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Medical Forum / General / General / September 2005Wyeth sued: HRT caused breast cancers
http://bcbshealthissues.yellowbrix.com/pages/bcbshealthissues/Story.n... http://tinyurl.com/akthq "Thousands of American women, including hundreds in Ohio, are filing lawsuits against Wyeth Pharmaceuticals, alleging that its hormone-replacement medications caused breast cancer, blood clots and other serious health problems. Two local women -- one from Stark County, the other from Wayne County -- are the latest to file suit. Columbus lawyer Gerald Leeseberg filed the suits recently in U.S. District Court in Cleveland on behalf of Jennifer Brubaker of Doylestown and Rose Ann Mastroine of Waynesburg. Both women contend that their use of Wyeth-produced hormone-replacement therapy led to their breast cancers. The lawsuits allege that Premarin, Provera and Prempro are "dangerous and defective drugs." Wyeth spokesman Doug Petkus declined to comment on the cases brought by Brubaker and Mastroine because he was not aware that they'd been filed. Wyeth faces between 3,600 and 5,500 lawsuits by women who say they were harmed by hormone therapy. " - - - - >"Thousands of American women, including hundreds in Ohio, are >filing lawsuits against Wyeth Pharmaceuticals, alleging that its [quoted text clipped - 15 lines] >Wyeth faces between 3,600 and 5,500 lawsuits by women who say they were >harmed by hormone therapy. " Brings to mind a patient I encountered some decades ago. A nice little old lady ("LOL" doesn't mean "laugh out loud" in the doctor's book of acronyms) who came to me for the first time because she needed a refill of her Premarin. I checked her chart. "You're on Premarin?" She handed me an empty stock bottle. "I've been on it for years." It turned out that she'd been on a tourist cruise to Mexico something like five years before, and walked into a pharmacy. She was surprised to find that she could buy all the Premarin she wanted, no prescrip- tion needed. Inexpensively, too. She stocked up - and then never told any doctor at home she was taking the medication. "So when was the last time you had a breast exam or a Pap smear?" I asked. "Not for five years or so. Why?" I had her in one of those silly paper gowns in about five minutes, up in stirrups five minutes after that, and slides on the way to the lab before the end of the day. No breast cancer, but she under- went a hysterectomy that caught her uterine cervical carcinoma before it spread outside the organ. We've gained a better idea of what risks are posed by hormone replacement therapy (HRT) in women at and after the menopause, but there's never been a moment in my professional life when we weren't aware of the correlation between estrogenic medications and increased risk of malignancy in tissue populations sensitive to these hormonal products. It's in the literature, it's in the FDA's product labeling (those prescription information fold-outs that patients never bother to read), and since the Web became avail- able, it's been all over that, too. For a helluva long time, Wyeth and other manufacturers of HRT products have been defending against lawsuits alleging that these medications are somehow intrinsically "dangerous and defective drugs," which is lawyerspeak for "give me a shitload of money, right now, and I'll make my client shut up and leave you alone." "Dangerous and defective" how? If a patient takes a drug like Premarin without adequate precautions - the way my LOL did - she puts herself at risk. The information regarding that risk is all over the goddam place (and she knew it, too, and was ter- ribly embarrassed about having failed to tell any doctor about the fact that she'd been able to score those stock bottles on her trip down to old Mexico). There are risks involved in taking any medications, even over-the-counter (OTC) drugs and vitamins and dietary supplements that people in the USA can obtain just the way people in Mexico have long been able to buy Premarin any time they damn well please, without bothering to seek the advice of a physician or ancillary health care provider. Have the Wyeth corporate clowns acted to conceal this infor- mation? Is there any true dereliction of duty involved here? Has a tortious act actually been committed? How? And how are the Wyeth people directly responsible for the adverse outcomes sustained by the plaintiffs in these cases? I love tort law as the American Bar Association and its co- conspirators have labored to create it over the course of my lifetime. My daughter's recent pregnancy was marked by de- bilitating and potentially deadly hyperemesis gravidarum, "morning sickness" of the sort that I used to treat with a cheap little pill called Bendectin. The tort lawyers drove the product completely off the market some years ago, not because it actually caused birth defects or other antenatal adverse outcomes, but because they could sue the manu- facturer any damned time they pleased. The profit that was made from Bendectin simply couldn't cover the legal costs, so the manufacturer stopped making it. My daughter's N&V was managed with intermittant intravenous infusions of Zofran (ondansetron, GSK) given "off-label," a costly measure that her obstetrician presented to her as the best alternative. For several months, she had to take care of her two older kids and try to handle her job as well while wearing an intermittent infusion port and settling back every night hooked up to an IV pump. The pregnancy went to term, and my wife is now baby-sitting the munchkin (and her brother and her sister) while my daughter is back at work. Outcome satisfactory. But if it hadn't been, would GSK been liable for selling a "dangerous and defective drug" because Zofran was used in this case? Especially because my daughter and her obstetrician decided to make use of the drug outside FDA-approved labeling? And if that drug could not have been used off-label for this purpose (bear in mind that a lot of sputtering a.sholes are making noises about how the FDA should act to forbid off-label prescription drug use) with the older, effective therapeutic alternatives having been driven off the market by tort lawyers pushing frivolous lawsuits that the judges hadn't blown their noses upon and thrown out of court to begin with - would it have been possible for us to sue the Association of Trial Lawyers of America for their role in any adverse outcome suffered by my daughter and her unborn child as the result of their actions? No? Well, golly gee-whiz. ----------------- The Ten Commandments display was removed from the Alabama Supreme Court building, but here was a good reason for the move. You can't post "Thou Shalt Not Steal" in a building full of lawyers and politicians without creating a hostile work environment. >>"Thousands of American women, including hundreds in Ohio, are >>filing lawsuits against Wyeth Pharmaceuticals, alleging that its [quoted text clipped - 117 lines] > > No? Well, golly gee-whiz. Thanks for posting your perspective--logical and reasoned as it is. How is it that the physicians are painted as the money-grubbers so frequently in this scenario? Glad everything worked out for your granddaughter. Steve > ----------------- > The Ten Commandments display was removed from the Alabama > Supreme Court building, but here was a good reason for the move. > > You can't post "Thou Shalt Not Steal" in a building full of lawyers > and politicians without creating a hostile work environment.  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > >"Thousands of American women, including hundreds in Ohio, are > >filing lawsuits against Wyeth Pharmaceuticals, alleging that its [quoted text clipped - 117 lines] > > No? Well, golly gee-whiz. First; let me remind you I'm Canadian. By and large we don't sue here; our law isn't written for this type of suit. But our culture doesn't support it either. I don't know of anyone (and I am formerly a journalist) who has sued for medical harm. I personally have been harmed three times. I did not sue. I wouldn't even think of it. The physicians, the surgeon, the nurses, did not get up that morning saying "let's get Zee." However: I find it dismaying that of the millions of women who took these drugs, and the thousands harmed, and the many likely in your own practice or experience, you could only find a dumb little old lady as lede for your story. If this is poetic license, the old news writer's gambit of "grab 'em by the throat" this editor is sending you back for a re-write. It's fictitious, and borne of your sexism. I can't argue American law but to say; it seems (to an outsider) that your whole system is arranged for this. Wouldn't it be smarter to just write in some checks and balances, more effective ones, that make sure all the negative information is known before the drugs are marketed? What did Wyeth, FDA and Health Canada and their ILK sit on, because letting it be known would have cut into stockholders share? If the patient and physician on the front line aren't provided with ALL information, don't blame the patient for not knowing. We did, after all, come to you with trust. Zee > First; let me remind you I'm Canadian. By and large we don't sue here; > our law isn't written for this type of suit. But our culture doesn't [quoted text clipped - 17 lines] > What did Wyeth, FDA and Health Canada and their ILK sit on, because > letting it be known would have cut into stockholders share? I guess you missed this part of SJ Doc's post: ..."but there's never been a moment in my professional life when we weren't aware of the correlation between estrogenic medications and increased risk of malignancy in tissue populations sensitive to these hormonal products. It's in the literature, it's in the FDA's product labeling (those prescription information fold-outs that patients never bother to read), and since the Web became avail- able, it's been all over that, too." It is of course possible that many physicians dispensed these medications irresponsibly. But if you start from the presumption that meds can cause harm if misused or abused, and that therefore any medication that can cause harm if misused or abused is not allowed on the market, what meds do you think would be left? Steve > If the patient and physician on the front line aren't provided with ALL > information, don't blame the patient for not knowing. We did, after > all, come to you with trust. > > Zee SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> First; let me remind you I'm Canadian. By and large we don't sue here; >> our law isn't written for this type of suit. But our culture doesn't [quoted text clipped - 39 lines] >> information, don't blame the patient for not knowing. We did, after >> all, come to you with trust. Zee HRT was in fact the default treatment for ALL women and any risks were pushed as minor compared to all the so-called advantages, now known to be fake and false based on self-selection, i.e. bad research which was the norm of the day, and still is. > > First; let me remind you I'm Canadian. By and large we don't sue here; > > our law isn't written for this type of suit. But our culture doesn't [quoted text clipped - 19 lines] > > I guess you missed this part of SJ Doc's post: Obviously I was talking of the *issue* of access to information re drugs, not only this class of drugs. Vioxx? Baycol? And the *issue* of access to information about devices put into our bodies, off-label. Pedicle screws? 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. I would be wealthy if I had a buck for everytime a physician said or implied if I knew a side effect I'd imagine I had it. 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. 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? 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. Zee 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 > ..."but there's never been a moment in my professional life when we > weren't aware of the correlation between estrogenic medications [quoted text clipped - 23 lines] > Brooklyn, NY > 718-258-5001 > I have spent my whole reproductive life fighting off first birth > control then HRT/HT, Whining is not fighting. You have offerd no evidence that you're fighting anything. > 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. You're surrounded by reproductive warriors. Evidence that I'm wrong on this? <chirp> moo >>>First; let me remind you I'm Canadian. By and large we don't sue here; >>>our law isn't written for this type of suit. But our culture doesn't [quoted text clipped - 47 lines] > in the future, and we can take HRT/HT drugs after; so what's the > problem? You may have had poor doctors. Steve > 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 [quoted text clipped - 36 lines] >>Brooklyn, NY >>718-258-5001 Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > >>>First; let me remind you I'm Canadian. By and large we don't sue here; > >>>our law isn't written for this type of suit. But our culture doesn't [quoted text clipped - 51 lines] > > Steve I don't dispute that. And pre-2002, almost all women and all doctors fit this scenario I have described. This was not one rotten apple in a barrel. This was standard practise. I am not unique. You really *do* want to ask women, and listen when they answer. Zee > > 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 [quoted text clipped - 43 lines] > "nospam" to reply\par > } >> >>>First; let me remind you I'm Canadian. By and large we don't sue here; >> >>>our law isn't written for this type of suit. But our culture doesn't [quoted text clipped - 59 lines] > > Zee Zee is correct in her postings. It was standard medical treatment at the time to push HRT, and to push it HARD. Also, surgery for hysterectomies and so forth and so on was very common and even cited as being one example of the 'best medical care in the world.' When foreign doctors did not agree that removal of famale reproductive organs at a high rate was normal, once again this was cited as evidence of socialized medicine and rationing. > I don't dispute that. And pre-2002, almost all women and all doctors > fit this scenario I have described. This was not one rotten apple in a > barrel. This was standard practise. I am not unique. You really *do* > want to ask women, and listen when they answer. > > Zee I've learned to listen to my wife. ;-) It hasn't even been suggested she get HRT, even though she is at increased risk for osteoporosis (16 yrs post-thyroidectomy). I haven't done a great deal of reading on the HRT issue, though I am aware of some of the issues related to Wyeth. I can't (and won't) dispute that this was standard practice among some physicians. But I can tell you that (at least in New York) it has NEVER been "standard practice" among all physicians. Steve >>>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 [quoted text clipped - 43 lines] >>"nospam" to reply\par >>} Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } >>>>First; let me remind you I'm Canadian. By and large we don't sue here; >>>>our law isn't written for this type of suit. But our culture doesn't [quoted text clipped - 51 lines] > > Steve No Steve, the lady above had doctors who relied on the usual, customary and reasonable practices of the time. Patients who had other ideas were listed as being non-compliant. > No Steve, the lady above had doctors who relied on the usual, customary > and reasonable practices of the time. Patients who had other ideas were > listed as being non-compliant. I will not dispute your experience, nor those of Zee. But it has most assuredly NOT been the experience of many (perhaps most) of the women I know whom I've spoken about this issue with. Could be regional differences, for sure. Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > 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 > > 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 [quoted text clipped - 8 lines] > > SBH Yes. I was given a prescription for Premarin alone. Zee >> > 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 [quoted text clipped - 12 lines] > > Zee Interesting comment Zee. Are you sure that Steve will accept your comment as true? > >> > 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 [quoted text clipped - 15 lines] > 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 > > > Yes. I was given a prescription for Premarin alone. > > > [quoted text clipped - 8 lines] > > SBH Probably overworked, underpaid, and cold. SBH > 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 [quoted text clipped - 6 lines] > 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 pregrant 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 > > 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 [quoted text clipped - 3 lines] > > Are you certain you heard what you thought you heard? That's it Steve. I got it wrong, we got it wrong; all the millions of women who managed to live through this crass turning of a natural event into an illness. 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 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. And, not only have I not asked for a safe drug; I have not ever asked for birth control, HRT, or HT. > > I guess *you* missed SJdocs last paragraph. Yup. Ummhmmm. Many > > physicians prescribed HRT/HT (and birth control) with little or NO [quoted text clipped - 11 lines] > here in the US to anybody who wanted to ask a pharmacist for one, for > at least a generation. They are available in Canada. One must ask. Oh there is an itty bitty list stapled to your bag. Don't operate machinery... 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. 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. 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. 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. Agreed. And I *do not*. > 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 [quoted text clipped - 4 lines] > a child. Which is a considerably greater risk than driving 10,000 > miles. So there again, communication is the issue. Patronizing b.s. Steve. > > I have spent my whole reproductive life fighting off first birth > > control then HRT/HT, and on into menopause and post. Women near [quoted text clipped - 9 lines] > 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? > I just read an interesting argument that the WHI mortality trends, if > analyzed properly as a time sequence, actually drop as a function of [quoted text clipped - 17 lines] > never would hear the end of it. That kind of thing is what doctors are > trying to prevent. Well they don't need to medicate every GD woman who walks through the doors to catch the 34 yr old who needs it. They usually easy to distinguish from the 52 years old women. > 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 [quoted text clipped - 4 lines] > 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. > By contast, 10,000 women driving 13,000 miles a year will have dozens > of serious injury-producing car crashes, producing long-term handicaps [quoted text clipped - 3 lines] > 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. > > 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 [quoted text clipped - 11 lines] > > SBH 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. Zee > 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 thended 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 [quoted text clipped - 6 lines] > > 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 [quoted text clipped - 5 lines] > 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 [quoted text clipped - 6 lines] > > 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 [quoted text clipped - 5 lines] > > 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 > > 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 [quoted text clipped - 12 lines] > (in this area) men are in many, many ways more clueless than women. As > the accident stats show. I have often been shocked to hear people say "I don't know" when I have asked why they are taking a certain drug. But it's intimidating for many people to ask their doctors for explanations. We feel like we are wasting your time, what we need to know is probably inconsequential. No matter how we enter the examining room with the best of intentions, questions jotted down. Never asked. Why else would we come to usenet and risk being savaged? > > Women are less assertive than men about this. Your profession was (and > > still is, often) very patriarchal. Women who want information and [quoted text clipped - 14 lines] > boot camp. It only gets called "sexist" when women are talked down to > by men. Men *are* subjected to sexism, of course they are. > 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 [quoted text clipped - 3 lines] > master. When I go to the doctor as patient (which I occasionally do), I > make the switch. Oh God can we get this on camera? Listen; it's a doctor/patient relationship. That most of the time it's a male doctor is not the point. It is almost always, even with my socialist physician friends, and my female physician, a master-student relationship where we, particularly those of my generation, defer. Why do you think I came at you with a question *after* I had seen my physician. She made me feel HORRIBLE about wasting her time. You're a patsy compared to her. Really. (Why do women who do get into these positions think they have to out-nazi the nazis? Rhetorical question I know the answer). 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. [quoted text clipped - 5 lines] > see the reason for your displeasure at being put in the subordinate > position by means of shear legalism. But let us continue). You too could have some respect. This person chose you. Capice? See the door? They can walk right out of it. > > 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 [quoted text clipped - 17 lines] > Citizen in (he US about 1995. Just after Netscape and the cheap 486 > machines. Well women aren't the Average Joe Citizen, for cultural and financial reasons, by and large. Yes. There are exceptions. > > > 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 [quoted text clipped - 12 lines] > experience of seeing it from the other side of seeing thousands of > average patients. Far from being bullshit, it's dead-on true. Alright I'll ignore the bs and say, it's more than a matter of communication. It's culture. You're the master. You said it yourself. > > > COMMENT: > > > Well, what IS the problem? Even the WHI study didn't find any [quoted text clipped - 10 lines] > 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. Yes, but thanks for this example, because even some emergency depts haven't the message on this yet! Nor do many physicians prescribing statins to some woman who doesn't have heart disease; because,of course, the numbers look good for her similar age husband. > 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, [quoted text clipped - 19 lines] > in women at age 50 a "disease" or not, as you like. A rose by any other > name. We wern't disputing that the upswing in cardiovascular disease is a disease. It was menopause that isn't a disease. But since you brought it up; I don't have cardiovascular disease until *I* do; not when some chart says I may be at risk. 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. This is sounding good. Where do I get this? Does it spray on? Stick on? Or do I take it orally or intra-vaginally? Cause sure as sh** your talking about some kind of hormone to replace what I can do fine on my own. Thanks. > 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? But drop dead of endometrial cancer in the meantime? Ne'mine. You saved me from cardiovascular disease. > And you know what? It damn near worked. They picked an artificial > progesterone (progestin) because they couldn't figure out how to give [quoted text clipped - 6 lines] > coming into menopause, but women who hadn't seen much estrogen in > years, and were as old as 79. I know you're wrong here but I don't have the cite. The women were not that old, exclusively. 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 [quoted text clipped - 9 lines] > from. But doing it anyway, out of altruism, out of love, and out of the > desire to be good doctors. <<sniff>> <<violins>> > 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. Could we just pick something somewhere in the middle of your nightmare and mine? > Look here, look there. The glass is different any way you turn it. > [quoted text clipped - 38 lines] > Well, it's the best we could do in 50 years after a a few millennia of > dark ages. It's all so explanable; when it isn't your body that has to pony up. Bend over... > 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 [quoted text clipped - 4 lines] > like they know what to do, than one that actually does (but doesn't > look so confident). Not true at all. The physicians I know, and trust (whom you are always ridiculing as socialists) are like the latter group. 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. You're talking to a person who made her livlihood being a professional cynic. Yes there are people who fit your description; master and teacher and at one time or another we all have. So what was it we disagreed about. Again? > SBH > > 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 [quoted text clipped - 228 lines] > > SBH Not all teachers are wise, just or right. But even if the patient decides *their* doctor (who went to Harvard yawn) is wise just and right, doesn't mean the patient shouldn't question him/her vigorously. Especially then; because once you start fraternizing with the enemy--you're lost. > 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. > > http://www.drtimdelivers.com/WHIMortality10.06.2004/WHIposter10.06.04.shtml > > [quoted text clipped - 6 lines] > 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 >> > http://www.drtimdelivers.com/WHIMortality10.06.2004/WHIposter10.06.04.shtml >> > [quoted text clipped - 14 lines] > 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. > 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 I don't think so. In any case, I would suggest that your predictions of the future are faulty. The issue is self-selection. > "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> wrote in message > > COMMENT: > > [quoted text clipped - 4 lines] > 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 >> "Sbharris[atsign]ix.netcom.com" <sbharris@ix.netcom.com> wrote in message > [quoted text clipped - 8 lines] > > The reinterpretation is he thinks the HRT actually improved mortality, I am waiting for the refereed article in a standard journal. I am not interested in private web pages. I also am not interested in self-selection as a basis medical research. > I am waiting for the refereed article in a standard journal. I am not > interested in private web pages. I also am not interested in self-selection > as a basis medical research. Fine. Then you cannot say that HRT doubles cancer levels, can you? And as for the refereed analysis of the WHI trial, which was NOT self-selected, they merely come to the conclusion that it does not influence mortality either way. Okay? SBH > COMMENT: > I just read an interesting argument that the WHI mortality trends, if > analyzed properly as a time sequence, actually drop as a function of [quoted text clipped - 17 lines] > never would hear the end of it. That kind of thing is what doctors are > trying to prevent. [snip] > > 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 [quoted text clipped - 9 lines] > 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. It disappoints me to see that so many commentators on this issue have their faces so firmly mired in the statistics that they've lost all view of the model which inspired the whole thing in the first place. I'm glad to see you're not one of them! What do you think of this recent little straw in the wind? http://www.eymj.org/abstracts/viewArticle.asp?year=2005&page=471 Title: Effect of Long-Term Hormone Therapy on Telomere Length in Postmenopausal Women Authors Duk-Chul Lee,1 Jee-Aee Im,2 Jeong-Ho Kim,3 Hye-Ree Lee,1 and Jae-Yong Shim1 Affiliation Departments of 1Family Medicine and 3Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea; 2Department of Laboratory Medicine, MizMedi Hospital, Seoul, Korea. "In conclusion, telomere lengths were longer in postmenopausal women who had a history of long-term HT than in postmenopausal women without HT. Long-term HT in postmenopausal women may alleviate telomere attrition." The link has a link to the free full text article. Fay >> >"Thousands of American women, including hundreds in Ohio, are >> >filing lawsuits against Wyeth Pharmaceuticals, alleging that its [quoted text clipped - 147 lines] > > Zee 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. The LOL mentioned above was simply following the cultural promises of the day that HRT was marvelous and she just avoided getting a prescription, for which she supposedly paid a price. But had she wanted a prescription, she would have had an easy chance of getting one, FAST. My wife had to fight off numerous efforts to get her to take HRT, even as she feared the label 'noncompliant' in doing so. HRT was, after all, pushed as the default position and you had to be pretty good to fight off the suggestions. So our so-called doctor above has posted a self-serving diatribe. > 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 >> Women have had to fight off physicians who pushed them actively into >> HRT [quoted text clipped - 8 lines] > SOME way, but that doesn't warrant calling them "biased research," > inasmuch as that phrase implies things which aren't so. A really ignorant comment. Self-selection is one of the oldest biases known and unfortunately the model for HRT research. It was crappy research, and unfortunatly such self-selection continues in the medical world. > >> Women have had to fight off physicians who pushed them actively into > >> HRT [quoted text clipped - 12 lines] > known and unfortunately the model for HRT research. It was crappy research, > and unfortunatly such self-selection continues in the medical world. COMMENT: ONCE AGAIN: Self selection is why you're supposed to be eating vegetables. Are you REALLY asking us to throw out all post hoc epidemiology completely? SBH >> >> Women have had to fight off physicians who pushed them actively >> >> into [quoted text clipped - 23 lines] > > SBH Healthy women self-selected for HRT in the first place. Epidemology involving large groups of non-selected people is quite different from the looking at those who go to doctors and who do not resist the push they are giving to get HRT. My wife had to say NO to HRT, but was pushed pushed and pushed. The benefits were supposed to be tremendous for diseases now known only to be made worse by HRT. You mentioned that doctors always knew the facts of HRT. Well, in fact the medical business did NOT know the risks because the risks were self-selected. Epidemiology is a vast field and but work based on who goes to the doctor is not the same thing either. > > COMMENT: > > [quoted text clipped - 5 lines] > > Healthy women self-selected for HRT in the first place. COMMENT: Yes, George, we know that now. Heathy people self-select for how much exercise they do and how many fruits and nuts they eat. And vitamins they take. So? > Epidemology > involving large groups of non-selected people is quite different from the > looking at those who go to doctors and who do not resist the push they are > giving to get HRT. How so? Did the doctor try to get your wife to lose weight and exercise? How do you know weight loss and exercise and healthy? Maybe they're just marker behaviors for the kind of people who go to doctors a lot. > My wife had to say NO to HRT, but was pushed pushed and > pushed. The benefits were supposed to be tremendous for diseases now known > only to be made worse by HRT. Maybe the same is true of dropping 10 lbs. > You mentioned that doctors always knew the > facts of HRT. No, you have me confused with SJ Doc. > Well, in fact the medical business did NOT know the risks > because the risks were self-selected. They didn't know anything about the risks because studies were retrospective, and the proper controls hadn't been done. That is all. People who smoke don't visit the doctor as much, either. People who are couch potatos don't take care of themselve in many ways. People who take vitamins are self-selected. So are people who are vegetarians, and people who eat pickled pig's feet. And people who buy pickup trucks. What is your point? Do you HAVE a point? > Epidemiology is a vast field and but > work based on who goes to the doctor is not the same thing either. Sure it is. I actually thought you knew something about epidemiology. [Revising opinion....] SBH >> > COMMENT: >> > [quoted text clipped - 10 lines] > exercise they do and how many fruits and nuts they eat. And vitamins > they take. So? So the results from such self-selection can never be used because they give the false appareance of success even if none is implied. In HRT, they gave the false impression of success when HARM was the result. How can doubling of cancer rates go unnoticed? Well, it did. And it will in the future unless real research takes place. >> Epidemology >> involving large groups of non-selected people is quite different from the [quoted text clipped - 3 lines] > > How so? Because what you are looking at with self-selection is the correlate of people who choose one or more treatments. It is not the result of the treatment. Now, if you have, as we do, large variations in treatment fashions for a population and people really have little choice, then you have more of a natural experiment. Large numbers of non-self-selected people are given treatment A, based on region. In other regions everyone gets treatment B. That would be a good thing to study. But if everyone gets a choice of Treatment A or Treatment B, then you get self-selection. Prostate cancer results have long been messed up with this kind of self-selection. > Did the doctor try to get your wife to lose weight and exercise? How > do you know weight loss and exercise and healthy? Maybe they're just > marker behaviors for the kind of people who go to doctors a lot. You would need other evidence than just what you mention because we know that such advice is also class-specific. By the way, my wife did loose weight and her doctor told her, 'enough,' even though she technically overweight. >> My wife had to say NO to HRT, but was pushed pushed and >> pushed. The benefits were supposed to be tremendous for diseases now >> known >> only to be made worse by HRT. > > Maybe the same is true of dropping 10 lbs. Irrelevant to HRT. >> You mentioned that doctors always knew the >> facts of HRT. [quoted text clipped - 11 lines] > people who eat pickled pig's feet. And people who buy pickup trucks. > What is your point? Do you HAVE a point? A proper clinical trial should have been done first before millions of women were put on HRT for mythical benefits. >> Epidemiology is a vast field and but >> work based on who goes to the doctor is not the same thing either. > > Sure it is. Totally wrong. >>>>"Thousands of American women, including hundreds in Ohio, are >>>>filing lawsuits against Wyeth Pharmaceuticals, alleging that its [quoted text clipped - 160 lines] > suggestions. So our so-called doctor above has posted a self-serving > diatribe. Unless you know SJ Doc personally, you have no way to know that he is one of those HRT-docs, nor that he has prescribed them irresponsibly. I can understand your frustration if you had a doctor who behaved otherwise; my wife has a responsible group of doctors who are both knowledgeable, open and empathetic. No one has had to fight with anyone on the HRT issue. My sympathies to you if your doctor(s) were not so responsible. Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } >>>>>"Thousands of American women, including hundreds in Ohio, are >>>>>filing lawsuits against Wyeth Pharmaceuticals, alleging that its [quoted text clipped - 170 lines] > > Steve I merely point out that HRT therapy was pushed hard for a varietey of benefits that were false. Regardless of medical speciality, the field as a whole was lined up behind the so-called benefits of HRT and women had to be very forceful to keep saying no against standard medical advice. > I merely point out that HRT therapy was pushed hard for a varietey of > benefits that were false. Regardless of medical speciality, the field as a > whole was lined up behind the so-called benefits of HRT and women had to be > very forceful to keep saying no against standard medical advice. I won't dispute that this was Wyeth's position. But among the physicians I know of, many did NOT push HRT, and I'd suggest that painting the whole "field" this way is unwarranted. Steve Signature{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fcharset0 Arial;}} {\*\generator Msftedit 5.41.15.1507;}\viewkind4\uc1\pard\f0\fs20 Remove "nospam" to reply\par } > 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 [quoted text clipped - 8 lines] >suggestions. So our so-called doctor above has posted a self-serving >diatribe. Oh, was that what I was doing? The point about that LOL who had stocked up on Premarin while on her cruise to Mexico was that she had been thus enabled to avoid asking any physician for a refill pre- scription. I was new in practice at that time (and awfully naïve about the potential for a patient to secure prescription medications out-of-country; it wasn't a big issue in the '70s), but I knew enough to follow what served us back in those days for therapeutic guide- lines, which included keeping postmenopausal patients on HRT under close scrutiny against the possible development of malignant and pre-malignant neoplasia in tissue populations responsive to estrogenic agents. That's why my first question was about her last Pap smear - and why I shuttled her into an exam room for a quick swab-and-scrape immediately rather than re-scheduling her to come back when I had more time. The rest of my patients that afternoon had to wait a bit. I would have been perfectly happy to refill her Premarin pre- scription at that time, based on prevailing standards of care in the late '70s. The problem was that she had side-stepped one of the key controlling mechanisms instituted to provide for the safe use of HRT, and that's what got her into trouble. I'm just happy she didn't buy herself one more hundred-tablet bottle of Premarin when she walked into that pharmacy in Mexico. The way I figure it, three more months of continued estrogenic stimulation might have helped her uterine cervical carcinoma go from Stage II to Stage III. Or worse. So are you any relation to SF editor and anthologist Groff Conklin (1904-1968)? I regret not having gotten active in SF fandom until a couple of years after his death, but as I recall Sam Moskowitz had nothing but nice things to say about him. ---------------------------- The art of economics consists in looking not merely at the immediate but at the longer effects of any act or policy; it consists in tracing the consequences of that policy not merely for one group but for all groups. -- Henry Hazlitt >> Women have had to fight off physicians who pushed them actively into >> HRT [quoted text clipped - 27 lines] > her to come back when I had more time. The rest of my patients > that afternoon had to wait a bit. I refereed an article about Pap tests on elderly women. It showed that they were unnecessary. Yet the recommendation was the opposite of the data, based on 'policy.' |
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