I handled a situation with a patient poorly a few months ago, and it shook me up so much I asked Jay Shah to write an article about the subject for Today’s Wound Clinic. I’d love some feedback about the topic, either through my blog or TWC. Here’s what happened. I have a wonderful and inspiring patient with several horrible medical conditions and an excruciatingly painful scleroderma ulcer on her ankle. I’m sure that, like me, many of you have found that cellular and/or tissue based products (CTPs) can sometimes improve wound pain. Unfortunately, she’s outside the coverage criteria for a CTP due to her scleroderma and multiple immunomodulating medications (a huge problem in the industry – the patients who most need these products can’t have them). A CTP manufacturer was kind enough to donate an amniotic product for her and I was EXCITED to be able to put it on. Her ulcer was getting worse and her pain medication needs were going up — and it just felt like her situation was a snowball rolling downhill.
As it happened, it was the day after the news stations aired the videotape of Planned Parenthood officials discussing the best way to harvest fetal parts for medical use. My patient works in an adoption agency and the thing that has kept her going, despite all her awful medical problems, is the joy and satisfaction she gets from her job. You can probably guess what happened. I rush into the exam room excited to offer this expensive treatment at no charge to her, whereupon she asks me what it’s made of, and I say, “amniotic tissue,” and she bursts into tears. I stood there confused, trying to process what had happened, and then of course, I figured it out. Within a few minutes we were laughing over the misunderstanding, but we regained our relationship primarily because I’d been taking care of her for years and it was solid to start with.
Weeks later I was placing a CTP that was new to me, and the patient asked me for some specific details about its components, and I realized to my embarrassment I wasn’t prepared to answer. And that’s when I said, “I need to change my practices about this.” We need some standard way to provide this information, and to develop a dialogue we are all comfortable with around patient preferences. I used to think this was solely a religious issue, but it’s probably more accurate to say that it’s about belief systems. The cosmetic store has a section for “cruelty-free” beauty products, a label that indicates the products “do not harm or kill animals anywhere in the world.” If some people feel that way about eye shadow, they are going to start asking about it in healthcare. And, at the rate some state laws are changing, it might be necessary to create a cruelty-free designation for products derived from babies. We live in confusing times.
What are your thoughts about how we inform patients regarding the use of animal derived products?