By Mike Magee, MD

If you've turned on the TV in the past few weeks, you couldn't miss one of two sets of images. The first is our new president attempting to weave his way through a long list of complex issues to stir the country down a different financial path. The second was  Nadya Suleman, a young divorced parent of six who just gave birth to eight more children, with the aid of a reproductive specialist. What do these two stories have in common? In both cases, the roles and responsibilities of individuals, communities, and society are up for grabs. Putting it bluntly, who should be allowed to do what?

The focus of the government for now is clearly on the financial sector, and new rules or regulations to deter the types of behavior that got us into this mess. I'll let the experts deal with that.

As for our young mother of 14, I have to agree with medical ethicist, Arthur Kaplan, who thinks that the idea of a physician being allowed to implant 8 embryos in a young women with 6 children is "ethically bonkers". Dr Jamie Grifo, director of the NYU Fertility Clinic, in a joint appearance with Kaplan on the Today Show, reaffirmed the voluntary standards of a maximum of 2 embryos implanted at one time in women under 35 of the American Society of Reproductive Medicine, and seemed to suggest there was not much more that could be done to control occasional "crazy" cases.

This aversion to placing into law protective rules that would assure some logical limits to human misbehavior I find bizarre. If something is clear enough and defensible enough to be the basis for a national organization's endorsement as a "voluntary guideline", why not have the guts to do it right? If the American Society of Reproductive Medicine had been as focused on supporting legislation to assure sane limits as they likely were in preventing unwanted government intrusion in the private practice of medicine, would we be wondering this week what will be the destiny of these 8 new lives, let alone the other 6 and their mother who, with the support of her doctor, played out her dream unencumbered and free?

This is not the first time the issue of regulation and the practice of  US Reproductive Specialists has been front and center. I've covered it several times in the past.

The most common risk associated with IVF is multiple births. While 1% of natural pregnancies result in twins, approximately 1/3 of parents who have live births after IVF have twins. Twins from IVF are more common in the US than in many other nations because laws in other countries prohibit implanting more than one embryo at a time. The US has no such laws but increasingly, fertility specialists are voluntarily not implanting more than two embryos at a time.

Twins do have higher rates of preterm birth and low birth rate. Mothers giving birth to twins require more bed rest, and are more vulnerable to premature labor, hypertension, birth hemorrhage and the Caesarean section delivery. Triplets and beyond up's the ante with much greater risk for mother and child. To their credit, most US programs fully inform parents of these issues prior to deciding to proceed with IVF, and parents are often more than happy to make whatever sacrifices necessary.

According to Nadya Suleman, her reproductive specialist fully informed her too. Technically everyone followed the rules. But that doesn't mean that either doctor or patient here were playing with a full deck. The time has come for professional organizations of all types to encode legally broad terms of responsible behavior. "Voluntary guidelines" in this instance and in so many others provide little protection, except to those in charge who lack the wisdom to do what is right.

By Mike Magee, MD

Incontinence– the loss of bladder control – affects about 25 million Americans, but you don't hear much about it. While 55% of women in their 80s have the problem, nearly 30% of women in their 30s experience some loss of bladder control at least once a month. Believe it or not, about 50% of American women have experienced incontinence.

Why is incontinence so common in women? Part of the reason is the construction of the bladder itself. The bladder must be able to contract in order to efficiently empty when it’s supposed to, as well as be able to relax enough to serve as an adequate reservoir for urine collection.  All of this relaxing and contracting must be in conjunction with the voluntarily controlled sphincter muscle that surrounds the urethra, the tube that empties the bladder. As it contracts and relaxes, the sphincter muscle alternately squeezes the urethral tube. In her lifetime, a woman’s bladder will be asked to relax and contract with perfection 300,000 to 400,000 times.

Basically, women are more susceptible to incontinence because of their anatomy. A woman’s urethra is much shorter than a man’s, so it offers less resistance to outflow when the bladder muscle contracts. There are other reasons – including effects on the bladder from childbearing as well as weight gain, which can have a similar effect on the urinary system as childbirth. In one study, women with a body mass index (BMI) of greater than 30 were 139% more likely to be incontinent than those within a normal weight range. Also, metabolic conditions and neurological degenerative diseases can injure the nerves of the bladder and urethra and increase the risk of incontinence.

As you might expect, problems with incontinence increase as women age. In the late years, it can become a serious enough management problem that it can trip a woman from independence to dependence. In fact, half of all nursing home patients are incontinent.

Is there anything women can do? First, as a woman, understand that bladder care is essential. If you have pain, frequency, or leakage, don’t suffer in silence. Be evaluated thoroughly. Second, for caregivers, routine questioning and screening for incontinence in women is crucial – especially among those who have had children or hysterectomies, are depressed or overweight, or are diabetic or have neurological problems.

The majority of incontinence conditions can be improved or cured with treatment. But in order to get treatment, you have to take that first step – talk openly and honestly with your health care professional. As always, to learn more, either watch this week's video or read the full transcript below, then leave a comment on this topic.