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Showing posts with label uninformed consent. Show all posts
Showing posts with label uninformed consent. Show all posts

Friday, November 11, 2011

OB bribes mothers to deliver babies on 11/11

"I'll pay you if you give birth before midnight tonight!" 
As we approached the landmark "11/11" this week, I'm sure all of us were waiting to hear "miraculous birth stories!" of babies that "happened" to be born on November 11, 2011 at 11:11 a.m. (or p.m.) Most of us are jaded enough to realize that no, usually none of these babies just happen to come into the world at such an auspicious moment all on their own, and when you read more details on many of these births it's no surprise that they are either planned cesareans or inductions. Yay.

The birth of a baby is always a joyous occasion and something to celebrate. But I cannot imagine actually planning the date, no matter how close I was to my due date, just to have a "fun birthday" like this. Kind of takes the magic and suspense out of it, you know?

So one Iowa OB has decided, back in February, actually, to put money into a savings account for those patients who delivered on 11/11. Oh, how nice! Helping baby to get a good start in life with a tidy sum saved up in an account just for Junior. Excuse me while I go vomit.

So far, he's had two scheduled cesareans lined up and one induction. Surprise!

In just reading between the lines, I get a few creepy suspicions about Dr. Valone. Two of his patients are repeat cesareans because "they delivered that way in the past," which sounds like he is not very pro-VBAC. Perhaps his idea of informed consent about surgical births and the dangers of VBAC includes, "Well, I could pay you to deliver your baby by repeat cesarean on November 11. How about that?" His fees, according to the article, range from $900 to $2,000, "depending on the case and the insurer." Financial incentive much? Does this almost sound like "the better insurance you have, the more I charge" to you?

Further down in the article, it says he will deliver two more women by induction "whose pregnancies have reached full term." Full term, to most people, is 37 weeks. His comment, "We're doing it proactively rather than just waiting to see what happens" sounds like he pushes the big baby scare tactic. How much do you want to bet this patient is not very close to 39 weeks? $2,000, maybe?

One of his patients, a young 20-year-old mother has passed her due date by THREE DAYS and is awaiting induction today. This is her first child. I fear for this woman, for many reasons. I hope she has a vaginal birth, but honestly - who can say? The article also says things like, "Natural birth proponents urge women to avoid the medications that induce delivery unless there is a strong medical reason to take them," but Dr. Valone assures us all that "it's safe" and you're better off if they go that route (meaning, "Take the Pitocin!") rather than trying to start their labor at home.

No sources, no nothing that indicates that Dr. Valone perhaps is a c-section, induction-happy doctor who is basically bribing women to give birth before the clock strikes midnight (or five p.m., which is probably the end of his shift). And these women are eating it up like candy, which is nauseating, at best. Yeah, it's their choice, but when you're presented with the possibility of a wad of cash and the assurance that "It's safe and you're better off!" how can you resist?

I would hope that offering financial rewards to patients in order to force their births to take place (or coerce them) would be considered, at the very least, unethical. When you blab in the media about doing such a thing, you'd better be willing to offer sound proof that they do, in fact, have some medical condition (besides a prior uterine scar) that means this induction or cesarean was necessary; otherwise all those hospital bans on elective inductions and cesareans don't mean a thing. I'd love to think an official from ACOG, and perhaps the Iowa State Medical Board, would be questioning this doctor on his choice of practices and perhaps taking a look at medical records. But then again, I doubt anyone will bat an eyelash.

Didn't have to dig very hard to find this one.

Monday, September 19, 2011

Gardasil and the systematic destruction of Michele Bachmann

As the election season draws closer, there is a lot of media attention on Minnesota Republican Michele Bachmann - namely a systematic destruction of her career a la Sarah Palin - because of Bachmann's views on the controversial HPV vaccine, Gardasil.

Many were not happy when Texas governor Rick Perry voted to push through legislation that would make it mandatory for the vaccine to be administered to Texas school kids. Some, including Bachmann, criticized him for being 'sold out' by the vaccine's manufacturer for the tidy sum of $5,000. Perhaps, but I'm not so sure. I think he was just drinking the Kool-Aid prepared for him by Merck - the same crap doctors, nurses, and just about everyone else feeds to us when it comes to making informed decisions for our kids.

The other day I decided to flip on the TV and watch a little Fox News, only to see a group discussing Bachmann and her 'radical' views on Gardasil on Greg Gutfeld's segment. One contributor said she couldn't understand what the big deal was and called the vaccine a "wonder drug for women," and made a reference to schools requiring vaccines anyway - so what's the big deal about this one?

During a news break just a few hours before, the news anchor made Bachmann sound like a complete moron for daring to question "science." Everyone is trying to make her look as pathetic and idiotic as they did Sarah Palin, nitpicking and ridiculing at every turn.

She's the candidate everyone loves to hate - and no one wants to admit that they agree with. Dr. Manny Alverez, a Fox News contributor, stated his piece on their website that he has to 'side with Governor Perry' on this one, but doesn't agree that it should be mandated by the government. He also goes on to say that it isn't 100 percent effective at preventing or treating all strains, and thinks Perry made the wrong move by endorsing it. Well then, it doesn't sound like you are siding with Perry at all, does it? Did I read that correctly?

He latches on to her claim that a parent told her it caused her child's mental retardation after she received the vaccine. True or not, he isn't making any mention whatsoever of the potential side effects of this or any other vaccine, a completely legitimate argument not to vaccinate. Bachmann never said she personally made the claim, only related the story of someone else that did - and Merck immediately, unsurprisingly, went on the defensive.

Basically what I have noticed is that they are completely ignoring the issues surrounding Gardasil - whether they're political, philosophical, medical or spiritual - and ganging up on her to destroy her credibility and her reputation. No one mentions anything about side effects or potential complications, or that it ideally should be administered to children as young as nine years old.

Apparently Perry's legislation did include an opt out* for parents, but that also seems to be publicized little. Some argue that bureaucratic red tape could make it difficult or virtually impossible to refuse, combined with pressure from districts to go ahead with it. The word 'mandate' implies that parents don't have a choice when really they do, but I bet Merck and others involved want you to think you don't - sort of the "if you can't beat 'em, you might as well join 'em" approach.

What everyone except Bachmann seems to be missing is the idea that yes, this threatens personal liberty - that of the child in question and that child's parents. The state, to some extent, does intervene in our lives, in the sense that we would be arrested if we were doing our children bodily harm. Unfortunately to some, not vaccinating your child constitutes as 'bodily harm.' Where do you draw the line?

As a result, the State of California is giving children as young as 12 years old the power of informed consent to be given Gardasil, without their parents' knowledge. Groups that support the legislation include the ACLU, ACOG, and Planned Parenthood, and opposition is considered "largely faith-based." (I find it laughable that the ACLU, of all organizations, is basically saying only the rights of certain people - in this case, not the parents - count.)  I find this probably the most alarming, least-talked about aspect.

As parents, we know how hard it often is to refuse vaccinations at the doctors' office that we might philosophically disagree with, and are frequently pressured by pediatricians, healthcare workers, school nurses, friends and family to vaccinate for everything, without question. How then, do you expect a 12-year-old to adequately make that decision? And why are they essentially ignoring the rights of the parents? What happens if a well-informed child tries to refuse? And if children are fed scare tactics to get the shot, but know their parents don't approve, isn't this essentially a situation of the school district (and the state) pitting the child against her parents?

Apparently this legislation is part of an already existing bill that enables children as young as 12 to seek treatment and testing for STD's without parental permission. (Click here) The thinking is that those kids who are too afraid to talk to their parents will get the treatment they need. Unfortunately, I think that is only feeding the problem.

The core issue at the heart of the state-forced Gardasil vaccine is that parents are not often adequately talking to their kids about sex. Period. Kids know little information about what constitutes sexual contact, and parents admit to not having appropriate conversations with their children about it. The state, in an effort to curb STD and pregnancy rates in teens, has no doubt decided to do the parents' jobs for them - figuring that if they don't, we will.

The problem is, many parents do educate their  children about the reality of sexual relationships and the dangers of STDs. In many circles this vaccine, and our overall sheeple mentality on vaccines in general, is that it will fully protect our children 100 percent of the time. Even though some suggest educated teens do wait longer to have sex, there is still the idea that "teens are teens" and will do this sort of thing, so why not provide a safety blanket of sorts. Others think that safety blanket is not enough, and it might fool teenagers into thinking they have a green light to engage in even riskier behavior.

In order for the vaccine to work, it's suggested that patients receive three doses, and some are speculating that often the girl doesn't get the remaining two vaccines. You're considered more at-risk for HPV if you've had multiple sex partners, or been with someone who has. Additionally, the younger a girl is when she starts having sex can also increase her risk. The irony in this is that culturally, we seem to condone teen sex or even embrace and tolerate it in an effort to remove the stigma. Combined with the fact that many parents do not adequately inform their teens about the potentially life-threatening repercussions of sexual relationships, this is like setting a trap for our children and then pushing them into it. Even so, is that really up to the state to decide?

In the meantime, legislators had to disclose that Merck personally paid them to push legislation through. And at $360 for a trio of doses, that's a lot of money the drug manufacturer stands to gain.

The Gardasil problem joins a number of other ones surrounding our medical community. What once started out as an altruistic approach for the common good, now the boundaries are blurred as more and more people want to take initiatives to force that "common good" on others. Forced or coerced vaccinations are just the tip of the iceberg; it's not unheard of for women to be forced into cesareans by court order, or for cancer patients who refuse treatment to be ordered to do so. A UK woman with severe hospital phobia and "learning difficulties" has been the subject of just such a debate, and was ordered into surgery to save her from potentially fatal cancer. What does it take to deem a patient unfit to make their own medical decisions? Probably not a whole lot.

Because Bachmann is essentially questioning the motives of the medical community and others' blind trust in it, I think it will be hard for her to wade through the mire of opponents. I'll also be waiting to see if Merck personally decides to take action to shut her up already regarding her claims on Gardasil, or if the media will essentially take care of that problem for them.

I'm seeing an interesting turn of events, though - perhaps what will amount to parents on both sides of the political and faith-based spectrum siding with Bachmann because she is such an outspoken opponent of this policy.

More reading:
Judge criticizes council for trying to force contraception on woman - The UK Telegraph
One More Girl - Truth About Gardasil documentary
Bachmann's Vaccine Theory pulls GOP to Jenny McCarthy Territory 

*The Association of American Physicians and Surgeons, Inc. issued this statement on Perry's approach to state-mandated Gardasil, as copied and pasted from the blog, "A Time for Choosing:"
“Opting-Out” of HPV Vaccine WILL NOT WORK for Many in Texas
Governor Perry is misleading legislators and families in Texas by claiming that they will be able to “opt-out” of having their 6th grade daughter vaccinated with the vaccine for the sexually transmitted virus HPV. For many families currently, the exemption isn’t worth the piece of paper it is printed on. Besides the simple fact that parents should not have to get permission from the state to make informed consent medical decisions for their own children, here are four reasons why “opting-out” of state mandated vaccines doesn’t work for many families in Texas:
“Opt-out” or Conscientious Exemption to Vaccination Process is a Bureaucratic Nightmare
To get the exemption form, parents must first submit a written form to State Health Department in Austin which forces the disclosure of the child’s full name, birthdate, and mailing address. The Health Department takes those written requests and creates yet another form on which they print the child’s same personal information that the parent had to send to health department, and the Health Department sometimes takes weeks to mail out these forms inevitably disrupting the child’s school attendance. The Health Department only sends the forms by U.S. mail, and once the parent receives the forms, they must be notarized within 90 days of submitting them and then repeatedly resubmitted every 2 years even though there is no expiration set in statute.
[1] Because the Health Department further eroded parental rights by publishing more rules getting rid of provisional enrollment for exemptions, (families used to have 30 days at the beginning of school to get their paperwork in), now schools participate in aggressive misleading education campaigns touting “no shots – no school” while not informing families of the exemption or the instructions how to obtain it.
Private Schools Deny Admission
The Texas attorney general issued an opinion in April of 2006, ga0420, that states that private schools do not have to accept the conscience exemption to vaccination in Texas Law[2], and many private schools do not. For example, the Dallas Diocese for Catholic Schools policy number 5024 states, “Schools will comply with immunization requirements established by the Texas Catholic Conference Education Department. Conscientious objections/waivers are not accepted in schools of the Diocese.” [3] Every new vaccine mandate causes more children with valid legal exemptions to be denied their private school education.
Doctors Refuse Medical Care
Even though you may be able to get a piece of paper from the state health department affirming your right to refuse state mandated vaccines for your child, just try and find a doctor who will honor it! According to a recent study published in the Archives of Pediatrics and Adolescent Medicine, 39% of pediatricians surveyed said they would throw kids out of practices who are not vaccinated. [4] PROVE has documented this rampant problem of doctors dismissing families utilizing a vaccine exemption in Texas to the legislature in previous sessions. Please review our report entitled “The Erosion of Public Trust & Informed Consent through Immunization Harassment, Discrimination and Coercion” prepared for the House Public Health Committee in 2005. [5]
Insurance Rates Rise and Accessibility Affected
Responsible parents who have secured health care coverage for their children will be forced to pay higher insurance rates whether they want the HPV vaccine or not. Even if you “opt-out” of the HPV vaccine mandate for Gardasil by Merck by securing a conscientious exemption waiver, there is no way for Texas parents to “opt-out” of the corresponding rise in their insurance premiums. § 1367.053. (a)
(2) of the Insurance Code REQUIRES that any vaccine required be law must be covered by insurance. [6] This first-dollar coverage requirement results in corresponding direct hiking of insurance premiums to meet costs, and for a vaccine as expensive as this one, an HPV vaccine mandate risks putting premiums for basic health care coverage out of reach financially for even more Texas families. Additionally, we have received complaints from families where insurance companies are harassing parents with letters and discriminating on coverage based on whether or not the child has had all their state mandated vaccines.

Saturday, December 11, 2010

The Obstetrical BS Series: My Doctor will Tell me Everything! Part I

"I'm 38 weeks and am going in for an induction
tomorrow. What should I expect?"
Photo credit: Karol 
A lot of times when I hear women asking pregnancy and birth questions, the usual response is, "Your doctor will tell you everything! Don't worry!" I think we can all agree that this isn't the case, most of the time.

Some doctors do take the time to inform their patients, true - but many do not. Many cannot, because they are often limited to the typical 4 1/2 minute visit that consists of little time to go over your aches, pains and other complaints. I remember asking my doctor about having no urge to push during my last labor, and wondered why. His quick, tidy response was "We'll help you with that when the time comes." I wasn't exactly sure what that meant, but it didn't sound like much of an answer to my question.

Later on in the pregnancy I had a lengthy discussion with another doctor in the practice who then asked me, "How do you know so much?" I'd like to think it's probably refreshing for him to see a patient who truly is informed and can make decisions accordingly. I imagine some doctors wish their patients were more informed, and they feel bound by time constraints that prevent them from delving into a topic that can't easily be answered with a "yes" or "no."

As mentioned in my last post about inductions, I am amazed - overwhelmed - saddened - by the number of women who go into something as serious as an induction of labor with no preparation or information ahead of time. Countless women ask at zero hour what they can expect of an induction, with it looming large in the headlights in a matter of hours. Would you prepare so poorly for brain surgery? Probably not. Even my gastroenterologist - her secretary, even - prepared me more thoroughly for an upcoming procedure in more ways than these women are.

Outside the scope of obstetrics, uninformed consent is a huge problem - and the source of more costly procedures that are completely unnecessary. I remember those commercials in between cartoons while growing up in the 70s and 80s - "Knowledge is power!" And if you don't have that knowledge, you've effectively been rendered powerless.

Considering the rising induction/cesarean epidemic, I think more childbirth classes should cover inductions more extensively. While I took a class seven years ago, I don't remember it being given more than a passing mention.

While I don't doubt that some women won't listen to their doctor's warnings about the risks, it sounds like not many doctors are even bothering to mention the risks. I consider what my doctor told me about the risks of primary cesarean - nothing. Had he done so, I'm sure my attitude about it would not have been so casual, that's for sure. I think that's what contributes to the rising problem of inductions - attitudes about them are way too casual because women are simply uninformed about what can and does often happen, and how it can change their perception of "normal" birth. A few women I've talked to don't even realize that an induction ending in cesarean is not really a successful outcome - at least I don't think it is. But unfortunately, there apparently is little criteria defining what a "failed induction" really means.

Perhaps doctors need to draw up a realistic outline of the risks and benefits of labor induction - and have the patient sign off on it. I know this is what I had to do when signing consent forms for doing a VBAC. Of course, this might actually force the physician to be more forthcoming with how he handles inductions, and some aren't willing to admit to more aggressive practices, I'm sure.

When it comes to overall pregnancy and birth questions, perhaps a list of recommended reading would be helpful. Then again, unfortunately not all pregnancy books are the same, and can offer wildly different, sometimes slightly inaccurate, ideas about what's normal and what isn't. And there's nothing saying that patient will actually read them, either.

If anything, I think some doctors mitigate the risks or outright lie about them, simply because they don't want you to change your mind. I've heard some doctors say that Pitocin contractions aren't worse than regular ones, for instance, even though lots of women feel this isn't true. Perhaps for a number of reasons, inductions hurt more because you are more monitored and allowed less freedom of movement, which is no doubt why so many women choose an epi during an induction. If a woman knew that perhaps her labor could be more painful, or at least more intense, during an induction, she might decide against it.

People blather on about "just talk to your doctor" about the risks, but I think you'd be hard-pressed to find one who is up front and on the level about it. Conversely, perhaps not many women ask beforehand (or perhaps their concerns are rebuffed) simply because inductions have been so routine. And sometimes, even when you do try and tell them, it's like they put their hands over their ears and sing, "La la la!" loudly to block you out. They don't want to hear anything negative or that sounds "wrong." They might as well go into the labor and delivery unit with a blindfold on and paper bag over their heads.

I felt badly when a thread showed up from a woman 40w6d who was on the verge of an induction. She wanted to know what to expect, and namely if it hurt more than a traditional labor. She had no cervical dilatation or effacement, and was facing an induction in less than 24 hours. By the time I responded, 11 hours had passed, so I figured she was already well on her way to whatever by then. I looked on, horrified.

It reminded me of that Sally Field movie where the mother is stuck in heavy traffic and on the phone with her daughter. Suddenly the mother can hear something going on in the background, as her daughter is attacked by a stranger in the house. The mother can do nothing but listen, helpless. Sometimes I feel like that - like if only we could better inform patients ahead of time, they might not have to go through this stuff. It's like being on the edge of a cliff, holding on to her shirttail, and you can't get a footing before she goes over the side, tumbling into a cascade of interventions that are probably neither wanted nor necessary.

More reading:
"The Benefits Outweigh the Risks" - My OB Said What?!?
"I highly doubt you have the intelligence to read a medical journal." - My OB Said What?!?