I’m OK. Thanks for asking.

It’s good to know that my two-week absence from blogging has elicited such caring inquiries from many of you, asking about my well-being. Now I need to be a bit more honest. I’m actually NOT OK.

Well, to be more precise, I’m just about as OK as anybody else who lives in the United States, or even more specifically, in the state of California, which at the moment, is not that great. For the first time since perhaps the 9/11 incident, I am questioning the security of our way of life. To put things in perspective, if you were to ask me any time in the past five years this question: “How sure are you that in the next year, you, your friends and your neighbors will continue to have adequate food, water, electricity, lines of communication and safety from people with criminal intent?”, I would have thought “Huh? What kind of silly question is that?” and then answered 99%+ sure. After all, we live in modern-day America, not some impoverished third-world country and not in medieval times. However, if you ask me that same question today, I would say that I am only maybe 70% sure. The significance of this difference to me is HUGE.

We have grown to take for granted that we will always have access to food, water and emergency medical care and that we will always be able to count on the police to protect us from criminals. But reality reminds us that we can’t always do that. The two most glaring examples that come to mind are New Orleans during Katrina and LA during the riots. I learned a lot about the reality of life during Katrina during my trip to New Orleans for the ASRM meeting a few years ago. I befriended a taxi driver and some other locals and learned their war stories firsthand. The tales were surreal, giving me a grim reminder of how quickly life as we know it can revert back to the barbaric conditions of the Middle Ages. I’m also reading a fictional book, “The Tin Roof Blowdown“, which contains some of the most gory graphic descriptions of the chaos that occurred during Katrina.

Just as I went into medicine partially out of a burning curiosity about how our bodies work, I love to regularly research psychology, sociology, history and politics to satiate my desire of knowing how the world works, and I am now of the opinion that there is uncertainty, enough uncertainty that I am officially “concerned”.

Bear in mind that I look with amusement upon the globing warning alarmists or the religious zealots who predict the Apocalypse is coming this week or that week. But I am not fanatically ranting that the world will end tomorrow, or even next year. However, let’s just say that based on my own research AND based on what my own eyes see happening in the real world all around me, I know in my heart that this country is headed in the wrong direction.

Prior to this recent revelation, the life for my staff and me consisted of working our hardest for our patients, which for me, meant willingly giving up around 60 hours per week (including many weekends and some late nights) seeing patients, talking to patients, reading up on new advances and blogging. Some friends would feel bad that I worked so hard, but I reminded them that this was my calling in life. The reward of helping people have babies makes it intrinsically fun for me. Also, as a very important added component, in return for my sacrifices, I was shown gratitude by patients, who paid fair financial compensation so that I was now empowered to accomplish my many other goals and leisurely pursuits. It was a very fair system and is basically the American way, or at least, the American way that was originally laid out by the writers of the Constitution. Equally fitting, my patients were out there productively working their hardest using whatever their own talents were to make life better for THEIR customers, patients and clients. And as a result, they were paid adequate compensation so that they could pursue their goals for happiness, which just so happened to include doing medical treatment to have babies. In this system, everybody had the freedom to choose how hard they worked, with the corresponding reward in return.

However, as I mentioned earlier, things are changing for the worse. Now, I, for one, was  glad to see George W. Bush leave office. I disagreed with his specific policies which led to a further shift in the balance from individual freedom to excessive government power. I was optimistically open-minded (but cautiously skeptical) that maybe Obama’s promises of a “change” were more than empty political promises. But, BAM! Out of the gate, like a slap in the face, the new president showed his true self. My friends tire of me reminding them time and time again that we should judge people by their actions and not by their words. Well, the president’s first major action, deceptively called a “stimulus” package, is what he should be judged by, not by his sweet words of promising to make the country a better place for the people. No, I have not read the entire word-by-word rendition of the package. But then again, neither have any of the politicians who voted for it. However, I have studied it enough to render my strong opinion that it has little to do with helping people and more to do with increasing the massively growing domination of political power.

I have an interest in discussing these details in future posts and I plan to do so, even at the risk of you readers eventually telling me “Enough politics already! Get back to writing about fertility!”, but for now, I just wanted to share with you why I have been absent from blogging these past few weeks. I compare my recent world view to that of a not-entirely-unsuspecting New Orleans resident in the few days before Katrina. Sure, the news keeps warning us something bad MIGHT happen. Sure, we can see the wind and skies outside ourselves. But we don’t really know if, when or how hard it will hit. Meanwhile, though, we’re getting ready stockpiling food, setting up emergency generators, boarding up our windows and making contingency plans to get out of New Orleans. So, in this instance, how am I getting ready for a future collapse of this country? By researching and learning so that I can share information with others. Because, unlike a hurricane descending upon us, the upcoming social and economic disaster IS potentially preventable. I am hopeful that we, as a people can wake up and reverse the ever-growing shift from government dominance to individual freedom. We’ll see.

But don’t worry, I’m still practicing medicine. In fact, things have been busy and pregnancies have been coming in bunches (little bunches, not 8-fold bunches) and I still have lots of good stories and insights to share in future posts. I just realize now that we all have to prepare for a potential disaster that I hope will never come.

This bizarre story illustrates how time and time again, turkey basters and alcohol don’t mix.

In the previous post, we introduced the setting, describing what’s going on in Georgia. A trio of politicians are pushing for the adoption of new laws governing what people can do with regards to in-vitro fertilization. Today, we’ll begin dissecting the actual meat of this proposed legislation to see if it really is the best way to prevent cases like the octuplets from ever happening again.

I tried to be open-minded. I really did. But, right away, looking at the very name made me fight with every ounce of energy to avoid rolling my eyes. This act is cited as the “Ethical Treatment of Human Embryos Act”. Ethical treatment of a microscopic cell? I do understand that physical size is not the sole criterion of how significant something is, but it does lead to some amusing perspective to imagine cruelty being done against something that can’t even be seen. A human embryo is smaller than the specks of particles that you stir up when you blow on a dusty old countertop. In fact, you can’t even see an embryo with the naked eye. I can visualize images of torture against human beings in North Korea. I can even imagine people being cruel to a kitten. And of course, there is a tiny part of my humanity that mourns for the life of the little ants, right after I blast them with Raid. But my limited imagination falls short when I try to conjure up images of evil scientists in the lab inflicting pain and suffering on macroscopically invisible entities.

OK OK. So size isn’t everything. One can argue that an embryo can become a golden-haired blue-eyed little girl some day. That’s certainly true. But it’s still a huge fallacy to compare the humanity of an embryo with the humanity of a baby. A sperm CAN become a person someday, if it meets the right egg, but most of them don’t. An egg CAN become a person someday, if it meets the right sperm, but most of them don’t. An embryo (union of sperm and egg) CAN become a person someday, if it is normal and encounters the right environment, but most of them don’t. As somebody who works with this day in and day out, I do not think of an embryo as having constitutional rights. And I take issue with the people who scream, “Eggs, sperm and embryos can’t defend their own dignity, so we have to do it for them.”

OK OK. I know. These people are not screaming for the rights of eggs and sperm (gametes) — only for the embryos that form after the two combine. So if you present these esteemed politicians with a culture dish with an egg in it, I understand they’ll just yawn and say “oh that’s just a fleck of biological dust”. If you then show them a droplet of sperm, they’ll likewise agree “move on, move on, nothing to see here”. However……..(drumroll)…..the moment that the droplet of sperm is added to the dish with the egg in it, these politicians begin having heart palpitations and start drooling and dancing around the dish, ranting about preserving the dignity of the contents of that dish.

OK OK. So maybe I should be a little more serious. Again, I work with this day in and day out. I fully agree with the sanctity of family and of human life. People rely on my labor to help them have little babies. This thrills me without end and gives meaning to my existence. I respect that out of the bodies of the husbands and wives we can take tiny tiny biological cells and put things in motion so that maybe, possibly, one of these combinations MIGHT end up causing a baby to start growing inside the womb (or so we hope), which is why, I immediately become protective when someone starts to impede our mission, and for what? For the purpose of preserving the dignity of an embryo.

The utter ludicrousness of this might be more evident when you consider that were this bill to become law, it would be illegal and punishable, for you to put an embryo dish on the counter at room temperature and allow it to sit long enough to become nonviable. But, (now this is just mind-boggling), if the embryo were transferred into a woman’s uterus and it happened to implant (most of them won’t by the way) and if this implanted embryo were to grow and grow to become a moving fetus with heartbeat and everything. OK, THEN, in the state of Georgia, it would be completely legal to terminate it. How can you argue to give rights of embryos that supercede the rights even of successfully implanted fetuses? Whether we agree with it or not, we live in a country where first trimester terminations are not illegal.

OK OK. I am aware it is very likely that the same people who want to make it illegal to treat embryos “unethically” are also in favor of banning abortion, which raises the obvious question of what’s going on here with this bill. Is it to improve the quality of life for people as a whole? Or is it an indirect way to advance a political agenda? You be the judge. Now many of you may be curious as to my view on abortion. I do have a view. There is a 99%+ chance that no matter what I say about it, somebody from either side of the debate will egregiously misinterpret what I say, and twist it around, so I’ll choose my words judiciously in asserting that I am emphatically OPPOSED to abortion, specifically to the concept of aborting a known healthy fetus that is very likely to be born normal, just for the sole purpose of not having it be born. However, there is a difference between being opposed to something and necessarily thinking that it absolutely must be made illegal. The question is will making abortions illegal stop them from happening, or even lessen their occurrence? What is the tradeoff in harm, if any? I am opposed to murder, rape and abortion (as defined earlier in this paragraph). And I agree that murder and rape should be fully punishable, because if we were to make murder and rape no longer criminal, life would suffer greatly as a whole. The laws against murder and rape don’t prevent them 100%. Every day, these horrible crimes occur. BUT, to make it legal is not only silly, but also would result in things being much much worse. This concept is not as clear-cut when it comes to the matter of making abortion illegal. Criminalizing abortion might make the number of abortions go down somewhat, but cases of deaths or reproductive injury to young women would very likely go up from horrid back-alley procedures. This is more than just a theoretical argument. My beliefs about human behavior along with historical observations convince me of this. So before I get too off topic, I would assert that if I were a politician, I would vigorously enact changes that could lead to fewer abortions. But for me, those changes would be targeted at changing the mindsets of people regarding how much risk they are willing to take when subjecting themselves to the chance of an unwanted pregnancy. In other words, I greatly favor doing what we can to prevent abortions, which I feel could best be done at the level of preventing unwanted pregnancies in the first place. Now as to what policy changes I think would lead to fewer unwanted pregnancies? That’s a whole other lengthy post, maybe for another day.

So after taking this entire post to address the very title of this proposed bill, I’m guessing this is going to take more than two posts to address. Stay tuned as we dissect this further.

The fears of many infertile couples regarding kneejerk government reaction to the octuplets case have now been validated. On February 18, the Georgia senate referred a bill calling for certain restrictions. Here is the official wording. Many thanks to the readers who called this news to my attention.

Before we dissect this, I want to take a moment to remind everyone of one fundamental, indisputable fact of life. PEOPLE MAKE DECISIONS AND TAKE ACTIONS THAT SERVE TO MAKE THEIR OWN LIVES HAPPIER. It sounds ridiculously obvious, but I take the time to mention it because recognition of this universal truth is critical in helping us evaluate the realities of this bill. In an ideal society, the rules are set up so that when people are driven by their own happiness, it also results in the happiness of others. Win/win. Case in point. We may wishfully like to think that the mission of a restaurant owner is to provide the best food and best service for their customers at the cheapest prices. Let’s call this these the IDEAL GOALS. But in reality, from the personal viewpoint of the restaurant owner, his mission is to do maximize his own happiness, plain and simple. Depending on his personal values, that happiness might entail making more money or enhancing the reputation of his establishment (and himself) and/or minimizing the labor, time sacrifice or stress that he has to put into running the place. Usually it’s some balance of all of these. Let’s call these the TRUE GOALS. The beauty of a fairly governed society is that the attainment of the TRUE GOALS are highly dependent on the achievement of the IDEAL GOALS, meaning that in a society where people are free to make their own decisions, the owner can best achieve his goals, by providing a product that is as yummy, pleasant and modestly priced as possible. This will entice patrons to very willingly flock to his restaurant and hand him money. They do this not out of a favor to the owner, but they do it because it is worth it to them to come and enjoy sitting in a romantic environment and consuming prime rib medium-rare, amazing creamed corn, crème brulee and a bottle of fine Merlot.

Now let’s talk about politicians. The THEORETICAL GOAL of a politician is to serve the public, ie make legislative decisions that will enhance the quality of life for the people as a whole. Agreed? However, the TRUE GOAL, in their minds is to get elected, so that they can continue to enjoy the prestige, power and financial perks of their position. There’s nothing wrong with admitting that, because, in an ideally governed country (and I am clearly not so naïve as to think that we live in such), the THEORETICAL GOALS and the TRUE GOALS would go more hand-in-hand, meaning that the more that politicians do to improve the quality of life of the people, the more likely they are to get elected. But in truth, there is a greater disconnect between these two thing in politics than there is with restaurant owners or other free-market based businesses.

Bearing this in mind, let’s ask ourselves what truly motivates politician to introduce new laws? ONE, they are acting with sincerity to improve the quality of life of the people. TWO, they are promoting the illusion of busy-ness to look as if they are actually doing something. THREE, they are maneuvering to give themselves more and more power.

How can we judge which of these things is going on? By dissecting the facts of the situation, we can get clues as to which of these three things is going on.

First of all, let’s ask if this bill was conceived out of careful thought about what legislative changes would make life better for people OR was it just a knee-jerk reaction to a sensational isolated current event. In other words, did the politicians one day, after due diligence of careful homework and thought, conclude, “You know, the taxpayers who elected me really really want more restrictions regarding people’s embryos, above and beyond what the current law provides. By golly, we’re going to give it to them.” OR did they one day say, “This single isolated octuplets incident has really stirred up some emotion. Now, while the iron is hot, is the ideal chance to exploit this anger and outrage to get votes in the future. Hopefully, I can get a bill out of this with my name on it.” So which was it? I clearly know my opinion on it and encourage you to make your own as we consider things further.

The outrage in this case is that it combines two different hot topics - the increasing use of advanced technology to override nature in the arena of human reproduction AND the concept of taxpayers supporting children born to parents who can’t care for them. We can separate these two issues by changing the scenarios and seeing how it changes how we feel.

Imagine if this were a case of octuplets born to Bill and Melinda Gates after fertility treatment, who out of respect for what’s right declare “We would like to thank the doctors and nurses who worked so hard to deliver our babies safely. We know it would be unfair to force anybody else to pay for all that hard work, so we have asked for an itemized bill and have paid every penny ourselves. It’s only right. We have even voluntarily made a generous donation to the hospital. Also, rest assured that we will be working hard to support these babies of ours and not burdening anybody. We will create eight new nanny jobs with full wages and benefits paid out of our own pocket to further help the economy. Thank you for all your letters of congratulation. We have a long road ahead, but will work hard to raise eight children who will be happy, healthy and contribute greatly to society as much as Microsoft has, er with the exception of Vista, of course.”

Now imagine, if this were a case of the theoretical Suleman sisters, five women from the same family who are all single, living off of disability, unemployment, food stamps, welfare and defaulting on their debt. In the past five years, all the sisters, out of their love of having children, decided to keep getting pregnant naturally through various liaisons, and now have given birth to three or four children each, one at a time, without fertility treatment, so that now this lovely family collectively has sixteen fatherless children running around. They clearly intended to have these children deliberately, but they did it without involving doctors, but just persuaded various men with no medical education to inseminate them the old-fashioned way. Now their crowning achievements have given them access to going on the talk show circuit and crying about how difficult it is to be a single mom nowadays.

Each of these two scenarios would create buzz in itself, but the fact that Nadya’s case involves both elements really gives it media sex appeal. And as could be predicted, new legislation has been drafted to address this situation. Bear in mind that there have not been an epidemic of octuplets this past year, nor even quadruplets. Until this case surfaced, reproductive restrictions ranked well below the bottom 5% of today’s concerns.  But all it takes is one case and all of a sudden, there is the sudden NEED for changes to the law. OK. Fine. Let’s assume for a moment that there is such a need. In the next post, let’s look at this bill in detail and see what these proposed changes entail and whether or not they really are the best way to serve their intentions.