ULTRASOUND Messages for September, 2002: Re: Newsweek article

As compelling images emerge, doctors say they are getting besieged with requests for "reassurance" ultrasounds that are not medically necessary and can cost $300 or more. Baby Views, in contrast, charges up to $125 per session. Insurance companies typically cover only one ultrasound during a pregnancy. Jamie Sandage, who sets appointments at Medical Park Women’s Clinic in Benton, said the office receives many phone calls from women who want a 4-D ultrasound. "We even get calls from out of state," Sandage said, but added that "we only make appointments for established patients." Sandage said most of the women who call want better pictures of their babies, not medical diagnoses. Dr. J. Richard Doss, an obstetrician at the clinic, said it is tempting to perform reassurance ultrasounds because insurance companies "keep raising rates and lowering reimbursements." "There are a lot of outside pressures to supplement income," Doss said. "It is hard to care for someone with Medicaid because Medicaid will not reimburse whether it is [a highrisk pregnancy] or not." For example, Doss explained that a pregnant woman with diabetes is considered high-risk, but Medicaid does not cover the extra care needed to ensure a safe pregnancy. Ethically, Doss questions the use of medical equipment used purely for entertainment. "There is something about being a physician that makes me feel uneasy," Doss said, "but as long as the technicians are certified and they are using quality equipment, there is no harm done." Dr. Kemp Skokos, an obstetrician at The Woman’s Clinic in Little Rock, said literature seems to indicate there is minimal risk with ultrasounds. "This is kind of a new thing, and I don’t have any strong feelings about it," Skokos said. "But I can see [potential] problems with it. "I would agree that [ultrasounds ] are not meant for entertainment," Skokos said. "It opens up the question on all kinds of machines."

Meanwhile, fetal-portrait studios, like Baby Views, are booming. Fetal Fotos, founded in 1994 in Salt Lake City, now operates five such stores around the country, and is opening more during coming months. Many women send videos to relatives who live far away or screen the tapes at baby showers. Although there are no known adverse health effects, many doctors discourage patients from getting more than one ultrasound because of the lack of long-range studies and the prospect that false findings may lead to unnecessary and invasive follow-up tests. "Ultrasounds are a medical procedure and shouldn’t be used for entertainment purposes," said Lawrence Platt, past president of the American Institute of Ultrasound in Medicine. In 1994, as doctors were starting to explore new applications of the technology, the U.S. Food and Drug Administration issued a warning letter saying that using ultrasound equipment for "keepsake" fetal videos is "an unapproved use of a medical device" and shut down some portrait studios. A spokesman said the FDA is looking into the practice as such studios "appear to be cropping up again." Foster of Baby Views said there is no law against her business ; there are just "people making a commotion over nothing." Leon Hansen, who founded Fetal Fotos, said he got the idea from his experiences delivering 250 babies a year. "You can do a 2-D ultrasound and in 10 minutes see what you need medically," he said, "but that is not enough for most people." Fetal Fotos said it conforms with FDA guidelines and provides "limited medical information," showing, for instance, that the baby is alive and moving, its position, where the placenta is located, and the baby’s sex. But Fetal Foto technicians don’t give diagnoses. If a technician spots something that looks abnormal, the woman is told to get a clinical ultrasound. Foster, a sonographer for 12 years, said that if she sees something in the ultrasound that might indicate a problem with the fetus, she does not tell the client, but contacts the woman’s doctor. She requires her customers to sign a waiver with her physician’s information. The waiver also states the ultrasound is not for medical diagnoses. "If I saw something that concerned me, I would not say [to the mother] everything is fine," Foster said. "If I see a clean bill of health, I don’t have a problem telling them that. "It is not my place to say something is wrong," Foster said, "But at the clinic, I do." She is a sonographer at Arkansas Women’s Center in Little Rock, where sonograms range from $130 to $300, and is a member of the American Registry of Diagnostic Medical Sonographers. Information for this article was provided by Amy Dockser Marcus of The Wall Street Journal and Stephanie Harris of the Arkansas Democrat-Gazette. This story was published Wednesday, September 25, 2002

On Tue, 24 Sep 2002 23:01:24 -0500 joshua copel <joshua.copel@yale.edu> writes: > I did speak to her. She interviewed me last week while preparing the > > article. She was pretty on target with her approach and told me that > the > story was shrinking as she wrote it because there wasn't much to > say. > Definitely wasn't trying to sell or promote the Fetal Foto outfits. > > While I haven't seen the article yet myself, it sounds like the > message > we all would want to get out there about scans for entertainment was > > included. Don't think they would do much follow up unless a more > acute > story breaks. > > Josh Copel > ----__JNP_000_16b6.1fc4.3ac3 Content-Type: text/html; charset=iso-8859-1 Content-Transfer-Encoding: quoted-printable

-----------------------------------------

=91Keepsake=92 trend worries=20

-----------------------------------------

doctors
Ultrasounds being used for pictures
DEMOCRAT-GAZETTE STAFF AND WIRE REPORTS

Kasey Cathey of Sherwood is just a few weeks away from her due date. She had ultrasounds at her doctor’s office when she was eight weeks pregnant and again at 20 weeks. Her insurance does not cover additional ultrasounds, so she went to Baby Views in Little Rock to see her unborn son at 36 weeks.
"I wanted to see how he’s doing," Cathey said, "and make sure he’s healthy."
Shea Foster, owner of Baby Views, said women see her for a variety of reasons, including determining a baby’s position and sex and just to have pictures for relatives and scrapbooks.
At a doctor’s office, ultrasounds are used for medical diagnoses.
Early in pregnancies, Foster said, "they are seeing if it is viable" and whether there is more than one baby. "At 20 weeks they are screening for birth defects and measuring growth. In the third trimester they check the well-being of the baby, if the mother or child is under stress, and if the mother has gestational diabetes" and make other diagnostic tests.
Cathey’s session lasted about half an hour, as Foster pointed out everything from each chamber of the heart to each tiny toe. Cathey’s husband, A.J., and sister Leesa Stephenson, also of Sherwood, watched with unwavering attention while the videotape rolled. They left with their video of the whole experience, three still photographs and, most important, peace of mind as the big day draws near.
Cathey is one of many new parents rushing to take advantage of advances in ultrasound imagery. The trend raises some controversy. Some of the new technology makes the images — once grainy and incomprehensible — sharp enough to show fetuses’ facial features clearly.
The latest ultrasounds have medical uses, like checking for Down’s syndrome or other abnormalities. But to many mothers, they are starting to look more like devices for getting their first snapshots of the baby.
Fueling consumer interest, General Electric Co. in May kicked off one of its largest marketing investments ever, touting a new "4-D" ultrasound with striking magazine ads and TV spots on cable channels. While all ultrasounds bounce the sound waves off the body to generate an image, the newer 3-D and 4-D ultrasounds also build a threedimensional image that doctors can manipulate to get a 360-degree view. The 4-D machines show fetal movements in close to real time. So the experience is more like watching a home movie.

‘REASSURANCE’ IMAGES

As compelling images emerge, doctors say they are getting besieged with requests for "reassurance" ultrasounds that are not medically necessary and can cost $300 or more. Baby Views, in contrast, charges up to $125 per session.
Insurance companies typically cover only one ultrasound during a pregnancy.
Jamie Sandage, who sets appointments at Medical Park Women’s Clinic in Benton, said the office receives many phone calls from women who want a 4-D ultrasound.
"We even get calls from out of state," Sandage said, but added that "we only make appointments for established patients."
Sandage said most of the women who call want better pictures of their babies, not medical diagnoses.
Dr. J. Richard Doss, an obstetrician at the clinic, said it is tempting to perform reassurance ultrasounds because insurance companies "keep raising rates and lowering reimbursements."
"There are a lot of outside pressures to supplement income," Doss said. "It is hard to care for someone with Medicaid because Medicaid will not reimburse whether it is [a highrisk pregnancy] or not."
For example, Doss explained that a pregnant woman with diabetes is considered high-risk, but Medicaid does not cover the extra care needed to ensure a safe pregnancy.
Ethically, Doss questions the use of medical equipment used purely for entertainment.
"There is something about being a physician that makes me feel uneasy," Doss said, "but as long as the technicians are certified and they are using quality equipment, there is no harm done."
Dr. Kemp Skokos, an obstetrician at The Woman’s Clinic in Little Rock, said literature seems to indicate there is minimal risk with ultrasounds.
"This is kind of a new thing, and I don’t have any strong feelings about it," Skokos said. "But I can see [potential] problems with it.
"I would agree that [ultrasounds ] are not meant for entertainment," Skokos said. "It opens up the question on all kinds of machines."

PORTRAIT STUDIOS BOOMING

Meanwhile, fetal-portrait studios, like Baby Views, are booming.
Fetal Fotos, founded in 1994 in Salt Lake City, now operates five such stores around the country, and is opening more during coming months.
Many women send videos to relatives who live far away or screen the tapes at baby showers.
Although there are no known adverse health effects, many doctors discourage patients from getting more than one ultrasound because of the lack of long-range studies and the prospect that false findings may lead to unnecessary and invasive follow-up tests.
"Ultrasounds are a medical procedure and shouldn’t be used for entertainment purposes," said Lawrence Platt, past president of the American Institute of Ultrasound in Medicine.
In 1994, as doctors were starting to explore new applications of the technology, the U.S. Food and Drug Administration issued a warning letter saying that using ultrasound equipment for "keepsake" fetal videos is "an unapproved use of a medical device" and shut down some portrait studios. A spokesman said the FDA is looking into the practice as such studios "appear to be cropping up again."
Foster of Baby Views said there is no law against her business ; there are just "people making a commotion over nothing."
Leon Hansen, who founded Fetal Fotos, said he got the idea from his experiences delivering 250 babies a year. "You can do a 2-D ultrasound and in 10 minutes see what you need medically," he said, "but that is not enough for most people."
Fetal Fotos said it conforms with FDA guidelines and provides "limited medical information," showing, for instance, that the baby is alive and moving, its position, where the placenta is located, and the baby’s sex. But Fetal Foto technicians don’t give diagnoses. If a technician spots something that looks abnormal, the woman is told to get a clinical ultrasound.
Foster, a sonographer for 12 years, said that if she sees something in the ultrasound that might indicate a problem with the fetus, she does not tell the client, but contacts the woman’s doctor. She requires her customers to sign a waiver with her physician’s information. The waiver also states the ultrasound is not for medical diagnoses.
"If I saw something that concerned me, I would not say [to the mother] everything is fine," Foster said. "If I see a clean bill of health, I don’t have a problem telling them that.
"It is not my place to say something is wrong," Foster said, "But at the clinic, I do." She is a sonographer at Arkansas Women’s Center in Little Rock, where sonograms range from $130 to $300, and is a member of the American Registry of Diagnostic Medical Sonographers. Information for this article was provided by Amy Dockser Marcus of The Wall Street Journal and Stephanie Harris of the Arkansas Democrat-Gazette.

This story was published Wednesday, September 25, 2002

On Tue, 24 Sep 2002 23:01:24 -0500 joshua copel <joshua.copel@yale.edu> writes:
> I did speak to her. She interviewed me last week while preparing the
>
> article. She was pretty on target with her approach and told me that
> the
> story was shrinking as she wrote it because there wasn't much to
> say.
> Definitely wasn't trying to sell or promote the Fetal Foto outfits.
>
> While I haven't seen the article yet myself, it sounds like the
> message
> we all would want to get out there about scans for entertainment was
>
> included. Don't think they would do much follow up unless a more
> acute
> story breaks.
>
> Josh Copel
>

use when must restrict search to only the ultrasound forum...
Enter search keywords:
	Returns per screen: Require all keywords: