I think that we should retain our current position (as stated in the welcome message). ** I would agree with Julian's response that, if only for legal reasons, it is entirely appropriate that the Ovary Science group continues NOT to provide medical advice to individuals. (As a research scientist that publishes in human fertility journals from a hospital medical school address, I receive a significant number of requests addressed to me personally every other week. To phrase a reply that is warm and sympathetic (so as not to put the School in a bad light) yet makes it clear that I can be of no assistance is always quite tricky.) However, I would agree that a simple reference to the news-group disclaimer can appear somewhat "cold". Can I suggest that, as a compromise, a more "compassionate" standard reply be phrased ("We regret that, while we sympathise with your position, members of this discussion group are not in a position..........We wish you luck in obtaining the advice that you seek...etc"). In addition, and in line with Julian's response, the standard response from the obary-science list owner could refer the correspondent to more appropriate internet resources (without appearing to dismiss the enquiry out-of-hand ) as well as referring them back to their medical practitioner. Hope that this helps. Best wishes, ** As much I would like to help all individuals with reproductive difficulties, I believe that legally (at least in the U.S.) we may become involved in various messy entanglements not of our making. ** I understand your decision and your dilemma. keep your list to your subscribers and refer the e-mail's to my free service of "Dear Doctor" on the European Infertility network site at www.ein.org. If a couple of you good doctors reading this want to set up a link from my site they can e mail you through that Your problem is then solved E.I.N. is a non profit making organisation supporting the work of infertility support associations, throughout the world. Please visit us on http://www.ein.org Internet Email Confidentiality Privileged/Confidential Information may be contained in this message. If you are not the addressee indicated in this message (or responsible for delivery of the message to such person), you may not copy or deliver this message to anyone. In such case, you should destroy this message, and notify the EIN immediately. If you or your employer does not consent to Internet email messages of this kind, please advise us immediately. Opinions,conclusions and other information expressed in this message are not given or endorsed by the EIN unless otherwise indicated by an authorized representative independent of this message. ** I would strongly urge you to limit this site to the original use. Keep up the good work. ** Advice form the UK indemnity organisations suggest that as the medico-legal consequences of giving advice over the Internet is unclear it would be wise to approach this with caution. Further, professional discussion of personal medical problems on an e-mail list brings into question issues of privacy and ethics. This e-mail list is primarily scientific thus it seems an inappropriate place to begin to address these issues. A frank rebuttal to a persons call for help is clearly at least a disappointment to the individual and may be taken as an offence. The approach we have adopted in the Centre for Reproductive Medicine, University of Bristol is to have a blanket policy not to discuss medical matters by e-mail but to point patients to other sources of possible help including Internet resources, national and local support groups. http://www.repromed.org.uk/crm/support/default.htm Hope this helps and I would also be interested in the views of others on this issue. Kind regards ** Hold the line on the policy, personal medical problems should not be discussed in this forum for a number of reasons. First, I guess that the majority of participants are not clinicians, and therefore could not give sound medical advice. Secondly, it detracts from function of the group. Third, I believe that those with medical problems will be disappointed with the fact that we do not have solutions to their specific problems. ** I think your response was entirely appropriate and agree with you that the ovary-science list is not an appropriate forum for the discussion of personal medical issues. Should the list be opened to such questions, I think it would soon be inundated with all sorts of queries, overshadowing the intended purpose of the list. There is also a problem with dispensing advice based on a few lines of information. If there is a need for such a list, then maybe someone should start one, with the expressed purpose of fielding fertility related questions from the internet audience. After all, will we notice a few more e-mail messages? Good Luck ** I believe that your response was appropriate. The group is intended for scientists, not patients. While this may seem "cold hearted" to some, this is not a forum for the discussion of personal fertility problems. There are other places for that discussion. It is probably also important to note that on this side of the pond we are liable for consultations on the net. In one subscriber's opinion, advice and information are best left to medical practitioners in reproductive endocrinology and are not appropriate here. We can cheerfully refer such inquiries to the infertility newsgroups in the future. Thanks for requesting opinions on the position. Amities, ** I agree with you that we should maintain the original intent of the list, that is to discuss ovarian research. If the list is opened to discussions of individual infertility problems, it will become so busy that I won't have time to read it at all. Perhaps a solution would be to generate a "gentle" response explaining the use of this list, and, if there is one, direct the person to another list that deals with infertility problems. ** I agree with your stance. It is not our custom to treat or give advice. The clarifying statement of see your physician is somewhat hard. However, I do not know what legal ramifications are if someone without a MD gives advice and things do not work out. ** I agree that we must maintain our current policy regarding medical advice. Although many members of the discussion group may be M.D.'s it is still inappropriate and possibly a legal nightmare to dispense this sort of information. It's too bad, because so many people have questions and often their personal physicians are unable to communicate effectively. ** I too think that the reply that is sent in these cases is "cold" and "insensitive" in its tone. Therefore, I took it upon myself to redirect [the enquirer] to the proper sources. (As I have done so with others who have emailed with these types of requests.) You see, as well as doing research on infertility, I myself have gone through infertility for 16 + years and know how she feels. Though I do not want to enter into the argument over whether to answer these types of questions or not, here in America, Drs from various specialties often answer peoples' questions. Often, it is a case of the person just wanting a direction in which to proceed, wanting info on a procedure or medication, wanting to know about new protocols being used, etc. Yes, they also answer other infertility questions as well. I do not know the medico-legal aspects of this issue, but I am very sure that they would not answer these questions if they did not feel safe in doing so. (As for the UK's legal ssystem, I know nothing about it, but would hazard a guess, that America is more lawsuit crazy than the people in England.) Therefore, I believe that at the least these people should be redirected toward other sources who would be willing to answer their questions. ** please keep it as strict as it is. ** I think that the list should remain as is. Providing medical advice without seeing the person and obtaining a medical history would be unethical and would open anybody on the list to a lawsuit. ** Both of you are right in a very real sense. First, I would be very uncomfortable in giving advice because of the personal liability I would feel in such a situation. If free advice is given over the net, the advice giver may be leaving themself open for possible litigation if something goes wrong. I too am sympathetic to the fertility problems people have. I know from first hand experience some of the pain these people go through, as it was 10 years between our 2 kids (not the same as not having any I know). As hard hearted as it may sound, I wonder if we are doing mankind any favors by helping people to have kids that nature is trying to prevent. There is reason that it doesn't happen "naturally." In the world of doemstic animals we have very strong recommendations to breeders that they should not force an animal to conceive because of the likelihood that the same problem will be propagated in the succeeding generations. The desire to have "your own" child is understandably strong, but there are so many children in this world that do not have any parents at all who would benefit greatly from adoption. I think the IVF procedure has gone from helping people to the bankbook for hospitals. Face it.... there is a lot of money being spent in this area. This is my question, do we have our priorities in the right place? I am not making a judgement, as a scientist and as a human I am just asking the question. Now, specifically to another point, I think a softer answer would be advisable. I am coordinator of a Program of study and frequently have to turn students away because there is no one who participates in the Program who has an opening. The Graduate School used to have a single standard response to the inquirer that said, in short, "your not acceptable and you have been rejected." After some talking, I convinced them it was not fair to the student applicants who applied at a time when there were no openings available to tell them they were unacceptable when they actually were. We, the Graduate School, now has a softer more sympathetic response to these students. I would suggest that the same thing can be done in this circumstance. ** I believe that the list should not be a forum for medical advice. Such sites already exist. Maybe try the type of line we see in our pharmaceutical ads on television, "Please see your doctor if you have questions about whether XXX is right for you." This will be a recurrent problem. Maybe a list of other sources (OB-GYN.net, RESOLVE (American Infertility support group, Serono Canada's Web site, etc.) in the welcome message would be helpful. ** There may be a legal problem also about people offering medical advice world-wide. Certainly in the US and Canada, a practitioner in one state or province cannot legally dispense his/her services in another state/province, let alone country. Is opinion offered on the 'Net for free considered legally to be 'medical practice'? Otherwise, I would have no objection to following discussion of scientifically interesting and unusual reproductive cases in humans; but how to moderate (a) the question, and (b) the answers? It could otherwise become a free-for-all! ** I think this response is carefuly worded to be neutral, which is as it should be for a `broadcasted' response. Possibly your second sentence could have been a bit more `cuddly' - but only a little bit. Obviously we do not know if you sent a different message to the original sender. One solution to this might be to have the list moderated so that such messages don't ever reach the list, ie returned with a `Sorry, this list is unable to ......'. Given the amount of current traffic that should not be too onerous. I do this for the SSF members e-mail and it is fine, although this has much less traffic. Regards ** I agree that we cannot give medical advice, but I also agree with your complainant that your reply was unsympathetic. We now spend much time in trying to get our medical students to communicate well - to develop a gentle bedside manner. Your reply was correct but callous. It could have been much more sympathetically presented. e-mail at best is telegraphic and conveys none of the nuances of spoken interactions. I thought of replying to the woman, but I have done this sort of thing on a couple of occasions with contacts that have not come through the list and they have become wearisome. In this case, she needs to be told she is being impatient. 80% of couples conceive within one year of unprotected intercourse, 87.5% within two and 90% within three. This she needs to know. She already has a child as I recall so her fertility is not in question. She is obviously concerned that a chance remark that an ovary is 'high' has some meaning. She needs some tlc, and that she did not get. The problem with offering medical advice on the web is that you never know all the facts so what you say may be misleading. It is all the hedging that makes it wearisome. The other two cases on which I was 'consulted' concerned a parent in Germany whose daughter had painful arthritic symptoms which were ultimately (and unconvincingly) diagnosed as Lyme Disease. That's a minefield. The other was someone who 'had a friend' that I think had had a gonadectomy for cancer and subsequently had raised hcg (a marker for teratomas), and who wanted to know what effect pot had on hcg levels! Again, another minefield. There is anecdotal evidence that tetrahydrocannabinol does enhance hcg production in testicular teratomas. Anyway, these complexities make involvement in such matters problematic. There are also the legal issues - will you get sued? - and I am not medically qualified. Did the list member who complained reply to the woman? If he did not, maybe I'll reconsider and send her a personal message. She seems to need simple information unlike the two examples I have cited. I have deleted her message from my machine. Will you please reforward it to me. I'm spending most of the rest of this week at home, but I can use the dial-in service. ** I agree with the reply given, although I am also personally sympathetic to such people. The recommendation to check with her personal practitioner was the only correct and ethical one to take. ** I am a medical practitioner with experience in infertility and I agree entirely with the stance that you have adopted on behalf of the group. It is neither possible, desirable nor advisable to give comment on an individual's medical problem (whether related to infertility or not) based on a few lines in an e mail message! Indeed I think it is ridiculous to suggest that decisions about medical practice can be addressed without full details being known and may possibly lead to further distress if inappropriate advice were to be given! With best wishes ** After reading the various messages and replies I am inclined to agree with you, that the list should remain as a research-based list as opposed to a self-help or support group for people with fertility problems. Although this may at first appear harsh, or cold, the people contributing to the discussion on this list are experts in their own fields and may not be or feel qualified to give expert medical advice. This may mislead the person seeking alternative information and also provide disappointment when they find their request ignored or they are told to seek the information elsewhere. It seems obvious that there is a need for a list where personal problems can be shared, and perhaps one of the subscribers to the ovary-science list who is medically trained to answer such questions and to provide some form of guidance or counselling should set up a list specific for this type of audience. I hope I have provided some constructive information as I can see that it is an area in which a great deal of discussion is required. On a personal level, I am a third year PhD student and feel highly unqualified when reading messages from people who are exposing their intimate problems, especially as they are being totally honest and we are not qualified to provide the information or guidance they require. Thankyou for allowing me to voice my opinion, I hope it is useful (?) ** I see no reason why the ovary-science discussion group should change its practise. Perhaps another group should be added "inline" to cater for such requests, then it would be up to the individual subscriber whether or not they would participate. ** I too felt that your reply to the person requesting advice was a little cold. However, as you say, the list has its position clearly stated in the welcome message. Your advice to consult a medical practitioner was sensible but without clearly without understanding of what this entails. I am a sufferer of PCO. Despite 20 years of repeated visits to my GP complaining of what I now know to be common symptoms, I was never once examined or given any medication to alleviate my discomfort. I was finally diagnosed last year. My only source of useful information since then has been the internet. Through this, I have become very well informed about the condition that has controlled most of my life. My symptoms remain, but at least I now know and understand what is happening. It is not a good idea to try to provide medical advice online; however, please try to appreciate that the person requesting advice may well have seen many doctors already. It is unfortunate, but those treating gynaecological conditions seem to have the worst reputation for poor communication. I think it is reasonable to assume that an "ovary-science discussion group" will be just that. ** I am replying to express my opinion on whether the lister should accept messages about personal problems. I feel that it just might become overwhelming for those of us that receive all of the messages. Not to mention I think it would be very difficult to assess the specific situation via email. Every person is different and has different problems. I know I would prefer to speak to a doctor / adviser in person face-to-face. I don't believe that the lister is being cold-hearted in anyway as long as the web site states clearly that we do not discuss personal diagnoses through here. Thank you for asking us for our input. Sincerely, ** I concur with you fully. We cannot expand this to a discussion group where personal medical matters are discussed because it is an unmoderated forum - there would be implications regarding liability for inappropriate advice, in adition to the ethical considerations. The further problem is that diagnoses of problems is not possible with scant information that may be provided by the request for information and this may lead to incorrect prognoses and advice.. ** it's my opinion that "ovary science" should not consider requests for personal medical advice ** Definitely stick with the scientific aspects. I think that you are correct in replying as you do. There are other chat sessions in the US for medical advise..i.e. the INCIID etc. THere may also be legal implications of diagnosis or medical advise by e-mail. ** I am frankly astonished by the response of the Ovary Science member who wished to be removed from the list. In addition, I strongly support your clear and entirely unemotional replies to those seeking medical assistance - surely there could be legal ramifications if advice was given? I don't know how many of the membership of Ovary Science are clinicicans with the relevant expertise but medical colleagues who deal with infertility suggest that it would be unwise for a clinician to offer anything but the most general advice (e.g. the largest single cause of anovulatory infertility is PCO) without having the patient's records and the patient available. The infertile have many, many, alternative sources of advice: lets keep Ovary Science within its existing remit. ** I sent her a private message referring her to a question and answer service on the net (http://www.obgyn.net) that might be helpful. When the question is about PCO, I usually send a private message referring the writer to obgyn.net and the PCO listserver. I don't think this list needs to duplicate the services provided by those sites. ** In reply to your concerns about offering medical advice, I think we should not give specific answers rather recommend units or centres who offer management of fertility related problems.