What Doctors Don't Tell YouA few weeks ago I attended a press conference announcing the launch of a drug, a new type of hormone replacement therapy, organized by a swanky PR company and held at the equally swanky London’s Savoy hotel.
The purpose of the party was the release in the UK by merger giant Sanofi Winthrop (SW) of Tridestra, a unique type of HRT developed to combat the main reason a large percentage of women come off HRT: they feel lousy on it. The main reason they feel so bad is the progestogen, added in most combination pills supposedly to combat the known risks of endometrial cancer with estrogen-only preparations. But monthly progestogen also often gives women monthly PMT and also the equivalent of monthly periods. With Tridestra, the added progestogen is concentrated into a 20 mg daily dosage for two weeks every quarter, resulting in only four periods and four bouts of feeling lousy every year, rather than the usual 13. This, they argued, made it appropriate for women even at the “perimenopausal” stage-that is, before periods have stopped altogether.
In support of the wonders of HRT, including its supposed ability to prevent osteoporosis and heart disease, SW wheeled out a consultant gynecologist, who proceeded to announce that one major “myth” about HRT was that it caused breast cancer. To this, I broke my vow to keep silent. I wondered how he could make this assertion in the face of a number of the studies, including a meta-analysis, showing an increased risk of breast cancer and the view of many authorities that taking HRT increased your risk by at least one-third. The consultant gynecologist didn’t bat an eyelash. Since one other collection of studies showed a very small increase, he announced, in effect, the risk was in dispute and therefore didn’t exist.
Next on the agenda was a consultant cardiologist. Although there have been no large truly scientific studies, he said, proceeding to flash in front of us many indecipherable slides, what we have from our observational data suggests that HRT prevents heart disease.
When we in the audience were finally allowed to ask questions, one journalist from a woman’s magazine asked what the consultant gynecologist thought about the American study showing that HRT only prevented osteoporosis while you stayed on it; as soon as you came off it, your bone loss caught up to women who’d never taken it. Neither he nor the president of Sanofi Winthrop had ever heard of the study-this, from the Framingham study, one of the most famous long-term studies of HRT.
This was too much for me. Now hold on, I piped up. You are saying that you don’t really know whether HRT prevents heart disease, and you’re not really sure about the exact cancer risk. Isn’t it a little premature to flog this to every woman, even before she reaches menopause? Isn’t it true that medicine is not really sure yet what it’s doing?
Yes, they admitted, you’re right. They muttered on about how many medical advances would be stopped if we waited for proof. I left feeling pretty lousy myself. What this was really all about, baldly, was merchandizing. Getting more women to stay on this drug. The last thing anybody wants here is science.
!ALynne McTaggart
Maryon Stewart
Tom Ferguson MD
Daniel Redwood DC