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I write Stirrup Queens when I'm not reading other people's blogs, cooking, or chasing after my twins. I'm the author of two books: Life from Scratch,...
 
 
 
 

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"Octomom" Nadya Suleman's Doctor Loses His Medical License

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The Nadya Suleman saga comes to a close. (Sort of... I mean, she still needs to raise those eight kids.) Michael Kamrava, the doctor of the woman better known as Octomom has had his medical license revoked in the state of California on the grounds of "not exercising sound judgment."


On one hand, it feels like a clear victory for patients. While there are possibly patients out there that could justify the transfer of 12 embryos all at once, Suleman is not one of them. She had multiple successful prior pregnancies. There was an enormous chance that she would end up with supertwins from a 12-embryo transfer and end up with supertwins she did. Beyond that, this wasn't the first time that the doctor performed a medical act that showed questionable judgment including other reckless transfers.

On the other hand, every silver lining also comes with a dark cloud. In this case, we step into the grey area of allowing a doctor to perform their job. Medicine is an art, one that often comes with chances and mistakes and information only learned in retrospect. Would he have transferred 12 embryos if he knew that eight would take? Probably not. But we're condemning this doctor based not on his decision but on information we know after the fact. If she hadn't gotten pregnant at all, even if he had transferred 12 embryos, he would still have his license.

Which is to say that I can name multiple people who have transferred eight or more embryos per cycle. I can also name multiple people who have had IUIs (intrauterine insemination) done with more than the recommended one - to - three follicles. The doctors who have made those decisions are celebrated because luck has led to a singleton or twin birth. The doctors who make the same decisions that prove to be unlucky are condemned.

And that's a problem right there. We can't call it a miracle when one woman transfers eight embryos and for whatever reason ends up with a singleton and call it an error in judgment when another women transfers eight embryos and ends up with quadruplets. Medicine needs to be consistent in doling out their punishments as well as handing out accolades.

I'm not a fan of having every doctor report how many mature follicles were present or how many embryos were transferred to a policing organization. As much as I want responsible medicine practiced, I also want to give doctors room to do their job. And that job can't be dictated from an external organization since every body responds differently. I want my doctor to be looking at my unique circumstances and weighing my best options, also understanding that the route they take, the medicine they prescribe, and the protocols they follow are all based on information they know in the moment vs. information they'll learn in the future when they see the outcome of the cycle.

So yes, I think Michael Kamrava exercised poor judgment and I fully support having his license revoked, but I also believe that if we're going to give him that label, that there are a lot of celebrated doctors who deserve it as well. And at the same time, if we're going to celebrate doctors who manage to create what we label as miracle pregnancies, then we also need to applaud Kamrava for doing the exact same thing.

And beyond that, what sort of judgment are patients exercising who continue to choose Michael Kamrava as their doctor?

What are your thoughts on this case?

(Credit Image: © The Orange County Register/ZUMApress.com)

Melissa writes Stirrup Queens and Lost and Found. Her novel about blogging is Life from Scratch.

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sheila daniels 5 pts

1. Nadya's reason for IVF was that she always wanted a big family. Where I come from, SIX KIDS is a big family. Let's not forget the 6 older children she was already raising as a single parent.

2. The AMA rules say that two embryos at a time is how it's supposed to be done. That's SIX TIMES the legal limit. If they had aborted all but the two strongest fetuses, nobody would have known, but they couldn't stop themselves.

I think they were both hugely irresponsible, and got caught up in the fame with no regard to the consequences.

He had it coming.

A single parent with 6 kids who still wants more is just a media hog.

Pale@BTPM 5 pts

License ... sorry. Nothing like starting off with a typo.

Pale@BTPM 5 pts

I am glad that he lost his liscence, if only to prove that this case is a non-representative outlander and a product of bad judgement. (Don't you think it's an outlander? And yet people with big mouths, big opinions and short attention spans won't notice that he ~lost his license,~ they will only remember the negative impressions left by the original, freakish headlines). The extreme negative Octomom associated with the profession and the practice of a branch of medicine that does so much more unadulterated good than harm is unforgivable.

I hear you loud and clear on the dark cloud. I shiver in my boots at the thought of the harm that blanket, Big Brother regulations could do. You are so right when you say that sometimes RE is as much art as science. Just to name one (highly controversial) variable, personal calculations about risk in how many embryos to transfer look entirely different depending on what you think of selective reduction as a back-up plan. Things as rigid as regulations can't possibly address all the variables. Age ALONE makes a huge difference ... what is irresponsible in the case of a 28 year old successful ivf veteran is entirely another matter in a 40 year old with ovarian reserve issues who has never been pregnant and has been trying for five years. People who would advocate for regulation and use Kamrava as the poster boy for it don't give a damn for the complexity involved. Nor can they appreciate that it's not their call to make.

The only way that I felt I could "ground" myself and tame the way forward in making the truly painful, "I wish I had a crystal ball" decisions while undergoing treatment was to look to sound, unemotional medical judgement/ professional perspective. Outcomes are always uncertain; what else did I have to cling to? Medical advice was less of a moving target (or at least it should be). I told myself, If things go (any flavor of) wrong, at least I can console myself that I made the best, most 'rational' decision medicine knew how to make. How much risk you are ~personally~ willing to take is always so much more subjective than the cooler estimations of "do no harm" according to the best available data/medical wisdom and experience-to-date. You have to believe you are in good hands, so RE's must police their own. When physicians debate torte reform, better professional self-policing always comes up as a part of the 'solution.' As it should. I have to believe there is a difference between the risks condoned by most celebrated RE's and the risk (? Can you even call it that? Wasn't it more like a predictable train wreck that even mere you and I could have predicted?) that Kamrava took.

I am looking forward to checking the RE blogs for the pros who dare to weigh in ....

I wonder what the state of RE malpractice looks like these days ... and if this changes anything. If it opens the door for Nadya to sue him for the consequences of his enabling.