For those wondering what actions our regulatory board is taking, here’s a letter from the esteemed Executive Director of our society that I received yesterday by email:
I am sure all of us have followed with interest and concern the unfolding story of the Suleman octuplets in California. I wanted to take a moment to share with you some of what ASRM and SART have been doing in response.
Our Public Affairs office began taking calls (after business hours on the East Coast) the evening the birth of the octuplets was announced on Wednesday, January 28. In these early days of the story we focused on reminding the media that while the successful delivery of the octuplets was novel, such a high order multiple birth should not be considered a desirable medical outcome.
On Friday January 30th an interview with the children’s grandmother made it appear that IVF treatment had indeed been involved. That morning we released a statement from ASRM President Dale McClure MD. That statement emphasized that we did not have the facts in this case, but that in recent years ASRM and SART had been working very hard, and with a fair amount of success, to reduce the number of high order multiple births. (That statement, and all our press releases are available at www.asrm.org.) By weeks end the Public Affairs Office had responded to well over 100 calls, and ASRM staff and leaders had done dozens of interviews.
Over the course of the next week, the volume of media calls remained very, very high. However, since no new information emerged, the media questions and coverage became increasingly speculative in nature. Because we did not feel it was responsible to engage in that speculation, we began to curtail our responsiveness. Meanwhile, SART sent a communication to its membership seeking any information anyone had on the situation.
As the Today show began to air its interview with the mother on February 6, she indicated all her children were the result of IVF and all from the same physician, and subsequent media reports named the physician. On Monday February 9, ASRM President McClure issued another statement, again emphasizing the field’s success in reducing the number of high order multiples, and indicating we were interested in looking into the matter. On Tuesday, February 10th I sent a letter to the California Medical Board stating our interest in this matter and our willingness to assist them in their inquiry. SART President Elizabeth Ginsburg, MD sent a letter to the physician named in media reports to ask for information about the treatment of this patient.
Examining and learning from both successful and unsuccessful cases is a vital component of medical education and an important tool in improving clinical practice. We are seeking information so that all of us may better understand how to avoid additional extreme high order multiple births. Moreover, we have all worked too hard to improve care and reduce the number of high order multiples to allow one unfortunate outcome to taint the whole field. Both ASRM and SART have membership standards and disciplinary procedures and should the facts warrant, those procedures will be used.
It is important to note that we do not have all the facts. At present I would say we have very little information, and most of what we think we know has come from sometimes conflicting media reports. All of us need to be very cautious before coming to any conclusions. We will keep you informed as additional information becomes available.
Robert W. Rebar, M.D.
Executive Director
American Society for Reproductive Medicine
The following excerpt from another recent press release shows just how much we, as a society, have accomplished in lowering the risk of high order multiple pregnancies.
We issued our first embryo transfer guidelines in 1996 and began to see a reduction in high-order multiple pregnancies the very next year. According to the CDC, in 1996 7% of fresh, non-donor ART cycles reaching embryo transfer and resulting in a live birth were triplets or more. By 2005, that number had fallen to only 2% of such cycles. This was achieved without hurting the pregnancy rates for our patients. In fact, during the same period, the success rate from fresh non-donor embryo transfers increased from 28% in 1996 to 34.3% in 2005.
I say the response published above does nothing to advance confidence in the capacity of self-regulation of fertility specialists.
It indicates a toothlessness and reactive, rather than proactive, stance in dealing with bad apples in the profession, and reactive only when it becomes apparent that there is no option of ignoring the situation.
Also it’s sort of rear-end-covery – careful to defensively self-congratulate about reduction in multiple pregnancies to stave off critisism, in a way that smacks of a peanut product PR flunky announcing the reasonable steps taken to reduce salmonella poisonings.
Here’s what – questions, serious questions, have been raised about Kamrava’s practice for more than a decade. Sanction of Kamarava is not sufficient now and I think anything less than kicking him out of SART will demonstrate a laxity in self-policing that will encourage know-nothing showboating politicians to intervene with inflexible, even draconian, controls.
THe best response now is to express MORE concern over this physician rather than less, to reassure that if any i in his records in undotted, and pattern of disreguard for safe and ethical practices will result in the severest loss of accreditation possible.
It’s better to overstate the concern than understate it, in this case. And frankly I doubt there is any overstatement to be concerned about. Patients and former employees and his own statistics indicate serious problems in his practice.
But in the broadest view, this case does point up a serious lack of self-policing or at least a slowness to act. Accountability may seem like a pain in the neck, but better to be accountable to professionals who understand the medical issues thoroughly than politicians who do not.
In other words, the faster and more willingly Kamrava is thrown under a bus, the better.
I know that in this post I used the words “regulatory board” when referring to the committee within ASRM which is looking into Dr. K’s case, but I have to apologize if I misled anyone. ASRM is NOT an official regulatory agency. It is possible for someone to perform IVF in the US and and not be a member of ASRM, let alone SART, which is a subgroup within ASRM. ASRM has the power to kick someone out, but they can’t control whether someone practices medicine nor even specifically control if they can do IVF or not.
Now the California Medical Board is a different matter. They DO have a say in whether someone practices medicine in this state or not.
If ASRM kicks out Dr. K, it can be but a symbolic gesture. It’s like if you get kicked out of the local bridge club, it can be embarrassing, but you can still go and play bridge somewhere else.
Let the symbolism begin. I wrote the top comment understanding that both ASRM and SART cannot stop him from practicing medicine or fertility medicine.
And “bridge club” expulsion is better than inclusion.
As a practical protection for patients and standards, It’s a red flag to patients; moreover, insurers actually will often not cover treatment costs (that would ordinarily be covered) if the fertility practice does not belong to SART/attest it follows SART guidelines.
To restate my point – it would be better to play up concern than downplay it, in this case.