On Down syndrome prenatal testing, they don’t get to have it both ways

The recent press releases by the American College of Obstetricians and Gynecologists (ACOG) and the video above show the inconsistency in policy positions in obstetric care. Regarding Down syndrome prenatal testing, they shouldn’t get to have it both ways.

Tomorrow I’m presenting on legislation and policy initiatives impacting Down syndrome prenatal testing at a conference. The conference is at Trinity University, free and open to the public, and available for live-streaming if you can’t attend in person. Having this at the forefront of my mind has me thinking about the role of legislation and obstetric care.

In just the past few weeks, ACOG has stepped up its public relations responding to the bills proposed in Texas and, most recently, in North Carolina concerning abortion restrictions. ACOG’s messaging is attempting to insert the meme into the public psyche of “Get Out of Our Exam Rooms.”

It has a certain appeal. During the Texas abortion bill debate, much was made of the joke that no one knew getting elected qualified a politician to practice medicine. So, the phrase “get our of our exam rooms” is catchy. Except, ACOG doesn’t mean it in every instance. When it comes to expanding coverage of maternity care services and mandating no cost preventive care measures through the Affordable Care Act, then ACOG supports politicians being in the exam room.

The inconsistent application of this slogan is no more clearly revealed than when it comes to prenatal testing. California has long had a state run prenatal testing program for Down syndrome as does Iowa. In my home state of Kentucky, the initial contract for managing Medicaid services that all women covered by Medicaid be prenatally tested for Down syndrome. In none of these policy matters did ACOG say “Get out of our exam rooms.”

Which brings us to the video above.

Dr. Nicolaides has been a pioneer in the development of prenatal testing for Down syndrome. He was one of the leaders in developing the nuchal translucency ultrasound test. That test went on to revolutionize obstetric care, removing the age limit when women were routinely offered prenatal testing to now every expectant mother being offered prenatal testing.

In the above video, Nicolaides is interviewed about the United Kingdom’s development of the blood-based Non-Invasive Prenatal Screening (NIPS) test. The video is only 3 minutes long, so watch until the very end.

At the 2:00 minute mark, the narrator notes that there are ethical issues surrounding prenatal testing for Down syndrome. Listen to how Nicolaides defends the administration of prenatal testing.

Nicolaides says he “respects” the argument that developing better prenatal testing for Down syndrome expresses a view that Down syndrome is a condition that is a “really bad thing” and should be destroyed. But, Nicolaides justifies his entire career’s work of developing more accurate prenatal testing based on “the alternative argument,”

The society through the House of Parliament has legalized termination. The Government has accepted the principle and is promoting the principle of screening for Down’s. And, therefore, our role, if those two things are accepted—termination and universal screening for Down’s—our role is to improve the method of screening.

Nicolaides is not saying to the Government “get out of our exam rooms!” He’s saying his entire work is justified by the Government being in his exam room. Nicolaides says he is only developing better prenatal testing because the Government is promoting universal screening and has legalized termination.  Nicolaides is reprising an old defense. He recognizes that his role in developing better prenatal testing is resulting in the elimination of lives with Down syndrome. But, Nicolaides defends his actions by in essence saying he’s “just following orders.”

If ACOG’s new slogan were applied consistently–if Government got out of the exam room–then Nicolaides’ role would no longer be justified. Similarly, if the slogan were applied consistently, then ACOG would express opposition to the way California and Iowa run prenatal screening programs for Down syndrome and to how state Medicaid programs fund prenatal testing. But, this will not be demanded because ACOG recommends the offering of prenatal testing and these programs pay ACOG’s members.

So when you hear the phrase, “get out of our exam rooms,” that really only means, “sometimes.”

Comments

  1. Yes, the moral disease of our age, dissolving oneself from the consequences of ones own actions.

  2. What an incisive blog ! Gets to the heart of the matter.

  3. I spoke just after Prof N on the show on Sunday and I was surprised to hear him allude to what amounts to a eugenics programme on behalf of our government. We knew of course that that was happening, but to hear him recognise ethical issues but carry on because that’s what the government and society wants was shocking.

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