Wednesday, November 30, 2011

We treat patients - not numbers !

Patients ( and IVF doctors ) need to remember that we treat patients - not just abnormal lab reports !

How do we sort out the significant abnormalities from the red herrings ? How do we prevent overdiagnosis and overtreatment ?

Saturday, November 26, 2011

Doctor vs Doctor

It's true that doctors often disagree. This means that patients get confused and frustrated, because they don't know what to do ! After all, if experts cannot agree, what's the poor patient to do ?

We need to remember that medicine is not an exact science - it's evolving rapidly, and recent advances can mean that there may be newer ( and better) options to solve a problem.

However, the bigger problems is that doctors have large egos - and are very fond of making up their own mind - and then closing it ! Many doctors will trust only their own "personal judgment" based on their "personal experience" - which means it's hard for them to accept alternatives. Some treat dissent as a personal insult - and will refuse to discuss options - it's "my way" or go away !

This is especially true when infertile couples seek medical help.

Gynec vs Gynec

The point of first contact for most infertile couples is their gynecologists. While most older ones are quite conservative, the young ones are more interventionist, and will often advise a laparoscopy as a preliminary investigation - even though most infertile women do not need one at all !

Gynec vs Gynec Endoscopist

Now that gynecologists have superspecialised, we now have a breed of gynecological endoscopists who will not accept the laparoscopy report of an ordinary gynecologist, and will insist on repeating this again. Even worse, they will make it a point to "diagnose" an abnormality which the earlier doctor missed, thus proving that they are better doctors ! Sadly, most of these "abnormalities" are just red herrings, which are of no clinical importance. This is especially true for those unfortunate infertile women who have endometriosis, for example.

Gynec vs IVF specialist

Most gynecologists are very reluctant to refer their patients to an IVF specialist, because they do not want to "lose" their patient. They will repeat IUI treatment cycles ad nauseum - till the patient gets fed up and frustrated.

While some of these differences are a result of maximising personal income, it's also fair to point out that it's not just pecuniary gains or vested interests which cause these differences in opinion. Many doctors have different world views, just because they see completely different patient populations !

Thus, older gynecologists who also practise obstetrics ( OB) are likely to see lots of older women who have got pregnant in their own bedroom. They are therefore much more likely to allow nature to take its own course and treat all 35 year olds as having normal fertility ! IVF
specialists , on the other hand, usually see only the ones who have problems - which is why they are much more worried about the biological clock , ovarian reserve and time !

We all have our biases - and this is completely natural . We tend to remember our successes and conveniently forget our failures.

IVF specialist vs IVF specialist

In fact, even IVF specialists differ amongst themselves ! Thus, many will remove a small hydrosalpinx prior to IVF; while others will routinely do a hysetroscopic metroplasty to "improve uterine receptivity" and facilitate embryo implantation !

Western medicine vs Alternative Medicine

This is also why IVF doctors have such a poor opinion of alternative medicine . They see lots of infertile women who have done a lot of alternative medicine and failed, which is why they then turn to IVF as their last resort. Because IVF specialists see only the alternative medicine failures, they start believing that alternative medicine is all rubbish and does not work.
Conversely, they have lots of faith in their modern technology - after all, they see embryos which they have created in their labs daily, and this can be quite awe - inspiring !

Alternative medicine doctors, on the other hand, have a completely different perspective ! They see lots of patients, many of whom have unexplained infertility , and who quickly get pregnant after they "treat them". Now whether the pregnancy was a result of the treatment, or inspite of it, is something we'll never be able to find out ! However, like all doctors, they are quick to take the credit for their successes - and their patients are more than happy to give them what they think is their fair due. This is how their reputation and practise grows !

I think the truth lies somewhere in the middle. Everything works, when used intelligently - the secret is to select patients carefully !

So what is the poor patient to do ? There's only one solution - you need to do your own homework, and the more you know, the easier it will be for you to make the decision which is right for you. It will be easier for your doctor as well !

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Friday, November 25, 2011

Beyond Organic Farming - a textbook in Hindi

This has been published by Deepak Suchde , who runs the organic farm in MP set up by the Narayan Chandra Trust , which my parents started , to help make Indian farmers self-sufficient

Why do doctors give cuts ?

Most doctors are like most of us - honest, ethical and happy to earn a comfortable living. Most doctors would rather not give cuts if they have a choice - after all, who likes doing something which is dishonest and underhand ? And I am sure no one wants to give away their hard-earned money in the form of a kickback !

Yet doctors in Mumbai do this all the time, routinely. How do they justify it ?

The truth is that the brain is wired in such a fashion that it's possible to justify practically anything and everything. The commonest excuses are:

I need patients and cannot survive if I do not give kickbacks
Everyone else does it, so why shouldn't I ?
What's wrong with being corrupt ? This is a corrupt society, so why should doctors be held to a higher standard than everyone else ? Why should I be expected to be God ?

The truth is that doctors give cuts against their better judgment. They do this because they feel they don't have a choice.

In reality, there is a better alternative - a solution which is good for both patients and doctors !

Remember that the only reason doctors give cuts is so that they can get patients - and this is the role which the "middleman" serves. This middleman could be :
the referring family physician;
the medical tourism company;
the taxi driver or tout;
the insurance company; or
the corporate hospital .

The trick to stop giving cuts is to cut out the middleman , so that doctors can get patients directly.

The only way to do this is to go to where the patients are - the internet !
This is why it's so important for doctors to have their own websites. It keeps doctors honest, open and transparent - and this is best for doctors and their patients as well !

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Thursday, November 24, 2011

How can we clean up the corruption in the medical profession ?

The Hindustan Times has run a great series of articles which document the unethical practise of giving cuts and kickbacks within the medical profession which is rampant in Mumbai today.

I am happy they have documented this practise. This was an open secret, which everyone was aware of, but preferred to sweep under the carpet. I am glad they have create awareness about how harmful this can be . We can no longer ignore this elephant in the room, and this is the first step is tackling this pernicious problem - talking about it, rather then pretending it does not exist.

However, the problem with such articles is that they sow the seeds of mistrust in the doctor. Patients are now likely to treat their doctor with suspicion. Is he advising surgery in my best interests ? or his own ?

My major criticism about these articles is that they do not provide solutions - and often end up up making a bad situation worse. Patients feel helpless and powerless - and start treating all doctors as crooks. Doctors start getting defensive - and if you treat someone as a crook, he will soon start behaving like one ! Is this the kind of self-fulfilling prophecy we want to achieve ?

Sadly, patients cannot differentiate good advise from bad advise - and some of them may end up saying no to surgery which they really need - causing a lot of unnecessary harm and suffering. Also, these articles end up making the doctor's life more difficult as well. Trust is an integral part of the doctor-patient relationship - and if this eroded, it's very hard to repair.

What's even worse is the fact that the silence from our medical associations is deafening. Where are the leaders in the medical profession who should be standing up for the doctor - there don't seem to be any left !

The truth is that patients are not powerless ! They can learn what is appropriate medical advise and what is not. It's important for them to trust their doctor - but the doctor needs to earn this trust - and patients need to verify that their doctor's advise is sound.

I feel a simple solution to help clean the Augean stables would be to make sure every doctor has their own website. Websites will force doctors to be transparent. They can publish their fees openly, so patients are confident they are not being overcharged or taken for a ride. These websites will allow patients to comparison shop - so they can make the right choice for themselves.

The truth is that patients doctor shop all the time - why not help them to do so intelligently ?

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Wednesday, November 23, 2011

Dr Anjali Malpani's presentation about IVF and alternative medicine at COGI, Paris

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Making sense of your IVF medications

Are you confused with the medications your doctor uses for your IVF treatment ? What's an agonist ? An antagonist ? Why do I need so many shots ? Will I run out of eggs because of all these hormones ?

One of the reason for the confusions is that there are so many different medications available - and so many different treatment protocols !

Why are there so many protocols ? Is one better than the other ? Did my online buddy grow more eggs than I did because her doctor started her meds before Day 1 ? Should I ask my doctor to also start my meds before Day 1 ? Or should I change my doctor ?

If you need help in making sense of your IVF treatment protocol, please
go to
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Thursday, November 17, 2011

I am going to be speaking at the Health 2.0 India conference

I am very excited to be talking at the Health 2.0 India conference to be held in Delhi on 30 Jan 2012.

There are some very interesting speakers I look forward to listening to; and many demos of clever products I want to check out. It's going to be a packed day !

This space is hotting up - and I am very pleased to be participating.

Success story for a man with azoospermia

We got married in 2000. After waiting for two years as my wife could not conceive we consulted a gynecologist in Nasik. He advised us for some blood test for my wife and semen analysis. To my surprise I was diagnosed with “Azoospermia”. Then I consulted Urologist he suggested Biopsy which took me another year. After Biopsy, my urologist confirmed I had obstructive Azoospermia. On one side we started feeling pain of not having baby ; and our life became miserable by lots of suggestions from relatives and friends. We started avoiding social meets and functions.

Our parents took us to many religious places, some of them were baba’s . We had many bad experiences , travelling long distance to cites in Guj, Mah and some in Konkan.

Then we again went to the same gynecologist in Nasik . He suggested us IVF treatment with TESA, we invested all our savings in the treatment but it didn’t worked.

Somebody suggested Ayurvedic medicine from Kerala, no result I was only gaining weight day by day. I tried acupuncture, Homeopathy and many more options.

We lost all our hope and didn’t even have enough money to go for next IVF and take risk and 2007 we left everything in God's hand and were waiting every month for a miracle which never happened. In 2007 somebody from Nasik suggested we try treatment in Mumbai as the doctors in Mumbai are well equipped . I started searching for Job in Mumbai and finally I got one in Dombivali. Without wasting a single day we started treatment at Dombivali but it didn’t work. We lost all hopes and started thinking on adoption , which we found out was not at all easy.

One day while surfing on internet , I found information on Malpani Clinic which seem to be very genuine and informative. We we both decided to visit the clinic and went first in 2008. Doctor was very informative , friendly and the environment I found in the clinic was wonderful. I decided to get the treatment done at Malpani Clinic but again my finances were not enough to immediately start the treatment. So, I made my wife to join art & painting college.

We arranged finances in 2011 and started our TESE-ICSI treatment in Malpani clinic . The staff and doctors are wonderful, they made us so comfortable that we never felt we are in a Clinic. At Malpani clinic , all the treatment procedures were clearly explained, everything is documented and transparent. All the possibilities were told . This place was a hope and home for us during this period. The Malpani staff trained me on giving injections at home, they were very cooperative.

Our first cycle didn’t work but our Doctor supported us morally, and we were ready for second cycle , which worked ! We were lucky that we were in right hands.

We are very thankful to Dr. Aniruddha Malpani, Dr. Anjali Malpani. and entire Malpani staff for supporting us throughout our treatment, they all are Angels on Earth.

May God Bless Them All!!!!

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Wednesday, November 16, 2011

Make the patients do all the work !

Doctors are always complaining about how busy they are and about how many patients they have to see every day.

Here's a simple solution - make patients do more work !

Patients can be very smart - and they can often do a better job at educating other patients, for example. Not only are their concepts clearer , they are much more patient-centric and use language which is easier to understand, because it is not burdened with medical jargon.

Patients can develop many clever tools, which we can then use to treat other patients !

For example, when I give patients their IVF treatment plan, I write this down - and then ask them to email me what they will do , in their own words , so I am sure they have understood it properly. One patient created a very clever spreadsheet for herself. I requested her to adapt this, and we now use this for all our patients ! They just have to enter their LMP and they get a customised daily treatment plan which spells out what's going to happen on each day. This helps them become better organised ; saves me time; and reduces errors and confusion.

If you are a busy doctor and have lots of patients , please learn to make good use of them ! They are a very inexpensive resource ! For example, they can help you search the internet; or help you design patient education brochures in their local language.

Remember, patients are not just consumers - they are the largest untapped pool of healthcare providers. They act as primary healthcare providers for themselves - why not tap into their intelligence to help them provide better health care tools for other patients as well ?

Doctors as a healthcare tool

Most people ( including doctors themselves) have an excessively inflated opinion as to how important doctors are in improving the health of their patients . I think this self-importance is completely uncalled for.

We need to remember that doctors are primarily illness experts , and they are good
( sometimes, but not always ) at fixing problems when you fall sick. However, the most important person for ensuring you remain healthy is - you !

Sadly, when we give too much importance to doctors, we create lots of problems.

I think doctors are simply one of the many healthcare tools we can use to remain well. Many other tools ( such as a healthy diet; money; safe drinking water; regular exercise; information therapy; and plain common sense !) are often much more important !

It's because we've handed over control of the healthcare system to doctors, that they progressively demand ever increasing importance. This is perfectly logical ( from the viewpoint of the medical profession), but is likely to hurt the common man.

Just like any other tool, the doctor can be used well. However , they can also be used badly - and because they often make the rules as to what patients are allow to do ( and not allowed to do), they are often overused and misused.

Like CT scans and MRI scanners, doctors are very expensive tools - and it's important that patients learn how to use them intelligently ! Just like you need to learn when to go to a doctor, it's equally important to learn when you are better off not going to one !

The trouble is that they command a lot of prestige and respect - and it is hard not to get blinded by their halo !

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Tuesday, November 15, 2011

A great series for infertile couples - None in the Oven !

Being infertile is hard - and often the rest of the world makes it much worse !

Here's a great video series, full of humor and empathy, which will help you realise that you are not going crazy ! Other couples have dealt with infertility successfully - and so can you !
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Monday, November 14, 2011

Launch of the Continua Health Alliance in India !

The Continua Health Alliance was launched in India at the recent Telemedicon 2011. This was a very well organised affair, and Rajendra Gupta gets full marks for doing such a great job !

I am very pleased that Continua is now focusing its efforts on India. This reinforces the fact that India is a huge market - and that healthcare entrepreneurs who develop clever products to improve personal health care now have a global opportunity they can tap into !

I also suggested to the Continua Chairman that they need to have an e-Patient working group. After all, if they are designing products for patients, they need to actively solicit patient input from Day 1 !

Sunday, November 13, 2011

Aneesh Chopra, CTO at Telemedicon 2011

I had the pleasure of listening to Aneesh Chopra, Chief Technology Officer, The White House, USA at Telemedicon 2011.

He is a very inspiring speaker - full of energy and bounce. Reminds me of Tony Robbins !

I was impressed by how sharp he is; and how he is using technology to tap into the expertise of ordinary citizens. He kept us glued to our chairs for 60 minutes - and shared lots of great ideas.

It's very heartening to see government led efforts which tap into crowd sourcing to come up with innovative cost effective solutions to improve healthcare. There's a lot the Indian government could learn from this exercise - we have lots of smart Indians !

Wednesday, November 09, 2011

I'll be speaking at the International Telemedicine Congress 2011 !

I'll be presenting the patient's point of view at the forthcoming Telemedicon 2011.

This promises to be a very interesting conference. Rajendra Gupta has done a stupendous job in getting together a galaxy of speakers from all over the world !

Since we cannot clone doctors, the best way of ensuring doctors can reach out to more patients is by using technology ! Telemedicine is a very cost effective way of doing so. However, while it can help the doctor to improve his efficiency, most patients still want to talk to their doctor face to face ! And how can telemedicine replace the human touch we all crave for ?

I'll be discussing some of these issues in my presentation !
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Busting myths about sperm and fertility !

This article appeared recently in Mumbai Mirror, one of Mumbai's leading newspapers.

Monday, November 07, 2011

What every infertile couple needs to know about DPO !

DPO stands for Day Post Ovulation, and is a key term every woman needs to be aware of. We all know that ovulation is the central event in a woman's reproductive cycle. Unfortunately, because ovulation is a silent internal event, most women are not sure when this occurs. This is why most of them use their last menstrual period ( LMP ) as their key reference timing milestone . This creates a lot of confusion .


Saturday, November 05, 2011

One more Malpani IVF Clinic success story !

When we first came to the Malpani’s clinic, we are a bit nervous. After reaching there and talking to him we came to understand why Dr. Malpani emphasises that the patients should be VIPs (very informed patients). If patients are informed well then, they will understand better and ask pertinent questions to get the best out of the treatment. Dr. Malpani has done a yeoman service of educating the infertile couples with his site and HELP organization. Kudos to him on such a noble dedicated venture.

We had been married for more than 3 years, when we started thinking seriously of starting a family. We went to the normal gynecology doctor who did the normal tests and then the journey began with the all the up and downs of varied nature. When we reached Malpanis we had already undergone one cycle of treatment which ended in failure. We had our second round of treatment with the Malpanis. The biggest differentiating factor of Malpanis with others is that once reach his clinic you leave your worries and transfer your worries onto them. They and their staff take adequate care of the worries and pains associated with the infertility treatment at their clinic.We had high hopes and expectations from this treatment. Anjali extracted eight eggs and six of them fertilised. The embryos were transferred two days after the extraction. Then the longest wait began. The next fortnight was seemingly too long. It was as if the Time has slowed down. Somehow we spent those two weeks and the D-day came for the beta Hcg test. By the evening hopes were dashed to the ground. The report was negative and we were dejected and exhausted mentally and physically.

But life has to go on. We mustered courage and visited Malpanis after some time and there was only one question before him-“what next?’’. He advised us suitably and counselled us to give it another try. We need to remember in this treatment that day by day we are aging and postponing the treatment only compounds the problem and more so for them who are on the wrong side of the 30s. We decided to give it one more try after taking a short break. The break period we utilised for the alternate therapies like acupuncture and some naturopath to enhance the chances of conception. We again went for another round of treatment under the Malpanis. We were still positive and thought that these therapies would do some miracle but the wheel of fate has many unexpected revolutions. This time also we were back to square one. This round also failed and we were thoroughly dejected. Again the same unanswered question-“what next?’’. But we never lost faith on GOD and the doctor. Probably time was not on our side.

One of the suggestions was to go in for adoption but that also takes a lot of time and procedure is still cumbersome in India. We again came to the Malpanis and he suggested exploring the option of embryo adoption which we liked very much. We went ahead with it. He transferred four beautiful embryos. Again the two weeks of prayer, suspense, anxiety et al. After the two weeks the result was again negative. We were totally wrecked and kind of given hope of becoming parents. We took our time and reconciled to the situation. For some time it was alright but when the fun is over and loneliness takes over, pain starts mounting at all levels. Again, we called the Malpanis and consulted him regarding the final attempt for the procedure.

We went under the procedure and hoped for the best. Throughout the treatment Malpanis have been a pillar of strength. Their professional treatment and dedication is par excellence. After 2 weeks of the resting phase and the blood test, the clinic informed over phone that the result is negative. We were devastated. Next day when we saw the report there was a surprise in store. The result was showing “In Range”. We again contacted Malpanis and he confirmed that the news was good and he again took care of the resultant weeks to see that the initial pregnancy develops well.

This time GOD has been kind to us and we are now awaiting our first child. The first trimester was having a lot of ups and down. We would every time contact him over phone and e-mail and he would respond at the earliest. Most of the times I found find solace in his advice rather than of the regular gynaecology doctor. Whenever I have doubt, I would mail him and his response would be there within 24 hours. We are thankful to the entire team of MALPANIS. Their co-operation and dedication is deeply appreciated from the bottom of our heart. May GOD bless Malpanis in their great work of bringing smiles to the childless couples from across the world.

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Friday, November 04, 2011

Ashok Jain on why it makes business sense for entrepreneurs to promote information therapy in India

Mr Ashok Jain is a very successful healthcare entrepreneur and CEO of OxygenHealth. He talks about how he uses Information Therapy to help his company to flourish by keeping patients healthy !

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Thursday, November 03, 2011

Dr Nikhil Datar on How Information Therapy can be used to promote patient safety

Dr Nikhil Datar champions the cause of Patient Safety in India ! He talks about how Information Therapy can help to make healthcare safer for patients.

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Wednesday, November 02, 2011

Promoting Information Therapy in India - Dr Aniruddha Malpani

Patients are the largest untapped healthcare resource ! Here's how we can mobilise the bottom of the pyramid in India.

I presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

Tuesday, November 01, 2011

Successful donor egg IVF pregnancy at Malpani Infertilty Clinic

When we got married we decided to plan our family after 6 months. I used to have serious pain during my periods and that used to get worse, that I used to unable to move .After ultrasound doctor found a chocolate cyst near my ovary and assured me nothing to worry it can be removed easily , soon after I found that my both tubes were blocked and I am having endometriosis, as I have endometriosis and my both tubes were blocked I was advised to have laparoscopy followed by IUI after 3 months by many doctors. These all test and making decision for surgery took 1.5 year , I finally got done laparoscopy , which showed I was having Stage - 4 Endometriosis , this laparoscopy opened my fallopian tubes and I was advised to go for IUI , I was given hormone injection but there was NO significant follicular development found, the FSH value was very HIGH , endometriosis has destroyed my ovarian tissues and I was detected with premature ovarian failure , I was advised to consider IVF with donor help. This all happened so fast that I could not believe that this had happened with us , just after this we had to move to US for work and our IVF decision got side tracked for couple of years .

In these couple of years I tried with clomid with no result, I looked at internet and made decision to go with Dr. Malpani, I wrote him for second opinion and immediately I got his response and after going thru with my history he also suggested to opt Donor egg but I really wanted to try at least once with my own egg , I am thankful to Dr. Malpani that he gave me opportunity to try my luck, without worrying about his numbers of successful cases. But I was not lucky enough, I did not respond well with the hormone medication and my cycle got cancelled, The IVF process was filled with so much hope and prayer that its failure was unbearable. Dr Malpani and Anjali Malpani took time to explain me things and he said nothing wrong that - you tried; it was worth of trying to rule out the option and for your own peace of mind, now you have more options to explore and suggested me to try with donor egg .He explained in detail about the donor egg option. He himself does screen their donors for their health and for infectious diseases and match their physical traits with us. Also, he explained that we should focus only that egg should come from healthy woman, which he ensures.

I was really touched by his behavior as in all these years of meeting doctors I had come across with so many rude doctors who treats their patients like their slaves, in spite of paying their high consultation fees.

We again planned to go for IVF this time with donor egg and emailed him about our plans, again he responded very promptly and precisely , due to some family emergency I had to travel to India immediately , he understood our situation and planned everything over email , Everything was well arranged when we reached to Mumbai. He assured me to take care of my chores well and he will take care everything regarding our treatment. I was well taken care by Dr Anirudh and Dr Anjali , On the day of egg transfer I was very nervous , after reaching to the clinic I was taken care by his staff , I would say whole staff is very friendly and always smiling, before going to operation theatre I got chance to look at our embryos , at the OT , Dr Malpani was very friendly as always , he was talking to me for whole time to get me on ease .While talking he cleared many of my doubts regarding what should I do or not do after embryo transfer , he cleared all the myths which really set me on ease. I was transferred 4 beautiful embryos.

My decision of choosing Dr. Malpani was very easy , as back in mid eighties, there was big news in India Today magazine, for Doctor couple, “Young Achievers Dr Anirudh Malpani and Dr Anjali Malpani, a gift to infertile couples”, I was very inspired by them ,I never thought at that time that I will meet them and with their help I will be able to build my family. I am now 8 weeks pregnant and very thankful to Dr Malpani and his clinic and also have deep gratitude to my donor.

I found his web site extremely helpful , whenever I used to be in doubt and think what should I do , I just go to his web site and read the relevant topic and while reading I feel that I am talking to him in front of me. I used to get accurate information on his web site which clears all my doubts. I thank him for his contribution to the society for creating such informative resource. Also, I get very prompt and sincere reply for each of my email from Dr. Anirudh Malpani , no matter what the question is .

I understand that the journey of having baby for couple like us is very difficult , I will be happy if I could be of any help to my friends in making their decision, please email me at [email protected].

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Information Therapy - Power to the Patient

This is my first column in a series called Power to the Patient in India's leading health magazine called Prevention.
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Information Therapy - Power to the Patient

This is my first column in a series called Power to the Patient in India's leading health magazine called Prevention.
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How Healthwise is promoting Information Therapy in the USA

The USA is far more evolved than India is , as regards providing Information Therapy to its citizens , and Healthwise is the global market leader in this space.

Ken Long from Healthwise, USA, spoke about how Healthwise is promoting Information Therapy in the USA - and what the future holds. Information Therapy can allow us to engage patients, so that patients can make their voice heard !

He presented this talk at the 2nd HELP Conference on Using Information Therapy to Put Patients First !

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