Dear List Members and Friends,


   The New York Times has the following excellent article
on how marketing and media exposure define medical
treatment before it has been scientifically determined to
be safe and effective.  It cannot be emphasized enough
that a good percentage of the medicine practiced today
is supported only by the cleverly crafted marketing
campaigns of the pharmaceutical industry.  Read this
article carefully and fully.  Your health and life depend
on it.

 Regards,
Catherine


July 16, 2002
Preventive Medicine, Properly Practiced
By SUSAN M. LOVE
http://www.nytimes.com/2002/07/16/opinion/16LOVE.html?tntemail1=&pagewanted=
print&position=top

(Entire article below)


LOS ANGELES - There are at least 6 million women in this country who are
asking themselves, "What happened?" Over the last several years they have
read books and magazine articles, listened to TV pundits and talked to
doctors and friends - all of whom assured them that taking hormone
replacement therapy for the rest of their lives would keep them healthy.

Then one bright summer day, their world shifted. Their little daily pill
carried not the promise of health but the risk of disease. How could this
be?

What happened is that medical practice, as it so often does, got ahead of
medical science. We made observations and developed hypotheses - and then
forgot to prove them.

We start with observational studies, in which researchers look at groups of
people to see if we can find any clues about disease. But all this
observation can do is find associations: it can't prove cause and effect.

With hormone replacement therapy, we did many observational studies. We
found that women who were on hormone therapy had a lower incidence of heart
disease, stroke, colon cancer and bone fracture. And we accepted these
findings before we did the definitive research, overlooking the fact that
these women were also more likely to see a doctor (which is how they were
put on hormone therapy in the first place), and probably more likely to
exercise and to eat a healthful diet, than women who were not taking the
drug. It wasn't clear whether hormones made women healthy or whether healthy
women took hormones. To answer this question we needed randomized,
controlled research.

The latest study, sponsored by the National Institutes of Health, enrolled
16,608 healthy women from ages 50 to 79 and randomly assigned them to take
hormone replacement therapy or a placebo. Much to everyone's surprise, after
5.2 years the study showed that the risks of hormone treatment outweighed
the benefits in preventing disease.

Many are already arguing that the study was poorly designed or that its
results are limited to one type of hormone therapy, or even that
"bioidentical" hormones will be safe. In fact what the study really
questions is the idea that we need to replace hormones in post-menopausal
women for the long term. Menopause is normal. We need high levels of
hormones to reproduce, but we shift down to a lower level for the second
half of life. The symptoms of menopause are really not the symptoms of low
estrogen but the symptoms of hormonal change - puberty in reverse.

And, as with puberty, the symptoms are transient, usually lasting between
three and four years. In one study following women through menopause, 50
percent of the participants complained about hot flashes but only 16 percent
felt they were really bothersome. For these women, it is perfectly
reasonable to take hormone therapy for up to four years. At that point, a
woman can either stop cold turkey (50 percent of women will do fine with
this approach) or taper off over several months.

There is a bigger issue than simply hormone therapy, however. There is a
tendency, driven by wishful thinking combined with good marketing and media
hype, to jump ahead of the medical evidence. In the 1950's, it was DES, a
drug given to pregnant women to prevent miscarriages. It was many years
later that a randomized, controlled study showed that it had no effect in
preventing miscarriages. Finally, in 1971 it was learned that daughters of
women who took DES were at increased risk of developing vaginal cancer.

In the 1990's, the bone marrow transplant - high-dose chemotherapy with
stem-cell rescue - was proposed to treat aggressive breast cancers. It was
widely used until four randomized, controlled studies showed it was no
better than standard therapy, and had far more side effects. Arthroscopic
surgery for osteoarthritis was commonly performed but just last week a
controlled study showed it had no objective benefit. Hormone replacement
therapy is just one more example of this phenomenon.

These examples show the importance of taking the time to determine the
safety and efficacy of a particular therapy before we embrace it. This is
particularly true in preventive medicine, since such therapy can create one
disease in trying to prevent another that might not occur at all.

The foundation of prevention still should be lifestyle changes: quitting
smoking, eating a healthy diet and exercising regularly. Drugs, whether to
prevent heart disease, bone fractures or breast cancer, should be secondary.
This is not necessarily an easy lesson, but we need to demand medicine based
on solid evidence, not hunches or wishful thinking.


Susan M. Love is author of "Dr. Susan Love's Hormone Book'' and an adjunct
professor of surgery at U.C.L.A. Medical School.