Insight on Babies

September 23, 2004 | 38 comments
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Yes, that’s T & S blogger Matt Evans in the New York Times (all the news that’s fit to print), talking about his business, Baby Insight. (Alert reader Matt Horlacher was the first to point it out to me). Matt’s business allows customers to take voluntary, often very high-definition ultrasound images of fetuses in the womb, usually at around 30 weeks. The article points out that some medical organizations oppose the taking of voluntary ultrasounds, but Matt counters by noting that there is no evidence of harm caused by these ultrasounds. And I suspect that as a pro-life advocate, Matt probably appreciates the pictures of smiling babies in the womb, which can only help advance his political cause. (Though I wonder — perhaps Matt or Adam can weigh in on this one — if the ultrasound is a good development, net, for pro-life advocates).

Anyway, I’ll stop pretending that I have something profound to say on this topic, and just end by saying “congratulations Matt!”

38 Responses to Insight on Babies

  1. danithew on September 23, 2004 at 11:27 am

    That was a fun article to read. Thanks Kaimi for noticing and congrats to Matt Evans for getting that kind of attention.

    Matt, it would be interesting to hear how much business picks up after a New York Times article like that.

  2. Adam Greenwood on September 23, 2004 at 11:31 am

    Good stuff. Way to do well by doing good, Matt.

    My gut feeling is that this is good for pro-life advocates like Matt and I who want to regulate abortion. It’s easier to argue that the fetus is a baby when, hey! look! it’s a baby. I also think that this is probably good for pro-lifers like you who think abortion is wrong but have hang-ups [ nice, neutral term, eh? :) ] about regulating it. It may lead to a voluntary decrease in abortion.

  3. danithew on September 23, 2004 at 11:37 am

    Adam, I couldn’t agree more with you. Seeing a baby in the fetus that is yawning, sucking its thumb, etc. makes it difficult refer to the child merely as a fetus. After all, it looks and acts like the babies we’ve all seen.

  4. danithew on September 23, 2004 at 11:38 am

    ‘Scuse me. I meant to type “in the womb” not “in the fetus.”

  5. Nathan Tolman on September 23, 2004 at 11:50 am

    I remember a article about a month or two ago when these same type of pictures started appearing in Britain, they caused an uproar for change in their abortion policy, so it is definitely good for the pro-life crowd. Is this a problem? I find it strange that pro-abortion people could seriously raise an objection to this type of procedure. On the other hand, I doubt people contemplating abortion will get this done. I doubt it will, in the end prevent many preemptive infanticides.

  6. Adam Greenwood on September 23, 2004 at 12:00 pm

    I doubt ultrasounds will have the sort of direct link that Mr. Tolman discusses. Like him, I don’t think most people will go to have a loving 30-minute video of their child made before they head off to abort it.

    But I do think that ultrasounds will shift the perceptions in the cultural air about what a fetus is, and this will prevent abortions.

  7. danithew on September 23, 2004 at 12:06 pm

    I am wondering if people in the medical profession will at any point require that a high-res visual recording of a baby’s expressions during an abortion be recorded. Wouldn’t physicians want to understand everything about the abortion procedure, including how the baby communicates what it is feeling? This is gruesome to talk about but it I know in the past the silent scream movie was made (though I never saw it). It seems with this new technology that it would be time for an updated version.

    I hate bringing this up, btw. I just feel that in fact this technology does change things and that since humans seem to inevitably use technology for whatever it can be used for, this type of video recording would be made.

    NOTE: before hitting “make comment” I looked up “silent scream” in google and came up with this:

    http://www.silentscream.org/

    There’s at least one letter posted there (who knows if it’s authentic or not) from a mother who decided to bear her child after seeing it on the ultrasound.

  8. Scott on September 23, 2004 at 12:52 pm

    What he is doing, in essence, is practicing medicine without a license. Courts have held that radiologists establish a doctor-patient relationship when they intrepret a study on that patient, even though they have never physically met the patient. How is it different in this case? It doesn’t matter that it is “just for fun” or that “there is no evidence of harm produced by these ultrasounds”. We used to think that Thalidomide was harmless.
    What he is doing is preying on the emotions of young couples who have to cough up the cash for these studies, and just can’t wait a few more weeks until the baby comes out.
    You lawyers out there- there could be a gold mine in “missed cases”, some of you should look into it.
    As far as the abortion issue, most abortions occur by 12 weeks, where the crown-rump length is 5 mm or so, So any high res imaging will not make a difference, you would not see any facial features.

  9. danithew on September 23, 2004 at 1:17 pm

    During my wife’s medical schooling I’ve heard at least a few snide remarks about the relationship between radiology and medicine.

  10. john fowles on September 23, 2004 at 1:44 pm

    Scott, why the presumption that he is practicing medicine rather than taking pictures like Kiddie Kandids or Sears?

  11. Frank McIntyre on September 23, 2004 at 2:06 pm

    Sears photography is also practicing medicine! Now that’s a missed case opportunity!

  12. Scott on September 23, 2004 at 2:17 pm

    Well, Danithew, no matter what field your wife goes into, aside from perhaps dermatology, the radiologist makes the diagnosis, and the clinician takes the credit. Radiologists are physicians with at least 5 years of post-graduate training (equivilant to general surgeons) and essential to the practice of medicine. Imaging studies are often performed even before the basic history and physical examination, particularly in the emergency department. The snide remarks that you refer to are the result of jealousy, in my humble opinion.

    As far as the practicing medicine comment- Ultrasound is a medical procedure with medical indications. There is a risk of tissue damage from ultrasonic waves, currently under investigation, namely heat production and cavitation. Think of the effect on the brain while you are spending time trying to line up the perfect face shot. The brain has the consistency of jello. Will it be clinically evident when the kid comes out? I don’t really know- no one does at this point. Misdiagnosis, however, may be the greatest hazard of ultrasound. I think that the people who get these scans may be given the false impression that everything is fine with their baby. At least when you go to Sears, you know your kid is ugly before you get the picture.

    Am I over-reacting? Maybe. But I think that there should be some restraint, every medical proceedure has its risks and benefits.

  13. Kim Siever on September 23, 2004 at 2:33 pm

    I have to agree with those medical organisations. I do not think parents should be quick to have voluntary ultrasounds. There is far too much controversy currently regarding the effect of ultrasound on developing tissue. Personally, I would rather be cautious and have a healthy baby than to be carefree and risk having a baby with tissue deformation. Besides, people are impatient enough as it is; why perpetuate or even enhance that impatience?

  14. danithew on September 23, 2004 at 2:42 pm

    I’m clearly going to have to go pull out a few issues of JAMA or some other medical magazine to read up on how radiology scans might impact developing (brain) tissue. Thanks Scott for the info.

    On another note I’ve heard some funny remarks about anesthesiology as well and I always am very quick to point out my eternal gratitude to those who NUMB the PAIN. So why should I heed a bunch of competitive med students ripping on each other’s chosen fields? :)

  15. lyle on September 23, 2004 at 3:04 pm

    Hm…I wonder if the nay-sayeers, who are so risk-adverse here, are also risk-adverse when other ‘risky’ social and/or medical issues come up where there are:

    1. potential, unknown, un-quantifiable risks
    2. the political outcome breaks against their own beliefs

    ???

  16. Kim Siever on September 23, 2004 at 3:04 pm

    Usually, yes.

  17. Nate Oman on September 23, 2004 at 3:27 pm

    Scott,

    I take it that you are not a lawyer.

    If one is not providing diagnostic or therepeutic services, I don’t see how you are practicing medicine. The fact that an ultrasound is a medical device hardly seems relevant. If the ultrasound is in fact hurting someone, then that might be tortious, but it would be tortious even if the person with the ultrasound was a doctor. (The legal standard would probably be slightly different.) Finally, practicing medicine without a liscense is a regulatory violation. I don’t think that it even gives rise to a cause of action.

    Don’t hold your breath on the class action…

  18. Mathew on September 23, 2004 at 5:33 pm

    Nate,

    Are you telling me that I’m not liable for using a stethescope to listen to my friends heartbeat?

  19. Ethesis (Stephen M) on September 23, 2004 at 8:18 pm

    Misdiagnosis, however, may be the greatest hazard of ultrasound. I think that the people who get these scans may be given the false impression that everything is fine with their baby.

    Err…surely you’ve seen the studies that doctors who use ultrasounds do worse diagnostic work than those who don’t.

    Or talked to an OB about ultrasounds as a revenue center, not a diagnostic one?

    Anyway…

  20. Scott on September 23, 2004 at 9:11 pm

    No, I haven’t seen those studies. Provide a link.
    “Or talked to an OB about ultrasounds as a revenue center, not a diagnostic one?”

    You have an OB who states that the only reason he does an Ultrasound is for revenue? Thats the best reason against self-referral that I have heard in a while. At least they’re not pretending to be doctors.

  21. Julie in Austin on September 23, 2004 at 9:47 pm

    I realize risk-benefit analysis is a very personal thing, but I wonder how someone could weigh the (hypothetical) dangers of ultrasound (haven’t these been done for 30 years?) against the very real information they provide. While I wouldn’t, of course, abort for a minor (or even not so minor) problem found during an ultrasound, I would be able to be much better prepared to deal with the problem. In a small number of cases, prenatal surgery is even an option. For other problems, parents and doctors can be better prepared than they would be if they were surprised by a problem at the birth. To say nothing of my experience (three times over) of a ‘clean’ ultrasound substantially reducing my stress level for the remainder of the pregnancy.

  22. Jonathan Green on September 23, 2004 at 9:54 pm

    I’ll agree with Scott that boutique ultrasounds will have little effect on abortion. Read the NYT article; one service provider urged parents to wait until 30-32 weeks, so the baby would be “cuter.” At that age, every fetus is viable and abortion is not an option. What if you could use a hi-res ultrasound to see that the wee little blastocyst at 21 days looked rather alien, or that the slightly older fetus has gills and a tail? I don’t think too many people would be framing those pictures.

    But I think Scott’s alarm is mostly misplaced. With our first three kids, the doctors, technicians, and midwives have always reassured us that ultrasounds were completely safe. Now there’s a little free-market competition, people seem to getting a bit more protective. At the moment, I see no reason to avoid any of the usual medical ultrasounds, but I have little inclination to pay for a 3-d version somewhere else. Not, of course, that the decision is really mine.

  23. Ethesis (Stephen M) on September 23, 2004 at 10:52 pm

    Scott, I read the last summary of an ultrasound diagnostic value study in the Wall Street Journal. I’m afraid I don’t have a link to it on a non-pay site. Should be easy enough to find on Medlars or a similar search service.

    But, Well, Danithew, no matter what field your wife goes into, aside from perhaps dermatology, the radiologist makes the diagnosis, and the clinician takes the credit … that is a bit extreme. Pretty much the way a radiologist thinks, of course, but not necessarily correct. Of course I’ve had clients who were disease control specialists, surgeons and internists as well as cardiologists.

    Last time I had a child get radiology treatment that included ultrasounds the radiologist failed to notice a hypoplastic left ventrical and a two vessel cord, in spite of being asked to look for heart and other problems. Diagnosis didn’t inlcude much radiology, nor did the surgeon rely on it much.

    BTW, note that you don’t have a website or an e-mail link active on your posts.

    Of course the OBs don’t pretend to be doctors, they are MDs, but I’m not aware of many medical doctors with a PhD thesis, except some of the neuros or cardiologists. Don’t recall a radiologist with a thesis, though I’ve known a few who were pretty good people. I’m not sure that counts though in terms of being a “real” (as in “traditional definition” doctor).

    One of the fascinating changes in medicine is that thirty-forty years ago, doctors would stand around and talk shop and about patients. I still hear some doing that, but many talk about investments and girlfriends. I’ve a friend who is an old time doctor who was pretty dispirited after a meeting where one of the other docs pulled out a hundred dollar bill and said “this is my only friend” when discussing whether or not to offer professional courtesy treatment to other doctors.

    Though I have seen a lot of chirpractors send out for a lot of radiology prior to beginning treatment. As far as I can tell, the largest consumer of CT scans and MRIs has to be chiropractic clinics. I’m impressed by the relationship between doctors of chiropractic and doctors of radiology ….

  24. Mephibosheth on September 23, 2004 at 11:32 pm

    From what I’ve heard the effects of electromagnetic radiation on living tissue is yet to be determined. They can’t prove that it causes cancer or anything like that, but they also cannot say that it has no effect or that it’s harmless (same with the whole cell phone thing).

    I can understand an OB taking the risk for diagnostic purposes, but I wouldn’t volunteer my unborn child for just a picture.

  25. Scott on September 24, 2004 at 8:12 am

    To Ethesis:
    OK- I put my E-mail on the comments section- I don’t know why it doesn’t get posted. I don’t have a website. I do not appreciate the nefarious implication, however.

    Radiologists are MDs. I never meant to imply that OBs were not doctors, I meant to state that if they were giving ultrasounds, at least they have medical training, as opposed to the boutique US, which is what this post was about. I am not sure what a thesis has to do with being a medical doctor.

    I can’t comment on chiropractors. I do know that in my experience, most of the imaging that I do is referred by orthopedic surgeons, general surgeons, anf family practice physicians. Rarely have I seen a request from a chiropractor.

  26. Nate Oman on September 24, 2004 at 8:25 am

    “At that age, every fetus is viable and abortion is not an option.”

    Jonathan Green: Actually it remains an option in most places. Under the Casey framework, states may constitutionally ban abortion after the point of fetal viability subject to health exceptions and the like. However, the fact that such bans are constitutionally permissible does not mean that states have actually enacted them.

  27. Nate Oman on September 24, 2004 at 8:26 am

    Mathew: “Are you telling me that I’m not liable for using a stethescope to listen to my friends heartbeat?”

    It is really shocking what the laws of this country allow isn’t it!

  28. Ethesis (Stephen M) on September 24, 2004 at 8:36 am

    To Ethesis:
    OK- I put my E-mail on the comments section- I don’t know why it doesn’t get posted. I don’t have a website. I do not appreciate the nefarious implication, however.

    Just thought you would want to know it wasn’t posting. I don’t know why either, probably something with the software.

    As for implications you will need to talk with WordPress about it ….

  29. Mark B on September 24, 2004 at 9:05 am

    Mephibosheth said:

    From what I’ve heard the effects of electromagnetic radiation on living tissue is yet to be determined. They can’t prove that it causes cancer or anything like that, but they also cannot say that it has no effect or that it’s harmless (same with the whole cell phone thing).

    I can understand an OB taking the risk for diagnostic purposes, but I wouldn’t volunteer my unborn child for just a picture.

    Ultrasound is not electromagnetic radiation. An ultrasound image is generated by “graphing” the echoes from high frequency sound waves, much as SONAR is used to search for submarines or to map undersea formations.

    I don’t know anything of the risks of heat production or cavitation arising from ultrasound, but in the cost-benefit analysis, any risk appears to trump the benefit, which seems to be simply a “pretty picture.” (And, to be honest, those are pretty pictures only in the same sense that a picture of a newborn is pretty–we say that because of the joy of having a new child, not because the kid is cute at 2 hours or 2 days or even 2 months.)

    Ultrasounds may have been around for 30 years, as Julie suggests, but they were not routinely done 16 years ago, when our youngest was in utero. I don’t know, and haven’t asked my wife, if the OB recommended it, but I do know that none was done, either for him or his older siblings.

  30. Kristine on September 24, 2004 at 10:14 am

    Both the ACOG and the NIH still recommend *against* routine ultrasounds in low-risk pregnancies. (see http://cpmcnet.columbia.edu/texts/gcps/gcps0046.html–it's an older text, but a quick search of the ACOG’s site revealed no changes in their recommendation) There haven’t been any studies demonstrating risks to mother or baby from routine ultrasounds, but most studies also show no benefits. There was one Danish study in the mid-80s that showed slightly increased risk of IUGR in babies who were scanned several times during pregnancy. Also, ultrasounds tend to slightly *increase* the number of abortions, because of their capability for detecting anomalies that other tests might miss.

    But by 30 weeks, 70% of pregnant women in the U.S. have already had an ultrasound, so what Matt’s doing is likely to have little impact on them or their babies.

  31. Frank McIntyre on September 24, 2004 at 11:05 am

    I’m currious about exactly where the medical degree monopoly kicks in. I am guessing that one can give one’s son medical advice legally (I do). Presumably the point at which the Health police drag you into court is when you start taking money for giving medical advice. Is that correct? Is any free medical advice illegal?

  32. jpatch on September 24, 2004 at 1:10 pm

    I frequently hear commercials on the radio advertising body scans and virtual physicals–run by radiologists. These seem almost unethical to me–one commercial has a guy who had a heart attack saying he wished he had had the scan so his heart problem could have been caught.

    I’m skeptical that they catch important problems very often. My bet is that most patients don’t gain any more knowledge about their overall health than those who take the cheaper option of an actual physical.

    If radiologists can push these things on the public, I think Matt should be able to continue his business. As long as no real harm can be demonstrated I don’t have a problem with either one–it’s a personal decision.

    Besides, it’s not like people are going to have voluntary ultrasounds every week. Aside from the cost, there are only certain windows of time where good pictures can be taken.

  33. a random John on September 24, 2004 at 2:38 pm

    As for the abortion argument, I am surprised that nobody has brought up China or India, where ultrasounds are done in order to determine the gender of the child and then abort her if she is female.

  34. Mark B on September 24, 2004 at 3:24 pm

    Frank,

    If you want legal advice about how far you can go in practicing medicine without a license, you’re going to have to pay for it. Like a whole lot of others here, I have a license to practice law, but that’s just a license to go broke if we don’t charge for it.

    Send me a payment through PayPal, and I’ll give you a ton of advice. :)

  35. Frank McIntyre on September 24, 2004 at 3:44 pm

    Mark, I take it that means you don’t know :)

  36. Bryce I on September 24, 2004 at 4:50 pm

    Which reminds me of an old Reader’s Digest joke.

    A man noticed he had a strange rash on his hand, and was worried about it. He happened to run into a doctor acquaintance of his at the store, showed him the rash, and asked him if there was anything he should do about it. The doctor looked at the rash, told the man not to worry, and went on his way.

    A week later, the man received a bill for medical services from the doctor friend. His neighbor the lawyer saw him muttering and cursing as he read his mail at the mailbox, and asked what the matter was. The man asked his neighbor if it was legal for the doctor to bill him for what he had thought was free advice and whether he should pay the bill. The neighbor told him “Yes, you are liable. I’ll send you my bill tomorrow.”

    /poorly told, I know, but it’s a lawyer joke, so laugh anyway.

  37. Geoff Matthews on September 24, 2004 at 7:50 pm

    I think that one of the greatest values for this service would be the opportunity for people other than the mother to bond with the child. While this isn’t a problem for the expecting mother, a short video of the child in utero would give the expectant dads/grandparents/uncles/aunts/etc the opportunity to have some sort of experience with the child.

    And, as far as using medical devices, my first thought was themometers (rather than stethescopes). We use them constantly to make judgements on health, and heck, they even contained a deadly toxin, mercury, at one time.

  38. Cath on September 24, 2004 at 9:26 pm

    - (And, to be honest, those are pretty pictures only in the same sense that a picture of a newborn is pretty–we say that because of the joy of having a new child, not because the kid is cute at 2 hours or 2 days or even 2 months.)

    I don’t know about your children, but my little girl – born exactly 7 days ago – was adorable just a few hours after birth. For proof, see baby.shyphoto.com. And she looks like she did in her ultrasound pictures, which were done by my
    OB-GYN almost every month for the first part of my pregnancy and every week for the last five or six weeks. I live in the Philippines right now, and my Spain-trained OB-GYN seems to use her ultrasound machine at every prenatal visit. I’m not positive that there’s no risk involved in frequent ultrasounds, but my OB-GYN is highly-credentialed and up on the latest ACOG protocols. A well-trained ultrasound reader can use it to monitor all sorts of things (not just check gender) going on with our wee ones in the womb. If ultrasounds weren’t so pricey in the USA, they’d probably be used much more frequently.

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