Man and woman on holding hands on a couch, pictured from the neck down

What Happens When Reproductive Tech Like IVF Goes Awry?

It sounds like the setup to a bad joke: Three couples walk into a fertility clinic. But the punch line—what happened to those families at one Los Angeles medical facility in August 2018—is no laughing matter. The embryos from two couples hoping to conceive were mistakenly implanted into a third patient. That third woman and her husband, both of Korean descent, suspected that something was amiss when their two newborns didn’t look anything like them.

DNA testing confirmed that Baby A and Baby B (as court documents called them) weren’t genetically related to either of the birth parents, or to each other—they were related to two other couples who had been seeking fertility treatments at the same clinic. The birth parents were forced to give up their “twins” to their respective genetic parents.

The other two couples, while granted the surprise of children they thought they’d never have, missed out on the experience of pregnancy and early bonding. One of the women explained her sense of loss: “I wasn’t there for his birth, I did not carry him, I did not feel him kick inside of me, I didn’t do the skin to skin, I didn’t breastfeed him.” The mix-up at CHA Fertility Clinic leaves all three couples bereft. They’re left to wonder what happened to their other embryos, and to worry whether their biological children might be born to someone else without them ever knowing.

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Why Race-Based Health Disparities Have Little to do With Genetics

By Jonathan Kahn

In a recent article in Wired, science journalist Angela Saini discusses “the disturbing return of scientific racism.” The piece is drawn from her new book, “Superior: The Return of Race Science.” Scientific racism per se might be succinctly characterized as (mis)using science to assert essential biological bases for differences among socially defined racial groups. It has been used over 200 years to justify, and indeed promote, the subordination of certain racial groups as purportedly inferior to others.

Saini does an admirable job of tracing the roots of modern scientific racism and identifying its resurgence. Her story in the Wired piece, however, focuses primarily on the more obviously pernicious manifestations of scientific racism exemplified by Bruce Lahn’s work at the University of Chicago asserting a genetic basis for cognitive differences across socially defined racial groups. Saini effectively shows how other geneticists and socially scientists dismantled these claims but frames its appeal in the widely held mistaken belief that “races have natural genetic propensities.”

The dangers of scientific racism, however, manifest not only in pernicious attempts to show superiority of inferiority among races. It also emerges more subtly and complexly in the well-meaning work of biomedical professional seeking to explore broader racial differences, particularly in the field of health disparities. Read More

A white hospital hallway

The Latest in the Continuing Cycle of NHS Patient Safety Inquiries

There does not seem to be a week that goes by without an NHS (National Health Service) patient safety crisis hitting the headlines and this has been the case for many years. Major public inquiry reports into patient safety and health quality failings are published. Recommendations are made, and then another crisis event follows soon afterwards spawning yet other reports, broadly saying the same thing.

The NHS has built up a huge back catalogue of inquiry reports into patient safety crisis’s, spanning decades containing a lot of deep thinking, useful analysis and valuable recommendations. Analysing present and past patient safety crisis inquiry reports is a very useful educational exercise and can help inform future policy development in the area. Some of the seemingly intractable, stubbornly persistent patient safety problems that beset the NHS, both past and present are identified and discussed. Revisiting reports and analysis can also refresh our perspective on patient safety issues and provides an information bedrock on which we can base change.

Patient safety inquiry reports also provide a momentum for change through their recommendations which the government of the day can accept or reject. Read More

A Professional In Vitro Fertilisation Laboratory Microscope Closeup - Image

How Technology is Changing Reproduction and the Law

Millions of Americans rely on the likes of birth control, IVF, and genetic testing to make plans as intimate and far-reaching as any they ever make. This is no less than the medicine of miracles. It fills empty cradles, frees families from terrible disease, and empowers them to fashion their lives on their own terms. But every year, thousands of accidents happen: Pharmacists mix up pills. Lab techs misread tests. Obstetricians tell women their healthy fetuses would be stillborn. These mistakes can’t be chalked up to reasonable slips of hand or lapses in judgment as often as human failures and flawed quality controls. Read More

An embryologist pulls out of the dewar with liquid nitrogen straws with frozenn embryos and egg cells in infertility treatment clinic - Image

The Legal Limbo of Lost Embryos

Last summer, a group of cancer survivors and others struggling to have children held a memorial service for their “hopes and dreams lost.” That’s the message they had engraved on a bench in the Ohio cemetery where these would-be-parents-who-won’t mourned.

More than 4,000 of their frozen embryos and eggs were destroyed when a high-capacity freezer tank failed at University Hospitals Fertility Center in Cleveland one Saturday in early March 2018. Another thousand were lost the same weekend, after a similar malfunction at an unrelated clinic across the country, Pacific Fertility Center in San Francisco.

Some of those affected had made appointments to try to initiate pregnancies the very next week. All had undergone painful procedures and paid, in some cases, thousands of dollars to keep their materials suspended in liquid nitrogen at a constant −196°C. But that weekend in March, tank temperatures began rising, and by the time the Ohio lab technicians returned for their next shift, everything inside had thawed beyond rescue or repair. It’s not clear why remote alarms were turned off; investigations are ongoing. So far, only coordinated cyberattacks have been ruled out. Read More

Icon of a patient id card

A National Patient Identifier: Should You Care?

The rather esoteric issue of a national patient identifier has come to light as a difference between two major heath care bills making their way through the House and the Senate.

The bills are linked to outrage over surprise medical bills but they have major implications over how the underlying health care costs will be controlled through competitive insurance and regulatory price-setting schemes. This Brookings comment to the Senate HELP Committee bill summarizes some of the issues. Read More

A doctor from neck down wearing white coat, holding clipboard in one hand and bowl of fruit in the other.

Medically Tailored Meals and the Reverberating Impact of Public Demonstration Projects

Recent headlines highlighted a $40 million investment by a range of Blue Cross Blue Shield companies in Solera Health, a start-up focused on improving chronic disease management. Solera Health will use the investment to scale up its wellness programs, which seek to improve social determinants of health for patients.

One of Solera’s initiatives focuses on providing medically tailored meals to beneficiaries. The concept behind medically tailored meals is simple. Patients with diabetes, congestive heart failure, and other chronic illnesses can be treated only to a limited extent in doctor’s offices. By extending services like meal provision to beneficiaries—thus improving their long-term health—insurers can potentially avoid paying for more costly interventions down the line. Read More

Image of a pile of contraceptive pills.

The Contraceptive Mandate Takes Another Hit  

By Elizabeth Sepper and John Aloysius Cogan, Jr.

Known for his national injunctions of federal legislation, district court judge Reed O’Connor is at it again. In DeOtte v. Azar [PDF], he issued a permanent injunction granting religious exemptions to two nationwide classes that object to the Affordable Care Act’s contraception mandate. Judge O’Connor’s decision is notable for both its expansion of religious exemptions—in contradiction of eight out of nine appellate courts to consider the issue—and its casual disregard for the realities of health insurance markets.

DeOtte is the latest in a series of lawsuits pitting the Religious Freedom Restoration Act, which bars the federal government from substantially burdening a person’s exercise of religion, against the ACA’s mandate that insurance plans cover FDA-approved contraceptives.

Initially, under the mandate, churches were exempt and religious non-profit employers—like hospitals and universities—received an accommodation. So long as non-profits gave notice of their objection, their plans could exclude contraception. Their employees then would receive contraception coverage through the insurance company or health plan administrator. In 2014, the Supreme Court extended the accommodation to closely held for-profit corporations in Burwell v. Hobby Lobby, Inc. Read More

When It Comes to Abortion Restrictions, State Legislatures Try Fighting Fire with Fire  

By Adrienne R. Ghorashi

After what seemed like a barrage of legislative attacks on abortion rights last monthsome states are hitting back by strengthening their laws to protect the right to an abortion. Illinois, Maine, Nevada, New Jersey, New York, Rhode Island, and Vermont have all passed legislation this year expanding access to abortion in various waysIn the current political climatewhere some fear that Roe v. Wade is in danger of being gutted or overturnedstate legislatures are a key battleground in the abortion fightLegislatures and courts alike have been testing the very limits of the constitutional protections cemented in RoeAs deference to Roe wavers in the courts, enacting proactive legislation is a strategy that advocates of abortion access are paying close attention to  Read More

NHS logo on the side of a building

Testing the Temperature of Patient Safety in the NHS

In terms of transparency and accountability the National Health Service ( NHS) in England is excellent at producing insightful, well-produced reports on health quality and patient safety. It does this on a regular basis and one of the great difficulties faced by NHS nurses and doctors today is the sheer volume of reports published. It’s an impossible task for nurses and doctors to keep up to date with all the reports published and to maintain heavy workloads in resource constrained environments. It’s also hard for health care staff to know which reports to prioritize and which are authoritative.

There is an urgent need for the NHS to create a one stop, patient safety information hub which collects reports from all NHS sites and other important global sites, putting everything into one accessible place. Some recent reports on written patient complaints have been published which are helpful in assessing, testing patient safety and health quality in the NHS. Read More