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Conferences, Incontinence, and In Vitro Fertilization

Posted Oct 23 2008 2:03pm
The conference I went to yesterday was really good, but I'm glad it's the last one that I'll be attending for a while. It's amazing how much these conferences totally screwed up my schedule. I also missed my MS class (which I have to confess that I'm not especially sorry about) and a Dean's Dinner by Steve Nissen (which I am definitely sorry about). That was the first Dean's Dinner that I've missed since I started med school, and I would have loved to have gone. I've seen him talk once before about his work on intravascular ultrasound, and he was supposed to discuss that again last night. But apparently he wound up discussing the whole Avandia brouhaha due to his meta-analysis that was published earlier this year.

Our PBL case had a very happy ending, and our only seminar today was anatomy. This was a review of the genitourinary systems of the male and female. The talk at the beginning was about different kinds of urinary incontinence. One type, called stress incontinence, can happen due to an anatomic problem when pressure increases in the abdomen (ex. from laughing or coughing). The other type is urge incontinence, which is due to a neurological type of problem. The difference is important because urge incontinence can be treated medically, while stress incontinence tends not to respond to medication and has to be fixed surgically.

I met with my PA also and we discussed my portfolio essay and my plans for next year. Right now I am tentatively planning to do Core I (medicine and surgery) starting in July, then a block of research and electives starting in November, and then Core II (neuro/ob/gyn/psych/peds) in March. I would probably then do my Advanced Cores in July of my fourth year and start my research year afterward in November. This will give me time to write a proposal and get it approved by the CCF IRB.

Our POD speaker today (sorry, our ARM speaker today) is doing research in infertility and in vitro fertilization. He was a really engaging speaker who told us a bunch of interesting anecdotes about the early days of in vitro fertilization. For example, he was involved with the first in vitro fertilization that was done in the state of Ohio, which was in 1983, and he was the first person in the world to implant an in vitro-fertilized embryo into a surrogate mother. Currently he has a project that raises money to help pay for gamete storage and in vitro fertilization for lower-income patients who could not otherwise afford it. The program particularly targets young female cancer patients who are undergoing radiation that could render them infertile and incapable of having children at a later date.

The talk was certainly enjoyable and the research was very interesting. But I can't quite push this nagging thought out of my mind that as frustrating as infertility must be to people who really want a child, it's maybe not the most pressing problem in all of medicine. Why should in vitro fertilization deserve so much of our limited supplies of funding and brainpower? No woman is going to die if she can't become pregnant, and couples who cannot have their own biological children can always adopt a child. I'm not saying that this kind of research shouldn't be done or that the technology for in vitro fertilization shouldn't be used. It's just that there are plenty of life-threatening problems that could possibly be ameliorated by setting up foundations to subsidize health care costs for lower-income people whose jobs don't provide them with health insurance. For example, why isn't there a foundation to subsidize yearly Pap smears for low-income women so that they don't die of cervical cancer that could have been treatable if it had been caught earlier?
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