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Estrogen Therapy

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Like millions of others Thursday morning, I woke up to this headline on the front page of my paper: "Doctors Change Course on Estrogen Therapy." Here we go again! The 'science' behind hormone replacement therapy has put women on a medically engineered, press-fueled, big pharma funded roller coaster ride. When will there be a definitive answer to this question? After reading the article, and posting it on the Living Now page for all of you to take a look at, I did what many of you probably did; I called a doctor for advice.

Dr. Harry Lodge is a nationally recognized physician, on the medical faculty at Columbia University, and the author of two best-selling books: Younger Next Year, and Younger Next Year for Women. He writes frequently on health, science and public policy. He believes everyone can understand the medical and scientific issues affecting our lives and that America is ready for clear, substantial and informed discussions about the challenges and opportunities we all face together. Here's a transcript of our talk:

WB: What's the significance of this new study?

Dr. Lodge: We frequently hear about smaller studies like this one which are reported as 'major news'. But the 'big news' here is just a slight variation in the data.

This current study examines a very small subset of 1,000 women from the Women's Health Initiative who had had hysterectomies. It is a small piece of the equation. And it has to be viewed as that. Otherwise, it will leave you on a roller coaster that doesn't reflect the underlying science. If you follow every one of these small pieces of the puzzle, women will continue to get whipsawed about what they ought to do about hormone replacement.

WB: So why is this front page news?

Dr. Lodge:
There will be innumerable news cycles like this where a very small, nuanced issue will be presented as a major change in public policy. And there will be gross exaggerations. As you read the Los Angeles Times articles, one of the spokesmen for Wyeth said, "Oh great, this means women can safely take hormones for decades." Give me a break!

WB: So can you read between the lines here and maybe even re-write the headline?

Dr. Lodge: Sure, the bottom line here is that hormone therapy is a very low-risk thing to do, but there is almost certainly some risk involved. If you need hormones to deal with specific symptoms of menopause, you can accept the small downside. But if you don't have a clear need for it, don't take it.

We do have a sizeable amount of data on hormone replacement therapy from the Women's Health Initiative, an extremely large-scale study of 160,000 women that cost more than $600 million dollars. That's the kind of scale you need to get real answers to basic biological questions. What that data tells us is that there are both slight benefits and slight risks for women from hormone replacement. Women can get relief from the symptoms of menopause from these drugs, but they won't get any real health benefits from them. And again, there is a small risk. So, clearly, if it took 160,000 women to find the very small risks and benefits in the larger study, the information from this tiny subset (less than 1% of the total) is not going to change the overall picture at all.

You can run as many studies as you want and you will get slight variations. That is the way a huge amount of medical reporting is done in America. You take a very small absolute difference and report that.

With each release of new, small studies like this one you can argue endlessly about those variations - whether there is a tiny risk or tiny benefit. My personal bias is that you should only use medicines when there is a clear benefit. The best studies done so far show there is a very slight negative.

WB:
So what is your advice to women?

Dr. Lodge: You can and should expect news cycles like this in which small studies are presented as major change. I think one of the messages for women and health care consumers in general is there is very little medical news of a major risk or benefit.

If I were a woman I would say, "Thank God there is a medicine that helps with symptoms if I need it. Unfortunately it doesn't do anything long term to benefit me. And then you're done. You never have to re-visit the issue again.

And that should be the outcome of this, to say to American women, "Relax. Hormones are not a good idea from a health perspective. They are not something you should be taking. But they seem to be safe or very low risk, so if you need to take them for symptoms, go ahead."

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