Hormones, heart disease, and breast cancer: first, do no harm
For years, hormones were touted as the panacea for the menopausal and post-menopausal (dare I say, “aging”?) woman. HRT (hormone replacement therapy) was seen to be a fountain of youth in all respects, and who wouldn’t want that? Skin benefits, heart benefits, sexual benefits—you name it, hormones had it.
But in recent years the bloom is off the HRT rose. First it was the sad fact that, contrary to earlier reports, hormones not only didn’t prevent heart disease in women but even seemed to cause more of it. And recently the news from researchers is similar about breast cancer: hormones appear to either encourage new cases or accelerate the growth of already-present but as-yet-undiagnosed ones.
It’s a real bummer, to be sure. Although I’ve never taken the things, most of my friends do, and they’ve all had to make some tough decisions about symptom alleviation vs. risk of death.
The other question that comes to mind is: how on earth could medical researchers and doctors have gotten it so wrong, and for so long? And how do we know they are right now?
The short answer to the second question is: we don’t know. Our need to make our lives close to risk-free, although understandable, is unattainable. The short answer to the first question is that scientists use the best data possible at the time to make recommendations.
For example, as this article makes clear, the early data on hormones and heart disease was so promising that doctors felt secure in recommending them. In fact, the long-term studies on the topic were undertaken with such optimism, based on earlier and more limited studies, that doctors were convinced the larger studies would only serve to prove how very beneficial hormones were in preventing heart disease. They were shocked when the evidence proved them exceedingly wrong.
There is a certain amount of hubris in medicine, and a bit more caution when prescribing potentially dangerous drugs and interventions would be in order, so that the old oath of “first, do no harm” could be fulfilled. But doctors are also responding to our own demands for a pain- free life and eternal youth, and our impatience with the slow pace of medical knowledge and its fits and starts progress.
This is a thing that bugs me no end. Science (and as a person with a background that is almost predominately science and technical) is very good at what it’s good at, but it’s not that good at everything.
Science is supposed to be wrong pretty often – otherwise a falsifiable hypothesis has no real point. It isn’t a realm for ironclad pronouncements from on high, but is rather a means to test and discard those theories that don’t conform to the real world.
So, when it comes to a lot of ‘science’ issues in policy, I cringe when folks go off with the ‘science’ stamp like it’s some sort of holy seal. That’s my objection to a lot of anthropogenic global warming discussion, the debate is often conducted with the an air of certainty that would put most religious zealots to shame.
When the science-folk say, “We’re not certain, we’re pretty sure, but not 100% certain.” it means just that – we don’t have to editorialize any additional meaning to it.
BRD
Neo,
When that early data came out (wrong as it was), I used to joke with my patients that it made me want to go on HRT myself! But the minute this newer material came to light, our recommendations of course immediately changed to using HRT only for a short time, and with very specific indications.
Public policy recommendations based on almost any medical research are extremely precarious. In Sleeper, Woody Allen very effectively satirized medical “common sense” ideas about smoking and cholesterol (those two have mostly held up, though smoking does seem to have at least two substantial benefits, a lowered risk of Parkinson’s disease and weight control…)
“You mean, you didn’t have deep fat?!
😉
Jamie Irons
Neo, science is inductive logic for the most part. The more accurate and powerful logic is called deductive logic, and it is what I’ve learned to use to make decisions. It is a difference between starting points. Deductive logic starts from a fundamental premise and branches off into either this is true or that is true. 1s and 0s, where it has to be one or the other, never both. That is the structure of the logic tree. It is such that you can use it to predict certain things, and it is fundamentally how wisdom works in human beings to cause human beings to make the right decisions. If your fundamentals are correct, then your future decisions will be more right than wrong.
Science goes backwards ala reverse engineering. They find the results, collate them, and then backtrack to an original “truth”. The problem with this is that while there are only one or a handleful of original Premises and Truths, there are giga billions of separate terminal branches. A tree has one trunk, but many branches. So when science starts collating info from branches, they are not going to get everyone of those branches because humans are not omniscient.
And that is what people do not understand when they say “prove this”. You can’t prove things in science, not in the sense people think of it. Things are not “true” because science says it is true. Science can only say what is useful or what is apparent, not what is “true”, because science does not use deductive logic. Mathematics is primarily deductive, and the combination of mathematics and science in physics, makes it a very pretty good hard science.
True and false infers that it is either one or the other. But for science, it can be both, one or the other, and neither at the same time. If the data says it is, it is. It is not like deductive logic where it says if this is true, that must be false, and if this is false, that must be true. Or that if this is false, that other thing is also false by logic.
for a long time there was resistance to conduct prospective controlled research in women. some of it was misplaced chauvenism, and some because of liability concerns. i am not referring to the hormonal agents but in general. thus the quality of data for medications in women were rather weak, more subjective than objective.
naturally this changed and many of the assumptions made before did not hold true when tested in a prospective randomized format.
i would be more concerned if there weren’t changes made in the practice of medicine. changes mean active consideration, reconsideration and challenges to the current practice, working toward a better standard.
I think it was a physics professor who told me that all measurement is approximation. Nothing is exact. We make the best guesses we can with the information we have. All earthly knowledge is provisional, and to believe otherwise is what the ancient Greeks called hubris.
Doctors were responding to the demands of women who desperately wanted to believe that there was a good reason to take very powerful, potentially dangerous drugs.
It’s strange to me that you don’t see any connection between this ill-informed interventionism and your own beliefs about Iraq.
But you’ll believe what you want to believe first, and what the facts tell you afterward.
If I said “there’s really no fast cure for Islamism, we have to limit our military interventions and take a slower approach” you wouldn’t be able to accept that because 9/11 “changed everything” in your little world and you want a quick answer.
It’s not there.
I took hormones for a short time during the worst part of menopause, then have quit.
I have never felt better in my life. And I think the main reasons are because I simply don’t eat sweets of any kind (not even honey), exercise daily and get plenty of sleep early in the night rather than later.
When I was in the thick of the change, everytime I ate sweets, sugars simple carbs, I would get a severe hot flash within hours. Somehow over time I correlated this to sweets and stopped and never, ever had one again.
Also, have you read recently that “medical science” is saying men who take certain mega-multivitamins are much more likely to get terminal testicular cancer.
I guess we never know, but certainly moderation is called for in everything we do. I never do multis anymore either, but rather try to get it from eating well. The only thing I take on a regular basis is magnesium before going to be and it helps me sleep like a baby.
doing nothing is a slower approach but it won’t move you any closer to anything, better health care or ridding of islamofascism.
you have to start out with a belief first, i.e. a hypothesis, and then test it, then objectively, and i mean objectively, what the resulting facts are for better and for worse.
to suggest that living under oppression under saddam is better than living in free chaos is rather presumptuous
You aren’t seeing the whole picture.
Originally, hormones were touted as “feminine forever” to stay young.
Then docs found that they prevented hardening of the arteries, stopped bone fracture, and improved genitourinary health.
But then we found increase in uterine cancer, so we added a second hormone, progesterone. Progesterone causes increased breast cancer.
So now we’re back to stage one.
The “increased heart disease” is due to blood stickyness , causing clotting in areas where the blood vessels are clogged from hardening of the arteries. Take an aspirin, and voila, problem solved.
I used to tell my ladies if they wanted an active sex live, which kept their husbands happy, stay on hormones and take an aspirin and get yearly mammograms.
The alternative is a frustrated husband, lots of peeing problems, and a hip fracture at age 75 that puts you in a nursing home.