Tuesday, April 29, 2014

Why are infertile women willing to acts as guinea pigs ?

I see lots of patients who have had numerous unproven experimental treatments, such as IV immunoglobulins, hysteroscopic metroplasty and immune therapy with paternal lymphocyte immunization.

I sometimes wonder why patients are willing to subject themselves to these treatments . They are expensive , have risks, and have never been proven to actually improve pregnancy rates .

Now I can understand why doctors want to push these treatments. They can charge a lot more of them, because they can sell these options as being “the latest, cutting edge technology”.  Doctors enjoy playing the game of one upmanship. They want to offer stuff which is new, because they want to show patients they are better than the other doctors !

The danger is that when patients sign up for these treatments, doctors are not frank and forthright in telling them that these treatments are still being tested and have not been clinically proven to be effective. The doctor frames these treatments as being “ state-of-the-art “ , and that they can do stuff which other doctors cannot !

It’s quite easy for doctors to take patients for a ride. They are often na├»ve and emotionally vulnerable. They are happy to trust their doctor. After all, the very fact that they have selected this doctor means they think he is the best !  Because most patients don’t bother to do their homework or invest in information therapy , they are easy to dupe. This is especially true when they have failed multiple IVF cycles . They are quite happy to sign up for whatever the doctor suggests.

Now while it’s fine to offer these new options in a controlled clinical trial setting , it’s not fair to do this by pretending to the patient that these treatments improve pregnancy rates. Sadly, doctors will not even bother to document the results of their interventions, and will continue tom-tomming their anecdotal successes to prove that their treatment works.

Patients need to insist that doctors practice evidence-based medicine . The truth is that it takes time for medicine to find the truth. Newer technology does not always improve success rates – and it can often harm the patient, because of the “learning curve” associated with anything which is new. The treatment intervention has to be repeated many times and we have to analyse the experience of many clinics , before we can judge whether or not a particular treatment is actually clinically beneficial or not.

Doctors can be very good at “selling” these treatments to their patients. They are happy to charge more for them, which means patients are actually paying for the “privilege” of being guinea pigs. Doctors wax eloquent about the difficult cases they have treated successfully with the gizmo – and patients are not sophisticated enough to cross-question their doctor, or read between the lines.

The medical device industry is very happy to promote these gadgets , and few doctors are willing to listen to the voice of reason in the clamour and excitement to be the “first” to offer the newest technology. The media also helps to make a bad situation worse, by uncritically promoting and reporting the “new” treatment as being “news”.

Patients are often fascinated by what is new, because they naively believe that “new is better”. However, this is not always true in medicine , where older, time-tested and proven techniques are often the better and safer option.

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