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To the Editors: We thank Dr Nielsen for his pointed response to our article on boutique fetal imaging. He raises a number of concerns, which we will address in turn. First, Dr Nielsen offers in response some of the opinions of his patients, with whom he shared our opinion piece. Empiric data about patients' attitudes is certainly relevant to ethical analysis of clinical controversies, provided that data about these attitudes are collected and analyzed according rigorous scientific standards.1Skupski D.W. Chervenak F.A. McCullough L.B. Horowitz S. Cesarean delivery for intrapartum fetal heart rate abnormalities: incorporating survey data into clinical judgment.Obstet Gynecol. 1996; 88: 60-64Crossref PubMed Scopus (5) Google Scholar Dr Nielsen failed to do so. His sample is biased because it comes from his own patients, who may have experienced potentially coercive influence from him not to disagree with him. He cites only 3 patients, a very small convenience sample that cannot be generalized beyond itself. After all, 3 patients from another physician's practice might have had very different responses. Second, Dr Nielsen resorts to rhetorical questions about patient autonomy to justify a clinical practice to which we raised substantive, argument-based objections. Rhetorical questions run a serious risk: they can be answered by readers in the opposite way expected by Dr Nielsen. More disabling, rhetorical questions do not count as arguments in ethics and are usually put forward by those who lack argument for their position.2McCullough L.B. Coverdale J.H. Chervenak F.A. Argument-based medical ethics: a formal tool for critically appraising the normative medical ethics literature.Am J Obstet Gynecol. 2004; 191: 1097-1102Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar Third, one of Dr Nielsen's patients asked for proof of our concern about how patients might feel about later decisions about intrapartum management. We offered this as a prudential consideration, ie, the wise obstetrician should want to prevent unnecessary complication of what will already be challenging decisions for both the obstetrician and patient. In the absence of data, prudential arguments are entirely appropriate in ethics. They should be rebutted with an argument showing that boutique fetal imaging does not involve risks that raise prudential concerns about the integrity of clinical practice. Dr Nielsen provides no such argument. Finally, we never used the phrase “filthy lucre,” and its use by Dr Nielsen involves a transparent attempt to distort our argument-based concerns about responsible management of economic conflicts of interest. Unfortunately for Dr Nielsen, the phrase may be relevant, based on what the Geddes Keepsake website itself states: “Geddes Keepsake services are designed to enhance the revenue of an existing medical practice or medical imaging center. We are so confident in the revenue potential of our services that we offer the following: if you have not had a complete payback on the investment within 8 months, we will buy back the equipment for the price you paid less the gross income you earned.”3Geddes Keepsake Ultrasound Images. Available at: http://www.geddeskeepsake.com/medical_professionals.html. Accessed October 1, 2005.Google Scholar Moreover, we did not object to offering “keepsake” images, on the condition that they are provided in the context of a regular ultrasound examination, not something as casual as getting “another look” at the fetus. This phrase could reflect a failure to understand the requirements of professional integrity in obstetric ultrasound examination, a failure that is not masked by the entertaining—but ethically vapid—rhetorical flourish with which Dr Nielsen closes his letter. Keepsake Ultrasounds: More than just another pretty faceAmerican Journal of Obstetrics & GynecologyVol. 194Issue 5PreviewTo the Editors: As a “generalist” Ob/Gyn, I offer keepsake ultrasounds using the Geddes Keepsake (Geddes Keepsake, Inc, Gilbert, AZ) program, which requires strict physician standards for affiliation. I agree that unsupervised keepsake ultrasonography in the malls without onsite physician support is wrong and dangerous. Full-Text PDF