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Final Thoughts on Exploitation, Baby Selling, and Theresa Erickson

This is a dark post.  I feel the need to say that because I think I usually see the good in people and write about the good I see in people, and I was fairly uncomfortable having these thoughts.

Long after I wrote the post about Theresa Erickson I was still thinking about the situation. The thoughts floating through my head formed into something akin to a strange film on my skin.  We were on holiday, walking through a supermarket to pick up chips for the beach. All I could think about was how those families were preyed upon, their situation exploited for someone else’s financial gain.

And once I saw it there, I started thinking about it everywhere.  She isn’t the first person who exploited other people.  She won’t be the last.  And what it comes down to is how to find your way back to trusting ground after entering a space where you doubt everyone’s intentions.

I think there is a very thin line between providing a service (and being compensated for fulfilling a need) and exploiting a need.  I was thinking about this in a supermarket and, after all, what is a supermarket except a store that is meant to exploit your need for sustenance.  Or wait, does it fulfill your need for sustenance?  Can you see where my thinking started to get grey and murky? Where does it cross the line from being compensation (something I wholeheartedly support) to being exploitation (something I wholeheartedly deplore)?

We need to eat, and we need assistance with our health, and sometimes we need professionals to help us build our families.  And I’d classify all these things as needs more than wants, though people could argue that the final one is a want more than a need.  But I’m not really looking for an argument — for me, in regards to my own sanity and therefore my own life, family building is a need.  For you, it may fall more as a want.

If there was one store selling food, you better believe they’d jack up the prices, knowing that humans are desperate for food to eat; we can’t live without it.  The only reason food prices are where they are is due to the abundance of food.  It’s a terrible side of human nature — that those with the means would hold it over the heads of those without.

And that is what Theresa Erickson did.

She knew the needs of the community.  She observed the community for years by working in the community and like a sibling who knows exactly how to push her sister’s buttons, Erickson knew exactly who would take her up on her offer for a child.  When a human has been beaten away from their need for so long, they are willing to pay the high price in the same way as if you were starving, you’d pay an enormous amount for food.

And I think that I have finally put my finger on why this bothers me so much; because if she can exploit our needs, then anyone can exploit our needs, especially one who remains in our community for a long time and observes how deep the need goes.

If he wanted to, my RE can hold my sanity over my head and put a disgustingly enormous price tag on helping me.  And who is to say that he doesn’t?  I have always taken the cost of ART to be the cost of ART: meaning; fertility treatments cost what they cost because you are not only paying for the supplies and the expertise, but you are paying for the research and the equipment.  That the price is enormous, but the cost of creating IVF is enormous.  And I’ve always trusted that, and I’m sure I’ll get back to a place where I do.

But how do I know?  This seed of doubt has been planted and it is eating away at what I’ve always felt comfortable with.

From what we know based on what she has admitted (and it is her choice to plead guilty and we can only base our understanding on what she states.  If we have the facts wrong, it is because she has provided the wrong facts) she has clearly crossed the line.   I’m not sure how anyone could twist this through a lens and make it look ethical.  But set aside for a moment (to mentally come back to later) the children at the heart of this, the families affected, the surrogates involved.  Set aside all of that.  At the heart of this is the fact that someone observed our needs for a long time and then started exploiting our needs in 2005.  And kept exploiting them until 2011.

That is too long a period of time for this to not be purposeful.

The unwritten social contract dictates that we request compensation for our expertise.  It’s the modern day barter that grows out of the olden days where I’d trade my surplus of apples for your surplus of tobacco and we’d all be happy (forgive me; Maryland history books seem to always use apples and tobacco as our two bartering items).  Therefore, when I pay my doctor to treat my illness, that money is covering the investment he made in his education.  It’s covering office costs and equipment costs.  I’m not sure how he adds up everything that needs covering and divides that by the average amount of patients, but I don’t begrudge doctors money and frankly, I can’t think too deeply about the fairness of the cost.  The job he does is worth a lot to me, and I wouldn’t begrudge him even more than what his education cost since my life has a high worth to me.

But the Erickson situation is like a doctor seeing someone with Stage 4 cancer and holding out a medication for an outrageous sum simply because he knows he can get the patient to pay the price because he is desperate to live.  This is like a doctor making the conscious choice to exploit that patient’s need for their own financial gain.

I have a lot of fears right now, and I’m finding it very difficult to return to that rosy, rational place where I was comfortable in my beliefs.  Where I knew that exploiters exist — does Madoff ring any bells? — and they may even cross my path, but the vast majority of people I surround myself with have my best interests at heart even if they want compensation for their work.  I know I will get back to that place because if that is your natural state, you always return to that place.  But right now, I’m waiting for this feeling to pass so I can return to a place of trust.  Because what else can I do when I have this need and I require others to help me fulfill it?

This needs to be my final thoughts on this because I find that in this particular situation, I need to vomit it out rather than take more in.  Though I want to hear your thoughts on this too to wrap it up.  And then we can go back to my usual musings on unicorns, rainbows, and sing kumbaya.


1 a { 08.14.11 at 10:03 am }

I don’t know what the unfortunate trend in our society is – to be distrusting of everything because we’ve been burned too often, or to take advantage of others because we can. Both of these seem excessively prominent these days.

I don’t know how to judge the true cost of medical care. The interference of insurance companies and Medicare has skewed it all anyway. So, I’ll just have to go along blindly trusting that the costs are reasonable.

2 Nicole { 08.14.11 at 11:19 am }

I think the sad truth is that if you do enough treatments or you get desperate enough you do get exploited. I had an RE that tried to bully and threaten me into experimental treatment that was extremely expensive and pretty risky by telling me if I didn’t do it I wouldn’t have a baby and it would be my fault…. turned out I didn’t need the treatment. Also I am trying to remember back but I believe the highest paid doctor at all of cornell is the head of the fertility clinic. It is a big business and makes many people pretty darned rich due to our misfortune. Why is it IVF is so much cheaper in other countries or how is it self pay patients are charged so much more then insurance… when I had insurance coverage they got out paying only a few thousand for a whole cycle where as a self pay patient I was charged $9000 just for the ultrasounds and bloodwork not including any bloodwork AFTER ER/ET.

3 Kymberli { 08.14.11 at 11:54 am }

What you’ve expressed here is one of the aspects that most saddens me about the entire situation (and there are many). Erickson’s actions have caused prospective parents to feel not ripples, but rather tidal waves of doubt in those who earnestly seek to help them grow their families. As a former surrogate and strong advocate for surrogacy, I consider myself a part of that populations of “professionals,” and part of me feels the shame that Erickson should be feeling (but it seems that she does not). The credibility of ART physicians, surrogacy/adoption attorneys, surrogates, and donors has been tainted thanks to Erickson’s and Neiman’s deplorable actions. Though I have done no wrong, I feel like I need to offer the apology that Erickson has yet to give.

In the days since this case has been blown wide open, I’ve seen several prospective intended parents and hopeful surrogates have to double their efforts to help those around them understand their decisions to involve themselves with surrogacy, or they’ve decided to pull their cards off the table and reconsider their play altogether.

There is so much more that I am still processing about this. Because of my background, I see the situation from both sides as one who struggled with a degree of infertility and depended on someone’s professional knowledge and treatment to help me build my family, and also as someone whose (unofficial) professional knowledge as a surrogate helped and tried to help others become families. It is so much to absorb, and I feel overwhelmed with it all.

4 It Is What It Is { 08.14.11 at 12:19 pm }

I think you hit the nail on the head that the fundamental and deep seeded pain over what Ms. Erikson and her co-conspirators did is of betrayal by a former trusted expert and adviser. I would say that what she did gets at the fear and skepticism most people have on some level: that they will find themselves in a position to need (or want, it actually doesn’t matter) a service that they are willing to pay for and that the person (or people) who they believe to be X (upstanding, truthful, trust-worthy, capable, rooted in a desire to help) actually end up being Y (conniving, manipulative, exploitive, selfish, narcissistic, and criminal). She was from withIN and not from withOUT. I keep coming back to shameful. Beyond criminal, what she set out to and accomplished doing at its core was shameful because her victims go far beyond the families she actually supplied babies to, it is the entire IF community who will now question the intentions of anyone who is supposed to be ‘helping’ them.

5 Sara { 08.14.11 at 2:09 pm }

I think you have this exactly right. It’s the knowing exploitation of need, AND of the willingness to help (on the part of donors and surrogates) that makes this so vile. Honestly, I have always been suspicious to the point of accusatory of the pricing of fertility treatment in the USA. I had four rounds of IVF in Korea for an average of about $2500 including meds, and for one round I used meds imported from the US. The quality of care was excellent, so why the price differential? It isn’t the cost of living, which is more or less equivalent, or the quality of training, which, again, is excellent. So what is it? Some of it is the boutique-iness of the experience. The clinic in Korea was very clinical, like a baby factory, and frills were few, but it was also safe, comfortable, and effective. Most of it, though, is just what the market will bear. I resent it that treatment is priced out of ability to pay for many or most couples, and I don’t think it has to be that way. This story just makes me feel bitter anew about the many different ways that our problems can be exploited by others.

6 Queenie { 08.14.11 at 2:19 pm }

I think you have to find the silver lining here. Yes, a human being did something really, really bad. But look at all of the human beings who looked at that situation after they learned of it, and said “you know what, we’re not okay with this,” and held her accountable. The prosecutors, the police, who saw it for what it is. In all likelihood, she will lose her license to practice law. She will pay a very heavy personal and professional price for what she did, and many others will learn important lessons about right and wrong, and hopefully do right, do better.

So yes, this is a very dark story. But my experience has been that it is from the darkest depths that the bright beams of the good people in society congregate and burn brightest. In bad times, I try to focus on those admirable people who rise to the challenges presented by adversity, and do amazing things for people they don’t even know.

With regard to health care, costs are clearly in some respects inflated in the U.S.. I’m in a country with a “Western” medical system, and I’ve been flabbergasted by how inexpensive tests are here when I pay for them out of pocket. Tests that cost hundreds or thousands in the U.S. are just a fraction of that here. My chorionic villus sampling in the U.S. (paid for by insurance) was somewhere between $7000 and $10,000, when I added up the hospital fees, the doctor’s fees, the ultrasound fees, and the labwork (big city; preeminent hospital and physician). Here, the cost is less than $1000, with one of the pioneers of CVS. I will say, you don’t get the same level of service here (it’s generally impossible to get any private physician on the phone here, unless you have their cell phone number. . .but then, they give you their cell phone numbers and expect you to use them!). But still. . .I find the inequities in pricing astounding. I can only chalk it up to our litigious society, higher malpractice insurance, and greater infrastructure costs (because there are nurses and receptionists in American doctor’s offices, something seemingly nonexistent here).

7 Queenie { 08.14.11 at 2:22 pm }

Funny how similar my medical cost thoughts are to Sara’s; I didn’t see her comments until after I posted. Anyone else who’s experienced healthcare both inside and outside of the U.S. want to comment on comparative healthcare costs, and comparative level of service?

8 Baby Smiling In Back Seat { 08.14.11 at 2:51 pm }

It is exactly about what the market will bear. Most REs are able to fill their practices with enough patients (maybe not to max capacity, though some are — my first RE had a 6 month waiting list to be seen for the first time and my second RE was 3 months) with the pricing system they currently use. If there weren’t enough patients, the industry would collectively lower prices.

I’ve gotten icky exploitation feelings with my (most recent) acupuncturist. Compared to others I’ve seen in the past, who saw one patient at a time and clearly weren’t getting rich, he books 4-6 patients into the same hour and is getting rich. Not that I don’t believe in acupuncture, which I clearly do given that I saw him weekly (or more, during IVF cycles) for 3 years. But the extent to which he runs a factory always made me uneasy, as did the fact that I think his greed reduces the quality of his care (e.g., occasionally when he was too busy he’d have the _receptionist_ remove the needles at the end of the session). It’s no coincidence that the bulk of his practice is focused on infertility. I saw him during my pregnancy to deal with early symptoms, but after that haven’t gone back once — he has enough of my money.

I also feel like my chiropractor is running a racket, even moreso than the acupuncturist, but because he does not specialize in infertility, it doesn’t bother me nearly as much.

As for Queenie’s question, once I was in central Europe and a traveling companion had an urgent medical need. He went to a doctor to get it checked out: 11 euros. The doctor referred him to the capital city of the country where he could get a laparoscopic exam: 40 euros. The Americans laughed and laughed at the low cost. The Canadians and Aussies did not laugh.

9 JessPond { 08.14.11 at 3:10 pm }

I’m pretty sure that the fertility treatment cost is high because it’s what the market can bear (aka people are desperate, and will pay what they will pay) and because medical professions in general are extremely hard to insure (on the dr’s/practice’s side not the patients’) and therefore that with other things mean a high overhead for the clinic.

That said, I’m also pretty sure that the first part of that does somewhat translate into—they’re dicking us.

BUT THAT SAID…doctors get paid a lot BUT they go to school a long time, they invest a lot of time and energy into it, and they often have high levels of expertise, which is also a big deal.

Some of it is the same way drugs cost a lot….it takes a lot to study new drugs, get things through the FDA, etc. So, for a while, at least, many drugs cost a great deal over their manufacture cost (or do they? lol…to some extent you have to include how they got there in the first place, at least a while!).

What I don’t get is why people paid so much for a non-genetically-linked child if they could adopt a non-genetically-linked child for much much less. It smacks of something smelly on all sides to me. Easier? Less background checks? Something.

10 tash { 08.14.11 at 4:06 pm }

I had a very disturbing conversation once with a friend about American companies employing people in developing countries. The example was a car company in South America, and when I found out what they were paying people there, I called it exploitation. He called it opportunity; it was the highest paying job in town. But does that make it *right*? I asked — just because it’s ok with them, is it really *ok*?

I often get depressed by the costs and the gross capitalist mindset that has permeated all parts of healthcare including reproduction (see: Makena), but sometimes I’m surprised. Didn’t a company/place recently agree to allowing unlimited single embryo IVF transfers? It’s ok to take as long as you want, as long as it’s safe to do so and doesn’t cost us in the long run? I thought, finally, some smarts. Maybe someone will develop some here as the usual suspects run off the cliff and try to ban surrogacy altogether.

11 coffeegrljp { 08.14.11 at 4:54 pm }

It’s probably a miracle that I trust anyone or anything. My father was a 4th generation police officer. Let’s just say that some distrust and watchfulness were bred into him at an early age. I observed a lot of his behaviors when I was growing up and picked up on many of them. I’m hyper-aware (relative to most people I know) about what’s going on around me and can sense trouble brewing (i.e. fight is about to break out, person is in medical need, etc.) before anyone I’m with else sees it. And yet….despite the way that I look at life through these distinctly gray rather than rosy colored glasses, I still see lots of good and don’t feel overly pessimistic or distrusting. I know it’s out there – the bad stuff. I *really* know it’s out there based on lots of 1st and 2nd hand experience. But that doesn’t change the fact that we can look at the positive. Maybe that’s what it comes down to. We can make choices about what we see and acknowledge and CHOOSE. We can choose not to do business with someone who we perceive as unethical. Yes, that might make things infinitely harder; I’m not saying it’s easy. But the more we make those choices, the better we sleep at night and hopefully, one day the better the world becomes. (I just watched the Freedom Riders on PBS – it’s a powerful reminder that bad people are out there but if we trust that the good outweighs the bad, changes can come!).

12 HereWeGoAJen { 08.14.11 at 7:52 pm }

I think the whole situation just sucks.

13 Mash { 08.15.11 at 7:18 am }

It’s something I have been grappling with for a long time. I’ve realised that it’s not a fine line, there simply isn’t a line.

A life coach I recently spoke to had done some work in prisons, and said that nobody he dealt with believed that they should be in prison, including a man who had admitted to shooting a friend in the head while they were driving.

Nobody believes they are wrong, people justify things to themselves one way or another. And I suppose in some ways, we do the same, in our ordinary lives.

It is simply about choice – making sure that you always go to great lengths to deal with people with the most integrity you can possibly find.

14 Mash { 08.15.11 at 7:19 am }

And PS – I also always wondered about why the costs of ART are 10 x higher in the States than here in South Africa. Our doctors are just as qualified and use the same drugs. It really just boils down to demand and supply!

15 Chickenpig { 08.15.11 at 8:25 am }

Every person who is doing IVF is being taken for a ride. I hate to tell you, but the cost is NOT that high. They are making a profit because the industry isn’t regulated, and because infertile couples are willing to pay it.

I was totally shocked off of my gourd when reading a Smithsonian magazine I learned that ranchers of black angus beef hyper stim the cows and do IVF on them, including ultrasounds, and then transfer black angus embryos into non-black angus cows to increase the production of black angus beef. All this for calves that are just going to be eaten. It is NOT expensive technology, it is done on animals frequently and inexpensively. It should be done for humans frequently and inexpensively.

16 Chickenpig { 08.15.11 at 8:28 am }

PS my clinic is attached to a state University system, so many of the clinic costs are paid by the state. It has brought the cost of IVF down to almost less than 10 grand for everything…and they have excellent stats.

17 MLO { 08.15.11 at 2:24 pm }

“But the Erickson situation is like a doctor seeing someone with Stage 4 cancer and holding out a medication for an outrageous sum simply because he knows he can get the patient to pay the price because he is desperate to live. This is like a doctor making the conscious choice to exploit that patient’s need for their own financial gain.”

This happens. Many people die because they can’t afford the care for their cancer in the USA. It is one of the things that capitalism has turned a blind eye on. We don’t have the greatest health care system in the world.

The problem is much more multi-faceted than most people are willing to deal with. Most human beings are not able to work with multiple causes and how they interlink. This is why we are in the pickle we are in in the USA.

18 Kathy { 08.16.11 at 3:09 pm }

Thank you for this post. I continue to be extremely dumbfounded by this whole thing, I appreciate that each person’s “moral compass” is not the same. However, I struggle to understand how and why someone can go as far as the people involved in this exploitation did.

I don’t have anything else to add. But I appreciate the thoughts that you shared here and those who have commented on your blog entry.

19 Alexicographer { 08.16.11 at 5:23 pm }

I’m with those who feel we’re being grossly overcharged for IVF (at least) in the US; when my DH had both his hips replaced surgery and spent 10 days as an inpatient in the hospital (3 in recovery, 7 in PT), the total cost, before insurance, before negotiated reductions, before anything, was $40K — or roughly the total cost of 3 IVF cycles (not including drugs) that would have required no inpatient time at all.

That said, in comparing the US to other systems, it’s worth noting both that US doctors earn *way* more than their counterparts in other nations and that they pay — and take on massive debt — to go to medical school, not generally true for other countries. So those are 2 other sets of differences that play a role, but not in differentiating IVF in the US by US-trained doctors from, say, hip replacement in the US by US-trained doctors.

@JessPond you write that you don’t understand, “why people paid so much for a non-genetically-linked child if they could adopt a non-genetically-linked child for much much less.” I’d guess it might be because of the reduced wait, the desire to parent an infant, the relatively higher likelihood of having a child without unusual health problems via the surrogacy rather than the traditional adoptive route, and/or the desire to have one’s child be able know at least some of the parents involved in bringing him or her into the world — the gestational surrogate, if not the gamete donors. And, of course, as Mel notes, a woman (Erickson) well positioned to identify and exploit a vulnerable population. I don’t think we need to read anything sinister into the adoptive parents’ decisions.

20 Hopeful { 09.13.11 at 5:49 pm }

Just love your blog! Amazing!


Re: TE and dishonesty. We did IVF in Spain, then went to a top IVF clinic in the USA where we were ripped off! Then had our baby through DE and surrogacy in India. So, out of the 3 different clinics we dealt with, the one that was dishonest was a well-know US clinic in NJ (picked out by me using stats figures from SARTS) (I am American). The US clinic said they understood our foreign language and all our test results in that language (Spanish) from our earlier IVF, no problem and that they would not have to be redone. But, like idiots, we signed a paper that they could do any test they deemed necessary without our consent and they did just that and sent us crazy bills for everything we had already presented to them (only that the documents were in Spanish which they had said was fine). Precisely, they sent us the bills after we had canceled our cycle and the donor because I had to have an emergency cone. Suddenly, we were getting bills months later for these “tests” (we live abroad) so I finally called them to complain and, the bills abruptly stopped, but we had already paid quite a few! Also, the woman who presented herself as “doctor” at the clinic for the 3+ hour interview to chose our egg donor (because, at that time I was going to/able to carry our baby), well, I found out from facebook that she is a doctor in theatre and nothing else!! Yep! Her “services” cost us 1500 USD! What a performance indeed! At least we were front row, and it was marvelous. She went on about how it normally took them 2 to 5 months to find a DE “match” but then produced one in 10 days who really did look like me when I was little. (My question now is: Was the “match” she sent us “real”?).

They have testimonies on Internet from people who say they have successfully had a child with them so I guess this is true but I think they prey on others and we, living abroad, were perfect targets. Or maybe these doctors are so “out of it” that they were like, “Heck” I really can´t understand Spanish; just have these tests re-done”. Geez. Each one was 600 to 800 USD. Yikes! They were like 50 USD here in Spain!!!

Although finding out you need a cone, immediately, is a nightmare, but it was definitely a blessing because if we had gone forth with this group in NJ, we probably would not have had success and definitely not enough money to then have then gone on to India and would not have our lovely daughter!

Caveat Emptor: Before going to an IVF clinic and spending your money, time and emotional effort, get a few good, solid references from people you come to trust (through blogs, forums). And, do not sign a form where they can perform (lab) tests or anything which you will later be charged for (at an outrageous price) without your legal consent!!

21 Hopeful { 09.13.11 at 5:54 pm }

Another thing I want to add is that there are a lot of thoughtful and intelligent comments on your blog (and not just this section). Not that I agree with everyone, but most of the people who respond really have given thought to what they write. Very interesting to read everyone´s comments.

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