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Alternative medicine - what every IVF specialist needs to know

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What every IVF specialist needs to know about alternative medicine

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Alternative medicine - what every IVF specialist needs to know

  1. 1. Doctors – Scientists and/or Healers ? <ul><li>Dr Anjali Malpani, MD </li></ul><ul><li>www.drmalpani.com </li></ul>
  2. 3. Conventional v/s Alternative Medicine – who Decides? <ul><li>Money </li></ul><ul><li>Colonisation </li></ul><ul><li>High Tech </li></ul><ul><li>These have made Western medicine occupy the premier position </li></ul>
  3. 4. <ul><li>Yoga, Ayurveda and Chinese medicine have a much longer tradition than modern medicine </li></ul><ul><li>In Germany homeopathy is mainstream medicine –not alternative! </li></ul>Conventional v/s Alternative Medicine
  4. 5. Doctors are Sceptical <ul><li>Lack of available scientific documentation and evidence </li></ul>
  5. 6. <ul><li>No need to be critical and dismissive </li></ul><ul><li>No need to look down upon these treatments just because there are no publications ! </li></ul>
  6. 7. Wake up! <ul><li>40% of all infertile patients use some form of CAM </li></ul>
  7. 8. Doctors don’t know everything <ul><li>Doctors need to be humble,keep an open mind and be willing to learn! </li></ul>
  8. 9. Jenner “discovered” vaccination by being willing to listen to cowgirls!
  9. 10. Alternative medicine is usually self-prescribed <ul><li>Why do patients look for alternatives in the first place ? </li></ul><ul><li>Because they are not happy with modern medicine ! </li></ul><ul><li>Good doctors need to be empathetic and to acknowledge this fact </li></ul>
  10. 11. Scientists or Healers? <ul><li>“ ART” specialists </li></ul><ul><li>have lost the ART of Medicine </li></ul>
  11. 12. Alternative Therapy <ul><li>Why ? </li></ul><ul><li>When ? </li></ul><ul><li>Who ? </li></ul><ul><li>How ? </li></ul>
  12. 13. Why? <ul><li>Holistic approach </li></ul><ul><li>Personalized touch </li></ul><ul><li>Patients experience control over their situation- “doing something themselves” </li></ul><ul><li>Low cost </li></ul><ul><li>Avoid side effects of drugs </li></ul>
  13. 14. When? <ul><li>When they have been given the frustrating diagnosis of “unexplained infertility” </li></ul><ul><li>When they have failed standard fertility treatments </li></ul><ul><li>To maximize their chances of having a child </li></ul><ul><li>Cultural beliefs </li></ul>
  14. 15. How do they work? <ul><li>Bringing the body back into balance? </li></ul><ul><li>Reducing stress level? </li></ul><ul><li>Placebo effect? </li></ul>
  15. 16. Who Benefits? <ul><li>Unexplained infertility </li></ul><ul><li>Ovulation disorders </li></ul><ul><li>IVF waiting list “ treatment independent “ pregnancies </li></ul>
  16. 17. Integrative Medicine <ul><li>Alternative therapies are very often used in conjunction with conventional treatments </li></ul><ul><li>Prior to undergoing treatment </li></ul>
  17. 18. <ul><li>Patients will often not tell us that they are using CAM </li></ul><ul><li>Are scared that we will criticize or pooh-pooh these </li></ul>
  18. 19. Show Me The Data! <ul><li>Western Medicine is evidence-based Medicine </li></ul><ul><li>Efficacy of a treatment has to be proven scientifically by convincing experts and scientific committees </li></ul><ul><li>The Randomized controlled trial (RCT) is considered the “gold standard” for evaluating the effects of interventions. </li></ul>
  19. 20. Why are there no trials in alternative medicine ? <ul><li>Too expensive, not enough funding </li></ul><ul><li>No money to be made by pharmaceutical companies </li></ul><ul><li>Drugs cannot be patented </li></ul><ul><li>Difficult to enroll patients for these trials </li></ul><ul><li>Difficult to conduct double blind trials </li></ul>
  20. 21. <ul><li>Lack of evidence of an effect </li></ul><ul><li>does not equal </li></ul><ul><li>evidence of the lack of an effect </li></ul>
  21. 22. Anecdotal successes <ul><li>Story of the old man and the starfish </li></ul>
  22. 23. <ul><li>“ Not everything which counts can be measured, </li></ul><ul><li>Not everything which we can measure is worth counting.” </li></ul><ul><li>Einstein </li></ul>
  23. 24. New trend <ul><li>Patients are doing research for themselves </li></ul><ul><li>Social networking </li></ul><ul><li>Health 2.0 </li></ul><ul><li>www.patientslikeme.com </li></ul>
  24. 26. Why are doctors sceptical? <ul><li>Quackery flourishes as there is no formal training required and there is no monitoring of practitioners of alternative medicine. </li></ul>
  25. 27. Dubious? <ul><li>That’s fine </li></ul><ul><li>We should be! </li></ul><ul><li>But we need to be equally skeptical about all medical interventions! </li></ul>
  26. 28. Modern medicine also uses Untested and unproven treatments! <ul><li>DHEA as a miracle drug in the treatment of poor responders; hype or hope? Human Reproduction. Kayhan and Urman </li></ul><ul><li>Is recombinant FSH really better than urinary HMG ? </li></ul><ul><li>Male infertility treated with hormones, vitamins,antiestrogens. </li></ul><ul><li>Operative treatment of varicocoeles </li></ul><ul><li>IVIG for treatment of repeated IVF failures </li></ul>
  27. 29. Evidence-Based Medicine : can the evidence be trusted? <ul><li>Many well reported RCTs are designed to deceive by biased study designs! </li></ul><ul><li>Vested financial interests! </li></ul><ul><li>Manipulation of statistics to produce desired outcomes that are selectively reported. </li></ul>
  28. 30. Keep an open mind <ul><li>Rather than looking down upon alternative medicine treatments it is better to be accepting and be willing to learn from our patients </li></ul>
  29. 31. Different Methods of CAM
  30. 32. <ul><li>Alternative Medical Systems </li></ul><ul><li>Ayurveda </li></ul><ul><li>Homeopathy </li></ul><ul><li>Naturopathy </li></ul><ul><li>Manipulative Bodybased Therapies </li></ul><ul><li>Acupuncture </li></ul><ul><li>Massage </li></ul><ul><li>Chiropactry </li></ul><ul><li>Osteopathy </li></ul>
  31. 33. <ul><li>Mind body Therapies </li></ul><ul><li>Yoga </li></ul><ul><li>Meditation </li></ul><ul><li>Reiki </li></ul><ul><li>Hypnotherapy </li></ul><ul><li>Aroma Therapy </li></ul><ul><li>Diet based Therapies </li></ul><ul><li>Chinese herbs </li></ul><ul><li>Vitamin therapy </li></ul>
  32. 34. Commonest methods <ul><li>Acupuncture </li></ul><ul><li>Chinese herbs </li></ul><ul><li>Yoga and Meditation </li></ul>
  33. 35. Acupuncture
  34. 36. Acupuncture – how does it act? <ul><li>Acts centrally by increasing B-endorphin levels which in turn affect the HPO axis and GnRH secretion </li></ul><ul><li>Acts peripherally by increasing the uterine artery blood flow and hence improving endometrial thickness and implantation. </li></ul><ul><li>Chang and Rosenwaks –Fertility and Sterility </li></ul><ul><li>Vol 78,No.6, Dec 2002 </li></ul>
  35. 38. How does Yoga help? <ul><li>Has a calming restorative effect on the mind and body </li></ul><ul><li>Reduces stress levels </li></ul><ul><li>Reduces depression </li></ul><ul><li>Feeling of control over one’s reproductive destiny </li></ul>
  36. 39. How does Yoga Help? <ul><li>Improves strained relationships </li></ul><ul><li>Helps to cope anxiousness, nervousness, helplessness </li></ul><ul><li>Reduces emotional stress </li></ul>
  37. 40. <ul><li>One cannot control what’s happening to your body but you can control how you feel about it! </li></ul>
  38. 41. What is success? <ul><li>We need to redefine the term success </li></ul><ul><li>pregnancy? or </li></ul><ul><li>patient wellbeing? </li></ul>
  39. 42. <ul><li>We need to acknowledge that CAM works! </li></ul><ul><li>How it works really does not matter </li></ul>
  40. 43. Information Therapy <ul><li>Better to be an agnostic rather than an atheist </li></ul><ul><li>It’s fine to say – We do not know! </li></ul><ul><li>Cannot be an expert on everything ! </li></ul>
  41. 45. Patient – centered medicine <ul><li>Putting Patients First ! </li></ul><ul><li>Respect patient’s desires </li></ul><ul><li>Best to offer all complementary therapies under one roof </li></ul><ul><li>Integrative medicine combines conventional medicine and CAM </li></ul><ul><li>Why lose your patients to another doctor ? </li></ul>
  42. 47. Best to keep an open mind <ul><li>The “ label “ does not matter ! We need to do what’s best for our patients </li></ul><ul><li>This is not a competition. We are all on the same side! </li></ul>

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