5 June 2010. firstname.lastname@example.org
Part 1: Transdermal better than oral estrogen for replacement: the importance of appropriate HRT.
PART 1: TRANSDERMAL BETTER THAN ORAL ESTROGEN: THE IMPORTANCE OF APPROPRIATE HUMAN HRT OVER PATENTED MEDICINES :
The health bite today from the BBC correctly highlights one of the many critical reasons why appropriate routine Hormone Replacement HRT should be taken permanently by any route – but preferably transdermally, not as tablets. In the appropriate low human dose HRT reduces the natural risk of stroke- and of the far more common chronic major diseases that cripple and kill – ie heart disease, cancer, fractures, dementia..
But the Menopause Societies (South African, British and International) ie BMS , SAMS , IMS , and the BMJ must promptly issue strong statements to the media condemning the BBC again for its typical misleading elementary misreporting- in this instance as regards progestins..
Transdermal and oral hormone replacement therapy and the risk of stroke: The source report – this week’s BMJ – describes HRT use in UK over about 6.7years among postmenopausal stroke victims mean age 70years (50 to 79) compared to matched controls without strokes. But the inexcusable error in the BBC report is that it twice mentions progesterone as being quoted in the BMJ study- which is nonsense. The BMJ report never mentions progesterone, it repeatedly says progestogen -ie synthetics progestins since these were and are deliberately and wrongly routinely prescribed (instead of progesterone) for HRT due to manufacturer-led market disinformation.
Progesterone is the original natural progestogen- but no major drug company promotes it, so it has been rarely used except by thinking women who prefer to use prime ie human – bioequivalent- hormones!
In the adjusted risk statistics, lowdose transdermal estradiol TD replacement 0.025 to 0.05mg a day lowered stroke risk by 19%; whereas the average gynecologist’s arbitrary patent pharmacological oral dose (20 to 40fold higher than the TD dose) of about 0.625 conjugated estrogens CE equivalent to 1 to 2 mg estradiol OET ) a day increased stroke risk by 35% . Thus, in contrast to lowdose estradiol TD which reduced the natural stroke rate, OET and highdose estrogen TD increased the stroke rate by 50% – 90%.
COMPARISON WITH USA WOMENS’ HEALTH INITIATIVE WHI: the WHI showed that on premarin 0.625mg/d the absolute risk of stroke in USA women age 50 to 79years was about 0.3% ie 3 cases per 1000 women per year -but about 45% higher in depressed women on antidepressants. And depression is even more common after midlife, especially without HRT. This cohort from the volunteer WHI trial was a mean of 63years at enrolment ie 7years younger than the British real-life cohort; and since the risk of stroke approximately doubles with every 10 years of aging, the basic risk in the British study women may have been about 5 cases per 1000 per year or 33 per 1000patients over the duration of the British stroke and HRT study. ie annually 4 cases per 1000 on lowdose estrogen TD versus 6 cases per 1000 on OET
Despite vast evidence that physiological replacement doses of the human hormone progesterone (the original progestogen in humans) has endless benefits for older adults, doctors, government clinics and committees overwhelminglly still are lead by the marketing hype of drug companies (and the regulators lobbyists and governments they fund) to use drugs designed for profit eg xenohormone progestens that they wish were and falsely claim are as good as the original one that our bodies produce.
Truthful information on HRT for women is widely and easily available from even Wiki and the real authorities like the British and International Menopause Societies, and any university department of gynecology. . Thus today’s BBC report reflects the BBC’s willful neglect of the most basic check of its facts before publishing health bites. In this case, it misleads women that conventional combined oral HRT (in fact containing the synthetic progestin that most drug companies and doctors encourage women to take) is beneficial in somewhat lowering the risk of stroke (never mind womb cancer) – whereas such synthetic progestins. progestogens especially in oral HRT have numerous sinister other adverse effects eg breast cancer and heart disease, compared to the numerous proven benefits of lowdose human progesterone. .
KEEPS: THE DEFINITIVE HEAD-TO-HEAD TRIAL OF APPROPRIATE HRT: ORAL vs NON-ORAL ERT WITH OR WITHOUT PROGESTERONE.: The small but definitive 5year KEEPS double blind randomized controlled trial RCT is now more than half way through and due to report in 2012, comparing the alternative regimes in women in the early menopause (10years younger and less overweight than in WHI) . “ KEEPS is a multicenter trial that will evaluate the effectiveness of 0.45mg of conjugated equine estrogens CEE Wyeth Premarin, a weekly estradiol TD Climara patch delivering 0.05mg estradiol a day -( both in combination with cyclic oral, micronized progesterone (Prometrium Solvay) 200mg for 12 days each month), and placebo”.
Recent information from KEEPS is that it is proceeding smoothly, with no significant differences so far between the three arms- no increase in serious adverse events has yet been seen by the Independent Monitoring Committee in the still unblinded results.
Wyeth (now Pfizer since 2009) is not crossfunding KEEPS, although they may be hoping that their premarin in lower dose will prove to be as safe as or better than estrogen TD in the medium term.. But given the ~70year experience with oral HT mainly premarin 0.625mg/d promoting breast cancer increase (although not mortality) after >12-15years of use , it is remotely unlikely that even ¼ of the long-standard premarin oral dose will prove anywhere as safe and effective as parenteral balanced human hormones for permanent protection in aging women. One hopes it is, to vindicate the insistence of so many doctors on still prescribing OHT for even just the first 10 years of menopause, despite so much damning evidence to the contrary (see this entire website of reviews).
SO WHY PRESCRIBE, RECOMMEND HRT PILLS FOR POSTMENOPAUSAL WOMEN? when hard evidence is that non-oral balanced human HRT (appropriate estrogen, progesterone and testosterone) is far superior in both benefits and zero risks for women? Whereas it is common cause that conventional oral HT ie about 0.625mg CE or equivalent started at menopause increases the early risk of dangerous deep vein thrombosis DVT; and begins to increase the risk of breast cancer to above that of untreated women after a cumulative dose of about 2 – 3 gms oral estrogen – after 10 – 15years ie by prime post retirement midlife in the midsixties. It is only some compensation that other cancers, fractures, ischaemic heart disease, dementia and (breast cancer- and all-cause) mortality, are reduced by appropriate m0dest doses of such OET combined with appropriate progestin; but such regime increases the risk of DVT, gallstones and fatness frailty- increasing body fat with increasing muscle wasting due to collagen loss which also promotes increase in the natural tendency to fractures and urinary incontinence by the midsixties.
Promoters of oral estrogen, bisphosphonates, SERMS, and strontium cleverly ignore the hard fact that by far the greater risk for aging fractures is not bone density but muskuloskeletal ie failing bone and muscle strength and global co-ordination – which bisphosphonates do nothing to promote, while estrogen and strontium nad SERMS may promote bone strength but not crucial muscle strength, and SERMS double the laready very high rate of stress urunary incontinence. .
American major authorities do anything to promote their own commercial interests. so they have long given their drug regulator the FDA – which is unashamedly paid for by big pharma- unbridled licence to make nonsensical claims and draconian laws. And because drug companies fund the FDA and the lobbyists and legislators in USA to promote their products, (in a $trillion disease industry – some 8% of American GDP) they have the vast profits to in turn influence medicines regulators and legislators throughout the world to follow their profitable lead.
So only the FDA and regulators decide what foods are good for people, what supplements (of microfood stuffs) people may take, and licence designer synthetics for human prescription after trials of only a few months in a few hundred subjects – but insist that old proven nutritional remedies may not even be claimed to have any health, preventative and therapeutic benefits unless they have undergone massively costly controlled trials that Big Pharma will never fund.
Their hypocritical deadly nonsense is then to use draconian measures to stop suppliers from making any health claims for even supplements that are well known to be gold standards for prevention and treatment eg fish oil and the scores of other highly effective and safe biologicals- minerals, vitamins, human (eg glucosamine, chondroitin, n-acetylcysteine, coQ10, arginine, carnitine, carnosine), and plant products- that are (co)-hormones, antioxidants, true anabolics, nitric oxide promotors, anti-inflammatories, antidepressants, memory and vision promotors, neurotropics, insulin sensitizers, antiatheroma, hypolipidemic , antimicrobial etc. .
In fact they now proclaim that citizens may not even buy supplements, foodstuffs or even legally prescribed compounded hormone creams made from legal components (as are all other prescriptions made by manufacturing pharmacists practicing alone or in Big Pharma), unless the FDA has proclaimed them safe, because “they have not been proven safe”.
This despite the facts that most enduringly successful prescription drugs (eg reserpine, metformin, digoxin, the synthetic progestins) are derived from/ based on successful evolution of and human experience with the parent supplement eg vitamin, mineral and other biologicals (eg non-oral progesterone, estradiol, testosterone) over thousands of years, and millions of patient years experience in the past >100years of scientific discovery.
The Disease Industry- FDA-Big Pharma – organized medicine international network- proclaims that no claims may be made for the benefits of supplements (the vehicles, parents of most prescription drugs in use) unless they have been tested in rigorous trials to the same standards as designer drugs are recently tested.
Yet the FDA and regulators allow the marketing of generics- chemical identicals but often far from identical pharmacology and therapeutic action- without clinical trials. Where is the logic for the vendetta against supplement creams like individually compounded bioidentical hormones that produce measurable physiological levels and appropriate relief?
This despite the fact that millions of patients have been and continue to be damaged (iatrogenesis that results in vast numbers of hospital admissions and deaths annually) the past 50 years by drugs promoted by the FDA at the pushing of Big Pharma, based on far too short poor and often fraudulent reports which the drug industry ruthlessly manipulates.
This led to the disasterous use of stilbestrol in pregnancy from the 1940s to the 1970s; to the disasterous registration and extensive liberal prescription – in many cases even promotion over-the-counter- of practolol, thalidomide, chloromycetin and other antibiotics; potentially fatal unnecessary patent anti-inflammatories up to the Cox2 inhibitors (eg Vioxx, celebrex) as painkillers; barbiturates benzos and antidepressants; lately sulphonylureas and glitazones as firstline drugs for type 2 diabetes instead of the gold standard metformin; new antihypertensive drugs as firstline therapy instead of the goldstandard lowdose amiloretic plus reserpine; appetite-weight suppressants instead of metformin; bisphosphonates for osteoporosis instead of the goldstandard combined dozen vigorous vitamins minerals and sex hormones that halve all major diseases; and statins for uncomplicated mild to moderate cholesterolemia instead of goldstandard combined minerals vitamins metformin and HRT.
And the simple fact that drug companies will no longer risk funding head to head trial of one of their profitable drugs against gold standard old drugs or supplements of proven great all-disease medicinal value; since prevention does not pay- only disease pays.
The cost of protectionism for the lucrative Big Pharma industry – for the sake of trade and taxes – is vast as witnessed by governments sponsoring eg statin , H1N1 flu vaccines , modern antidepressants, bisphosphonates and nonsteroidal anti-inflammatories, and when each of these products of unproven benefit in mass use nets the manufacturers obscene multibillion dollar profits- in the case of vaccines, with 100% indemnity guaranteed them at taxpayers’ ie the consumers’ expense!
The lesson from the new UK study of oral versus estrogen TD is that appropriate ie balanced physiological-dose human sex hormones are the logical 1st-choice prevention and treatment for postmenopausal women (and their peer mates) – not the multirisk wannabe synthetic substitutes that Big Pharma keep hammering on the public- new psychotropes, NSAIDs, Cox2 antagonists, statins, bisphosphonates which lack the multisystem benefits of physiological balance of evolution-evolved natural micronutrients ie nutriceuticals.
Part : 2. DOCTRINE OF CENSORSHIP and DECEIPT; vs DOCTRINE OF TRUTH/… see next review above this.