Sunday, June 11, 2017

Why is overtreatment of infertility so rampant?

Lots of Indian IVF doctors put their patients on anti-TB medicines . While some of them will do tests to decide which patients to treat with these toxic medicines, others routinely put all their patients on the drugs, irrespective of whether they actually have TB or not.  Thus, in the Ashvini Hospital of the Indian Navy in Mumbai, all infertile patients are put on anti-TB treatment " empirically".

I have often wondered why medical treatments which are completely unproven have become so prevalent. In this case, it's obviously not driven by financial considerations - after all, it's not as if the Navy doctor makes more money by prescribing this treatment !

The truth is that overtreatment is rampant because of a common fallacy which it's very easy for doctors to fall prey to. They suffer from skilled ignorance and unawareness. This is the fallacy of expertise , where they don't know what they don't know

If you give unnecessary treatment to infertile women who don't need it, lots of them are going to get pregnant. The point of course, is they would have got pregnant whether you'd put them on the anti-TB medicines or not, but you have no way of judging that.

Since all human beings are biased , and because doctors don't carry out controlled clinical trials, they naturally start believing that it was the anti-TB treatment which they prescribed which caused the patient to get pregnant. Patients also contribute to this misconception, because when they get pregnant , they go back to the doctor with a box of chocolates. When they don't get pregnant, they drop out. This is  why over-treatment has become so prevalent.

In fact, the same principle applies for many ineffective treatments. Thus, if you do IVF only for patients who actually need it, which is, for example, women with blocked tubes, then your pregnancy rates are going to be average. But on the other hand, if you start doing IVF for everyone who comes to you, whether they need it not, then obviously your IVF pregnancy rates will go through the roof, because then you'll start doing it for young women with unexplained fertility, or for women who are just getting anxious and didn't need IVF in the first place . These are the women who had an excellent chances of getting pregnant on their own even without the IVF.

However, when they do get pregnant, they tell ten of their friends that they got pregnant thanks to the IVF, so that the doctor gets even more patients ! This sets up a positive virtuous cycle, where the doctor ends up doing lots of unnecessary IVF , and achieves a high pregnancy rate because of clever patient selection.

The doctor then starts believing that his IVF pregnancy rates are far better than anyone else , but is actually deluding himself , because he is doing it for lots of patients who didn't actually require it ! However, this ploy means he starts attracting lots of infertile patients from the community , all of whom end up getting overtreated, because they demand the same IVF treatment which helped their friend to have a baby !

This is why IVF has become so overused and misused in some IVF clinics.

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1 comment:

  1. . My repeat beta hcg on 23/07/2017 was 10854, and on transabdominal untrasound on 28/07/2017 found IUP with g-sac of 1.41cm and fetal pole of crl 0.037 cm. 6w, 0 days but no heart beat seen. doctor advised to repeat usg after two weeks and am scheduled for day after tomorrow. respected sir please advice is the pregnancy progressing normally. she has severe nausea and occasional vomiting and hiccuffs all the time these days and feels giddiness all the time. she has been prescribed prognova 2 mg 2 tablets twice, inj gemstone 100 mg once daily, tab duphaston 10 mg once, tab Medrol 4 mg once , tab fol-xt once, tab ecosprin 75 mg once, cvapsule evion for vit e supplementation once daily. Further she has been prescribed oral rehydration liquids to ease dizziness. sir pl advise.


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