Tag Archives: PROGESTERONE

SPECIALIST NATURAL MEDICINE CLINIC 2015

SPECIALIST NON-XRAY PAIN, BONE, BREAST, BRAIN,  HEART, CHEST, GENITOURINARY, HORMONE RISK SCREENING  @ NATURAL MEDICINE CLINIC

for appointments for consultations,   or non-xray procedures by registered practitioners :  Sure Touch breast prescreening on  Saturday mornings next on  7 February 2015  by Sister Zeneath Ismail – cash R650 (then R450 if followup scan desired within 3 months);   -QUS  ultrasound quantitative bone density  cash R450 -tariff item 3612-  anytime;  Unlike radiologists’  and thermography reports (which describe only  the imaging finding), the rates quoted include relevant breast or bone consultation and management planning  by specialist nurse & physician.

IF BOOKED TOGETHER, (not necessarily the same morning) then combined breast and bone screening is R1000.

OTHER SERIOUS health problems ARE DEALT WITH BY CONSULTATION DURING THE WEEK (OR ON A DIFFERENT SATURDAY MORN) : heart- ECG,  fatigue, HRT, sexual health, hypertension, depression, memory/dementia, lung & lungfunction, anaemia-haematology; kidney/bladder/pelvic, hormone-endocrine, depression, osteoporosis, sleep, diabetes, thyroid, adrenal; cramp; skin,  infection including STDs & HIV/AIDs, stroke, epilepsy-neurology, dizziness, heartburn/digestive/liver,  neuropathy,  sexual health, menopause, HRT, genitourinary; immune problems, or arthritis relief;

Thermography no-touch infrared screening  for suspicious  cancer /inflammatory  changes:  by Radiographer Melinda-next 23 March 2015.   R900 breasts; R1100  head and  upper;  or lower body & pelvis;  R1300 whole body.

Bookings/queries contact Evelyn/ Reyhana / Val at  the Natural Medicine Clinic, 1st Floor no 15, Grove Medical Bldg, opp ABSA (parking ABSA Parkade )  near Warwick/Cavendish  Square Claremont Cape Town RSA, ph +27216831465 or a/h +2783 4385248 or reyhanadaya@yahoo.com  .

For the disabled – by arrangement  drive  up the ramp  to the Clinic door on the Grove Bldg 1st floor  parking deck.

Under CMS Council for Med Schemes Reg 10(6), open Medical schemes eg hospital plans  have to pay from their own funds (not members’ savings) for appropriate outpatient consultation (tariff item 0191) for  PMBs ie major conditions eg  cancer,   depression, neck/spinal problems, serious heart, lung, other disease., etc. Breast and osteoporosis concerns are generally part of menopause consultations N95.9   (if not already eg breast cancer code C50) and thus are often billable  med scheme benefits. The menopause billable item only applies if you are 45yrs upwards, unless you have had total hysterectomy.

On patients’ requests, appropriate invoice can be prepared and submitted to your scheme for refund of your due benefits. Some schemes eg hospital plans  falsely deny due benefits until reported to their regulator  CMS. For medical plans where the billable tariff benefit rate is higher than the breast screening fee paid, the med plan rate 0191  will be charged eg R790 by the contracted  specialist,  and refundable by Discovery to the member. some basic schemes eg Keycare, Bonitas require preauthorization, or referral by their contracted GP  .

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29 SEPT 2014 OVARIAN CANCER UPDATE: PROGESTERONE REPLACEMENT IS IDEAL; WHY USE ORAL HT? WHEN ESPECIALLY LONG TERM PROGESTINS GREATLY INCREASE RISK OF OVARIAN AS WELL AS BREAST CANCER.

: ABSTRACT:  since last review in  this column 5 years ago, what progress has there been with ovarian cancer OvCa? On Pubmed there are 81000 references,  45500 reviews on OvCa

5 Oct 2014:  Ovarian Cancer Often Arises from Precursor Endometriosis    Frontline Medical News, 2014 Sep 29, B Jancin

   29 Sept 2014  The good news is that if ovariectomy is not done at hysterectomy, then at least salpingectomy should be done- it does not cause earlier menopause.  And the modern fashion for progesterone cream as baseline hormone balancing in this age of estrogen dominance, the feminization of nature,  also adds major protection for heart, bone, memory, mood,  and against cancer, without the risks of estrogen.

Before this month’s update,  the latest, an Australian cancer review  Mette ea 2013, shows that cigarette smoking increases the risk of OvCa by 30% to 60%.

The latest   review 2013 Modugno ea at Univ Pittsburgh/Mayo Clinic  Hormone response in ovarian cancer: time to reconsider as a clinical target?   said “Ovarian cancer is the sixth most common cancer worldwide among women in developed countries and the most lethal of all gynecologic malignancies. There is a critical need for the introduction of targeted therapies to improve outcome. Epidemiological evidence suggests a critical role for steroid hormones in ovarian tumorigenesis. There is also increasing evidence from in vitro studies that estrogen, progestin, and androgen regulate proliferation and invasion of epithelial ovarian cancer cells. Limited clinical trials have shown modest response rates; however, they have consistently identified a small subset of patients that respond very well to endocrine therapy with few side effects. We propose that it is timely to perform additional well-designed trials that should include biomarkers of response.The most consistently reported reproductive and hormonally related factors found to protect against EOC are use of oral contraceptives (OCs), increasing parity, and having a tubal ligation. In contrast, increasing age and nulliparity have been consistently shown to increase EOC risk. 

    Recent studies, including the prospective Women’s Health Initiative (WHI) (Anderson et al. 2003) and the Million Women Study (Beral et al. 2007), report an increase in risk for both estrogen-only (ET) and estrogen–progestin (EPT) formulations, although the risk associated with EPT was lower than that of ET. A recent meta-analysis of 14 published studies found risk increases 22% per 5 years of ET use compared with only 10% per 5 years of EPT use, suggesting that risk differs by regimen (Pearce et al. 2009).               Exogenous androgens may be associated with EOC. One case–control study found that use of Danazol, a synthetic androgen commonly used in the treatment of endometriosis, significantly increased EOC risk (Cottreau et al. 2003), although this finding has not been replicated (Olsen et al. 2008). Ever use of testosterone (tablets, patches, troches, or cream) has been associated with a threefold increase in EOC (Olsen et al. 2008).             

     Reproductive disorders and other reproductive factors :  Factors affecting childbearing have also been shown to be associated with EOC. In most studies, infertility has been associated with an increased risk, which may be greatest among women who fail to conceive (Vlahos et al. 2010). In general, infertility treatment does not appear to increase EOC risk, although the subset of treated women who remain nulliparous may be at an increased risk (Vlahos et al. 2010).

         Endometriosis, defined as the presence and growth of endometrial tissue outside the uterine cavity, has also been associated with EOC. A recent pooled analysis of 13 case–control studies showed a threefold increase in the incidence of clear cell EOC and a twofold increase in endometrioid EOC among women with a self-reported history of endometriosis (Pearce et al. 2012).

    An increased risk of EOC was reported by one case–control study (Schildkraut et al. 1996) among women with polycystic ovary syndrome (PCOS), a condition associated with menstrual dysfunction, infertility, obesity, the metabolic syndrome, hyperandrogenism, and insulin resistance. However, the finding was based on a small number of cases (n=7) and the association was limited to nonusers of OCs and thin women. Further case–control and prospective studies have failed to confirm this relationship (Pierpoint et al. 1998, Olsen et al. 2008, Brinton et al. 2010).

   Tubal ligation has been consistently shown to be associated with reduction in EOC risk (Cibula et al. 2011). This protection appears similar in magnitude to OC use and child bearing (about 30%) and is protective in high-risk women (i.e. BRCA1/2 carriers) as well. Hysterectomy has also been shown to reduce EOC risk, although the magnitude of the association is not as great nor as consistent as that reported for tubal ligation (Riman et al. 2004). Finally, reproductive factors associated with other hormonally linked cancers, such as age at first menarche, age at menopause, and length of reproductive years, have not been consistently associated with EOC (Riman et al. 2004).

    Estrogens and androgens –  The evidence linking these  to EOC are mixed. The majority of women who develop ovarian cancer are postmenopausal at the time of diagnosis. In postmenopausal women, the major source of circulating estrogen is from the peripheral conversion (in skin and adipose tissue) of androstenedione by the enzyme aromatase.

    Progesterone and progestins- Epidemiological data suggest that progestins and progesterone may have a protective role against EOC. Importantly, there is some evidence that progesterone might synergize with chemotherapeutic drugs to induce apoptosis.

Now this month  comes exciting news about  a  Paradigm Shift: Prophylactic Salpingectomy for Ovarian Cancer Risk Reduction   Frontline Medical News, 2014 Sep 24, B Jancin     :   Removing the fallopian tubes at the time of pelvic surgeries as a potential means of reducing ovarian cancer risk appears to be a movement that’s picking up steam in clinical practice.
       A recent survey of 234 U.S. gynecologists showed prophylactic bilateral salpingectomy is catching on when performed in conjunction with hysterectomy, but far less so for tubal sterilization, Dr. Austin Findley observed at the annual Minimally Invasive Surgery Week.                                                                       A total of 54% of respondents indicated they routinely perform salpingectomy at the time of hysterectomy in an effort to reduce the risk of ovarian cancer as well as to avoid the need for reoperations. However, only 7% of the gynecologic surgeons said they perform salpingectomy for tubal sterilization, even though 58% of respondents stated they believe the procedure is the most effective form of tubal sterilization (J. Minim. Invasive Gynecol. 2013;20:517-21).
  “In my experience at various hospitals, I think these numbers are a pretty accurate reflection of what folks are doing,” commented Dr. Findley of Wright State University in Dayton, Ohio.
     The prophylactic salpingectomy movement is an outgrowth of the tubal hypothesis of ovarian cancer.
    “There is now increasing and dramatic evidence to suggest that most ovarian cancers actually originate in the distal fallopian tubes. I think this is a concept most people are unaware of or are just becoming accustomed to. The tubal hypothesis represents a major paradigm shift in the way we think about ovarian cancers. The previous belief that excessive ovulation is a cause of ovarian cancer is no longer regarded as accurate,” he explained at the meeting presented by the Society of Laparoscopic Surgeons and affiliated societies.
      Ovarian cancer is the No. 1 cause of mortality from gynecologic malignancy, accounting for more than 14,000 deaths per year, according to National Cancer Institute data. The lifetime risk of the malignancy is 1.3%, with the average age at diagnosis being 63 years.
       Only 10%-15% of ovarian cancers occur in women at high risk for the malignancy because they carry a BRCA mutation or other predisposing gene. The vast majority of ovarian cancer deaths are caused by high-grade serous tumors that have been shown to be strongly associated with precursor lesions in the distal fallopian tubes of women at low risk for the malignancy.
            There is no proven-effective screening program or risk-reduction method for these low-risk women. However, with 600,000 hysterectomies and 700,000 tubal sterilizations being performed annually in the United States, prophylactic salpingectomy has been advocated as an attractive opportunity to potentially reduce ovarian cancer risk. Other common pelvic surgeries in which it might be used for this purpose include excision of endometriosis and laparoscopy for pelvic pain. It also has recently been shown to be feasible and safe post partum at cesarean or vaginal delivery (Obstet. Gynecol. 2014 [doi: 10.1097/01.AOG.0000447427.80479.ae]).
   But the key word here is “potentially.” It must be emphasized that at present the ovarian cancer prevention benefit of prophylactic salpingectomy remains hypothetical; in theory, the procedure should reduce ovarian cancer risk, but there is not yet persuasive evidence that it actually does, Dr. Findley emphasized at the meeting, presented by the Society of Laparoendoscopic Surgeons and affiliated societies.
            In contrast, one well-established ancillary benefit of prophylactic salpingectomy is that it eliminates the need for future reoperation for salpingectomy. This was demonstrated in a large Danish cohort study including close to 10,000 women undergoing hysterectomy and a similar number undergoing sterilization procedures. Among the nearly two-thirds of hysterectomy patients who had both fallopian tubes retained, there was a 2.13-fold increased likelihood of subsequent salpingectomy, compared with nonhysterectomized women.
        Similarly, Danish women who underwent a sterilization procedure with retention of the fallopian tubes – typically tubal ligation with clips – were 2.42 times more likely to undergo subsequent salpingectomy, most often because of the development of hydrosalpinx, infection, ectopic pregnancy, or other complications (BMJ Open 2013;3 [doi:10.1136/bmjopen-2013-002845]).
     The most commonly cited potential risk of prophylactic salpingectomy – decreased ovarian function – now appears to be a nonissue. This was demonstrated in a recent retrospective Italian study (Gynecol. Oncol. 2013;129:448-51) as well as in a pilot randomized controlled trial conducted by Dr. Findley and his coworkers (Fertil. Steril. 2013;100:1704-8), which appears to have answered many skeptics’ concerns. Indeed, Dr. Findley’s coinvestigator Dr. Matthew Siedhoff said he has recently been approached by researchers interested in collaborating in a larger confirmatory randomized trial, but all parties eventually agreed it was a no-go.
    “It’s a little hard to demonstrate equipoise for a larger randomized controlled trial. We’re beyond that now, given that prophylactic salpingectomy really doesn’t seem to make a difference as far as ovarian function,” according to Dr. Siedhoff, director of the division of advanced laparoscopy and pelvic pain at the University of North Carolina, Chapel Hill.
         Another oft-expressed reservation about salpingectomy as a means of reducing ovarian cancer risk in women seeking sterilization is that salpingectomy’s irreversibility may lead to “tubal regret” on the part of patients who later change their mind about further pregnancies. However, Dr. Findley cited a recent editorial whose authors criticized colleagues who made that claim. The editorialists argued that the tubal regret concern indicates surgeons weren’t really listening to their patients’ true desires during the informed consent conversation.
     “We should not have started thinking about salpingectomy for female sterilization only once a decrease in ovarian cancer risk became part of the equation,” they declared (Obstet. Gynecol. 2014;124:596-9).
           Dr. Findley noted that Canadian gynecologists are leading the way forward regarding prophylactic salpingectomy as a potential method of ovarian cancer prevention. The Society of Gynecologic Oncology of Canada in a 2011 policy statement recommended patient/physician discussion of the risks and benefits of bilateral salpingectomy for patients undergoing hysterectomy or requesting permanent sterilization. The Society of Gynecologic Oncology followed suit with a similar clinical practice statement in late 2013.
        Additionally, the Canadian group declared that a national ovarian cancer prevention study focused on fallopian tube removal should be a top priority.
    Gynecologic oncologists in British Columbia recently reported the eye-catching results of a province-wide educational initiative targeting gynecologists and their patients. In 2010, all British Columbia gynecologists had to attend a course on the role of the fallopian tubes in the development of ovarian cancer, during which they were advised to consider performing bilateral salpingectomy for ovarian cancer risk reduction.
              Surgical practice changed dramatically in British Columbia in response. In 2009 – the year prior to the physician education initiative – salpingectomy was utilized in just 0.3% of permanent sterilization procedures. In 2010, it was 11.4%. By 2011, it was 33.3%.
           Similarly, only 7% of hysterectomies performed in British Columbia in 2009 were accompanied by bilateral salpingectomy. This figure climbed to 23% in 2010 and jumped further to 35% in 2011. Meanwhile the rate of hysterectomy with bilateral salpingo-oophorectomy remained steady over time at 44% (Am. J. Obstet. Gynecol. 2014;210:471.e1-11).
     This project was conducted in collaboration with the B.C. Cancer Agency, which maintains comprehensive province-wide registries. Over time, it will be possible to demonstrate whether prophylactic salpingectomy is indeed associated with a reduction in the incidence of ovarian cancer. “I think this study demonstrated that there’s a lack of awareness on this issue, but also [that there’s] potential effectiveness of introducing an educational initiative like this in changing our practice patterns. As we start talking more about this issue amongst our colleagues and our patients, we’re more likely to see a practice pattern shift in the United States as well,” Dr. Findley commented.

17 July 2009     A new cancer study of  over 7 million women years is another major coffin for unopposed estrogen ET, for progestin Pg, and for oral  sex hormone therapy SHT.

Danish  Universities prospectively document  the incidence of ovarian cancer OvCa in a million postmenopausal women PMW  from 1995 through 2005.  Compared to non-users, use of HT increased OvCa (mean age 62yrs) by about 40%   for up to 2 years after stopping Ht, ie increased the absolute incidence  of clinically diagnosed OvCa from ~ 0.04 to ~0.052% ie per 100 patient yrs.

Transdermal TD ET alone  increased risk by 13%; vaginal ET by 23%;                                            Oral ET alone increased  risk by  34%; oral E+ progestin Pg by  48%;          TDE+Pg by 67%.

Thus the relative incidence of OvCa rose about 33% by 7 years on HT, to 48% if HT continued beyond 7years.

In 2004 Glud ea reported an increase risk of 31% for OvCa in Danish women on OHT use – total ET dose of ~5gm ie for about  for 15yrs – at a time when the standard premarin  dose was 0.625mg/d (equivalent to l mg E2)  if not double that .

For perspective,  the relative incidence of cancers in similar mostly 1st world European women from the  the USA SEER data for 2006 age over 50  years  are: BrCa 0.33%,  uterus 0.07%, ovary o.03%(ie very similar to the baseline Danish figure of 0.04% above), colon 0.15%,and cervix 0.01%. The new (Norwegian)  analysis in the latest BMJ suggests that screening mammography may result in overdiagnosis of BrCa by up to 50% (the other 50% may arguably never have been clinically significant-diagnosed- during life) , so the provocative could argue that the relative incidence of clinically significant BrCa to OvCa is more like eg BrCa 0.2 to ovary 0.03 ie just below 10:1. But OvCa is notoriously about 70% fatal within a few years, so  the absolute  mortality rate – at age 60-64yrs-  from  the same SEER  source and period are as relevant: BrCa 0.063%, uterus 0.011%, ovary 0.033%, colon 0.03% & cervix 0.005%. ie new OvCa may be only 1/10th as common as newBrCa, but BrCa  kills only twice  as many PMW as OvCa.

And finally the 2007  survey by  Rossing ea of  Menopausal Hormone Therapy and Risk of Epithelial Ovarian Cancer in women in Washington State 2002-2005 showed that  ET -mostly premarin (but not ET + progestin- MPA medroxyprogesterone provera) – especially in  low-parity  younger slim women increased OvCa compared to non-users, and that this risk  was highest- up to 90%-  in  users of OET  for more than 6 years.

By comparison – BREAST CANCER BrCa and HT: Hoover ea  1976  are the first on Pubmed to report doubling in  risk of breast cancer  BrCA after 15yrs on premarin in USA ie at least 5gm cumulative dose.

In Denmark by 1994 Ravn ea reported that if there was a risk of BrCa from OHT, it was small, and only after prolonged use of estrogen (15-20 years).  But by 2004 -2005 Tjønneland ea , Stahlberg ea  and Ewertz ea  found increased risk for BrCa  of 61 to 112%  associated with current use of HT.  Stahlberg ea already in 2003 concluded from recent studies from both the USA and Europe that the combined treatment regimens with estrogen and progestin increase the risk of BrCa  beyond the risk of unopposed estrogen.

In Norway, a recent Tromso study suggested that the dominant HT therapy used in Norway was oral estradiol E2 plus the progestin norethisterone acetate. . An earlier Tromso study in only 35000 PMW was too small- it showed that use of such OHT for >5yrs trebled the incidence of breast cancer BRCa, but did not influence that of OvCa.

Apart from smokers’ lung cancer, the commonest cancer in older women- BrCa- clinically affects perhaps 5% of PMW  lifelong – but  with prompt therapy after clinical presentation kills as few as 5% of sufferers- and with appropriate OHT (premarin +- provera)  for up to 8years in the Women’s Health Initiative both the incidence of and mortality from BrCa, and all-cause mortality,  were reduced by about one-third. Hence appropriate HT saves many from both BrCa and from premature death and disability from the commonest degenerative diseases- vascular, dementing and fracturing. 75% of women who develop BrCa  die with it –  not from it but from far more prevalent degenerative diseases after an  otherwise normal lifespan. But the Danish evidence is that combined OHT will increase OvCa by >50%.

Ovarian Ca kills 70% of victims, and is it so rare compared to BrCa? .

Hence with the perhaps 2/3  lower incidence of OvCa, it is a relatively trivial problem for women overall- except for the 4  in  10 000 women  who develop it, who have <50% 5year survival, ie 3 out of 4  of whom it will kill within a few years- compared to <25% of breast cancer victims who will be killed by the BrCa.

However, it becomes clear that these hormone-dependent cancers are both  duration-  and total-dose HT related; but even more important, that unopposed OET is a risk if persisted more than about 12 yrs; and even if used in far lower dose parenterally, the risk of OvCa is far higher if combined with the European fashion of androgenic synthetic progestins Pg – even parenterally; whereas the American MPA for up to 8years at least apparently if anything mitigates the OvCa risk of ET..

By contrast this column has repeatedly reviewed evidence that balancing physiological ERT with physiological testosterone replacement TRT eliminates the risk  for BRCA and endometrial cancer of unopposed ERT +- PRT in PMW.  Intuitively this should also apply to ovarian cancer.

Hence the message strengthens that PMW should not be exposed for  any length of time at any stage to the much higher oro-hepatic HT doses (needed for symptom control) or OET+- Pg; but as in all other endocrine replacement for permanent  multisystem prevention – let alone sexual function-  patients with gonadal deficiency should have physiological sexhormone balance restored  ie with balanced parenteral  human androgen, estrogen and progesterone replacement.

It is common cause that (reproductive cycles and pregnancy aside) all the physiological  prime sex hormones-DHEAdehydroepiandrosterone, P4, T, E2, E3 – are as important as all other human hormones, essential life long  for optimal health; and that estrogen dominance (due to inadequate  androgen and progesterone levels) is deleterious. Hence most PMW require both physiological progesterone and androgen replacement- sometimes to balance excessively high endogenous estrogens, usually to accompany necessary ERT for full balance.

ndb

CHRONIC ILLNESS- MANAGED ANTIAGING & GENERAL PRACTICE CLINIC SOUTH AFRICA

update 6 April 2015

In Claremont  Cape Town

A  Specialist Family Internist Clinic offers consultations by appointment especially for managing (and ideally preventing)  the major chronic degenerative diseases of aging  and  maintaining physical, mental (and why not sexual?) vigour to a ripe and healthy old age; as well as preventing and managing acute disease at all ages.

The clinic (a specialist physician and a nutritionalist)  offers all-system evaluation and if available, natural  (as well as essential prescription orthrodox) prevention/treatment including metabolic – weight-endocrine-diabetes; heart-lung -kidney; hypertension; neurological-pain; joint & muscle; abdominal, immune system ie infection, cancer and auto-immune  support;  genito-urinary, & sexual problems;

and appropriate screening – ECG, non-xray ( no-touch thermography- eg thermomammogram;   SureTouch tactile) mammograms, non-xray (ie  ultrasound) BMD ie  bone fracture risk measurement, body composition, and appropriate hormone profiling/replacement.

Phone during office hours for appointment: for Claremont office  ph 021-6717415  or 6831465 (or 083-6299160) – at Grove Medical Bldg 1st floor no 15 (opp ABSA Bank Parkade c/o Grove Ave Pearce Rd)  , or neil.burman@gmail.com ;  or consultation by telephone/Skype or email .

by appointment only:        OFFICE HOURSby appt: ph office:  9am-5pm weekdays, 9am-1pm Saturdays.  AFTER  HOURS up to 9pm any day generally at office: –  email doctor   neil.burman@gmail.com  or ph 6am to 9pm  0836299160. EMERGENCIES  cannot be dealt with- acute emergencies and trauma, bleeding cases  must go to any  Emergency Unit .

Billing according to means ie specialist professional rates:  eg as a preferred provider for Discovery Health-  consultation procedure  0190; for needy patients, what the medical scheme pays  Detailed medical report and advice protocol provided at R300. Even Hospital Plans have to pay for outpatient consultation for scores of PMBs ie Prescribed Medical benefit conditions like Menopause.

 Needy patients desiring brief consultation can be seen by arrangement at GP rate.    Bone density scan  (covered by some medical schemes)  procedure 3612..  Non-xray mammograms are not yet covered by medical schemes codes: R650 for SureTouch including clinical consultation, R800 for thermomammogram.

DOES PROGESTERONE SUPPLEMENT REDUCE FRACTURES? NO, BUT…

  neil.burman@gmail.com 

Question: Some say that ‘progesterone / progestins worsen bone loss’. everything I’ve read about progesterone says the opposite.   In fact Dr John Lee wrote a book about it.

Answer:    Most published stuff is rehash, opinion- not evidence. 

 Dont forget that Drs John Lee  & Kathy Dalton never did or published a trial, merely their opinions. They  wrote  books and articles based purely on subjective experience- and didnt have Medline to give them  evidence.. They   probably benefitted millions of women by advocating at least some safe progesterone cream replacement that was undoubtedly a lot better than nothing.  But all one can do from observations is formulate a theory, a hypothesis. Massive evidence is accumulating that all  men and women with low progesterone  should supplement with it to around a level of 1 -2 nmol/L   for immune and neuroprotective -benefits; – but to no clear benefit against fractures when used alone.

No significant reported  trials of progesterone or it’s synthetics that one can find, including from the top Osteoporosis reseach units in the world,  show benefit of any progestin on its own  on  fracture risk – if anything the contrary–   in postmenopausal women

At best, progesterone and androgenic progestins alone stop bone loss.

The only substances that safely and effectively reduce fractures and actually increase bone density  and muscle longterm in  simple safe lowcost combination – in both spine and hip –  at all ages are the natural anabolics – calmag, boron, zinc, manganese, copper, selenium, vits (B6,9, 12,C, D & K),  proline, glycine, creatine, lecithin, testosterone, estrogen and melatonin; and if deficient, iron (obvious in children and pregnancy); iodine and fluoride (regional deficiencies).

     [It is unclear from published trials whether adding strontium, biphosphonates, SERM, calcitonin,  parathyroid hormone , or  human growth hormone in HGH-deficient elderly patients,  further reduces fracture rates when added to appropriate essential supplements already listed above – this seems unlikely. and no Drug manufacturer is going to fund such a trial, which will likely only confirm the fruitlessness and risks  of their exensive patent drugs] . .

Estrogen at best stops bone loss- and in the WHI, reduced fractures by just below a third . When combined with progestin, th anti-fracture benefit was slightly reduced.

What matters is that only vigorous vit D & appropriate testosterone actually restore lost bone and muscle mass /  strength.

Bone density improvement on progesterone alone has been claimed, but there are no definitive studies in humans or animals to show this.

  We do know that the synthetic progestins if anything reduce bone density EXCEPT perhaps the androgenic progestins -which progesterone is not. !

  In the two arms of the giant Womens’ Health Initiative, in well-matched women, compared to placebo, premarin alone reduced all fractures by 29% (and hip fractures by 35%)  whereas premarin + progestin reduced all  by only 23% (and hip fractures by 33%) .

In the PEPI and the Lydeking-Olsen trials, progestins at least stopped fall in bone density- but only in the WHI did estrogen reduce fractures- and progestin did not help further.

So where are the trials showing  that progesterone actually does reduce fractures? It will be great to see them.

However, in a landmark review that matches her study-of-the decade on the Perimenopause in 1998   (showing that that phase is in fact a time of estrogen excess) – Jerilyn Prior last month published with Seifert-Klauss  another  study-of-the-decade  showing that progesterone itself  is in fact a vital co-hormone in enhancing the bone-strengthening effect of estrogen provided they are given together continuously.

How much better against fractures  is estrogen+progesterone than estrogen alone?  There is still no objective data- but such a trial by Seifert-Klauss ea   is in progress. 

And given their increased cancer and cardiovascular risks, synthetic progestins ‘ theoretical bone benefits cannot be extrapolated to human progesterone.

But there is so much other evidence about the independent multisystem benefits of progesterone without estrogen – especially for its immune, anti-cancer and neuroprotective benefits- to make it obligatory for progesterone always to be prescribed with estrogen, irrespective of hysterectomy status.

Thus John Lee was wrong on progesterone alone against fractures, but correct for the combination of progesterone with estrogen giving better antifracture protection than estrogen alone. .

HOW USEFUL IS DHEA AS A SUPPLEMENT?

neil.burman@gmail.com  Cape Town

DHEA PRASTERONE- THE PARENT SEX HORMONE :

Steroid physiology course 101 teaches that our bodies convert vitamin C to cholesterol and then PREGNENOLONE – the progenitor  of the human adrenal and gonadal steroid hormones. that are formed also in our liver, skin and brain. In turn this grandparent steroid produces PROGESTERONE (- one of the three prime sex hormones- and thence also some the anti-inflammatory (cortisones) sex hormones and the salt-controlling steroid mineralocorticoids: and 

 DHEA – dehydroepiandrosterone, prasterone – an important sex steroid in its own right, and one of the parents of the main androgen-TESTOSTERONE – and the ESTROGENS.

The above steroid hormones are distinct from the other human steroid hormones, the calciferols (vitamin D) which we make in the skin; and the heart-formed glycosides, which regulate and strengthen the failing heart and may suppress some cancers.

DHEA is by far the most abundant blood steroid hormone, peaking at around 30 years of age, then like most dropping by up to 95% into old age,. DHEA seems to be as a resevoir for our needed androgen and estrogens.

USE AS  HRT sex steroid hormone replacement/therapy:  There was high hope that DHEA would prove major benefit for many diseases including the major degenerative diseases of aging, systemic lupus, etc; but this has not been confirmed by trials and experience except for osteoporosis in androgen-deficient women. .

The Mayo, Creighton and Cleveland Clinic websites give   it a cautious but doubtful nod.

RECENT TRIAL EXPERIENCE: Judith Rabkin ea  2006 showed significant improvement in non-major mood depression in AIDS cases.

Labrie 2007 showed that DHEA in women preferentially boosts androgen rather than estrogen levels- which explains its energizing and bone-strengthening benefits in women with low androgens ie estrogen dominance.

 The last trials of DHEA in osteoporosis (Jankowski 2008 ; von Muhlen 2008) in the elderly showed improvement in women. So this is a potential use in the old.

The two trials published this year of DHEA in systemic lupus (Marder USA and Hartkamp Netherlands) also failed to show significant benefits.

 Review by Panjari and Sue Davis 2010 from Monash University found no significant role for oral DHEA in women.

PERSONAL PRACTICAL EXPERIENCE AND CONCLUSION: The only time DHEA is often worth trying, helpful is in the frail elderly – biologically old  or past the mid-sixties- with low bloodpressure, low energy, wasting or inflammatory disease, osteoporosis. In such patients one is for obvious reasons very cautious about starting even non-oral testosterone in men, and appropriate ie non-oral testosterone/estradiol/estriol in women. One soon sees whether any dose has any benefit, as compared to balanced titrated testosterone-estradiol-progesterone.

Dr Lee Vliet (endocrinologist in Tucson, Arizona) starts DHEA as low as about 1mg a day ie a quarter or 1/8th of a 25mg tablet to start, repeating the dose every few days and then gradually up to 1/4 to /2 to 1 – 2tabs a day.

The difficulty is the unpredictability of whether metabolism to androgens and estrogens will be balanced, or cause adverse effects through imbalance. Such adversity can be better minimized by using separate non-oral daily testosterone and estrogens, but obviously these are both more emotive and more potent, with sexual overtones that the aged often dont want.

For the frail and old, or those concerned about androgenic/estrogenic adverse effects, an even safer alternative is the human metabolite 7 keto DHEA , which is also like DHEA generally available over the counter. It reputedly cannot be metabolized back to androgen and thus estrogen. Ihler 2003 suggested it useful as a thermogenic agent for Raynaud’s phenomenon ie periodic white cold digits; Some consider it no different from DHEA, some stronger; and worth trying for weight loss.

Overall, DHEA supplement may be useful, but only in the elderly.

ABANDONED DOCTRINE OF TRUTH IN MEDICINE: POSTMENOPAUSAL HRT:USE HUMAN TRANSDERMALS. WHY RISK TABLETS? BIG PHARMA WINNING THE (DIS)INFORMATION WAR. part 2

 6 June 2010. neil.burman@gmail.com 

Part 1: Transdermal better than oral estrogen for replacement: the importance of appropriate HRT.

Part : 2. DOCTRINE OF CENSORSHIP and DECEIPT;   vs DOCTRINE OF TRUTH:

The Doctrine of Truth (as opposed to theological disputes)  may be said to  date back perhaps 2400 years to Plato.     The  opposite, the Doctrine of Deception and Censorship may have been used by ruthless rulers throughout history  against their own citizens to justify achieving their goals at any cost; and may be said to have been adapted from the Cold War enemy and  perfected by the Kissinger-Bush Regime  in the past 40 years, and  after 9/11 used to  plunge  America into multitrillion dollar futile  war debt  in Iraq and Afghanistan.  The same team (Kissinger’s kindergarten- the  Bushes, Cheney, Rumsfeld, Wolfowitz) has been operating in Washington Administration since the Vietnam war, fuelling failed states- Shock Doctrine  , promoting the policy of two foreign wars for profit at any time,  and disseminating nuclear weapons to Pakistan, South Africa  and many other warring states. .   But fortunately that ruthless regime  was not able to emasculate the USA Supreme Court   as the ANC Govt is now doing in South Africa, and most powermad governments do.

Last week the California Supreme Court under the First Amendment guaranteeing free speech, threw out the FDA Doctrine of Censorship    that bans truthful health claims about supplements, the Doctrine of Deception that corporations, politicians and governments now use to further their own interests not those of  citizens.  

This Court victory  is progress after the revelations  the past year  this column and others review serially about the  endemic Big Pharma-FDA- governments’  fraud around  modern drugs and technology, the ficticious Celebrex-Bextra-Vioxx and swine flue ‘pandemic’  scams,   the flu vaccines,  Tamiflu, and now the Rotavirus vaccine and HPV- Cervix cancer vaccines;   and the evidence-based vindication of Dr Andrew Wakefield’s work and martyrdom on  damage inflicted by multiple early vaccinations . 

For example, the H1N1,  swine flu and HPV vaccines may produce strong antibody reactions, but where is the evidence that they translate longterm into reduction in serious sequelae  from infections and cancer, and without serious long term unintended complications like neurological impairment?  But Big Pharma is immunized at incalculable cost to future taxpayers- by the USA government – (which blissfully passes out of responsibility  after it’s 4 to 8 year term)- which simply denies the possibility of risk and blocks cost-benefit trials of swine flu vaccine lasting  even 2 year let alone 5 years.

The best evidence  summary on Pubmed for HPV vaccine is a 2007 review that serological results “imply they will be effective at preventing related cervical cancer” -on which supposition multimillions of  young women, even  pre-teen boys and grils are being/ have been  coerced into having unproven costly risky vaccines.  Why else would health insurers be still opposing the $360 cost of this unproven vaccination?

The precedents for longterm vaccine adversity are  horrendous, especially after previous misdirected western medical zealotry for  clitoridectomy and oophorectomy for rebelliousness even up to the 1900s, the incarceration in asylums of the ‘mentally ill’  including  dissidents, to mass forced electroconvulsive therapy, to misdirected elective hysterectomy , or gastric surgery for peptic ulcer, to gross antibiotic abuse, to the numerous major complications and deaths after the previous shotgun antiflu vaccination campaign not a few decades ago – never mind the gross disasters from hasty new drug profiteering with eg stilbestrol, the early highdose oral contraceptives,  and  nonsteroidal anti-inflammatories,    discussed in a recent previous column. 

By contast, the USA delayed the introduction of lithium there- heavy competition for it’s new -psychotrope  empire- by refusing  to licence for decades  lithium carbonate- the gold standard for treatment of deadly bipolar disease outside USA- until the great Dane  father of lithium Dr Magnus Schou had been forced to put his patients at risk by doing a double-blind withdrawal trial of lithium; and it refused to licence and encourage  metformin- the gold standard drug (aet 1922) outside USA since the 1950s against type 2 diabetes- until  the UK did the unique double-blind UKPDS trial which confirmed that metformin is the only patent ever drug which reduces both major disease and all-cause mortality by over a third.

And despite major trials for up to 4 years on 4 continents proving that preventative  metformin in overweight  ie prediabetic patients more than halves the occurrence of new diabetes, reduces all markers of lipidemia, inflammation, thrombosis,  and therefore  future mobidity, obesity and mortality, the FDA and the disease industry  still continue the farce of maintaining that metformin is proven solely to treat type 2 diabetes and polycystic ovary syndrome, while they promote new antidiabetics , antilipidemia and  appetitite suppressants  (unproven by longterm trials)  until enough patients suffer and die, like from the glitazones, incretins, statins, fenphen, acarbose, sibutramine, rimonabant,  xenical etc.

 Fortunately the landmark California judgement comes in the same week as UK society questions the abandonment of religious ie moral education in secular UK schools. This hard-won judicial and moral Doctrine of Truth, of Human Rights – which especially USA, UK, Europe and South African governments up to the present  have abandoned this century- applies equally to the BBC ie the media, and Governments/Corporations – politicians and officials; and the Disease Industry including Regulators, Big Pharma and clinicians.

INFORMATION WARFARE AND THE DOCTRINE OF DECEPTION:       Prof   Bill Hutchinson (Chair of the Australian Information Warfare and Security Conference)  in his seminal essay Information Warfare and Deception(2007)   describes  the  Doctrine of  (Dis)Information Deception  strategy  best practiced by the most developed countries that can monitor electonic media and control mass media via small cartels..    He quotes the Soviet Marxist-Lenminist  concept of maskirovka which includes deception, disinformation, secrecy, feints, diversions, imitation, concealment, simulation and security.. Basically, it is concerned with “anything capable of confusing, and therefore weakening, the enemy” (Lloyd, 1997). 

Which strategy the USA politicians  rapidly put to good use from lessons learnt in the wars in Vietnam, Panama, the Falklands , the disaster capitalism used to loot countries by shock doctrine; and so tightly applied in the past decades’ wars started by the Bush quintet;  the senior Bush having served as head of the CIA. Donald Rumsfeld was successively head of GD Searle till it was sold to the rogue company Montsano so deeply involved in the  growth hormone, pesticide and genetically modified seeds scandals, and then of Gilead Science manufacturer of  Tamiflu – one of the scandals of the swine flu scam last year. Dick Cheney was head of Halliburtons, the US corporation most scandalously favoured by $billions in government contracts throughout the Iraq war. Marcia Angell details how Rumsfeld’s GD Searle subsequently ended up as part of Pfizer; and that one recent (2003) annual meeting of PhRMA included Bush senior, the Secretary for Health, former FDA commissioner McClellan and Senator George Allen. So deeply are the politicians involved in Big Pharma.

This deception strategy  has  long and  expertly been deployed by Big Pharma and others in the Disease megaIndustry.   In the marketing health complex context,  for ‘enemy’ read those not in Big Pharma/ Disease technology manufacture-  the reputedly independent regulators, legislators and clients- healthcare insurers/ medical aid groups, State healthcare organizations, healthcare providers and patients. For the other side read ‘Government-Regulator-Diseasemongering- Disease Technology producers- Big Pharma’ complex.  

 It remains to be seen whether, as Hutchinson writes, the government -disease industry -mass media complex uses draconian (paramilitary)  tactics yet again to overturn judical vigilance for free speech and choice.  So after millennia of  promotion, growth  of   truth and human rights as portrayed  and promoted  by rational moderate thinkers (in modern times like Kierkegaard, George Elliot, Winwood Reade, Rudolf Steiner, Churchill, Ghandi, Margaret Sanger,  Linus Pauling, Ivan Illich, Ken Galbraith, Herman Wouk,  and now Naomi Klein, AC  Grayling, and medical Drs   James Le Fanu, Andrew Weil and Marcia Angell) ,   now  greedy  zealots of all faiths – muslim, catholic, baptist, jew, taoist, atheist, – in business,  industry, politics,  and specifically the Disease and Big Pharma  Industry   continue to expand  their   manipulative power and profit interests. 

HARM NOT PREVENTION FROM HIGHTECH SCREENING:

We have watched with increasing alarm the past decades  the proliferation of supposedly preventative costly technology mushroom , from autoanalysers and hypercholesterol mania  to screening for low risk silent breast prostate and colon cancers, to molecular and genetic screening- each multibillion dollar goldmines. .  Now the lid is coming off the obvious, that the more “diagnostic” xray screening eg xray mammography, the more cancer ;

 and the more the preventative new designer synthetic drugs   promoted eg  statins  bisphosphosphonates  nonsteroidal antiinflammatories psychotropes & agents eg genetically modified seeds, the greater the unintended consequences- without any overall benefit except to monster profiteers in  industry and government. 

So the  rights achieved by many martyrs against  European, Muslim, Asian,  panAmerican  and even African ethnic and religious despotism  for so many – especially  for the poor, women and childen, the ill and the aging – in the late 20th century are fast fading as the power-and money-mad destroy the environment, democracy,  health and security including especially for old age  in almost all  countries, on all but two of the continents.

Which brings us back to yesterdays’ ‘ headline health soundbite: to fight for appropriate affordable optimal ie  parenteral balanced human hormone replacement supplements to manage aging.

ABANDONED DOCTRINE OF TRUTH IN MEDICINE: POSTMENOPAUSAL HRT:USE HUMAN TRANSDERMALS. WHY RISK TABLETS? BIG PHARMA WINNING THE DISINFORMATION WAR.

 5 June 2010. neil.burman@gmail.com 

Part 1: Transdermal better than oral estrogen for replacement: the importance of appropriate HRT.

part 2: Information warfare, Big Pharma, Appropriate HRT and the Doctrine of Deception.

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.