Cross-posted from Biopolitical Times, the online publication of the Center for Genetics and Society.
The Medical Board of California has revoked the license of Dr. Michael Kamrava, effective July 1st. This is the doctor who became notorious after his patient, Nadya Suleman, gave birth to octuplets following fertility treatment. However, the Board emphasized (pdf linked here) that:
This is not a one-patient case or a two-patient case; it is a three-patient case, and the established causes of discipline include repeated negligent acts (all three patients), gross negligence (two patients) and inadequate records (one patient).
Overruling the recommendation of the Administrative Judge who held in the original hearing that Kamrava should be put on probation, the Board argued that “the revocation of [his] certificate is necessary to protect the public.”
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The report emphasized that Kamrava’s decision to transfer 12 embryos at once constituted “gross negligence” and noted that even the doctor testifying for the defense described that as a “lapse in judgment.” That witness was Dr. Jeffrey Steinberg, who has a long history of pushing the boundaries of acceptability for fertility treatments, including a brief and controversial attempt to offer pre-pregnancy genetic selection for hair color, eye color, and skin complexion.
Steinberg supported Kamrava all along, asserting in 2009, “Who am I to say that six is the limit? There are people who like to have big families.” In an interview with the AP after the judgment, he insisted that patients were often adamant about implanting more than the recommended number of embryos:
“One-on-one, physicians talk about it all the time. We all pretty much feel like we have to wing it and hope for the best. … In the end that tissue belongs to the patients. We worry about them turning around to accuse us of murder or some such thing if we don’t do as they say.”
No mention there of worrying about the health, physical and mental, of the patient. Or of the consequences for the health of the babies, since multiples — even twins — tend to be premature and to suffer far more medical and developmental consequences than singletons. Or of the American Society for Reproductive Medicine (ASRM) guidelines [pdf], whose goal is singleton births. Or of the financial costs to the family. Or indeed of the responsibility of the expert to guide those who come for care.
Steinberg also suggested that Kamrava was not a very successful practitioner, which seems to be true. According to the CDC’s most recent report (covering 2008, which includes Suleman’s pregnancy), his clinic performed 39 total cycles of IVF using fresh embryos from nondonor eggs, which resulted in 7 women giving birth, 5 to singletons, 1 to twins, and one, notoriously, to octuplets. The success rate for small numbers, the report notes, “may be misleading” but it’s lower than the national average: For women under 35, 41.1% of cycles resulted in live births, nationally; in his clinic, 5 of 17. Steinberg commented:
“Kamrava had very low pregnancy rates and that’s why he got so courageous with those embryos.”
It’s a strange use of “courageous” — “reckless” might be more to the point. Kamrava did ask his patient to agree ahead of time to “multi-fetal reduction” should a multiple pregnancy occur, but in the event she refused. Which should not have been too much of a surprise, given that she had expressed a desire for a family of 10 and specifically for twins. Indeed, Dr. Victor Fujimoto of UCSF, who testified for the prosecution, thought he should have referred the patient to a mental health professional. Given her subsequent, and continuing, erratic behavior, that does seem plausible. (Incidentally, William Heisel has made a compelling case for dropping the nickname “Octomom,” though Suleman at one point attempted to trademark it.) The professional had a duty of care, and a patient is more than a customer. Sean Tipton of the ASRM, which expelled Kamrava in 2009, said, “[L]osing his license is sort of like the sad but obvious ending in a tragic novel.” But it’s not the end for the patient, and still less for her children.