June 12, 2007
Preventive Health care, John Edwards style
On the front page of Sunday's Philadelphia Inquirer is a shocking expose on what I think is a corruption of medical practice -- the fact that the once-risky (and distinctly icky if not unnatural) procedure of delivering babies by cesarian section is "now is used in about a third of U.S. births":
"This is mostly about changes in culture," said Eugene Declercq, an expert in maternal and child health at Boston University's School of Public Health. "In all the gray areas of clinical decision-making, obstetricians have moved to cesareans. Mothers are more accepting, too."Far be it from me to call it "obstetrical terrorism," but if we must call it that, shouldn't we also be looking for the root cause? Is it that there's a new generation of doctors who just enjoy cutting women open? Or is something motivating them?
Sure, it's easier to perform a c-section than ever before, but the rates are still four times that of a normal delivery. The Inquirer hints at economic factors:
....the specter of lawsuits heavily influences the use of cesarean.I know Lankenau Hospital very well, and the implications of the statistical change shocked me.
I think it is a violation of the Hippocratic Oath for a doctor to take into account potential legal liability in deciding to cut a woman open instead of waiting for nature to run its course.
It's not preventive health care on behalf of the patient; it's preventive legal care on behalf of the doctor and the hospital.
Doctors, of course, counter that it isn't their fault, and a number of commentators have pointed the finger at John Edwards:
Edwards specifically has made much of his fortune suing doctors for not performing C-sections, arguing that they help prevent cerebral palsy in children. In 1970, six percent of all births were C-sections; in 2003, that number had climbed all the way up to 28 percent. However, as John Stossel reports, there had not been a decrease in prevalence of cerebral palsy during that time. Hence, although Edwards' lawsuits have not, apparently, prevented anycases of cerebral palsy, they have, at least in part, yielded a great increase in the occurrence of C-sections. Now doctors do C-sections "just to be safe," meaning safe from lawsuits, though the procedure is not so safe for mothers. While C-sections are not overly dangerous, women are four times more likely to die during a C-section than during vaginal birth; this is not an insignificant risk.Michael Fumento has more on the c-section scam, especially the role of John Edwards:
Medical malpractice was his specialty, and he reportedly tried more than 60 such cases, winning more than $1 million in over half of those. Most involved Ob/gyns. Indeed, he was so feared, according to the Center for Public Integrity, "that doctors would settle cases for millions of dollars rather than face him at trial."The rise in c-sections parallels the rise in this legal strategy:
in what's called "defensive medicine," lawsuit fears increased the number of "When in doubt, cut it out" C-sections. Cesareans in the U.S. had begun dropping in the late 1980s, going as low as 22 percent of deliveries. As Edwards and friends spread fear across the Ob/gyn land, rates began to climb again. The rate is now 30.2 percent, a record high for the nation.One advantage of blogging is that I'm allowed to mention stuff that the Inquirer fails to mention, and I can easily understand why John Edwards' role in the rise of c-sections might be off-limits.
I'm not saying this is the Inquirer's fault, either.
There's just too much money involved, and too much money is why there will never be meaningful tort reform, as trial lawyers like Edwards fill the coffers of the Democratic Party money machine.
But Edwards is a man of the people, right? There's been some discussion recently which was linked by Glenn Reynolds to the effect of how unfair it is that rich guy like Edwards is seen as phony whereas in the old days, the sincerity of patricians like FDR went unquestioned. I agree with Glenn that identity politics is largely to blame -- because it assumes that in order to speak for the poor, you must be poor, in order to speak for a woman you must be a woman, etc.
....FDR was a rich guy who cared about the poor, he says, so why can't John Edwards be?It is a shame, because I'm sure there are progressives like FDR who should be able to legitimately advocate on behalf of the poor.
His father James Roosevelt was heir to a huge coal and railroad fortune, while his mother Sara Delano was heir to an opium fortune amassed by her drug-smuggler father. Such a background might (along with heavy influence of Endicott Peabody) well have contributed to the development in young Franklin a sense of guilty noblesse oblige, and a genuinely earnest desire to help the poor.
No matter what might be said about the sources of FDR's parents' income, no one can say that he made money by taking it from the needy (especially in the form of 40% contingency fees).
I agree that John Edwards is no FDR.
And while I don't agree with the way identity politics has thwarted genuine noblesse oblige, I don't think the man has any more moral authority to speak for the poor than anyone else.
I'm not even sure that Edwards has earned the moral authority to speak for the handicapped babies he's enriched, because he's taken so much of their money doing it.
What about the pregnant women who've been hoodwinked into having themselves cut open unnecessarily by obstetricians fearful of Edwards-style litigation? While it might not be "legal terrorism," it sure isn't FDR-style moral authority.
posted by Eric on 06.12.07 at 02:17 PM
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