The Author Replies



A response to Anne Haehl's commentary, “Fertility Treatment: Medically Necessary?”


Since people have different ideas about the goals of medicine—and the goals of health insurance—we may never reach consensus on whether fertility treatment ought to be covered. At some point, one either accepts that infertility is a serious problem and deserves medical help, or one does not.

In the vast majority of cases, infertility is caused by a biological malfunction, a fact that satisfies those who think that medicine ought only be used to treat “biological” ills. Others might be persuaded by the fact that untreated infertility can have a negative impact on psychological health. Still others might be persuaded to extend insurance benefits to infertility treatment because excluding coverage can encourage women to use fertility treatments in unnecessarily risky ways.

One might also be persuaded to see fertility treatments as medical care deserving of insurance coverage due to the simple fact that medicine has come up with ways to overcome infertility that show reasonable efficacy in many patients. A study published last year of nearly 250,000 women who underwent IVF reported live birth rates of over 50 percent after three embryo transfers for women under 35 and over 65 percent for women under thirty-one. Since IVF is reserved for those whose infertility has not responded to other interventions, those sound like decent success rates to us. Yes, U.S. clinics currently charge between $4,000 and $12,000 per “dose.” Whether that is too costly depends, we suppose, on how valuable one considers the outcome.

We agree that all options should be considered, made available, and respected, but we think some should be able to turn to medicine for help.

Bioethics Forum

Public Citizen: The SUPPORT Study Was Even Worse Than We Thought

By Michael Carome and Sidney Wolfe

We obtained the complete SUPPORT study protocol and consent forms that were approved by 22 IRBs. Our analysis demonstrates that the consent form deficiencies were far more significant than those discussed in OHRP's letter.

The SUPPORT Study and the Standard of Care

By Lois Shepherd

The central disagreement between defenders and critics of the SUPPORT study appears to be whether participants were receiving medical care that was different from the care they would have received outside the study and whether participation therefore carried any medical risks that required scrutiny by IRBs or disclosure to parents of the infants enrolled. This would appear to be a factual matter about which one could obtain some clarity, but discussions of this issue have been opaque.

Learning to Talk Like a Doctor

By Colleen Farrell

In their 1994 article on the so-called hidden curriculum in medical education, Frederic Hafferty and Ronald Franks wrote that “medical training is not just learning about becoming a physician, it involves learning how to ‘cease’ to be a layperson.” This has been most evident to me in my medical immersion program.

Shame and Guilt in Minnesota

By Carl Elliott

A petition asking the governor of Minnesota to investigate a research scandal at the University of Minnesota has been steadily gathering momentum. The petition also has a noticeable gap.

Also: in The Hastings Center's other blog, Over 65, Peg Ackerman relates the story of Mary, age 93, H. Steve Moffic writes “A Letter to Our Grandchildren,” and James Sabin discusses the benefits of phased retirement.