From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med.nutrition,alt.food.vegan
Subject: Re: Vegetarianism, Diet, and Sexual Desire
Date: 27 Jul 1998 06:40:45 GMT

In <6pfm6p$stq$1@europa.frii.com> Kate McDonnell
<kate@prometheus.frii.com> writes:

>In alt.folklore.urban Steven B. Harris <sbharris@ix.netcom.com> wrote:
>> Vegan diets lower estrogen in women
>> (though not in men), but I can find no evidence that it lowers
>> testosterone in either sex.
>
>I wonder whether a carnivorous diet would naturally have the
>effect of increasing estrogen in women, or if this effect is due
>to residual steroids or other hormones used to promote cattle
>growth in the meat industry.



   No, it's apparently due to enterohepatic ciculation of conjugated
estrogens in the normal woman.  They get conjugated in the liver,
secreted in the bile, get reabsorbed, and so on.  Fiber traps some of
these estrogen conjugates, and they go out of the body in the feces
without going round again.  Feces of vegetarian women have been proven
to contain more estrogen, so it's not just a theory.  High fiber diets
do lower estrogen in women.

                                    Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.health.alternative,sci.med
Subject: Re: Raloxifen/Evista for Breast Cancer [was Re: Animal Testing (was 
	Vitamin Vultures (was Re: Life Extension HIV protocol))
Date: 20 Dec 1998 10:26:06 GMT

In <367CA1B7.569D@netcom.ca> Tom Matthews <tmatth@netcom.ca> writes:

>Steven B. Harris wrote:
>
>>     BTW, this debate is all going to be academic soon. I just heard
>> results of a 13,000 woman study of the estrogen-like drug
>> raloxifen/Evista. At 4 years there is no increase in uterine or ovarian
>> cancer, but 70% of new breast cancers have been prevented in the drug
>> group (with respect to placebo). And the stuff prevents and treats
>> osteoporosis in the bargan. Only major side effect is one Tamoxifen and
>> natural estrogens share: a tendency to produce abnormal clotting for
>> the first year of use. But lives saved from breast cancer prevention
>> far outweighed deaths from clotting.
>
>Can you avoid the clotting effects with aspirin, vit E, fish oils, etc
>and still have all the benefits of the drug?


    I have no idea, though it seems a reasonable thing to try (I
certainly, after careful screening, put all my first time users of
either estrogen or Evista on half doses for the first year, and I do
indeed add aspirin and E for everyone who doesn't have a
contraindication).  The next big estrogen study should certainly
include an aspirin+E arm.

     The real question is whether or not Evista works as a replacement
estrogen (which it does only partly), but whether or not it might
prevents the bad effects of replacement estrogen, while allowing some
of the good ones that estrogen does as well or better than Evista (such
as estrogen's superior effects on bones, lipids, and perhaps even brain
and memory).  Nobody knows THAT, either.  Evista's best role might well
be to act as a kind of super-progesterone, but one with protective
effects from estrogen not only on the uterus (which progestins gives),
but breasts as well (which progestins do not).  I see no reason why
this is probably not the case, but it remains to be proven with a three
arm study that contains an Evista PLUS estrogen arm.  I've been
pounding on Lilly reps to take this up with their Masters, and they
promise they will.  Lilly probably doesn't want to admit that its new
drug isn't all things to all people, but of course one day they'll have
to.   Better to start now.

                                     Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.life-extension,sci.med.diseases.cancer,sci.med.nutrition
Subject: Re: Genistein and blood clotting
Date: 5 Apr 1999 10:29:11 GMT

In <37088B8D.4C96@netcom.ca> Tom Matthews <tmatth@netcom.ca> writes:

>Soy estrogens do *not* convert to any of the three human estrogens
>(estradiol, estriol, estrone) which can  interconvert.

Partly intraconvert.  Generally it goes estrone-->estradiol-->estriol,
and never the reverse.


>What they do to the cell depends on the how the receptor 'sees' them and
>responds. Generally, while they tie up the receptor, there is little
>response on the 'inside' of the cell.
>However, I think that you are correct, there may be cell types where the
>response is quite strong even with phytoestrogens.


    Yep.  Plants don't make estrogens for nothing, you know.  They're
birth control chemical warfare for animals that eat those plants.  The
genistein in red clover makes sheep eating a lot of that plant
infertile as long as they do.

                                          Steve Harris

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,sci.med.pharmacy,sci.med.nutrition
Subject: HRT (hormone replacement)
Date: Wed, 10 Jul 2002 20:33:24 -0700
Message-ID: <agiub8$dam$1@nntp9.atl.mindspring.net>

> Gerald Clough
>
>    A friend of mine had this take on the HRT story from yesterday. Any
>comments?
>
>> This is another one of those things where, even with the investigators'
>> public caveats, people can't really make reasonable use of the results.
>> While the numbers are statistically significant, look at what it says in
>> absolute numbers. Heart disease and breast cancer, two of the foci of
>> the study, showed a difference in 7 and 8 cases per 10,000
>> patient-years, which was an increase from 30 to 37 and from 30 to 38 per
>> 10,000. Sure, that a "23 percent increase", but it's more realistically
>> an increase of from 0.3 percent to 0.37 percent risk per patient-year.
>> So, unless I read it wrong, the risk only goes up 0.07 percent on
>> account of the therapy.

COMMENT:

They stopped the PremPro arm of the WIH study before they could tell if the
total mortality was going to increase or not, but it's a safe bet that it
will, since breast cancer is deadlier than hip fractures. As a drug, PremPro
is dead, and I imagine the biggest class action lawsuit in the history of
medicine is brewing against Wyeth, which has been selling Premarin for 60
years.

To quote from the JAMA:

"The absolute excess risk (or risk reduction) attributable to estrogen plus
progestin was low. Over 1 year, 10 000 women taking estrogen plus progestin
compared with placebo might experience 7 more CHD events, 8 more strokes, 8
more PEs, 8 more invasive breast cancers, 6 fewer colorectal cancers, and 5
fewer hip fractures. Combining all the monitored outcomes, women taking
estrogen plus progestin might expect 19 more events per year per 10 000
women than women taking placebo. Over a longer period, more typical of the
duration of treatment that would be needed to prevent chronic disease, the
absolute numbers of excess outcomes would increase proportionately."


Here's some Q and A from the LA-GRG reading group; Comments by me.


Q:Do you know whether the hormones they were administering in that HRT study
were of equine origin (or otherwise not molecularly identical to
human estrogen and progesterone)?  I've been wondering for a while if that
might be behind the increased incidence of cancer with HRT.

COMMENT:
The recent Women's Health Initiative (WHI) trial reported in JAMA and in the
news yesterday, and stopped because of increased breast cancer incidence,
used equine estrogens (Premarin = pregnant mare's urine) plus a progestin
(=synthetic molecule with progesterone-like action, in this case
medroxyprogesterone = Provera). The product actually used is made by Wyeth
and is called PremPro (for Premarin/Provera). Wyeth's stock took a beating,
needless to say.

Q:
My layman's understanding, from what I've read, is that most "estrogen" on
the market today is of equine origin; that human and equine estrogen
are each composed of several different kinds of estrogens, in different
proportions, and that there are substantial chemical differences between
what humans produce and what horses produce.


COMMENT:
Though the most common estrogen product on the market is Wyeth's Premarin
and Prempro, there are many products which contain simple synthetic
estradiol, same as in the human body. Alas, few trials have used these
because drug companies will not put up research dollars for the trials,
because the native hormone is unpatentable. This is exactly the problem we
have getting research done on vitamins. We don't KNOW what the long term
effects of the pure estradiol, much less estriol are, in humans. We've
just gotten around to looking at Premarin, and that's been available since
WW II, and is the number #3 selling drug in the country!  So don't hold
your breath.

Q.
And isn't Progestin also of equine origin?

COMMENT:
No, but progestins by definition (including Provera) are synthetic molecules
not to be found in nature.

Q:
The progesterone I take is Prometrium: of vegetable origin, and supposedly
made to have identical molecules to human progesterone.

COMMENT
That's correct.  Only very recently approved as an ethical
pharmaceutical, because of unpatentability issues (no money to get it
though FDA trials).  And for the same reason there are few studies on it,
and nobody knows really if it's going to be better than the progestins. I
will guess so, but can't prove it.


Q: I do not know if there is an identical-to-human estrogen product out
there -- does anyone else on the list know?

COMMENT
There is: Estrace and others. The estradiol patches and vaginal rings also
all release normal human estrogen (human estrogens are estrone, estradiol,
and estriol-- the first two are available pharmaceutically, and the third
from compounding pharmacists).

Incidentally, the question of "what now?" is about to hit the fan. Either
progesterone or a progestin must be used if an estrogen is taken by women
with a uterus, because of risk of uterine cancer with estrogen alone. But
it's beginning to look like Provera at least contributes to breast cancer
risk (since the estrogen-only arm of the WHI has not yet been stopped, and
some earlier studies like PEPI have suggested that estrogen alone has a
lower breast cancer induction risk).

We DON'T know if natural progesterone will cause the same breast cancer risk
when given with an estrogen. We don't know if natural estadiol will do so,
when given with a progestin.

Progestins as a class of drugs are starting to look like nasty things, but
we don't know if natural progesterone is better as an estrogen additive. We are
fairly certain that progesterone alone is safe.

Clearly, the estrogens of all kinds cause the venous and pulmonary clotting risk
(and probably including increased stroke and heart attack risk, which arises
from coronary and cerebral clotting).
And probably also all non selective estrogens increase breast cancer risk,
though there may be differences, and there are some "SERM" estrogen
blocking drugs like Evista which work like Tamoxifen and possibly would
decrease breast cancer risk (while still, alas, increasing clotting).

One thing I can guess from the data: any woman with breasts who is bent
on taking an estrogen to prevent colon cancer and osteoporosis, should
also be taking Evista (raloxifen) and aspirin. And if she has a uterus,
also Prometrium (natural progesterone). Since PremPro has gone down in a
big way, it's probably better to now stay away from both its ingredients,
and instead use estradiol or estratriol for the estrogen, and natural
progesterone/ Prometrium.  If you can get away with it symptom-wise,
Evista/aspirin and Prometium or Evista/aspirin, is the hormone
replacement likely to be the safest bet. Of course, without the studies
we can't know for certain.  Of course, some of this depends on what your
prior risk factors for stroke, breast cancer, heart disease,
osteoporosis, and colon cancer are.

SBH

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,sci.med.pharmacy,sci.med.nutrition
Subject: Re: HRT (hormone replacement)
Date: Thu, 11 Jul 2002 13:26:59 -0700
Message-ID: <agkpno$oah$1@nntp9.atl.mindspring.net>

Hillary Israeli wrote in message ...
>In <agiub8$dam$1@nntp9.atl.mindspring.net>,
>Steve Harris <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
>
>*will, since breast cancer is deadlier than hip fractures. As a drug, PremPro
>*is dead, and I imagine the biggest class action lawsuit in the history of
>*medicine is brewing against Wyeth, which has been selling Premarin for 60
>*years.
>
>Why is Wyeth's fault? The drug was approved by the FDA.


So was fenfluramine. Class action settlement has been 5.8 billion.  So was
silicone for breast implants, and that broke Dow (however unfairly).


>The drug was
>prescribed by thousands of MDs. The drug was taken by thousands
>(millions?) of women. Don't these people bear any responsibility??


Sure. It all depends on what information is locked up on Wyeth's files.  I
personally don't think that Wyeth really knew or even had reason to suspect
the stuff would prove to increase breast cancer-- at least up to a few years
ago, or it wouldn't have funded part of this WHI study.  So they may escape.
I myself have suspected that estrogen/progestin combos were going to take a
rap since the outcome of the HERS trial recently. But that also was a
surprise, and the data we've had before that didn't really suggest it.

--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,sci.med.pharmacy,sci.med.nutrition
Subject: Re: HRT (hormone replacement)
Date: Thu, 11 Jul 2002 13:38:04 -0700
Message-ID: <agkqch$7tu$1@slb6.atl.mindspring.net>

Richard Cavell wrote in message ...
>> I've been wondering for a while if that might be behind the increased
>> incidence of cancer with HRT.
>
>Maybe.  I doubt it, personally.  One estrogen receptor agonist is as good
>as another.

Except there's no such thing as a simple estrogen receptor agonist. There
are a number of different estrogen receptors, and each estrogen has a
different spectrum of affinity for them.



>> research done on vitamins. We don't KNOW what the long term effects of
>> the pure estradiol, much less estriol are, in humans.
>
>I doubt that.  There are oral contraceptive pills containing ethinyl
>oestradiol.

Which is not the same thing as estradiol.  Moreover, I'm not aware of any
long term studies of the health effects of birth control pills vs placebo,
in a prospective randomized study in women of an age to get breast cancer
(ie in post menopausal women).  Ethynl estradiol is specifically used in
women under 35 who are generally too young to get breast cancer (ie, their
baseline incidence is very low), so any effect it might have in that
direction would have gone undetected. The same is true for heart disease. It
IS known that birth control pills vastly increase clotting risks in veins in
young women.


>> Progestins as a class of drugs are starting to look like nasty things,
>
>I don't think so.  It's the oestrogens that cause all the trouble.

I gave my reasoning. The estrogen-alone arm of the WHI is still going, and
it wouldn't be if the breast cancer risk increase were the same.
PEPI trial results are also consistant with a bad effect of progestins when
combined with estrogens, on the post menopausal breast.

SBH
--
I welcome email from any being clever enough to fix my address. It's open
book.  A prize to the first spambot that passes my Turing test.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,sci.med.diseases.cancer,sci.med.nutrition,
	sci.life-extension,sci.cryonics,sci.med.cardiology
Subject: Re: The Quick and Dirty on Prevention and Life-Extension
Date: Wed, 7 Aug 2002 17:26:54 -0600
Message-ID: <aisako$i6u$1@slb2.atl.mindspring.net>

"FurPaw" <furpawnews@comcast.net> wrote in message
news:3D5196E1.60907@comcast.net...
> Steve Harris wrote:
>
>
> > No one set of rules works for everyone, but in the interest of doing more
> > good than harm, here's
> >
> >
> > DOC HARRIS' RULES OF PREVENTION: THE QUICK AND THE DIRTY
>
> Excellent compendium.  Most of my (few) questions/quibbles have
> already been addressed, save these:
>
> > 7. Women: know your bone density and do your mammograms. Post-menopausal
> > women stay away from more than a few years of estrogen, unless you also take
> > raloxifen (Evista) and aspirin.  Consider a natural progesterone
> > (Prometrium) rather than an artificial progestin (ie, Provera).
>
> Why would you want to take both raloxifen and estrogen?  I've
> never seen anything that would suggest that raloxifen would offer
> some form of "protective" function against effects of estrogen
> ... and what would that be?

It would protect against breast cancer, exactly as Taxomifen does. Selective
Estrogen Receptor Modulator (SERM) drugs like Tamoxifen and Raloxifen
complete with estrogen for receptors in breast tissue, but have no estrogen
activity in sex organs (breast or uterus). Therefore it stands to reason
that they will block some of the procancer effect of estrogen in the breast.
The only reason they haven't been tested WITH estrogen is that nobody has
gotten around to it. A different company makes Evista than makes Prempro,
don't you know.






>
> You might add, "If you still have your uterus, and if you are
> taking estrogen, you need to be taking a progesterone to prevent
> endometrial cancer."
>
> And, what is the evidence that a "natural" progesterone is any
> better than an artificial one?  (Please don't cite Dr. John Lee!)


We suspect that the unnatural one either augment's estrogen's effect on
breast cancer, or else does something bad to estrogen's protective effect on
arteries. It's one or the other, or else the estrogen-only arm of the WHI
would not still be going on.

Now, it is known that natural progesterone doesn't have the same tendency to
undo estrogen's good effects on blood lipids, as Provera does. So if you
have to replace Provera with something (and women with a uterus do if they
take estrogen) then I suggest natural progesterone until we know more.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,sci.med.diseases.cancer,sci.med.nutrition,
	sci.life-extension,sci.cryonics,sci.med.cardiology
Subject: Re: The Quick and Dirty on Prevention and Life-Extension
Date: Wed, 7 Aug 2002 21:43:34 -0600
Message-ID: <aispm4$qk2$1@slb6.atl.mindspring.net>

FurPaw" <furpawnews@comcast.net> wrote in message
news:3D51CE9A.3010309@comcast.net...
> Paul Chefurka wrote:
> > On Wed, 7 Aug 2002 17:26:54 -0600, "Steve Harris"
> > <sbharris@ix.RETICULATEDOBJECTcom.com> wrote:
> >
> >
> >>>Why would you want to take both raloxifen and estrogen?  I've
> >>>never seen anything that would suggest that raloxifen would offer
> >>>some form of "protective" function against effects of estrogen
> >>>... and what would that be?
> >>
> >>It would protect against breast cancer, exactly as Taxomifen does.
> >>Selective Estrogen Receptor Modulator (SERM) drugs like Tamoxifen and
> >>Raloxifen complete with estrogen for receptors in breast tissue, but
> >>have no estrogen activity in sex organs (breast or uterus). Therefore
> >>it stands to reason that they will block some of the procancer effect
> >>of estrogen in the breast. The only reason they haven't been tested
> >>WITH estrogen is that nobody has gotten around to it. A different
> >>company makes Evista than makes Prempro, don't you know.
> >
> >
> > Whoa there, big fella.  If SERMs haven't been tested with estrogen,
> > aren't you the least bit worried about recommending the combination as
> > a common-sense approach to treatment?


No. SERMs, which block estrogen, have already been shown to prevent breast
cancer. Estrogen has been shown to promote breast cancer. If the mechanism
by which SERMs block breast cancer is not their estrogen-blocking activity,
it will rank as the biggest *&^%ing coincidence in the history of science.

The only piece of the puzzle left in my argument is the supposition that the
breast can somehow tell the difference between estrogen a woman takes as a
pill, and that which she makes herself. If it's the same substance (as it
would be if she was taking Estrace or using some other pure estradiol
preparation), you have to not believe in fundamental chemistry and biology
to not accept this.

So I think I'm on pretty solid ground. And what the heck-- remember that
lots of standard recommendations in health (I've given examples like
exercise) aren't strictly proven by double blind study either. We all pick
our lifestyles with lots of unknowns. Wait for all the science to come in,
and you'll be long dead of old age first.

> > After all, you have no way of knowing
> > if the Law of Unintended Consequences might pop up and hurt someone.


You never know that. You can get hit by a car while jogging for your health.
It's not my problem if you do.




> > And "it stands to reason" has a pretty shaky history in scientific
> > circles.

I would say the opposite, of course. Fortunately, the universe is uniform
enough that I don't have to have run a perfect lifespan study with 1000
identical furpaws to have some idea of what's good for furpaw. Unless you're
a Martian.


> > If there is no proof that "[SERMs] will block some of the procancer
> > effect of estrogen in the breast", and not even any studies on that
> > effect, why on earth would you recommend such a treatment?  "I think
> > so" doesn't seem quite solid enough.

I've given my reasoning. It's up to you to accept or reject. As in anything
else I write. And somebody else reading this may come to a different
conclusion.



> > I'm not saying you're wrong (WTFDIK?), but a common-sense guide like yours
> > should have scientifically supportable premises for each of its
> > recommendations.  If there are no studies there can be no scientifically
> > acceptable support.

Agreed. But the science is supportable. SERMs work to prevent breast cancer
and we are certainly more certain of how they do, than we are of most drug
mechanisms
in biology. Based on that, if you take estrogen, you should take a SERM.
Hey, this doesn't take Einstein.



> Yes.  That's a whole lot of supposition behind the
> recommendation, given that not only are there no data behind it.

There is data behind it.


>   Even the manufacturer of EVISTA warns:  "Concurrent Estrogen
> Therapy: The concurrent use of EVISTA and systemic  estrogen or
> hormone  replacement therapy  (ERT or HRT) has not been studied
> in prospective clinical  trials and therefore concomitant  use of
> EVISTA with systemic  estrogens is not recommended."

The FDA makes them say that. The FDA are nitwits.


> I'm not a fan of taking everything a pharmaceutical manufacturer
> says without question, but in this case it would seem a bit
> irresponsible not to follow this warning, would it not?

ROFL.  Let me count the ways I've done things which manufacturers
recommended not doing, only to be proven right later. I once wrote out
prescriptions for Nicorette gum at parties, and was told I was being
irresponsible because I had no doctor patient relationship with the parties
and it was dangerous (manufacturer said so). I gave anybody who wanted it
ranitidine, and was told that I'd be sued by somebody bleeding to death from
an ulcer being treated merely symptomatically. Well, I wasn't. In the days
when chronic active hep C was being treated with interferon alone (10% cure
rate), I recommended that my patients go to Mexico and get bootleg "Vilona"
to increase their cure rate to 50%. I said the FDA would eventually
countenance this as soon as they'd finished their feud with ICN. And so it
was.

In all these things, the FDA has eventually come my way. And with routine
supplementation with folate, as well. And multivitamin therapy, which I've
been using since Christ was a corporal, is suddenly respectable. I
*remember* when it wasn't. I remember when all these things were ways in
which you could tell a good internist. And now they're all backwards.

It's enough to make one cynical. Fortunately, my sweet and optimistic nature
prevents.

SBH

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med,sci.med.diseases.cancer,sci.med.nutrition,
	sci.life-extension,sci.cryonics,sci.med.cardiology
Subject: Re: The Quick and Dirty on Prevention and Life-Extension
Date: Thu, 8 Aug 2002 18:14:02 -0600
Message-ID: <aiv1pl$545$1@slb1.atl.mindspring.net>

"FurPaw" <furpawnews@comcast.net> wrote in message
news:3D51D186.5030401@comcast.net...

> >>And, what is the evidence that a "natural" progesterone is any
> >>better than an artificial one?  (Please don't cite Dr. John Lee!)
> >
> > We suspect that the unnatural one either augment's estrogen's effect
> > on breast cancer, or else does something bad to estrogen's protective
> > effect on arteries. It's one or the other, or else the estrogen-only
> > arm of the WHI would not still be going on.
>
> Huh???  The "natural" form pf progesterone wasn't even tested in
> the WHI studies!  How can you know that it would not behave in
> the same way as provera?  This logic doesn't fly.  (I'm not going
> to argue the suppostion that Provera is the agent responsible for
> the breast cancer finding here, or that estrogen-only has
> "protective effect on the arteries" (not yet demonstrated) -
> since it's not germane to the discussion.)

COMMENT:

The natural progesterone wasn't tested in the WHI study, but it was in the
PEPI study, and it and unopposed estrogen gave the best lipid results (see
the abstract that ends this message). There have (to be sure) been smaller
studies which have found no advantage of micronized progesterone on lipids
(I'm thinking of a Chinese one a while back), but they are small and in a
minority. PEPI is the biggest and the best study done yet on the subject,
and its data remains the strongest. Nor is it the only trial to implicate
Provera as being bad stuff.

> > Now, it is known that natural progesterone doesn't have the same
> > tendency to undo estrogen's good effects on blood lipids, as Provera
> > does.
>
> Known?  Known by whom?  Cite, please!

See above. Also the following review and cites within, which should curl
your hair.

J Reprod Med  1999 Feb;44(2 Suppl):180-4

Progestogens and cardiovascular disease. A critical review.

Clarkson TB.

Comparative Medicine Clinical Research Center, Wake Forest University
School of Medicine, Medicine Center Boulevard, Winston-Salem, NC
27157-1040, USA.

Although progestational hormones are clearly beneficial in preventing
estrogen-induced endometrial hyperplasia and cancer, their effect on
other areas is far less clear. Of particular interest is the attenuating
effect medroxyprogesterone acetate (MPA) has on the cardiovascular
benefits of postmenopausal estrogen treatment. MPA reduces the dilatory
effect of estrogens on coronary arteries, increases the progression of
coronary artery atherosclerosis, accelerates low-density lipoprotein
uptake in plaque, increases the thrombogenic potential of atherosclerotic
plaques and promotes insulin resistance and its consequent hyperglycemia.
These effects may be largely limited to MPA and not shared with other
progestogens.

Publication Types:
Review
Review, Tutorial

PMID: 11392029 [PubMed - indexed for MEDLINE]


My comment: just because Dr. Lee's a quack doesn't mean nature isn't bearing
out some of his views. Nature can be cruel that way.

Furpaw
> > So if you have to replace Provera with something (and women with a
> > uterus do if they take estrogen) then I suggest natural progesterone
> > until we know more.
>
> This recommendation ("natural" vs. synthetic progesterone) likely
> doesn't have the potential for harm if followed that the one re
> taking raloxifene along with estrogen does, but it's still on
> pretty thin ice, AFAIK.


Er-- then read the literature more.


> So what I really don't understand is, how did these two
> recommendations based on supposition creep into this list that is
>   based on evidence, or at the least, preponderance of evidence?


Yes, I think so.


> I do hope that you will revise the list and remove them.


Nope.

Here's the PEPI result on lipids


J Reprod Med  1999 Feb;44(2 Suppl):221-6

Estrogen, progestogens and cardiovascular risk.

Stefanick ML.

Stanford Center for Research in Disease Prevention, Stanford University
School of Medicine, 730 Welch Road, #B, MC-5736, Stanford, CA 94304-1583,
USA.

This paper provides an overview of hormone replacement therapy (HRT) and
its relationship to cardiovascular risk factors, based on several recent
studies that evaluated risk using lipid and nonlipid parameters. In the
Postmenopausal Estrogen/Progestin Interventions (PEPI) trial, which
included a placebo group, an unopposed-estrogen group and three different
estrogen-progestogen combination groups, high-density lipoprotein (HDL)
cholesterol increased in all treatment groups. Women assigned to
conjugated equine estrogen (CEE) alone or CEE plus micronized
progesterone (MP) had significantly greater HDL increases than did other
treatment groups. Also in the PEPI trial, low-density lipoprotein
cholesterol decreased 10-15% in all active treatment groups, regardless
of the progestogen evaluated. In the nonlipid measurements of the PEPI
trial, fibrinogen was reduced in the nonplacebo groups. Carbohydrate
metabolism, measured by two-hour postchallenge insulin level, decreased
in all groups, including placebo; however, two-hour glucose increased in
the CEE plus medroxyprogesterone acetate (cyclic and continuous) groups
vs. placebo but was unchanged in CEE alone and CEE plus MP groups.
Neither systolic blood pressure nor diastolic blood pressure differed
between PEPI groups. Estrogen, with or without progestogen, was
associated with a lower weight gain as compared to placebo over the
course of the PEPI study. Also discussed in this review are data on oral
contraceptive-related cardiovascular risk. Current generations of oral
contraceptives have been found to have some deleterious effects on lipids
but fewer than those seen with earlier preparations.

Publication Types:
Review
Review, Tutorial

PMID: 11392036 [PubMed - indexed for MEDLINE]

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med.cardiology
Subject: Re: Statins help prevent breast cancer, study finds
Date: 20 May 2005 17:21:48 -0700
Message-ID: <1116634908.117424.296470@g14g2000cwa.googlegroups.com>

>>The most famous observational study stunningly dismissed after years
of damage and death had occurred was the HRT study which said hormone
replacement therapy (HRT) PROTECTED women against osteoporosis (no
evidence) heart disease (no evidence) and certain cancers (no
evidence). In fact, once SCIENCE NOT MARKETING entered the picture,
these "facts" were disproved and in a couple of instances, the very
opposite proved to be true. <<

The very opposite proved to be true for heart disease and stroke indeed
(at least for estrogen alone and estrogen progestin combos). And HRT
did cause breast cancer (but that had been suspected).  However, HRT
*does* slow osteoporosis. That much did turn out to be fact. Randomized
prospective studies sometimes falsify our notions, but rarely ALL of
them.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 11 Sep 2005 12:47:44 -0700
Message-ID: <1126468064.303090.30310@f14g2000cwb.googlegroups.com>

fresh~horses wrote:
> And just a couple months ago I was handed a prescription for Premarin
> without any caution. It was the height of irony that I was to take it
> until I had a diagnostic for a condition the label warns, in large
> print, that it *may* cause.
> Zee


Surely nobody gave you a prescription for Premarin ALONE. That would
have been malpractice. And that label warning is intended as a warning
to women with uterus who use it alone, without progesterone or a
protestin.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 11 Sep 2005 14:27:42 -0700
Message-ID: <1126474062.539394.258090@g44g2000cwa.googlegroups.com>

george conklin wrote:
> "fresh~horses" <fresh~horses@despammed.com> wrote in message
> news:1126469417.275469.149120@f14g2000cwb.googlegroups.com...
> >
> > Steve Harris wrote:
> >> fresh~horses wrote:
> >> > And just a couple months ago I was handed a prescription for Premarin
> >> > without any caution. It was the height of irony that I was to take it
> >> > until I had a diagnostic for a condition the label warns, in large
> >> > print, that it *may* cause.
> >> > Zee
> >>
> >>
> >> Surely nobody gave you a prescription for Premarin ALONE. That would
> >> have been malpractice. And that label warning is intended as a warning
> >> to women with uterus who use it alone, without progesterone or a
> >> protestin.
> >>
> >> SBH
> >
> >
> >
> > Yes. I was given a prescription for Premarin alone.
> >
> > Zee
> >
>
>     Interesting comment Zee.  Are you sure that Steve will accept your
> comment as true?


COMMENT:

Sure. It means she had a crappy Canadian doctor.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 11 Sep 2005 14:31:20 -0700
Message-ID: <1126474280.771507.215760@g47g2000cwa.googlegroups.com>

Steve Harris wrote:
> > > Yes. I was given a prescription for Premarin alone.
> > >
> > > Zee
> > >
> >
> >     Interesting comment Zee.  Are you sure that Steve will accept your
> > comment as true?
>
>
> COMMENT:
>
> Sure. It means she had a crappy Canadian doctor.
>
> SBH


Probably overworked, underpaid, and cold.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine,sci.med.cardiology
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 11 Sep 2005 14:26:31 -0700
Message-ID: <1126473991.351158.188270@g43g2000cwa.googlegroups.com>

fresh~horses wrote:
> HRT/HT (and birth control) was/is presented as safe. If we did hear
> about side effects they were rare rare side efffects don't worry not
> you.

COMMENT:

Are you certain you heard what you thought you heard?  All of this is
confused by people going around demanding "safe" drugs and "safe" cars
and "safe" this and that, when any rational adult knows there is no
such thing.  So what on Earth did you and the doc THINK you were
talking about?


> I guess *you* missed SJdocs last paragraph. Yup. Ummhmmm. Many
> physicians prescribed HRT/HT (and birth control) with little or NO
> caution about the side effects. You practically had to fight a
> prescription off, as another poster attests. They were the answer.
> Didn't much matter what the question was as long as it happened to a
> woman. You had to be very motivated to become knowledgeable enough to
> know why you should fight them off. Hand out information was in the
> most abbreviated form (rare rare) and self-found information not
> readily available in pre-internet days without a hassle. Believe me, I
> have had to be a very assertive many times to get what I wanted.


COMMENT:
I don't know about package inserts in Canada. They've been available
here in the US to anybody who wanted to ask a pharmacist for one, for
at least a generation. My main complaint is the things don't have an
executive summary, and are written in such as way as seems aimed to
maximize attention to legal concerns, and minimize attention the kind
of writing that would prioritize safety issues.  But that's because
these things are literally written by lawyers at drug companies under
the (non-optional) oversight of lawyers at the FDA or Health Canada, so
it's not something I'm going to blame doctors for.

Mostly when the patient asks if a drug is safe, the doctor understands
it (I think!) in the context of something like: "Is it as safe other
stuff I do, like drive my car 10,000 miles a year (risk of death: 1.5
in 10,000). And the answer to such question is usually "yes."  Even for
HRT.  For birth control, you need to factor in how safe it is to NOT
use it, and some of that is how safe it is to get pregnant and deliver
a child. Which is a considerably greater risk than driving 10,000
miles. So there again, communication is the issue.

> I have spent my whole reproductive life fighting off first birth
> control then HRT/HT, and on into menopause and post. Women near
> menopause are told we can have our reproductive organs removed at the
> slightest off-kilter test, because they may be dangerous at some time
> in the future, and we can take HRT/HT drugs after; so what's the
> problem?


COMMENT:
Well, what IS the problem?  Even the WHI study didn't find any
increased mortality risk in taking HRT, and that was in a somewhat
artificial group of women who started quite late (I think average was
about 60), and not at 50, when the major menopause-increase in
mortality starts to show up in NORMAL untreated women.

I just read an interesting argument that the WHI mortality trends, if
analyzed properly as a time sequence, actually drop as a function of
time.

http://www.drtimdelivers.com/WHIMortality10.06.2004/WHIposter10.06.04.shtml

George Conklin, you need to go over this one, too. There more info here
than you probably want to see, but the two mortality curves of treated
and untreated women over time, really speak for themselves. They end up
with treated women doing better. That's the unspeakable HORROR all
those doctors perpetrated all those years. Yawn. At worst, we thought
we were doing a lot of good, and just ended up doing not very much good
or bad, but make drug companies money. At best, HRT may well do some
good. We haven't looked at it started at menopause, when it's expected
to do the MOST good.

Women who experience premature menopause (ie loss of ovarian function
at <35) have a a DOUBLING of mortality rate-- did you all know that?
That's the epidemiology. If HRT ever showed a risk rate like that, you
never would hear the end of it. That kind of thing is what doctors are
trying to prevent.

Indeed, what you're hearing now is the result of a study (WHI) showing
that a group of 10,000 women taking HRT for one year starting at age 60
might expect (per year) 8 more breast cancers and 6 fewer colon
cancers. The negative side on non cancer was 8 more strokes, 7 MIs, and
8 pulmonary emboli. But 6 fewer hip fractures (which are not a small
thing-- hip fracture actually has a mortality rate, over the next year,
higher than any of those other things). As I said, in all they couldn't
tease any extra deaths due to HRT out of this study.

By contast, 10,000 women driving 13,000 miles a year will have dozens
of serious injury-producing car crashes, producing long-term handicaps
quite similar to hip fractures(indeed will produce hip fractures),
strokes, and MIs. And I have little doubt all the orthopedic trauma car
will produce at least 8 pulmonary emboli. And 2 out of 10,000 women who
make the choice to drive that much, will die.  We can't say that about
HRT, even yet.

> We were always taking these drugs for the good they would do us. Or
> because we wanted to be sexual creatures and not have 14 children. We
> really didn't know what harm they could do, until 2002.

COMMENT:

You STILL don't know what harm they do. All we know is that it's
probably not worth all press. It still may *very well be* that if we
remove the progestins (specifically the evil Provera) from HRT, use
progesterone instead, cut the estrogen dose and add an estrogen blocker
for the breasts, give everybody aspirin, refuse it to smokers, start it
AT menopause and stop after a decade, the whole thing may live up the
promise it had 40 and more years ago. It will take research to see.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine,sci.med.cardiology
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 11 Sep 2005 19:10:04 -0700
Message-ID: <1126491004.490679.86540@o13g2000cwo.googlegroups.com>

fresh~horses wrote:
> I have never in my life asked for a safe drug, or asked if a drug was
> safe. I have asked, for another class of SHALL REMAIN NAMELESS drugs
> what the major side effects were. Could we start from a reasonable
> assumption here? I, Mrs. Conklin and most of the millions of women who
> had these drugs foisted on them are not imbeciles.


COMMENT:

I would start from a slightly different conclusion, brought on by many,
many years of practicing medicine including moonlighting in EDs and
urgent care centers. Generally, when it comes to the subject of risk,
humans in general are not rational. That means, in a segmental way,
that they really are "imbeciles."  Myself not excluded here, even after
much thought and study. And I'm not being sexist in the least, since
(in this area) men are in many, many ways more clueless than women. As
the accident stats show.


> Women are less assertive than men about this. Your profession was (and
> still is, often) very patriarchal. Women who want information and
> demand it, as they sometimes must do to get it, may be penalized. We
> may be called names like Vitriolic Life Hating Bitches.


COMMENT:

I don't deny any attempt to knock knowledge into the noggins of the
ignorant *sounds* like patriarchialism (is that a word?), when it comes
to male physician/teacher interaction with woman/student patient. And
similarly, it sounds like "parentalism" when it comes to physician
interaction with youthful patient. The "Listen up here, meathead: me
teacher, you student!" interaction gets called by many names. When it's
men getting the attention of other men, "Listen up maggot!" it's the
RESPECT game. Not paternalism but mastering or ranking. The last can be
literal: if you want to see it squared and cubed, take a look at Marine
boot camp. It only gets called "sexist" when women are talked down to
by men.

Which is rather ironic, don't you think?  You-all women only RECOGNIZE
it when your sex happens to be on the Deshi end of some Deshi-Sensai
relationship. But gender there is not the issue-- teaching is. It is
well to recognize the master-student relationship, and well to remember
that you are the student, when you go in to take instruction from the
master. When I go to the doctor as patient (which I occasionally do), I
make the switch. In this life, the switch from instructor to student
and back must takes place many times a day, but one generally should
not forget it, when it happens.

This does not mean you may not question what the Master says. But do
remember that if he or she wasn't the master, you wouldn't be seeking
the knowledge in the first place, so have respect. (Unless possibly
your doofus country made it legally necessary, in which case I can well
see the reason for your displeasure at being put in the subordinate
position by means of shear legalism. But let us continue).

> MOST people I have advised about the product monograph, male or female,
> Canadian or American DID NOT KNOW SUCH A THING EXISTED or that they
> could have access to it.

COMMENT:
Well, this was not because the AMA or CMA was trying like mad to keep
it a secret!  It's because of the MEGO (my eyes glaze over...) reaction
that tended to happen whenever anybody attempted to make use of the
thing.

MEGO until they got some awful consequences, and then the eyes opened
WIDE, and then sometimes got very angry, and then sometimes went back
and started looking for that fine-print.....   HEY!!!


> Also keep in mind we are not talking only about the past few years when
> consumer medical education has been blown wide open with the internet,
> but about 1968, 1987, 1999.

[Side COMMENT: Would say the internet got blown open to the average Joe
Citizen in (he US about 1995. Just after Netscape and the cheap 486
machines.

> > Mostly when the patient asks if a drug is safe, the doctor understands
> > it (I think!) in the context of something like: "Is it as safe other
> > stuff I do, like drive my car 10,000 miles a year (risk of death: 1.5
> > in 10,000). And the answer to such question is usually "yes."  Even for
> > HRT.  For birth control, you need to factor in how safe it is to NOT
> > use it, and some of that is how safe it is to get pregrant and deliver
> > a child. Which is a considerably greater risk than driving 10,000
> > miles. So there again, communication is the issue.
>
> Patronizing b.s. Steve.

COMMENT:
No. I'm afraid you're wrong. You are not the average patient, so it may
sound patronizing to you. As for bullshit, you've never had the
experience of seeing it from the other side of seeing thousands of
average patients. Far from being bullshit, it's dead-on true.

> > COMMENT:
> > Well, what IS the problem?  Even the WHI study didn't find any
> > increased mortality risk in taking HRT, and that was in a somewhat
> > artificial group of women who started quite late (I think average was
> > about 60), and not at 50, when the major menopause-increase in
> > mortality starts to show up in NORMAL untreated women.
>
> The problem is this is not a disease. I think the risk benefit ratio
> just went clang on the floor don't you?


NO!!  That's the point! There was every reason to think this may not
have been so. To do a risk benefit you need to know the risk absent the
drug. And if you look at the heart disease risk of the average woman,
you see that it doesn't look like that of the average man at all.
Rather than take a nice even exponential increase upward starting at
age 35 or so, in women the risk seems oddly suppressed until about 50,
when it takes a *steep* upward jog until its rate of slope increase
equals that of men, just displaced by a decade or so.

Somebody with no medical education, can take a look at the female heart
disease risk graph, compare with the male graph, and point at that
female upward risk curve inflection around age 50, and say "So what the
hell happens THERE?"

Some horrid toxin?  Some awful pill? NO. As noted, these are women
untreated with anything, undergoing normal menopause and no HRT. This
is the natural course of atherosclerosis in healthy untreated women in
Western societies. We knew this in 1940. And in women undergoing
untreated natural premature menopause (even without the surgical
"castration,") the curve just gets shifted by that many years that the
menopause is premature. Looks like menopause is to blame. In animal
models of atherosclerosis, you can induce it by ovariectomy, and
prevent it with hormone replacement.

Now, you can call that sudden upswing in cardiovascular risk starting
in women at age 50 a "disease" or not, as you like. A rose by any other
name. You can refuse to call it disease and call just the "sudden
removal of an gender-specific protection," if you like. No disease at
all, but the natural maturation process, by which the lives of normal
healthy women begin to take on the beautiful texture and autumnally
nuanced life of a changing-leaf, preparing for its gentle and normal
fall from the great Tree of Being into the heart of the Great State of
All Oneness.

But a bunch of flinty-hearted chemistry-minded life extensionsts from
Wyeth, and a not a few women among them, did some experiments with
animals which showed that estrogen is good for artery walls. As we
mentioned. And they began to wonder what might happen if women were
given back the hormones they'd lost at 50. Perhaps the curve is not
chiseled in stone. they might have a chance to keep a vascular
advantage they'd had over men, and then began to lose?

And you know what?  It damn near worked. They picked an artificial
progesterone (progestin) because they couldn't figure out how to give
progesterone orally in those days. And it turned out to cause its own
problems. They picked odd horse estrogens because they couldn't (then--
we're talking WW II) make them yet. And then, when they came finally to
do the last and final proof of the pudding experiments (partly funded
by the drug companies themselves; since they really believed this stuff
too)--- it came out more or less a draw. They picked women not just
coming into menopause, but women who hadn't seen much estrogen in
years, and were as old as 79. They hit them all over the head with the
full dose like a sledge hammer.  And although the women had fewer hip
fractures, all that estrogen did make some of them clot up, younger
arteries or not. All in all, it was a failure. Not a horrible failure--
that's press hysteria. Just not a success. No increase or decrease in
mortality, just changes in the cause of mortality. Time to start over.

So you can look at the glass of these last 60 years of HRT as
half-empty or half-full. If you choose, you can look at a lot of
(mostly male) doctors trying to keep their mothers and their sisters
and their wives alive and young and happy, forever. Despite the fact
that it was being down by a mechanism men would never hope to benefit
from. But doing it anyway, out of altruism, out of love, and out of the
desire to be good doctors.

Or you can see it as an evil misogynistic plot by patriarchal
paternalistic capitalist money grubbing witch doctors, pushing any pill
the drug rep came round with, as a chance to see the lives of lovers,
mothers, and sweethearts, for sake of a coffee cup and a PremPro
prescription pad.

Look here, look there.  The glass is different any way you turn it.

> > Indeed, what you're hearing now is the result of a study (WHI) showing
> > that a group of 10,000 women taking HRT for one year starting at age 60
> > might expect (per year) 8 more breast cancers and 6 fewer colon
> > cancers. The negative side on non cancer was 8 more strokes, 7 MIs, and
> > 8 pulmonary emboli. But 6 fewer hip fractures (which are not a small
> > thing-- hip fracture actually has a mortality rate, over the next year,
> > higher than any of those other things). As I said, in all they couldn't
> > tease any extra deaths due to HRT out of this study.
>
> Those perfect women George mentioned who made it through the winnowing.

COMMENT:

They were far from perfect. Most of them were probably too old. And all
of them got hammered by study designers who have no clinical feeling
for how to start medications. But I've made that point.

> > By contast, 10,000 women driving 13,000 miles a year will have dozens
> > of serious injury-producing car crashes, producing long-term handicaps
> > quite similar to hip fractures(indeed will produce hip fractures),
> > strokes, and MIs. And I have little doubt all the orthopedic trauma car
> > will produce at least 8 pulmonary emboli. And 2 out of 10,000 women who
> > make the choice to drive that much, will die.  We can't say that about
> > HRT, even yet.
>
> Really Steve you have to get over this infantile analogies.


Now, now. If you think this sort of analysis infantile, you're fighting
to be included in the "risk imbecile" category. MEGO? Cars don't sound
like pills?


> That's right. Millions of dollars later, and gawd knows how many lives
> and how much risk yet to develop into something later and we still
> don't know.
>
> What a fine system.

COMMENT:
Well, it's the best we could do in 50 years after a a few millennia of
dark ages.

If we quit spending 95% of our money on medical care while spending
only 5% on research as to what kind of medical care we should be
giving, it would go a lot faster. But there's that risk-imbecile thing
again. Most people have no idea that's what the ratio is. And if they
aren't faced with a really bad medical problem this moment, and a tough
choice about it, they don't care. They'd rather have a doctor who LOOKS
like they know what to do, than one that actually does (but doesn't
look so confident). People like acting. They even have been known to
mistake Hollywood stars for generally competent, intelligent, educated
and wise human beings. Just because they've seen them really big and
load, with no visible pores, appearing to have done something well.

But don't you dare call them imbeciles.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 10 Sep 2005 14:10:53 -0700
Message-ID: <1126386653.518866.62940@o13g2000cwo.googlegroups.com>

george conklin wrote:
>    Women have had to fight off physicians who pushed them actively into HRT
> therapy not only for hot flashes but also for promised that they would have
> all kinds of other benefits, now known to be false and based on biased
> research.

COMMENT:

"Biased research" your rear-end, George. All studies are imperfect in
SOME way, but that doesn't warrant calling them "biased research,"
inasmuch as that phrase implies things which aren't so.

Use of HRT was based on much the very same kind of research which is
used to tell people to eat fruits and vegetables. Hey, maybe all that
produce is actually BAD for you?  If you secretly suspect so, super
statistician that you are, now and here's the time to get it on record.

We just didn't have the gigantic prospective blinded controlled studies
on HRT. And don't for fruit, either. But then we hardly ever do. So
what to do in absense of them, oh Karnac?

The effects of hormones turned out to very complex, with some small
effects cancelling out others. And it was further complicated by the
use of progestins, which probably did additional bad things on top of
the estrogen. So far as I can tell, we STILL don't know if estrogen
alone increases risk of breast cancer. Estrogen plus progestin does (so
it's the opposite of the effect the uterus), but the WHI estrogen alone
trial was stopped for stroke, and before the breast cancer question
could be asked, and the HERS trial never did have an estrogen-alone
arm. So here we are, still in the dark. And the package inserts handed
out to women in the old days really only warned about the combination
treatment insofar as increase breast cancer risk, NOT estrogen alone.
For estrogen alone they mearly said some epidemiology showed increased
risk and some didn't. Boy, now THAT's helpful.

And as for natural progesterone instead of progestin, we don't know
those answers either.

Unless you'd like to consult your crystal ball and tell us? Mine says
natural progesterone alone will be a lot safer and progestins/"Provera"
in all respects, and perhaps have no risk at all. But estrogen will
still cause increase risk of stroke and other clots, because that's
what estrogenic hormones DO. Maybe this can be decreased by use of
aspirin and fish oil. I can't say for sure, but I would bet that way.
I'm on record as what my guess is. I think esterogen/progesterone will
increase risk of breast cancer, but the increase will be smaller than
drinking one martini a day, and not nearly so bad as the old prem-pro
combos.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine,sci.med.cardiology
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 12 Sep 2005 12:57:42 -0700
Message-ID: <1126555062.589236.231190@g44g2000cwa.googlegroups.com>

george conklin wrote:
> Steve Harris <sbharris@ix.netcom.com> wrote in message
> news:1126473991.351158.188270@g43g2000cwa.googlegroups.com...
> >
> > http://www.drtimdelivers.com/WHIMortality10.06.2004/WHIposter10.06.04.shtml
> >
> > George Conklin, you need to go over this one, too. There more info here
> > than you probably want to see, but the two mortality curves of treated
> > and untreated women over time, really speak for themselves.
>
>    I suggest that if the man who posted his complaints on his personal home
> page had anything to say that was important, it should have appeared in a
> refereed journal by those who know methodology.  Special-interest posting is
> anti-science.


COMMENT:

I've seen the mortality curves of HRT vs. Placebo in the WHI before, in
the primary papers themselves---- and these are they. Yu wanna argue
it? I'll be glad to make a fool of you.

As for the *analysis* of time sequence mortality change, which is the
new thing here, I agree that it's less interesting if it's just an
abstract poster at a conference (which is all it exists as, at this
point). We'll wait for the peer reviewed paper, which will surely come
(there's quite enough data here and analysis for it). Meanwhile, my
position must remain the present one of the peer-reviewed published
papers on HRT from WHI-- the mortality is unaffected by HRT.

Your assetion that HRT doubles cancer rates is NOT from the WHI placebo
controlled study, where HRT increased breast cancer rates 26%, and
decreased colon cancer rates 37%, for a net change which was down in
the noise.

You're probably talking about the so called "Million Woman Study" of
HRT, which (ironically enough) is a post-hoc epidemiological study of
self-selected women. Just the kind you've been fulminating about as
providing crap conclusions. So double shame on you.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med,talk.politics.medicine,sci.med.cardiology
Subject: Re: Wyeth sued: HRT caused breast cancers
Date: 12 Sep 2005 14:04:42 -0700
Message-ID: <1126559082.021915.234100@o13g2000cwo.googlegroups.com>

george conklin wrote:
> Steve Harris <sbharris@ix.netcom.com> wrote in message

> > COMMENT:
> >
> > I've seen the mortality curves of HRT vs. Placebo in the WHI before, in
> > the primary papers themselves---- and these are they. Yu wanna argue
> > it? I'll be glad to make a fool of you.
> >
>
>     Then why does the article say, "A Reinterpretation?"  Make a fool of
> yourself and try refereed sources.


The reinterpretation is he thinks the HRT actually improved mortality,
based on the last point there where the curves diverge the most. If you
do a time sequence analysis of each whole mortality curve against the
other, you get a different result that if you just compare each
point-by-point at the various times.

It's sort of like global warming, George. At any given time, it's not
significantly warmer than last year. And last year is not significantly
any warmer than the year before. But that's not the whole picture.

Anyway, the refereed sources agree that mortality was not changed by
HRT in the WHI. If you don't agree on at least THAT, I'll be glad to
pull them out. Or you can do it yourself.

SBH