay.livejournal.com]

I didn't mean to imply that we'd ever get the average as high as 33, or that everyone should do that -- only that it's not a weird thing to want to do, and it's completely consonant with a lot of other reasonable goals. But of course I agree with having better socioeconomic supports in place for people making whatever decisions they want.

I may have a skewed view of how healthy people tend to be at 66-76. My then-teenage cousin went to live with my grandmother (her mother having kicked her out) when Grandma had turned eighty, for instance, and that turned out rather well. My stepmother was also quite a help with the twins, despite then being in her late sixties or so (but then she still plays tennis now, at past eighty -- generally seeming less "old" than my grandmother did at that age). Having grandchildren arrive right about the time when, if working, you'd be likely to be about to retire (that too may change, if lives lengthen and benefits decrease), so you could spend more time with them, seems about right to me. I don't know whether our generation (who did at least grow up with fewer years of leaded gas and what not) is going to do any better, but I don't see why we shouldn't do about as well, barring some new health crisis. And I'm just as glad not to have my eldercare needs overlapping with my parents'.

I think there's a lot of very weird age-shaming in obstetrics (look at the term "elderly primipara"), and I've always thought a lot of it was doctors trying to control women more than is medically justified.

I come from a big family full of anxious people, a little over half of whom smoked at some time, and as far as I can tell the nicotine really doesn't help -- in fact, by relieving temporary anxiety, it may even contribute to keeping you from changing the things in your life that need to change. (My dad gave up smoking and took up long-distance running, which was generally more beneficial, but still didn't get at the root of the problem.) But I am certainly glad I never started, because it was pretty obvious I was just the sort to get addicted.