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)
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