Doctors – Scientists

and/or Healers ?

 DrAnjali Malpani, MD
 www.drmalpani.com
Conventional v/s Alternative
Medicine – who Decides?
 Money
 Colonisation
 High Tech
 These have made Western
medicine occupy the premier
position
 Conventional v/s Alternative
Medicine
Yoga, Ayurveda and Chinese
medicine have a much longer
tradition than modern medicine

In Germany homeopathy is
mainstream medicine –not
alternative!
Doctors are Sceptical
 Lack
of available scientific
documentation and evidence
• No need to be critical and
dismissive

• No need to look down upon

these treatments just because
there are no publications !
Wake up!
 40% of all
infertile
patients
use
some form of
CAM
Doctors don’t know
everything
 Doctorsneed to be humble,keep
an open mind and be willing to
learn!
Jenner “discovered” vaccination by
being willing to listen to cowgirls!
Alternative medicine is
usually self-prescribed
Why do patients look for
alternatives in the first place ?
Because they are not happy with
modern medicine !
Good doctors need to be
empathetic and to acknowledge
this fact
Scientists or Healers?

“ART” specialists
have lost the
ART of Medicine
 Alternative Therapy

Why ?
When ?
Who ?
How ?
Why?
 Holisticapproach
 Personalized touch
 Patients experience control
over their situation- “doing
something themselves”
 Low cost
 Avoid side effects of drugs
When?
 When they have been given
the frustrating diagnosis of
“unexplained infertility”
 When they have failed
standard fertility treatments
 To maximize their chances of
having a child
 Cultural beliefs
How do they work?
 Bringing the body back into
balance?
 Reducing stress level?
 Placebo effect?
Who Benefits?
 Unexplained infertility
 Ovulation disorders
 IVF waiting list “ treatment
independent “ pregnancies
Integrative Medicine

 Alternative therapies are

very often used in
conjunction with
conventional treatments
 Prior to undergoing
treatment
 Patientswill often not tell us
that they are using CAM

 Are scared that we will

criticize or pooh-pooh these
Show Me The Data!
 Western Medicine is evidence-based
Medicine

 Efficacy of a treatment has to be

proven scientifically by convincing
experts and scientific committees

 The Randomized controlled trial

(RCT) is considered the “gold
standard” for evaluating the effects
of interventions.
Why are there no trials
in alternative medicine ?
 Too expensive, not enough funding
 No money to be made by
pharmaceutical companies
 Drugs cannot be patented
 Difficult to enroll patients for these
trials
 Difficult to conduct double blind
trials
Lack of evidence of an
effect
does not equal
evidence of the lack of
an effect
Anecdotal successes
 Story of the old man and the
starfish
“Not everything which
counts can be
measured,
Not everything which
we can measure is
worth counting.”
Einstein
New trend
 Patients are doing research
for themselves
 Social networking
 Health 2.0
 www.patientslikeme.com
Why are doctors
sceptical?
 Quackery flourishes as
there is no formal training
required and there is no
monitoring of practitioners
of alternative medicine.
Dubious?
 That’s fine

 We should be!

 Butwe need to be equally

skeptical about all medical
interventions!
Modern medicine also uses
Untested and unproven
treatments!
• DHEA as a miracle drug in the
treatment of poor responders; hype or
hope? Human Reproduction. Kayhan
and Urman
• Is recombinant FSH really better than
urinary HMG ?
• Male infertility treated with hormones,
vitamins,antiestrogens.
• Operative treatment of varicocoeles
• IVIG for treatment of repeated IVF
failures
Evidence-Based Medicine :
can the evidence be trusted?
 Many well reported RCTs
are
designed to deceive by
biased study designs!

 Vested financial interests!

 Manipulation of statistics to
produce desired outcomes
that are selectively
reported.
Keep an open mind

 Rather than looking down

upon alternative medicine
treatments it is better to be
accepting and be willing to
learn from our patients
Different Methods of CAM
Alternative Medical Systems
• Ayurveda
• Homeopathy
• Naturopathy

Manipulative Bodybased Therapies

• Acupuncture
• Massage
• Chiropactry
• Osteopathy
Mind body Therapies
 Yoga
 Meditation
 Reiki
 Hypnotherapy
 Aroma Therapy

Diet based Therapies

 Chinese herbs
 Vitamin therapy
Commonest methods
 Acupuncture

 Chinese herbs

 Yoga and Meditation

Acupuncture
Acupuncture – how does
it act?
 Acts centrally by increasing B-
endorphin levels which in turn affect
the HPO axis and GnRH secretion

 Acts peripherally by increasing the

uterine artery blood flow and hence
improving endometrial thickness and
implantation.

Chang and Rosenwaks –Fertility and Sterility

Vol 78,No.6, Dec 2002
 How does Yoga help?
 Has a calming restorative effect on
the mind and body

 Reduces stress levels

 Reduces depression

 Feeling of control over one’s

reproductive destiny
 How does Yoga Help?
 Improves strained
relationships

 Helpsto cope
anxiousness, nervousness,
helplessness

 Reduces emotional stress

One cannot control what’s
happening to your body
but you can control how
you feel about it!
What is success?
We need to redefine the
term success

pregnancy? or
patient wellbeing?
 We
need to acknowledge that
CAM works!

 How it works really does not

matter
 Information Therapy

 Better
to be an
agnostic rather than
an atheist

 It’s
fine to say – We
do not know!

 Cannotbe an expert
on everything !
Patient – centered medicine
 Putting Patients First !
 Respect patient’s desires
 Best to offer all complementary
therapies under one roof
 Integrative medicine combines
conventional medicine and
CAM
 Why lose your patients to
another doctor ?
 Best to keep an
open mind
 The “ label “ does not
matter ! We need to do
what’s best for our
patients
 This is not a competition.
We are all on the same
side!