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.