Amazon is widely criticized for its size, but it is big because so many consumers choose to buy from it. Consumers value the wide selection and the quick delivery. But I hypothesize that what consumers value most is the information. Product ratings are informative. The ratings themselves are rated. Comparisons within categories are offered. Price changes can be tracked for a given product, and compared among different products. Features can be easily compared. In healthcare the government, as with HIPAA, often mandates the protection over the provision, of information. But even when healthcare information is provided, it is often provided too slowly and too obscurely to be actionable by patients. In the example discussed in the passages quoted below, quick and accurate information is literally a matter of life and death. Entrepreneurs like Jeff Bezos in a free enterprise system have the freedom and the incentive to please consumers by providing them with quick and accurate information. Bureaucrats in government or highly regulated systems, lack the freedom to violate rigid rules and are rewarded if they please their bosses by preserving the status quo.
(p. A3) After her water broke early, doctors told Fatima Goines to prepare for her newborn’s death.
Goines was 22 weeks into her pregnancy, just past the halfway mark. Doctors at Methodist Hospital in suburban Minneapolis said they couldn’t save such a premature baby and that no hospital could. They told her that once the baby girl was born, Goines could hold her until the infant died.
Goines didn’t want to give up. She checked herself out of Methodist Hospital and, on the recommendation of a fellow mom on Facebook, went to a birthing center connected to Children’s Minnesota hospital, 7 miles away from Methodist. After Goines gave birth, doctors there immediately intubated the baby to help her breathe and placed her in an incubator.
Me’Lonii is now a healthy 4-year-old, and has surpassed all the developmental milestones for her age. “She’s doing wonderfully well,” said Dr. Thomas George, who directs (p. A7) the Children’s Minnesota neonatal intensive care unit.
Medical advances over the past several decades have given hospitals the ability to save younger and younger premature newborns. Yet most hospitals don’t try—and parents often aren’t aware of what’s possible or that other hospitals, even just a few miles away, might offer their newborns a fighting chance.
Doctors are now capable of saving the lives of babies born at 22 weeks and, in rare cases, a week earlier, with improved techniques to help tiny lungs develop and protect fragile skin and organs. Hospitals with extensive experience resuscitating extremely premature babies report survival rates as high as 67% for babies born at 22 weeks.
Fragile infants
Some U.S. hospitals aren’t sufficiently equipped or capable of pulling off the new advances. Others have chosen not to offer the care, saying it is likely to fail, is expensive—typically more than $100,000 a child, and sometimes much more—and subjects tiny, fragile infants to needless pain and the risk of long-term disabilities.
Instead, they often provide comfort care: wrapping the newborn in a blanket, placing it on the mother’s chest and sometimes giving medicines to ease the child’s final moments.
The difference can be a matter of life or death for the roughly 8,000 infants born between 22 and 24 weeks gestation in the U.S. each year.
Doctors agree that babies born at 25 or 26 weeks can and should be treated as long as they don’t have other complications, while those born at 20 weeks or less are too small to save.
In between is a “gray zone,” as doctors call it, where newborns’ fate can depend on which hospital happens to be delivering.
. . .
No way to know
Rachel Sherman, a hairstylist who now lives in Florence, Ariz., wishes she had had more information.
When her water broke at 22 weeks pregnant in 2021, while she was living in Utah, the first Salt Lake City-area hospital she went to told her they couldn’t help until her baby was 24 weeks. She and her husband drove about 30 minutes to the University of Utah Hospital instead. It has a Level 3 NICU and shares a campus with a children’s hospital with a Level 4 NICU.
The staff there also told Sherman it wouldn’t save a 22-week baby and there wasn’t a neonatal unit in the U.S. that would treat an infant under 24 weeks, she recalled. But another hospital within half an hour’s drive was offering active treatment for babies at 22 weeks that year, The Wall Street Journal confirmed.
For the full story see:
(Note: ellipsis added.)
(Note: the online version of the story has the date August 7, 2024, and has the title “Doctors Can Now Save Very Premature Babies. Most Hospitals Don’t Try.” The “Fragile infants” sub-heading quoted above appears in the print, but not in the online, version.)
The paper co-authored by Christensen and mentioned above, is:
The 2021 paper co-authored by Vaupel and mentioned above, is: