Tuesday, February 14, 2006

Fuddled Logic

I recently read a quote from a doctor - in the context of the new study that claims that reducing dietary fat does not reduce risks of heart attacks or cancer - saying that "we in the health profession tend to give very strong advice based on very flimsy evidence".

So true. I could go on and on about this. But a great example just came up. Estrogen replacement therapy for postmenopausal women.

For years, estrogen was recommended for post-menopausal women. I was married to a biologist, and these were the reasons I'd hear for it:

1. To relieve symptoms of menopause - namely, hot flashes.
2. To reduce bone lose that could lead (later in life) to osteoporosis.
3. To maintain the youthfulness of the vagina (sounds creepy, but true...).

All these three benefits have been scientifically demonstrated.

The downside, so I was told, was increased risk of breast cancer. The general argument was that taking estrogen was a value judgment. A question of how much you valued the three benefits, vs. how much you risk you were willing to take on the breast cancer front.

So that was the insider view. Slowly I became aware of the medical establishment's official line on the subject. It went something like this: Premenopausal women are protected from heart disease because of the high levels of estrogen in their bodies (How was that concluded? Unclear...). How do you maintain that protection when they're postmenopausal? Give them Estrogen.

So suddenly, just in a few conversations with women I knew, I realized they were taking estrogen replacement not for reason 1-3 listed above, but for the purported heart benefits.

Well,... Then along came the Women's Health Initiative study a few years ago and "discovered" that in fact estrogen did not help prevent heart disease in women, and did (we knew this...) increase the risk of breast cancer. The information was all over the front pages, and the new recommendation was not to take estrogen. True panic set in among many women, and use of estrogen replacement dropped dramatically.

Now what was that all about? What about the three well established benefits listed above? They hadn't gone away. And they're still very significant. But because doctors had pitched estrogen replacement for a fourth, unproven benefit, the moment it was disproved, the treatment was disqualified. Nowhere in the media did it mention that there actually were several significant benefits to offset the downside...

I bring this up because today USA Today has an article titled "Final Estrogen Report Finds No Heart Disease Benefit". So why did the medical establishment promulgate the idea that estrogen protects against heart disease based on what appears, in hindsight, to be virtually zero evidence?

And more along my lines of interest: How much money did drug companies make off this idea? How much money did they invest in convincing us of it in the first place?


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