Let the reader beware - making sense of medical stories in the news
from the book How to Have a Baby:
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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Most infertile couples are aware of the dramatic advances reproductive
technology has made in the recent past, and many of them rely on the media (TV,
radio, newspapers, magazines) to remain updated with the latest news about
However, many news stories about infertility treatment are often misleading
and incorrect, and there are many reasons for this. Remember that news, by its
very definition, implies something new and unusual. The media is often guilty of
oversimplifying or exaggerating results , and headline writers may focus on an
angle that gives a distorted impression, which often means that facts are
sacrificed at the altar of readability or circulation figures. Since space is
limited, many reporters do not provide a balanced perspective, and often focus
only on the success stories, so that pictures of doctors and couples holding
newborns are very common. While these do provide excellent photo-opportunities,
the sad stories of the many failures never sees light of day. Newspaper articles
usually paint a very rosy picture – but these often lead patients to have
false hopes and unrealistic expectations. Many reasons can be attributed to the
somewhat shoddy standard of reporting in the lay press with respect to
infertility. Editors crave for stuff which is ‘new’ and doctors and
hospitals are only to happy to tom-tom their latest gadgets and gizmos.
Reporters are often not specialised enough to understand the medical technical
background. Often, they do not do their homework properly, which results in
misreporting, which is, unfortunately, a common occurence in India.
The outcome is that patients are often confused and are not sure how the
latest advances in reproductive technology apply to them, so that they often
rush to their doctor’s clinics with the cutting in hand ! The report often
raises false hopes and gives them unrealistic expectations. As a result, the
media loses credibility, so that they often end up performing a disservice to
patients and their doctors. Because the public is eager, for any scrap of
medical news, the media often reports individual studies out of context, as if
each study could stand alone. However, single studies rarely yield a simple ‘yes’
or ‘no’ answer to a medical question. One ought to realise that scientific
discovery is a process that often takes years to unfold, and an individual
medical report or isolated success story means little. Remember, that new does
not always means better ! For example, many doctors have started using lasers in
the IVF laboratory. However, whether these actually help to increase pregnancy
rates is still unproven. Nevertheless, patients get carried away easily by the
glamour of this "new technologic advance", and are happy to pay more
for the use of the laser, even though it may not help them increase their
chances of conceiving. This is why some cynics have suggested that the term
LASERS should stand for "Latest Advanced Source for Extra Remuneration for
What can you do to separate the wheat from the chaff ?
First of all, identify the source of the story. Does the information come
from a reputed publication (such as The Lancet) or a leading medical
professional organisation (such as the American Heart Association)? Second, look
beyond the statistics. When reports hurl at you statistics like ‘a 50 per cent
pregnancy rate ‘, take a closer look at the exact numbers. Many of us get ‘turned
off’ by numbers, but this attitude can prove dangerous: you need to ask
yourself what the numbers really mean and how they apply to you? Benjamin
Disraeli once remarked that there are three kinds of lies: lies, damned lies and
statistics. Remember that statistical methods are simply tools, and they can
produce blatantly wrong conclusions unless sensibly used. How many patients were
treated ? How were they selected ? Have these results been consistent ? Have
these results been confirmed in other studies and other centers ?
One important safeguard against imperfect or flawed scientific reporting is
peer review; i.e., scientists scrutinize each other's work in advance. Almost
all well-respected scientific journals rely on peer review to select papers for
publication. Any study that has not undergone peer review should be regarded
with the utmost scepticism. For example, one should be wary of findings
announced at a press conference that are not accompanied by publication in a
journal or by a presentation at a scientific forum. Many doctors and clinics
will send out press releases to get media attention, in order to attract more
patients, even though the information they provide to the press may not be
reliable or trustworthy.
Inappropriate use of technology
While it is true that reproductive technology does represent one of modern
medicine’s success stories, the wide range of technological advances in
reproductive medicine can leave many infertile patients feeling completely
confused. How is a patient to make sense of which technology may be useful for
his particular problem? New technology can be dazzling, and undoubtedly, when
reproductive technology is used properly, it can help many infertile couples to
have a baby. However, technology can be a two-edged sword; and we need to
remember that every rose has its thorns! For example, growth hormone was
introduced as an adjuvant for superovulation in the early 1990s with great hopes
and expectations, and leading doctors announced at many conferences that growth
hormone helped to improve pregnancy rates dramatically. Unfortunately, these
claims were found to be unfounded, and no one uses growth hormone anymore.
However, many patients ended up wasting large sums of money.
What can you do to protect yourself ? Remember that fashions come and go in
medicine as well, and many doctors are happy to jump onto the latest bandwagon,
so that they can present papers at conferences and give lectures, to show that
they are the leaders in the field. When you read a report of a new advance, it’s
usually a good idea to let the froth and the hype to settle down before
accepting it. If it is in fact a real advance, it will be replicated in many
centers all over the world – remember that the best way to assess the true
value of a treatment is to see whether it can withstand the test of time !
You need to be aware of the following inappropriate uses of technology in
reproductive medicine today, so that no one uses you as a guinea pig .
- Excessive use of technology, even when it is not required. A prime example
of this ‘folly’ is routine ultrasound scanning to "time "
intercourse. While no one will dispute the fact that ultrasound scanning can
provide extremely useful information on ovulation, to use this simply to
time intercourse only adds to the infertile couple’s stress !
- Use of technology which is not suitable for a particular patient. An
example of this would be advising IVF (in vitro fertilization) for all
infertile patients, just because the equipment and expertise are available
and because the procedure is technically feasible. However, for most
infertile patients there are many simpler treatment options available, which
should be fully explored before considering IVF.
- Misuse of technology by unqualified doctors. A common example is the use
of lasers or endoscopic equipment for complicated surgery. Just attending a
two-day workshop and acquiring a certificate do not make a doctor
sufficiently expert in using this technology; a number of mishaps have been
reported because of operator inexperience.
There are many reasons for the inappropriate use of medical technology. For
- The major factor, of course, is money or the need to generate income.
Doctors need to justify the purchase of expensive incubators and
micromanipulators, and as hospitals have become profit-oriented
organizations, doctors are becoming increasingly answerable to the
management regarding the profitability of their services. Nowadays, once a
piece of equipment has been purchased, it needs to be ‘utilised’ to make
it ‘cost-effective’. Woe betide the doctor who does not generate enough
money through the latest gadgets! He may find that his contract is not
- The glamour and the dazzle of the latest medical gizmos tend to lure most
doctors, and this can be as tempting as wanting to drive the latest model
car! One gains prestige by being the first to adopt the latest technique; or
by being the only one in the world/country/city to possess the latest and
- The pressure from manufacturers to buy the ‘latest and newest’. ‘New
and improved’ versions prove attractive, not only to toothpaste consumers,
but also to doctors, and the medical industry (both equipment manufacturers
and pharmaceuticals) has developed powerful tactics and techniques to induce
doctors to prescribe and use their newest products. The companies involved
can afford to spend large amount of money on advertising, and they use this
capability very effectively to maximize their profits.
The most crucial question is: how can you intelligently apply what you have
read to your treatment? Make sure you are well-informed, so that you can
critically assess the reported advance, and judge its relevance (as it relates
to your problem ) for yourself. Make it a point to ask your doctor as well !
Your own doctor can help you make sense of the technology, and put it in the
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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