De­bate over pre­na­tal test­ing shouldn’t gloss over the sci­ence

Modern Healthcare - - MODERN HEALTHCARE -

It’s pol­i­tics vs. medicine in de­bate over pre­na­tal test­ing

Here we go again. Last week brought yet an­other clash of sci­ence and pol­i­tics into the na­tional spot­light. And once again health­care was at the cen­ter of the storm. No, it wasn’t a con­tin­u­a­tion of the re­cent drama over the fed­eral gov­ern­ment’s rules on em­ployer cov­er­age of con­tra­cep­tion ser­vices. While that is­sue still hasn’t blown over com­pletely, a re­lated topic cap­tured head­lines.

This time the de­bate was driven by com­ments from for­mer Penn­syl­va­nia Sen. Rick San­to­rum, who, based on his elec­toral tri­umphs in sev­eral pri­maries and cau­cuses to date, as well as re­cent polling data, clearly stands as one of the top two con­tenders for the Re­pub­li­can pres­i­den­tial nom­i­na­tion.

His re­marks last week ques­tioned the role and pur­pose of pre­na­tal test­ing, in­clud­ing his be­lief that such ser­vices should be re­stricted be­cause they lead to more abortions. He tied those com­ments to an­other of his fa­mil­iar at­tacks on the Pa­tient Pro­tec­tion and Af­ford­able Care Act, say­ing in one in­ter­view last week that rules un­der the law re­quir­ing in­sur­ers to cover tests such as am­nio­cen­te­sis en­cour­age more women to have abortions that will “cull the ranks of the dis­abled in our so­ci­ety.”

These are in­deed strong state­ments, and San­to­rum says them with the con­vic­tion of his faith. But they’re trou­bling on many fronts, es­pe­cially re­lat­ing to ac­cess to crit­i­cal health­care ser­vices for women and how they di­min­ish the med­i­cal value of these di­ag­nos­tic tools.

Clearly a goal of pre­na­tal test­ing is to track the health of a de­vel­op­ing fe­tus, look­ing for chro­mo­so­mal ab­nor­mal­i­ties that might in­di­cate any num­ber of se­ri­ous de­vel­op­men­tal prob­lems. Could such in­for­ma­tion play a role in a decision to ter­mi­nate a preg­nancy? Of course. But in 21st-cen­tury medicine, that’s also true of other tech­nolo­gies. Even some sim­ple blood tests are used in pre­na­tal di­ag­nos­tic screen­ing. Should gov­ern­men­tal health­care pro­grams im­pose stricter lim­i­ta­tions on which blood tests they will pay for?

Sono­grams and ul­tra­sound ex­ams have long been rou­tine for preg­nant women to as­sist health­care providers in an­swer­ing the key ques­tion—is the baby healthy and de­vel­op­ing nor­mally? It’s price­less in­for­ma­tion for the ex­pec­tant par­ents. Are those pro­ce­dures also to be dis­missed as dele­te­ri­ous when they are di­ag­nos­tic de­vices that in the vast ma­jor­ity of cases have noth­ing to do with elec­tive abortions?

An­other prob­lem with San­to­rum’s state­ments re­lates to the con­stant knocks against the Af­ford­able Care Act—not just from his cam­paign—that the law amounts to med­dling in the prac­tice of medicine by gov­ern­ment bu­reau­crats. How many times have we been told that the law’s many pro­vi­sions in­ter­fere with the physi­cian-pa­tient re­la­tion­ship?

So how is an at­tack on pre­na­tal test­ing not med­dling? How is it not ra­tioning of es­sen­tial health­care? How is this not a re­jec­tion of sci­en­tific progress?

In the mid­dle of all this last week, Google posted an­other of its in­trigu­ing and al­ways creative “Doo­dles” on the search en­gine’s home­page, this one us­ing col­or­ful un­du­lat­ing waves, mark­ing what would have been the 155th birth­day of an ac­com­plished sci­en­tist named Hein­rich Ru­dolf Hertz.

Hertz is the fa­ther of to­day’s wire­less world, be­ing the first to broad­cast and re­ceive ra­dio waves and de­ter­mine that light and heat were forms of elec­tro­mag­netic ra­di­a­tion. While the Ger­man physi­cist did achieve recog­ni­tion for his re­search dur­ing his life­time, the true scope of his ac­com­plish­ments wouldn’t be known un­til much later with the de­vel­op­ment of ra­dio, tele­vi­sion and the now-ubiq­ui­tous Wi-fi. The “hertz” is even used as the stan­dard mea­sure of fre­quency.

His work is also in­di­rectly linked to the de­vel­op­ment of some­thing else al­ready men­tioned above: ul­tra­sound tech­nol­ogy.

It’s nice to see sci­ence be­ing cel­e­brated, not den­i­grated.

DAVID MAY As­sis­tant Man­ag­ing Ed­i­tor/fea­tures

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