Bioidentical Hormones are under attack again from Medscape, an online medical information site funded by the major drug companies. In spite of all the “Guidelines” created by medical organizations advising women to use their “FDA approved” synthetic hormone products, women and their physicians have rejected these “Guidelines” and have switched to bioidentical hormones. Could it be possible that a few “rebellious” physicians refuse to cooperate with “Big Pharma”, revealing a callous disregard for authority ? No, this couldn’t be possible.
It must be the doctor’s lack of training on using the proper phrases and arguments in a conversation with the patient on hormone replacement. This Medscape article then goes on to instruct us doctors exactly what to say to you when asked about hormone replacement. What follows is a comedy of errors of monumental proportions. I almost fell off my chair laughing (1)
This time, the lies about bioidentical hormones come from an appropriately named author, Dr. Lie, a recipient of sizable funds from Merck, maker of women’s hormone products Nuvaring and Nexplanon. (4-10) Both products contain etonogestrel, a chemically altered version of progesterone which does not occur anywhere in nature or in the human body.(2,3) Altering the chemical structure of the ovarian hormone progesterone, creates a “Monster Hormone”, causing cancer and heart disease. This is not a good idea.
For example, a cousin of etonogestrel, medroxy-progesterone was found to cause breast cancer and heart disease in the ill-fated Womens Health Initiative Study published in 2002 in JAMA.(11). Left image Hormone Therapy Courtesy of ANH.
You might therefore ask the question:
“Does etonorgestrel cause breast cancer? “
Since the drug is “FDA approved”, one might mistakenly think this has been thoroughly studied. The FDA approved patient label will set you straight. It has never been studied. Here is a quote from the product label for Nexplanon, the implantable etonorgestrol product by Merck:
“It is not known whether NEXPLANON use changes a woman’s risk for breast cancer.” quote from FDA approved label (13)
As we see above, Merck’s two synthetic hormone products have not been thoroughly studied as to whether or not they cause cancer or heart disease?
One of the main criticisms of bio-identical hormones by Dr Lie, and her colleagues who represent the major drug companies, is Bioidentical Hormones have not been studied in a double blind placebo controlled trial, the type of study needed to obtain FDA drug approval. Well, if I lived in a glass house, I wouldn’t be throwing stones. The truth is that synthetic hormones like these two Merck monsters should never have been approved for human use.
The truth is that Biodientical Hormones have been studied and found safe, and are the preferred choice
Getting back to our Medscape “Medical Education” article: Firstly, the author laments that women and their physicians have rejected the “Medical Guidelines” and have switched to bioidentical hormones, identical to those made by the human ovary.
Could it be possible that some rebellious physicians refuse to cooperate with “Big Pharma”, revealing a callous disregard for authority ? No, this couldn’t be possible. It must be the doctor’s lack of training on using the proper phrases and arguments in a conversation with the patient on hormone replacement. The author’s job is to provide this missing information.
The article then goes on to instruct us exactly what to say when asked about hormone replacement.
“how should clinicians approach the conversation with their peri- or postmenopausal patients about the use of bioidentical hormones for their symptoms?”(1)
The Medscape author then explains that your doctor should first understand a few myths about bioidentical hormones so these can be clarified in a conversation with you, the patient. What are these myths? Well, here they are:
Myth (1): “Bioidentical hormone therapy is natural and therefore superior to CHT.” (Note:CHT means Conventional Hormone Therapy, chemically altered synthetic hormones like Merck’s etonorgestrel)
This is not a myth. This is actually a true statement. Hormones made by the human ovary are superior and safer than chemically altered synthetic hormones offered by the drug companies. The drug companies must alter the chemical structure of the hormone in order to qualify for patent protection which makes the drug profitable.
The author, Dr. Lie, in spite of her Oxford and Cambridge pedigree, missed the mark on the meaning of “bioidentical”, a word indicating the chemical structure of the hormone is “identical” to those made by the ovary. Dr Lie goes on to make another error in the statement “bioidentical products that may be derived from equine or other sources.“. Here, Dr. Lie is referring to Premarin, estrogen from horses (equine).
Yes, Premarin is bioidentical if you happen to be a horse. Horse estrogen (Equilin) is a different chemical structure and is not the human estrogen, estradiol, made in the ovary. Premarin is by definition NOT bioidentical, as any high school kid could understand.
Myth (2): Compounded bioidentical hormones are better than CHT.
This is actually a true statement, and not a myth. There are many reasons why individualized compounded formulation are better than mass produced pre-packaged hormone products. The main reason is obvious. Compounding allows more versatility and choice by the doctor in making up a specific formulation. Three or four hormones can be mixed in proper ratio to make an individualized topical hormone cream. This cannot be done with the prepackaged hormone products from the major drug companies like Merck and Pfizer.
Myth (3): Custom compounding individualized to the patient using salivary hormone assessment is superior to CHT because it mimics the patient’s own natural hormone levels.
Contrary to what the author, Dr Lie says, most patients expect a competent physician to perform testing for either salivary or serum hormone levels. Dr Lie says:
“Hormone therapy should be individualized by symptom relief and side-effect profile and not laboratory test results.”
I actually agree with this statement, and we do not routinely use salivary hormone testing. Rather hormone dosages are titrated for menopausal symptom relief. Even so, we routinely include hormone testing on our routine blood testing panels.
Unlike Dr Lie, I wouldn’t belittle the salivary hormone testing technique, as I have found clinically useful results can be obtained with salivary testing. Not only that, there is an extensive body of medical literature on salivary hormone testing in athletes, and in astronauts on the space shuttle (12), etc. Left image astronaut courtesy of NASA.
The next section of Dr Lie’s Medscape article is so hilarious, I almost fell out of my chair in laughter. In this section, Dr Lie explains how the doctor (that’s me) should use “beneficial persuasion” techniques to convince the patient that bioidentical hormones are “bad” and synthetic chemically altered monster hormones are “good” for you.
These are techniques you might see in a training manual for closing auto sales : 1) vivid depictions, 2) framing, 3) regret, 4) refocusing. This might be OK if you are buying a new car. It is not OK in your doctor’s office.
Let me put it very simply. If your doctor is learning how to have a conversation in the office with you about hormone replacement from a Medscape article like this one, then you need a new doctor. Left upper image : used car salesman courtesy of Kurt Russell Escape from New york.
This study reported by LaCroix in JAMA 2011 showed that women treated with estrogen alone (Premarin) after hysterectomy had reduction in breast cancer by 23% compared to placebo users.(14)
This Medscape article is drug marketing masquerading as medical education.(1) Why do we even have to put up with this nonsense? I am really tired of it. However, we should be prepared for more of the same. We can expect the lies and deceptive drug marketing to intensify further as the public rejects synthetic hormones for the monsters they really are.
1)http://www.medscape.com/viewarticle/855845 Bioidentical Hormones for Menopause: What Should We Tell Our Patients? Désirée A. Lie, MD, MSEd December 15, 2015 Served as a speaker for Merck
2) Merck- nuvaring.com NuvaRing is a small, flexible vaginal ring used to prevent pregnancy. You put it in for 3 weeks, take it out, then put a new one in a week later. (etonogestrel/ethinyl estradiol vaginal ring)
3) nexplanon.com NEXPLANON is a small, soft, and flexible birth control implant—it’s just 4 centimeters in length. Your health care provider places it discreetly under the skin on the inside of your upper arm. This means it’s hidden from view. NEXPLANON provides up to 3 years of continuous pregnancy prevention.* That means no more daily, weekly, or monthly dosing routine. (etonogestrel implant)
4) pdf file Merck_Disclosure_Speakers_3Q09-Transparency-Report Merck & Co., Inc., Disclosure of Payments to U.S. Speakers 2009…paid in 2010 Lie, Desiree Annabel Total 20 events in 2009 for total of $ 39,675.00
5) https://projects.propublica.org/docdollars/doctors/pid/575924 DESIREE A LIE Payments: At a Glance 20 payments $13,040 payment total. This doctor received a payment on 15 out of 518 days from Aug. 2013 to Dec. 2014.
6) https://projects.propublica.org/d4d-archive/payments/10880015 Payment Disclosure Lie, Desiree Annabel
7) pdf Tech_View_6_3_10_Desiree Lie_speaking for Merck Weekly News | 06.03.10 Texas Tech Tech View is published weekly by Communications & Marketing, Texas Tech University Health Sciences
8) http://www.medscape.com/public/bios/ed-familymed Editorial Board — Medscape Family Medicine Board Members Desiree A. Lie, MD, MSEd Keck School of Medicine, USC Los Angeles, California
9) Speaker Bio: Desiree Lie, MD, MSEd Desiree Lie, MD, MSEd., is Professor of Medicine at Duke National University of Singapore, Graduate Medical School and at the University of Southern California. She was Professor of Family Medicine at the University of California, Irvine for 22 years, with roles combining practice, educational and research in areas including faculty development, international primary care, integrative medicine, cultural competence, relationship-centered care, the Medical Humanities and health literacy. Dr. Lie attended the Universities of Cambridge and Oxford, England, and completed residency training in Pediatrics and Family Medicine. She is board certified in the UK and US. She is the recipient of multiple teaching awards and grants, an editorial board member and author for Medscape, and is active in federal grant reviews, the STFM, and inter-professional education.
10) Merck Payment Disclosures 3Q10-Transparency-Report-2
11) Writing Group for the Women’s Health Initiative Investigators. “Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial.” Jama 288.3 (2002): 321-333.
12) Putcha, Lakshmi, Ram Nimmagudda, and Chantal Rivera. “Assessment of sleep dynamics in a simulated space station environment.” Isolation: NASA Experiments in Closed-Environment Living- Advanced Human Life Support Enclosed System Final Report 104 (2002): 131-139. Salivary Melatonin NASA AStronauts Sleep Study
14) LaCroix, Andrea Z., et al. “Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial.” Jama 305.13 (2011): 1305-1314. Health outcomes after conjugated equine estrogens postmenopausal women with hysterectomy LaCroix Andrea Jama 2011