Corporatization: a new term in medicine

So, the New England Journal of Medicine just announced a new "Perspective" series of articles addressing the corporatization of US health care, pointing out that the corporatization of US health care is not a new thing and can be traced to its beginnings in the 1920s (1). But there can be little doubt that the reach of this process and its impact have in recent years achieved absolutely new heights and, therefore, have also received considerable coverage in the VOICE, especially, of course, with reference to infertility practice.

We, therefore, are very much looking forward to this series of articles in The Journal, of course, hoping for objective coverage of this important subject. The same issue of The Journal already offered the first installment, a quite interesting article by Erin C. Fuse Brown JD, MPH, a Professor of Health Services, Policy & Practice at the Center for Advancing Health Policy through Research at the Brown University School of Public Health in Providence, R.I., who used this paper to define what is really meant by "corporatization" (we—apparently grammatically incorrectly—in the past called the process "corporization") (2). And her definition in one sentence is worthwhile repeating:

"The term 'corporatization' now refers to the general trend throughout the health care industry toward higher levels of integrate control by consolidated profit-seeking enterprises."

She also reminded us in the article of two key elements of corporatization, the first being shareholder primacy in such situations, which means that the primary duty of the corporation is to maximize shareholder profits, subordinating the interests of other stakeholders (in this case, patients and health care providers, community, and others) and the second being consolidation, which in recent years has become increasingly apparent throughout the health care system in the form of vast horizontal as well as vertical consolidation in single markets by single corporate entities and multiple markets by conglomerates.

The consequences are manifold, including increased costs, declining quality of care and patient satisfaction, and the infertility field has, of course, witnessed all of this and more. Fuse Brown concludes that we have reached a boiling point which likely will lead to political interventions to initially, at least, break up conflicting powers of these commercial entities, like medical insurance companies, for example, also owning medical provider organizations, pharmacy operations, and/or vice-versa. The article is also accompanied by an audio interview with the author.

References

Malina et al., N Engl J Med 2015;393(1):81-82
Fuse Brown EC. N Engl J Med 2025;393(1):1-3 (The New England Journal of Medicine also offers an audio interview with the author)

Is the microbiome really ready for prime time?

So, we learned a lot about the importance of microbiomes in recent years! And it, of course, all started with the gut microbiome, and the big breakthrough happened once the gut-brain axis came into focus (1). A recent Perspective article in Cell, however, poured some cold water over overheated expectations and commercial excesses that threaten the integrity of this still relatively new field of research and clinical practice (2).

Here is the article's summary:

"Despite promising evidence in diagnostics and therapeutics, microbiome research is not yet implemented into clinical medicine. Several initiatives, including the standardization of microbiome research, the refinement of microbiome clinical trial design, and the development of communication between microbiome researchers and clinicians, are crucial to move microbiome science toward clinical practice."

And, as the article also pointed out, the challenges are multifactorial, from biological, over methodological, to logistical, and cultural: Biological, because identification of causal links between gut microbiome and human diseases can, due to the heterogeneity and complexity of the gut microbiome, be difficult. Methodological, because diet, environments, medications, and other environmental influences affect microbiome studies. Reproducible results, therefore, are often lacking. Logistical, because studies usually are underpowered single-center studies that cannot be generalized (does that sound familiar?); and, finally, cultural, following from all the other considerations—treating physicians, understandably, still lack confidence in microbiome data.

That even when it comes to the gut microbiome there are still such very obvious limitations may surprise; but what does not surprise is that in infertility practice there, apparently, does not exist any such hesitancy in promoting commercially available vaginal microbiome tests under the usual categorical representation that they can improve the outcome of infertility treatments (3, 4).

What a shame!

References

Mayer et al., J Clin Invest 2015;125(3):926-938
Porcari et al., Cell 2025;188(11): P2836-P 2844
Evvy. Vaginal Microbiome Test with Fertility Insights. https://www.evvy.com/vaginal-microbiome-test-fertility
Juno Bio. Updated February 6, 2025; https://www.juno.bio/blogs/learn/assisted-reproduction-and-the-vaginal-microbiome?srsltid=AfmBOorPiFcOCTjczKq9VJzNzKNR5w9ob7I4HZOwm8g3GFn51LDIqiSh

Salaries of REIs in the US: Who pays best?

So, here is an interesting Research Letter article in Fertility and Sterility: Canadian colleagues investigated how REI salaries compared between academic positions and employment in so-called private clinics (1). And rather unsurprisingly, those in the private sector did much better, especially once they reached 10 years of seniority.

But we found the article rather unsatisfactory because nobody will, of course, be surprised by the reported discrepancy between academic and private salary spectra. It is widely known, and not only in the infertility field. What would have been a much more relevant question is—within so-called private practice jobs—what are the income/salary differences between truly private practice (i.e., physician-owned clinics) and Private Equity and other large Wall Street-owned clinic networks?

If we had to guess, we would find a greatly varying pattern from that reported in this communication among physicians in private settings: We would suspect that, (i) starting salaries would be the highest in organizations owned by outside investors; but (ii) that advantage would increase much slower with seniority than in truly by physicians privately owned clinics.

Why is all of this of importance? Because outside-investor-owned clinic networks have, for all practical purposes, taken over the field when it comes to hiring. Nobody among the still truly private clinics can compete with their starting salaries. But once they "own" their physicians, they become much stingier and start asking for much more in return. Academia, in most cases, cannot compete with either form of private practice.

The consequences for the field, therefore, should be obvious: Don't expect much true innovation, but we would not be surprised by more and more revenue-generating useless "add-ons" to IVF. Just more evidence that infertility practice is quickly moving away from being a medical subspecialty and moving toward becoming an industry.

Reference

Kolokythas A, Dahan MH. Fertil Steril 2025;124(1):159-160

The New England Fertility Institute (NEFI) sold to CSG.BIO

The sale of infertility clinics has become so much of a routine that most are not even publicly announced any longer. But when Dresner Partners recently published an announcement about having served as advisor to the NEFI's sale, noting that the buyer was a company called CSG.BIO (1), we got interested because we had never before heard of CSG.BIO as an owner and/or purchaser of fertility clinics. And as will become quickly apparent, this commentary is highly relevant to what is, unfortunately, happening to the infertility field and medicine in general.

Looking up CSG.BIO, we found confirmed by the company's website that the company, indeed, had never before purchased an IVF clinic. And our research, in addition, revealed several very interesting facts about CSG.BIO: Its website described the company as a "global life science company that has helped over 500,000 families grow and safeguard healthy children” (2) (how this deed was accomplished remained unmentioned), launched in 2005 as a company processing stem cells, testing as well and storing them. According to the website, the company by 2019 had grown to span businesses in 3 continents—North America, Asia, and Europe—and by 2021 acquired another private stem cell banking provider in the US called AlphaCord. By 2023, the company formed a "strategic partnership" (again, not explaining what that meant in practical terms) with the Dubai-founded Bioscience Institute and Abu Dhabi Stem Cells Center (ADSCC, apparently the same corporate entity) (3).

So, we continued our research and looked up both of these two new partner organizations: The Bioscience Institute according to its website now has five locations in Dubai, Rome and Milano in Italy, San Marino—a tiny island state in the midst of Italy, Lugano in Switzerland and San Francisco, USA. Its website offers stem cell treatments for body shaping, skin rejuvenation, scars/stretch marks reduction, regenerative orthopedics, vaginal rejuvenation, and (lo and behold) premature ovarian failure (though without telling how it does it!) (3).

The ADSCC, with locations in Abu Dhabi and Dubai, describes itself as "a healthcare center focused on cell therapy and regenerative medicine, delivering cutting-edge research on stem cells and offering accessible hematopoietic stem cell transplantation for both adults and children, regenerative treatments for orthopedic problems, women's and men's health concerns, general wellness, and specialized treatments, such as UAECell19 for long-COVID and smokers, as well as stem cells for cosmetic and anti-aging treatments" (4).

In other words, the NEFI appears to have become part of a worldwide stem cell enterprise, in some unclear ways associated with financial partners in the Emirates.

Now, a final word about the NEFI, a well-respected mid-size fertility clinic in Connecticut, which, as at least as of July 5, 2025, does not report the sale on its website (5). It was established and to this day is run by Gad Lavy, MD, a well-regarded fertility specialist who, prior to establishing NEFI, was for four years in charge of the IVF program of Yale University. He was later joined by a second well-regarded physician, Michael M. Guarnaccia, MD, MPH, who, before that, was on the faculty of Columbia University in NYC.

Though not a research center, NEFI—especially in more recent years—achieved special recognition for serving the LGBTQ+ community. A new affiliation with a corporate entity practically exclusively involved with stem cell therapies, of course, raises important questions, especially as the Bioscience Institute claims to treat premature ovarian failure (now more correctly called primary ovarian insufficiency, POI) with many commercially advertised stem cell treatments in the US currently under scrutiny by the FDA, as has been reported.

One, therefore, wonders what the planned strategy is behind the purchase of NEFI by CSG.BIO may be? Never a dull moment in the infertility field, and still, new players entering!

References

Dresner Partners. Press release. July 2, 2025; https://www.dresnerpartners.com/news/article.asp?id=26303
CSG.BIO, https://csg.bio/about-us/; accessed July 5, 2025.
Bioscience Institute. https://bioinst.com/en/; accessed July 5, 2025.
Abu Dhabi Stem Cell Center (ADSCC). https://adscc.ae/; accessed July 5, 2025.
New England Fertility Institute (NEFI). https://www.nefertility.com/; accessed July 5, 2025.

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