Tuesday, November 07, 2006

Clear Passage Therapy - taking infertile patients for a ride !

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Clear Passage Therapy - taking infertile patients for a ride !
One of the most seductive websites for infertile patients today is the Clear Passage Therapy website, which offers infertile women a “natural” way of getting pregnant. If I were infertile, and if I were not an infertility specialist, I am sure I would get taken for a ride by this site too. Let’s look at their claims a little more closely, and see why they are so useless. The number of things they claim to achieve by simply massaging the pelvic organs is incredible – and amazing. Not only do they claim to cause adhesions to “melt” away by breaking them; they also believe that massage will help to improve ovarian function by reducing FSH levels by improving blood flow.This is all rubbish ! Let’s look at adhesions first. Adhesions are made of fibrous scar tissue. They form during healing, and once they are formed, the only way of getting rid of them is to remove them surgically. In fact, often this surgery is also not helpful, because these adhesions will reform again. How anyone can even imagine that massage could selectively cause the fibrous scar tissue to “melt away” without also tearing and damaging the normal organs is beyond my imagination ! Similarly, there is no way to increase blood flow to internal organs by simply massaging them ! If one could do so, then doctors could bypass bypass surgery by referring patients with angina and heart attacks for massage therapy, to improve blood flow to the heart as well ! I must admit the Clear Passage owners are very smart – they have cleverly chosen to focus on infertile patients. This is a heterogenous population , and we all know that many patients with unexplained infertility will conceive no matter what you do. Of course, if you happen to treat them with Clear Passage, then you can claim that the pregnancy was a result of your treatment – and this patient then becomes one of your “success stories” ! If you treat enough patients, you will have many successes – often not because of your treatment, but inspite of it ! This is also a clever technique , because it is “hands on”. Patients feel good about it because they feel that something concrete is being done, which they can actually see - and feel ! Moreover, because it is non-surgical and inexpensive, it is also very appealing !Everyone wants to get into treating infertility – and physical therapists are no exception ! Infertile patients are a highly motivated group, and because treatment is often not covered by insurance, they will pay for these services themselves ( the lucrative “ fee for service” group ). Moreover, it’s easy for infertile patients to identify themselves as being infertile, so they can self-refer themselves. Another benefit is that they are unlikely to have any complications as a result of the treatment. ( Most likely , they will continue to remain infertile even after the massage, but this is hardly a complication !)What amazes me is why such few doctors have raised objections to these ridiculous claims ! Perhaps most doctors just acknowledge that this is ineffective treatment, and feel that the best option is to ignore it. And if patients choose to waste their money, why should their doctors stop them ? Cleverly, CPT has now positioned itself as an adjunct to IVF treatment, by claiming that Clear Passage Therapy helps to improve IVF pregnancy rates too ! Patients who are spending thousands of dollars on IVF are quite willing to spend a little more on CPT if it will increase their chances even a little bit ! However, the reasoning is completely incorrect . The so-called medical studies which they tout, which they have published in “ medical journals “ ( an online low impact journal called Medscape General Medicine) are fatally flawed. None of these are prospective randomized studies ! They just compare IVF pregnancy rates in women who did IVF in the past without CPT; and are now doing IVF again after doing CPT. The apparent improvement in pregnancy rates could simply be because they selected a better IVF clinic the second time around – or the doctor modified their treatment, based on the results of the first failed IVF cycle. However, by quoting statistics, they know they have won the battle, because most patients are simply not sophisticated enough to analyse the numbers or even to try to make sense of them. They believe that if they are quoting “ statistics”; and if the studies have been “medical studies” published in “ medical journals” , the stuff must be valid and reliable. The website is full of clever touches. It is peppered with articles which have appeared in the lay press ( most of which simply repeat the same information ad nauseam, and seem to be based on clever press releases); as well as a dramatic photograph of Mrs Wurm closely scrutinizing a hysterosalpingogram, and stating that her therapy opened a tube which had been blocked ! ( I wonder if the US government approves of Physical Therapists interpreting X-rays ?) There is no question that “alternative medicine” is becoming increasingly popular in the US. CPT has cleverly got on the bandwagon, and added a new wrinkly by “patenting” their technique of massage, by adding a generous helping of technical terms ( most of which are hocus-pocus) to their description of what they do. I quote, “ site-specific manual soft-tissue therapy improves soft-tissue mobility, elasticity, and distensibility. Theoretically, mobilization of the soft tissue may break collagenous cross-links and adhesions that cause pain and dysfunction, including physician-diagnosed mechanical infertility.” Lots of gobbledygook and jargon, full of sound and fury, signifying nothing !I must also admire their clever selection of a very evocative name – “Clear Passage” , which suggests that the massage clears the passage of the eggs and sperm through the tube ! I was very intrigued by the fact that they claim to have a patent pending for their technique ( after all, what could be patentable about massage therapy, which has been practiced for centuries all over the world ?) They claim that their “ non-surgical therapy is so unique that we have been granted US patent protection” . I did a search at the United States Patent and Trademark Office website website for Wurn or “clear passage” – and came up with – zip ! Are they lying ? I’d like to quote the Quackwatch website on Massage Therapy. “ Ordinary massage and the legitimate practice of massage therapy can help people feel better. However, many practitioners falsely claim to do much more, and the agencies that oversee the educational and licensing systems display no evidence of concern about this. If the therapist tells you what is wrong with you, the therapist is probably wrong and breaking the law to diagnose ! “The problem with Clear Passage is that they are using clever marketing tools to take advantage of vulnerable patients. By making them waste time and money , and raising false hopes, they are doing the infertile community a disservice. posted by Dr Aniruddha Malpani, MD @ 5:14 AM

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