Wednesday, July 15, 2015

The Full Planned Parenthood Body Parts Video

Not many people will have time to slog through the entire video, nearly three hours of the lunch meeting between two investigators from the Center for Medical Progress and Dr. Deborah Nucotela, the Medical Services Director of Planned Parenthood Federation of America. Here is is:

I will start by giving you my impression after watching the whole thing: The edited video which is making the rounds is very misleading. It is, in fact, misleading to the point of bearing false witness against Dr. Nucotela. 

Dr. N is not engaging in a discussion about how Planned Parenthood can turn fetal tissue into a revenue stream. In fact, she cautions the investigators not to offer too much money when talking to an affiliate because that will be so off-putting to the affiliates, who don't want to be seen as, or see themselves as, making any kind of profit from the tissue. She reiterates again and again and again that getting the fetal tissue into the hands of researchers is something that the affiliates want to do, both for the patients and for their own support of fetal tissue research, but in a way that does not disrupt patient flow or cause an avoidable expense.

Dr. N. is highly invested in the idea of the fetal tissue being used to do good for medical science, to the point where she is bending over backward trying to hook the investigators up with Family Planning Associates Medical Group, which is Planned Parenthood's biggest California competitor. She even texts the FPA medical director during the discussion in order to see if she can get these people hooked up. Dr. N. goes back again and again to how many patients want to donate the tissue, what an important service this is to their patients, and how much the affiliates want to meet an emotional need of their patients and how they want the fetal tissue to go to good use rather than just end up in the incinerator.

Dr. N. is meeting with these people because she thinks that she can build a mutually beneficial system in which patients can feel good about what's happening to the remains of their fetuses, workers at affiliates can have a feeling of satisfaction about what happens to the fetal remains, and researchers can have access to fetal tissue for medical science. It is the investigators, not Dr. N., who keep bringing up the money.

What is accurate about the video? The casual way Dr. N talks, while cheerfully scarfing down her salad, about how she changes where she crushes the baby in order to harvest a heart or a liver. Her motives, however, are entirely misrepresented -- to the point of bearing false witness. And the claim that PP is using Partial Birth Abortion is again bogus.

I would have no beef with the edited video if it stayed with the facts: Dr. N. really did cheerfully scarf down wine and a salad while chatting about how she decides how to crush the body of a fetus in order to avoid damaging his heart or liver so that the organs can be used for medical research. That is ghoulish and damning. It's when they started cutting and pasting to make it look as if Dr. N was motivated by money and to make it look as if she does illegal "partial birth abortions" in order to harvest undamaged fetal heads.

If you are going to use the video, do so with a caveat that once she's done discussing crushing the body in order to carefully harvest the liver everybody wants the rest of it can be dismissed as being taken out of context.

That said, me break the video down for you:

0:00 - 4:19: Chit-chat, talking about travel, wine, etc.

4:20 - 5:51: Does it look like profiteering? The affiliates want to arrive at a number (price) that looks like it's reasonable for the effort they're putting into it.

5:53 - 6:29: Ordering food and wine.

6:30 - 7:45: Discussion of how different affiliates, based on staff and how much of the work they do (lab work, shipping, etc) they need to develop a number so that if they're asked, "What did you do for this $60? How do you justify that?" they can give an answer that won't raise eyebrows.

7:46 - 8:35: Discussion of non-profit status, hoping to at least break even if not bring in a little money to cover expenses related to other patients rather than just cost of tissue harvesting.

8:38 - 10:00: Discussion of intention of which affiliates to deal with. Just local or nationwide? Male investigator brings up Stem Express, the business whose order form is featured on this video, as a competitor. Investigator says his company wants to be able to collect tissue from facilities nearer to their customers so that tissues are fresher.

10:02 - 13:20 Dr. N. wants to know what gestational age they're talking about. Male indicates that they'd need facilities that definitely go to 18 weeks but it would also be nice if they could go to 20, 24 weeks.  Dr. N. brings up the issue of use of Digoxin (used to kill the fetus prior to removal; typically used a day or two before the fetus is removed) and how its use differs from state to state so this might change how late in the pregnancy a digoxin-free fetus might be available. She goes on to ask if they've spoken to Family Planning Associates in California. Male says he was told "they start diging (pronounced "dijjing") at 13 weeks." Dr. N. dismisses this as absurd.

13:21 - 14:35: They begin discussing PP's Orange County affiliate. Dr. N. says they're already working with another organization and aren't interested in negotiating with other groups. She discusses other facilities with male investigator, how late into gestation they do abortions and whether they're working with any other tissue dealers.

14:36 - 14:58: Discussion with server about wine.

14:59 - 16:10: Male brings discussion about $30 - $100 price range being "per specimen." Dr. N. indicates that for Planned Parenthood, a "specimen" is per patient. Dr. N talks about staff time for informed consent for donation versus patients being "flagged as appropriate." Discussion slows and becomes more vague as server arrives with wine.

16:11  - 17:10: Attention is turned entirely to the wine.

17:11 - 18:02: Dr. N turns back to how it's all about how much staff time or clinic space is involved. Does the clinic staff have to remove and prepare tissues? Does the company want on-site lab space so they can collect the tissue? Etc.

18:03 -  23:44: Dr. N says affiliates want to offer fetal tissue donation because "patients ask about it." Female investigator broaches what that's like for the patient. Dr. N said the patients who ask about donation are easiest to talk to. Her preference is to finish the consent for the entire procedure then broach the topic with the patient regarding what they do with "the tissue." It's presented to the patient as an opportunity to contribute to different kinds of research, and patients are sometimes "pleasantly surprised" that the "tissue" might be used to some good end so they're satisfied and they consent. Female researcher asks if there's specific informed consent about what tissue will be used and is the abortion technique different. Dr. N. says that they use the same method for the abortion, it's just a matter of what happens to the tissue afterward.

23:45 - 28:13:  Dr. N. segues more into the ethics of modifying the procedure to procure tissue. She says that she will keep in mind what tissue is wanted and think about what patients she can get it from, but doesn't do extra dilation to increase the chances of getting the desired tissue out intact. It's a bit unclear if she draws the line at how many dilators are used, but she does indicate that they do not do an extra day of dilation in order to get an intact fetus. In addition to the extra day for the patient it knocks the schedule off for the clinic. Some patients don't dilate as much as expected so even though a patient consents, the desired specimen might not be able to be gathered. Female investigator brings up topic of later gestation patient who wants to donate specific organs and that this might require a different approach. Dr. N indicates that this would be a whole different consent issue that would have to be discussed clearly with the patient.

28:14 - 31:00: Male brings up what Dr. N. might do differently if she has in her mind that the researcher wants an intact liver or, more tricky, a delicate and undamaged brain. Dr. N. says that since livers are wanted so much the practitioner would do those abortions under ultrasound guidance. In this section she goes back and forth between the issue of the calvarium and that if the practitioner is trying to preserve a specific organ he will crush above or below in order to avoid damaging that organ. She goes back to inverting the fetus to a breach presentation so that there is dilation as the procedure progresses. The preparation, she says, is the same, it's a matter of what order the removal is done in.

31:02 - 33:20: Male asks what Dr. N procured the previous day. This is where she talked about a lot of people want hearts, "looking at specific nodes." Dr. N segues into recommending that in addition to building relationships with clinic owners and directors they also develop relationships with the practitioners, explaining what they want and why. The providers, she says, really are invested in the idea of knowing that the tissue is going to be used. She also recommends avoiding trying to get new "trainee" providers to get tissues out undamaged, and she personally doesn't let them do the cases in which tissues need to be harvested until they're more skilled. NB: This gives me the distinct impression that the patient might want to request donating the tissue in order to get a more skilled practitioner doing her abortion.

33:21 - 36:54: Male says that when Dr. N referred to "training" he thought she meant "tissue training." Dr. N indicates that barring space issues, clinics prefer that the biotech company just come and remove and preserve the tissues since PP lab techs are only looking for limbs, thorax, placenta, etc. to make sure the abortion is complete; they don't know how to identify organs. Clinics also prefer that the biotech company do the consent with the patients because PP's counselors only have a few minutes with each patient. Female asks for specifics and Dr. N says 10 minutes per patient typically, and that includes the discussion of post-abortion contraception plans. Some discussion of logistics of fitting biotech company staff into clinic patient flow. Some side discussion of getting adipose tissue from cosmetic surgery centers.

36:55 - 37:45: Brief side trip into discussion of collecting adipose tissue from cosmetic surgery facilities. Male broaches topic of jokes but Dr. N. doesn't go into any joking at abortion facilities and the topic moves on.

37:46  - 46:45: Male goes back to Orange County relationship with company and what that company did to establish good relationship. Dr. N knew no details to relay. Male transitioned into getting specifics about PP affiliates in geographic areas as they move east from the LA area into other states. How late in the pregnancy do they do abortions, are they currently working with other fetal tissue procurement organizations, etc. Also segue into discussion of research facilities and their locations.

46:46 - 53:44:  Dr. N asks male if they are interested in exhibiting at PP meeting, how to network there. She said that providers (except Warren Hern who is "out there") are very interested in doing this because it adds "another level of good to what we're doing." She recommends getting in touch with Family Planning Associates because they're expanding services. Discussion goes into other abortion facilities, as well as PP affiliated, that might be interested. Discussion of her helping them connect. She coaches them on clinic needs and how to approach facility operators to show that they understand clinic flow and can fit in. Discussion also goes into some affiliates' relationships with other fetal tissue procurement companies.

53:45 -  54:46 Discussion of why a growing interest in hooking up with fetal tissue procurement in past year and a half. She indicates that it's patient-driven: they want to know if they can donate their "tissue." This leads to Dr. N advising them to get women talking about the possibility of donating their fetal tissue so that this will become a patient request, which will then lead to facilities being eager to work with procurement organizations as a patient service.

54:47 - 1:00:12: Male asks about how many affiliates are currently working with procurement organizations. The discussion shifts to how to broach the topic with facilities. She recommends not to go in offering to double the money they're getting "because it's going to look bad." She said that they want to see this as an option that they provide to their patients. Also the affiliates like the idea of having less tissue that they have to deal with themselves. This segued into the disposal of fetal tissue and how anti-abortion people are really pestering SteriCycle, the biggest medical waste disposal resource. Dr. N said that even if a clinic didn't have patients who wanted to donate, if the procurement firm said they'd deal with all of a facility's fetal tissue, "they'd PAY you." They'd still need to do the consent for the patients who do donate, but that this might give them a competitive edge setting up a relationship with a facility. Male wanted to know what quantity of tissue that would leave them dealing with. She eyeballed about 1 liter of tissue per patient.

1:00:13 - 1:01:30 Server breaks up conversation with coffee or tea and chit-chat resumes about female's headache.

1:01:31 - 1:05:52: Male returns to issue of volume of fetal material. Dr. N discusses how different kinds of medical waste must be disposed of, and fetal tissue by classification needs to be incinerated. Male asks why facilities don't just have their own incinerators. Dr. N discussed costs, regulations from OSHA, Department of Health, etc. This sort of squashed the idea of the procurement firm taking over fetal disposal in order to get the desired tissues. This goes to the whole issue of getting a competitive edge as a procurement firm and that PP has 40% of the abortion "market" and thus she recommends coming up with a strategy that will remove complexity and expense.

1:05:53  - 1:06:11 Server arrives and conversation returns to restaurant related matters.

1:06:12  - 1:09:36: Topic segues into PP, due to 40% market share of abortion, is "the target." Man moves this into the topic of dealing with PP versus independent clinics where the relationship might not be stable because the clinic closes down. Dr. N presents the fetal tissue thing as a "keeping the doors open," "doing good for the medical community," "providing a service to women." Male goes to the "specimen fees" as being part of establishing a relationship with the abortion facility.  Dr. N drifts into PP having resources that small independent clinics don't have, and then she starts to talk about "How to frame this."

1:09:37 - 1:14:17: Dr. N. leans in close to talk about the "How to frame this" as a PR thing for the mutual benefit of abortion facilities, patients, and fetal tissue procurement companies. She seems to think this might make people stop wanting to stop abortion. She wants to find somebody to "champion" the cause, referring back to Christopher Reeve's advocacy for fetal stem cell research. Male discusses organization of stem-cell researchers who are "techy" and "nerdy" and are not sophisticated in presenting to the public. Discussion about plugging biotech research. Dr. N drifts into how she feels about what she does versus hesitating to discuss it. Then she goes into some talking points about how common abortion is and how many people benefit from stem cell research and she is clearly a True Believer. Figuring out talking points. "We all want to be strong partners in this, for sure."

1:14:18 - 1:16:18: Male asks about possible partnering with PPFA as a whole rather than individual affiliates.  Dr. N explains that their litigation and law department nixed the idea, which had first been broached by an affiliate that had developed a good relationship with a procurement firm. She says something about the idea of finding "all the people that are doing this and present everybody with a menu," but legal department decided it was "too touchy an issue for us to be an official middleman." Dr. N. talks about possible Supreme Court case, and sees SCOTUS as not friendly to "us" at this time. More talk about SCOTUS and possible legal challenge issues. She reassures investigators that "behind closed doors these conversations are happening among the affiliates." Talk about political climate.

1:16:19 - 1:20:04 Returns to patient and affiliate enthusiasm for tissue donation and explains why she thinks they should go to the upcoming PP/Society of Family Planning meeting in Miami. Society of Family Planning is organization of people who train abortion "providers." (Unclear if doctors or management of facilities.) Discussion that "academics" would also be present, meaning customers for procurement firm. Specifics about the "academics." People investigators should network with. She suggests Cook County Hospital because they're the "largest family planning provider in the Midwest." They do abortions to 24 weeks.

1:20:05 - 1:21:25:  Male asks, "Do they dig (use Digoxin to ensure a dead fetus)?" Discussion of who diges and at what gestational age. Dr. N indicates that PP's only dig guideline is that they have to follow the "federal abortion ban," by which I assume she means the PBA ban, since that is the only Federal abortion ban. She talks about "a variety of ways" to comply with the ban. She says you can't dig before 20 weeks but doesn't say why. She talks about PP volume in New York and that because they do abortions Tuesday through Saturday they can check a patient for dilation and do an additional day without throwing off the schedule.

1:21:26 - 1:26:05: Discussion goes to what I think is aimed at getting sufficient volume of non-diged fetuses after 20 weeks from PP of Los Angeles and how now's not a good time due to transition to a new director.  Possibility that the Orange County PP doesn't have a taker for their later fetuses. Back to checking with Family Planning Associates. Dr. N actually texts FPA medical director to get info about the diging, again scoffing at the idea of 13-week diging. She doesn't think FPA diges at all. Gets quick answer: "They don't do diging until 18/6." (18 weeks 6 days). Discussion of specific small-time procurement firm while waiting for text response about whether FPA would be interested. Dr. N. seems to miss question about FPA's reputation, which the male seems to be trying to lead her into. While waiting for text response Dr. N. talks about FPA medical director, who works in LA's Korea Town, and who Dr. N actually trained.

1:26:06 - 1:26:49: Male finally conveys that he is asking about FPA's reputation. Dr. N admits that "for many years I was apprehensive about working with FPA because it's a for-profit corporation" but they are moving into providing prenatal care and "are becoming a competitor to Planned Parenthood in California." No mention of their patient deaths & malpractice history. She seems oblivious of that. Turns attention to texting.

1:26:50 Male brings topic around to if they offer to do the consenting and all the lab stuff, can they get the tissue for free? She says, "Probably." The PPFA guidance is that this shouldn't be a thing you're making an exorbitant amount of money on. "Our goal is to give patients the option without affecting our bottom line. the messaging is that this should not been seen as some new revenue stream, because that's not what it is." I can't make out what female says; Dr. N responds that "at the end of the day you have to have the paperwork to back it up because we are under a microscope." More talk with female that I can't make out the gist of.

1:28:20 - 1:29:37: Female talks about brainstorming if they can make an offer that can "offset their cost in other areas" Dr. N talks about "reasonable and customary." "Nobody should be (air quotes) selling tissue. That's just not the goal here." This gets into the issue of what is being paid for. Male says "The researchers are not paying for the tissue, they're paying for the procurement. You're not paying for a brain; you're paying for a procurement service."

1:29:38 - 1:30:32: Dr. N: "Exactly! And at the end of the day, it's all just sitting there, and it's all just going to be wasted. And that's what it is. It's a waste." Dr. N says she also works at a private clinic where patients can "take their remains with them and have them cremated, and that's not a waste" but otherwise it's all just hauled off by SteriCycle and that's a waste. If researchers can get the tissues then it can have an impact. "At the end of the day, I'm just trying to make the most people happy, and do the most good."

1:30:32  - 1:32:41: Male broaches a presentation at a National Abortion Federation meeting in which a presenter said something about how sometimes "stigma sometimes masquerades as ethics or conscience." Dr. N makes affirmative murmur then returns to how much good fetal tissue research does. Male is unable to engage her in the idea that there's any other motive going on. There is discussion about the presenter and her facility and its small size. Dr. N gets back to thinking about who else might be able to provide the investigators with the tissue their customers need for their research. She goes back to FPA. "They have a ridiculous volume." She really, really wants these folks working with FPA because of the quantity of tissue potentially available.

1:32:42 - 1:33:05 Irrelevant chat with female about a specific person who evidently has recently had surgery.

1:33:06 - 1:34:09 Male goes back to asking about knowing in the back of her mind that there are organs needed that need to be intact, how is that handled. Can they rely on having major areas -- "torso, thorax, abdomen" -- in good shape? Dr. N. says that if she sees an organ her procurement person wants, she'll collect it. "To me, it makes the procedure that much better. I've just done something even better." Talks about forming relationships between procurement firms and abortion providers, who would love to participate. "It just adds another level of interest to what they're doing."

1:34:10 - 1:35:10: Dr. N talks about how "everyone has a different technique." No two practitioners do any procedures the same way, and that applies to D&E (second-trimester dismemberment abortions) as well. But if they dialog with the practitioners, "if they see what the end game is, there are little things, changes they can make ..." Female asks, "Even if they have a set way that they do it? They're open to changing?" Dr. N: "The reasonable people? Sure. There's always gonna be the unreasonable people who say 'This is the way I do it, this is the way I've been doing it for years...'" Male interrupts: "Warren Hern." Dr. N smiles. "Yeah." Thinks a moment. "I love Warren Hern, and he serves a purpose. But he just -- he lives in an alternate universe. He lives in Warren's Universe. I use his instruments, I use a lot of his techniques ... you know." Shrugs."He's Warren."

1:35:11  - 1:38:56: Male asks about looking nationwide "at the providers who are most technically skilled" To whom can we say, "We need two intact brain hemispheres, we  need thymus, liver, not shredded...." She recommends going to a private provider who will do exactly what they (the provider) wants the way they (the provider) wants to do it. "For example, when I work at PPLA," she describes how the patient is prepped by a nurse practitioner, she has to deal with the patient as the patient is presented to her after all the preliminary work is done. But for her private patients, she does all the steps herself, putting in the laminaria, doing each stage the way she thinks is optimal. "But if there are very specific things that you're thinking of, that with a private clinic the volume will be lower but the quality will be higher. Typically. She discusses 8 causes she'd done the day before, balancing the desired tissue with how the patient was going to be prepped for her according to the usual clinic protocol. She likes being involved in the procurement process so she meets with procurement people before starting procedures, noting that if a patient only has three laminaria they're probably not going to get the tissue they want from her. This seems to be a matter of telling the procurement people which patients they should approach for "consenting" and which ones they shouldn't bother because her abortion, due to the standard technique at the clinic, will not likely yield usable tissue. She talks about a NAF meeting and specifically tries to steer the investigators toward a sub-meeting of those who do second-trimester abortions that will provide the needed tissue. Typically, she says, the clinic owner or director decides how things are done, but if they talk to the practitioners they might get better results. Encourages trying to establish relationships with practitioners and lab people so they understand the need to get specific tissues.

1:38:57  - 1:40:21: Male says he thought there was a standard number of laminaria per patient, but Dr. N explains that every clinic has its own protocols. In New York affiliate, the doctor takes out the laminaria, assesses dilation, and if he thinks it's necessary he inserts more laminaria and has the patient come back the next day. In PPLA, there's a set number of laminaria for different gestational ages. Vague talk about specific other folks having their own guidelines. Refers to this as a "data free" area as far as research. More research is being done and she thinks there will be more standardization in ten years or so. But each affiliate has their own protocol within the PPFA guidelines, which allow a lot of leeway regarding laminaria, digoxin, etc.

1:40:22 - 1:41:04 Male said he spoke to somebody at a clinic that uses StemExpress that using misoprostal along with laminaria and that allows much more intact specimens. He wants to know if they tell a facility that they'd prefer using the misoprostal to get better specimens, or if somebody usually diges at 20 weeks, if the procurers said that they really needed a 22 week thymus, would the provider comply?

1:41:05 - 1:43:06 Dr. N looks thoughtful. "Let me tell you an interesting story." More thought. "There's not a lot of clear research on digoxin. Providers who use digoxin use it for one of two reasons. There is a group of people just who use it so they have no risk of violating federal abortion bans. If you induce demise before you do the procedure, nobody's gonna say say you did a (air quotes) live .... whatever the federal government calls it. Partial birth abortion." "Others do it because they actually think it makes the tissue softer and it makes it safer and easier to do the procedure." She speaks of the lack of research data, then says that the PBA ban is a law, "and laws are up to interpretation. So there are some people who interpret it as, 'It's intent, so if I say on Day One I do not intend to do this, what ultimately happens doesn't matter because I didn't intend to do this on Day One so I'm complying with the law.' There are other people that say, 'If you induce demise, then it doesn't matter.You're never gonna do it so you don't have to worry about intent." There are others who use it because they make it easier, and she's one of them.  Dr. N continues that they tried to get a randomized control trial going among the affiliates, but those who did use digoxin didn't want to give it up, and those who didn't use digoxin didn't want to use it. This leads her adamantly to believe that any affiliate is gonna stick with their usual digoxin use or non-use and will not change that because of a request by a fetal tissue procurement company.

1:43:06 - 1:43:24: Dr. N checks text and discusses what researchers, and thus what procurement company, FPA works with.

1:43:25 - 1:44:00 Dr. N reiterates that if they need an older fetus that hasn't been diged, they're gonna have to work with a facility that doesn't dig. She's very firm about that. She repeats that she tried for over a year to get randomized trials going on use of digoxin, and finds it strange that people weren't willing to budge, in spite of the lack of data, in order to GET data.

1:44:01 - 1:47:19 The female asks about emotions versus data and Dr. N. said that the research primarily says if the digoxin is effectively causing fetal demise. Anything else is subjective. She believes they would need tens of thousands of cases to get reliable data on whether digoxin use reduces complications. There's only one study that looks at how patients experience it, and the study showed higher nausea in the patients who got digoxin, but the data wasn't thorough enough to link the nausea specifically with the digoxin. This takes Dr. N back to her point that nobody's gonna change whether or not they use digoxin at the behest of a fetal tissue procurement company. Dr. N talks about a randomized control trial being started about use of misoprostal during dilation, but gets back to the issue of practitioners having their reasons why they do or don't use digoxin and that's that. If you want no-dig you can go with Ucsf or PP of New York City who all train at UCSF.  Those are the only people she knows who don't use digoxin past 20 or 22 weeks.

1:47:20 - 1:49:42 Dr. N broaches genetic abnormalities and does anybody need that kind of tissue. Some affiliates do cases "beyond what they normally would" for fetal indications. Would that tissue be useful? Male said he doesn't think so because researchers are looking for therapeutic applications and thus need healthy specimens.Some discussion about starting cell lines and the lawsuit about the Henrietta Lacks HeLa cell line, then back to only rarely do researchers want genetic abnormalities, they usually want healthy cells..

1:49:42 - 1:53:53: Dr. N broaches "providers that go beyond 24 weeks." Male goes into long ramble about Shelley Sella who was featured in After Tiller, but bottom line is she works at affiliates that dig at 18 weeks. Typical research, he says, wants 16 to 22 weeks, but postulates that this might be because it's so hard to get tissue from 24 or later. Dr. N. says Sella is working elsewhere now so she might not be diging; "You might have just hit the jackpot," male says that he will have to open discussion about that. Dr. N goes into current PP looking at whether providers are doing abortions up to the legal limit in their states, and if not why not "and what we can do about that" so she'll keep fetal tissue in the back of her mind. He should consider Utah, where there are "no other providers" and the PP affiliate wants to go farther. (NB: There is no gestataional  limit enforceable in Utah.). Male asks how far they're going. I think she said David Turow is their medical director in Utah but it was difficult to hear. Whoever he is, she calls him an "incredible guy" and says he's "always willing to push the envelope much farther than anybody else." More talk about making contacts with specific people.

1:53:54 - 1:55:23 Talk about how October is approaching and upcoming meetings and how fast time goes. Male segues into R&D timelines and how that gets stuck on whether or not "material" is available to work with. He talks about if she can help researchers get what they need when they need it, that can cut R&D time in half, and then needing to replicate trials and this means they need volume.

1:55:24 - 2:00:48: Dr. N. says she thinks about how fetal tissue procurement effects research progress and wonders if male has thought about giving a talk about it, perhaps at a NAF meeting. She wants people to understand the impact and where the tissue goes, "they're dying to know that." And then she said "backwards word of mouth" that the providers will get this information to patients. She suggests about a 30 minute presentation, "Once a patient donates tissue, this is what really happens. This is how it affects timelines, this is how critical it is to the people, this is the impact that you can have. That's the best marketing you can ever do."  Male suggests getting some people together, researchers and abortion folks, for conversation about opening dialog, and Dr. N gets excited and starts talking about contacting people about the idea. Male says, "We're gonna change the world!" Dr. N. "Every day, that's what we want to do." She said she's changing the way she thinks about this. Suggests the get-together start as a local thing and if it goes over well, go to a bigger group. Dr. N talks about logistics, when would be a good time when PP medical directors are all in the same place for a meeting anyway, and she can pull in some researchers and some staff from FPA. Can limit it to medical directors or bring in local providers as well. She thinks the providers will be very happy to hear from the procurement side and that the procurement folks can learn about how it plays out in the clinic setting. She's hoping to see if they can start at the next meeting time in October. She envisions a lot of "stimulation" and "insight."

2:00:49 -2:03:05  Male asks if she has PP guidelines with her regarding tissue donation. She says, "There are no guidelines." There are guidelines on research but not on tissue procurement. "And there will never be that." There are just provisions for reviewing any contracts the affiliates want to enter into. Originally national treated tissue procurement under their research guidelines and decided that was "overkill." Male asks, "Even in terms of compensation and stuff like that?" Dr N: "Nothing is written." Affiliates can ask for guidance, but there are no written guidelines. She does not anticipate written policy any time soon. Dr. N attends to a text and says that FPA considers it under the umbrella of research and as a for-profit they don't get into research. Male offers that they can talk about profit. Dr. N just brushes that off and wants to go back to talking about how all the players fit into the fetal tissue picture. "I think it's worth doing. For sure. I think this is definitely to be continued"

2:03:06 - 2:04:09 Male asks if there's anything else she wants to talk about. No. She thinks they've got some good ideas going. She's really excited to get more idea of what happens to the tissue once it leaves the clinic, "what it means to the researchers, what it means in the big picture of it all." She adds that it is "image building.And that's a good thing. For everybody."

2:04:10 Chit chat reiterating what's already been said, then Dr. N asks man how he got involved in what he does. He said he majored in biology and started into research on mice. They talk about lab mice and mouse-based research using human stem cells, primarily the male describing specific immune system research, etc. Dr. N goes back into how this is the sort of stuff he needs to convey in order to get access to the tissue.

2:09:02 - 2:21:35 Female asks Dr. N how she got started on her work. Long story of how she got into medical school, originally thinking about orthopedic surgery, "I really like babies," so she thought about pediatrics but you deal more with the moms and with the sick babies, so she thought about perinatology, dealing with just-born babies, so OB/GYN, maternal/fetal medicine. She said she remembers the date, it was her last day on-call in OB/GYN residency, February 28, 1998, and she got a patient transferred from an outside clinic after late second trimester D&E, bleeding, white as the table napkin, "And she looked up at me, and said, "Don't let me die," and she bled to death. (I don't have this death in my Cemetery of Choice.)  She decided she needed to train people to do D&Es safely so no more women would bleed to death. When she did her fellowship, she was asked what she wanted to do and she described this goal and was told, "You want to be a medical directer at Planned Parenthood." The opportunities opened up and she ended up where she is now. Dr. N asks female how she got to where she is now. Female said she's probably "older than both of you put together" so there's not the time to get into it. Male excuses himself to go to restroom. He leaves camera at table and women talk about not taking enough bathroom breaks and risking UTIs. Dr. N pushes female until she gives vague "working in a women's clinic" story in the 1980s, then about five years ago niece talked about women who are suffering years, years after their abortion, and that made her think of giving a more positive message and education. Lots of chit-chat.

2:21:36 - 2:28:24 Female brings back the issue of compensation. Male says they want to be sensitive when they talk about that. He postulates that it's not about "competing piles of money" but about meeting the needs of the affiliate. Dr N: "Exactly." "If you were trying to take money out of the equation, which is what most affiliates are trying to do, 'How do we do this for you in the most beneficial way?'" Man asks for "typical cost gaps" for affiliates. She doesn't understand and stresses that they need to approach from taking up the least possible space and making it the procurement people's staff time and not the affiliate's staff time. "Then maybe there is some other in-kind, something else, that can happen." Thinks for a while, gets her thoughts together. "They all want to do this." It's all about how much time and space the procurement takes up, and making that "as small a footprint" as possible. Ponders. Maybe feedback -- what becomes of the tissue? "It adds a whole other human touch." It's about "the benevolence" and not the cash price. "If the affiliates could be proud of this, they would go back to their donors, they would go back to their boards, and say, 'Look. We contributed to this, this, this, this, juts by adding this one service with this one partner.'" Affiliates want to contribute in different ways "than just dollars and cents." "They're not gonna do it in a way that costs them money. They're gonna do it break-even. They want to be compensated reasonably for the time and space and whatever impact that it has." The man goes back to $30 to $100 and she said that will probably work. She used training time as an example of how hard it is to calculate the actual cost to a specific facility of time and space. Maybe they can create a template telling affiliates that they need to take certain things into consideration when calculating how much the procurement is costing them, but it will always be variable.

2:28:19 - 2:29:32: Dr. N: "In a perfect world if you could help them deal with their biologic waste, pathologic waste, they would loooove that." Male talks about looking into the detains of getting an incinerator or getting researcher to dispose of fetal tissue along with their other medical waste. PP looked at how the labs they send tissue to deal with it, and it turns out they also use SteriCycle. Dr. N. ponders "There has to be another option" for dealing with the fetal tissue disposal.

2:29:33 - 2:30:15 Dr. N turns to "messaging." Producing perhaps a one-page thing that describes the service of making fetal tissue donation available to patients. What kind of research gets done "Ask your doctor or nurse." "It'll make it easier for whoever does consenting. It'll drive up demand. That's a win/win/win."

2:30:16 Man asks who does the consenting. After the medical assistant does the PP consenting, "Oh, by the way, we also do this." On multi-day procedures, NovaGenics will talk to patients who didn't consent on the first day, and they will consent after talking to NovaGenics. "Somebody has some time and energy to actually sit down and have a conversation with them. So she usually ends up picking up several more specimens, just from being there and speaking to the patients. They can use their own consent form once the affiliate approves it. Since they use the same protocol for the abortion, the donation consent would be "between you and the patient." Some chat about research protocols that they get to avoid during tissue procurement. Reiteration of things they'd discussed before. Also letting UCSF know about what they do and tell providers while they're being trained. Again, she sees fetal tissue donation as a service that they offer to patients. Plans for follow-ups. Also wants to have their staff know more about procurement so that they can do better job talking to patients and asking questions.Goodbyes.

No comments: