Xenophobia: How the IVF industry are failing their patients.

On March 21st every year we “celebrate” the International Day for the Elimination of Racial Discrimination. The day itself is a remembrance of the Sharpeville massacre when, on March 21st 1960, police opened fire on a peaceful demonstration killing 69 people in Sharpeville, South Africa. 

The United Nations have recognised this day since 1966 and it is meant to earmark a time to reflect on the progress made toward racial equality and to provide a reminder that there is still a long way to go… No more so than in Medicine. 

We all hear plenty of news stories of people being shot for no other reason than skin colour, but rarely do we hear news stories of biased clinical trials. For decades, wide-scale racism has prevailed in the pursuit of pharmacological innovation with, usually African-Americans or Mexicans, used to trial “riskier” drugs and procedures. While White people are given the opportunity to be candidates for exciting, low risk trials that will likely improve the quality of life for its participants. 

In a study entitled "More than Tuskegee: Understanding Mistrust about Research Participation”, 2010, the authors highlight why it is now more difficult to recruit African Americans to clinical trials due to a general mistrust. The Tuskegee trial being an experiment on syphilis involving African Americans where researchers failed to collect consent for their participation and to deliver readily available treatment to its affected participants. The trial ended in 1972. 

The history of medical experimentation on minority races and classes is a long, dark one but there’s another racial discrimination going on that we all seem to have gladly accepted. One in which I find myself even falling into the trap of… That is, the acceptance of “Chinese” and “Western” Medicine being differentiated as such. 

As Frederick F. Kao first wrote in a special edition of the World Health Magazine published in 1969, “why do we discuss medicine in such isolated and culturally relative ways, while disciplines like chemistry, mathematics and physics know no such boundaries?” Yet here we are, 56 years later, still viewing medicine derived in foreign lands as ‘the other’. And yet all modalities of medicine have a common purpose —to cure and relieve the human body. Perhaps they should not compete but rather complement each other? 

The special edition magazine was published following a symposium on acupuncture where the WHO highlighted over 100 medical conditions where acupuncture could be identified as an effective form of treatment. Infertility was among those on the list. Since then, a myriad of clinical trials involving acupuncture alongside IVF, or acupuncture as a standalone treatment for infertility have been carried out, all showing the same outcomes - that acupuncture significantly increases pregnancy outcomes, live birth rate, has a positive effect on pregnancy symptoms, can be used effectively to induce labour and women who have used acupuncture in their pregnancies have less complications in labour *. So, with infertility affecting 1 in 6 couples and with the maternal death rate rising sharply in recent years (Gregory & Thomas, 2024), why isn’t acupuncture used to complement NHS services and reduce the need for expensive IVF provision and emergency obstetrics departments? 

An unwillingness for Western medicine to accept a Chinese treatment modality widely considered to be appropriate and effective for fertility patients - could this be as simple and as senseless as racial prejudice? 

Acupuncture is widely considered an incredibly safe form of medical treatment. We’ve all watched the movie Joy… those women who participated in the early IVF trials were told that it may not work. The participants were still willing to give it a go even though they were pumping drugs previously only tested on rats into their bloodstreams. I’m pretty sure that, given the choice, if women were told they could have a treatment that is widely considered to be effective for fertility, is considered safe with no side effects, and will cost EVERYONE a great deal less money they would bite their arms off for it! 

So what is holding us back if it’s not racism? Well, at the end of every clinical trial involving acupuncture it will say that the trial wasn’t “robust’ enough and that “future high-quality ‘randomised controlled trials’ (RCTs) are needed to confirm our findings”. That’s great! So who’s going to pay for it? Well, not the pharmaceutical companies since they have nothing to gain in legitimising acupuncture. Not the IVF industry - it would be like signing their own death warrant. The acupuncture community? Sure! We’ve all got a cool few million we can pitch in to get the job done. The sad fact remains that unless the motivation for RCTs is to actually help people rather than for monetary gain, acupuncture will never receive the acceptance it deserves. 

Interestingly however, the Scandinavian countries, (who were ranked among the top countries for racial equality by the International Convention on the Elimination of All Forms of Racial Discrimination (ICERD)) actually recommend acupuncture to be used alongside all ART treatments with most fertility clinics offering an in-house acupuncture service. Is it a coincidence that these clinics also rank highly for ART assisted birth rates, with Denmark having the highest number of babies born via ART?

China, acknowledging the importance of both forms of medicine, have an integrated approach. And, much like China, I’ve sought to do the same in our clinics. 

If science is the pursuit of fact, surely modern medicine is the vessel in which to honour those facts. The fact is, acupuncture works for fertility, let’s honour it and by doing so help a good deal more people become parents. And perhaps, going forward, we can all just call it “Medicine”!



References
* The pregnancy rate was significantly improved with treatment (RR = 1.84, 95% CI 1.62 to 2.10, P < .00001), compared to that in the control group. Subgroup analysis showed that comparing with pure western medicine intervention, no matter intervention with acupuncture alone, with acupuncture plus western medicine, with acupuncture plus Chinese medicine, or acupuncture plus Chinese medicine and western medicine, all of these subgroups exhibited significant improvement. The subgroup according to different types of infertility showed a significant improvement in infertility caused by polycystic ovary syndrome, tubal infertility, ovulatory disorder, and other factors. In addition, the ovulation rate and endometrial thickness were significantly increased. The level of LH was obviously decreased. Moreover, with acupuncture, less adverse effects occurred.

Scharff et al, 2010, More than Tuskegee: Understanding Mistrust about Research Participation [https://pmc.ncbi.nlm.nih.gov/articles/PMC4354806/]

Frederick F. Kao, 1969, WHO publication, The talk of the town: "Western" or "Chinese"—why do we discuss medicine in such isolated and culturally relative ways, while disciplines likechemistry, mathematics and physics know no such boundaries? [https://iris.who.int/bitstream/handle/10665/351993/WH-1979-Dec-eng.pdf]

Yun et al, 2019, Acupuncture for infertile women without undergoing assisted reproductive techniques (ART): A systematic review and meta-analysis [https://pmc.ncbi.nlm.nih.gov/articles/PMC6709164/pdf/medi-98-e16463.pdf]

A. Gregory & T. Thomas, 2024, The maternal death rate increased,maternal deaths in the UK.
[https://www.theguardian.com/society/2024/jan/11/number-of-women-in-uk-who-die-during-pregnancy-rises-sharply#:~:text=]
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World Population Review, Least Racist Countries 2024, [https://worldpopulationreview.com/country-rankings/least-racist-countries]