Easy to fool or scare people but hard to un-fool or un-scare them

[AJMD429]

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I was thinking how it is with things like guns or covid - that once people get a bit of misinformation in their mind, especially if it is negative, they can't un-learn it even if it is proven wrong.

I think this is why liberals can't have a rational conversation - they have personalities that somehow lean towards being easily led and easily frightened, so even if you 'reassure' them with facts that countradict the stuff they were told before, it seldom works.

We've seen this medically, and basically had to write-off a couple generations of women, consigning them to frailty and most likely about three years less life expectancy than they'd otherwise have. When the Women's Health Initiative came out, the 'news' media (and the medical journals) blared the news that "estrogen causes breast cancer" and everyone who cared about women was horrified, and of course well-meaning physicians stopped prescribing estrogen. I remember being skeptical of the 'news', as the group of women who gets the most breast cancer is the over-65 crowd, and that groups has very LOW estrogen - the ones with high estrogen, in their 30's, hardly ever get breast cancer. It just didn't make sense. Of course after a few years of reviewing the data and more sensibly evaluating it, no such 'conclusion' was meritied at all - in fact many reviewers felt that the actual impact of hormone supplementation was to REDUCE breast cancer deaths, as the incidence was not all that changed, but the lethality of the cancers gotten by women on supplemental hormones was far less. Of course many confounding variables, patient selection issues, and even fundamental issues with defining 'estrogen', or 'progesterone' versus 'progestin', existed.

It has all been characterized fairly well now, and most who dare to read the literature and dig into it feel that the estrogen-phobia was unwarranted. However, a patient of mine who is herself a gynecologist, was in for her physical recently, and she explained why SHE wanted to be on hormone replacement (bioidentical estrogen, testosterone, and progesterone), but why she ALSO didn't really advise patients to do so. It is sad, but relates to the above political phenomena.

Here's what she said:

"We know breast cancer will strike about 14 of 100 women. So if you prescribe nothing, you'll have 86 women without cancer, and 14 with cancer, and of those, NONE will be angry with you, because 86 won't have anything to be angry about*, and the 14 who got breast cancer will just assume they were unlucky.

If you prescribed something that actually DID increase their risk (the initial claim of the WHI study), say by 50%, then you'd have 21 women with breast cancer - 14 who would have gotten it anyway, and 7 who got it due to your Rx. The 79 lucky ones would be happy, but ALL 21 of the cancer patients would assume they wouldn't have gotten cancer, but did, due to your Rx. THAT was where we were at in the early 2000's, so no doctor wanted to prescribe hormones postmenopausally.

But now things are different, or are they....??? We don't think our regimens reduce cancer, although some think it may be so, but many of us don't think they increase it. But let's just say a miracle happens, and our new 'bioidentical' regimens reduce breast cancer 50%....we'd be crazy not to precribe then, right...??? OK, now you have 93 women with no cancer, and only 7 with breast cancer. 86 didn't get cancer because they weren't going to anyway, but 7 more didn't get cancer because YOU SAVED THEIR LIVES. However, they have no clue that is the case - they just assume like the other 86, that they are 'normal' and weren't going to get cancer anyway - you won't get any cookies from them. But of the seven who got breast cancer, DESPITE your attempt to save them, they will ALL be convinced that they would have been in the non-cancer group, but your Rx caused their cancer."

Wow.....that's sad, but THIS is why doctors still hesitate to treat menopause in regular patients, but will treat 'special' people like family and friends. Only those people they feel won't play the blame-game, and those who they are willing to spend the extra time with to explain WHY the data shows it is better to treat than not treat, and to explain that despite our best efforts, yes, some women will STILL get breast cancer.

*However if those women knew the real 'data' those 86 WOULD have something to be angry about...

The sad thing is to think how many women die prematurely due to the other things NOT treating with hormone replacement leads to - increased heart disease, more strokes, more diabetes, earlier dementia, and hip fractures (which have a 5 year mortality far higher than breast cancer). Not to mention the increased frailty women have as they age. Think how many men you see who make it into their 70's or 80's who are still 'spry' and do a lot of stuff - sometimes too much - albeit maybe more slowly. Then how many women live as long, or longer, but spend the last decade or so frail, bent over, fragile, and unable to do much of the things they used to do.

People used not to live long enough to get 'old age' things like cataracts or osteoarthritis or even atherosclerosis - or menopause - but live expectancey in 1900 was 42 in the US, and now it is twice that. We don't just tell people "it's normal not to see for the last couple decades" - instead we fix their cataracts...! But when it comes to women and their hormones, we let them deteriorate. Men don't have such abrupt or severe declines in hormones, and when we do, we get both our testosterone AND estrogen restored to normal (relatively we have about 1000 of T vs 5 of E), and the only question is if we should also use progesterone (because it virtually eliminates uterine cancer in women, by negating the stimulating effect of estrogen on the uterus - and the prostate arises from the same embryologic tissue and is also stimulated and enlarged when our estrogen is high). But for women, who before menopause have (using the same scale) a T of about 200 and an E of about 25, we typically only replace the estrogen, adding progesterone because we know it balances the estrogen in the brain, breasts, and uterus. But we seldom address their testosterone unless they complain of problems in the bedroom, as if that's the only thing testosterone does. Yet as young vibrant energetic feminine women they had far more testosterone circulating than estrogen - estrogen is NOT their 'main' hormone - they have five times as much as we do (and we have five times as much testosterone as they do), but both sexes have more testosterone than estrogen. And testosterone is a huge factor for 'vigor' and muscle mass and bone health - not just a 'libido' hormone...! But for women we have consigned a couple generations now to NO hormone replacement, so they are getting more cardiac issues, more fractures, and more cognitive issues with age, and even as we timidly have resumed using bioidentical hormones (which is what we did with men all along, and why men had such good results), we STILL ignore their primary hormone because we assume all it is important for is 'libido'.

But it boils down to the same thing - do we spend a half hour informing Suzie about the physiology of menopause and then prescribe her testosterone with her estrogen, only to have her convinced that each chin hair she plucks is OUR fault (yet her neighbor who isn't on testosterone plucks just as many), or do we just shrug it off, and figure screw Suzie - she's on her own, and who cares if 20 years from now she's too frail to hike in the woods or do other stuff she likes - she won't blame us, and besides - by then she'll have a different doctor, as we'll be retired...

Like Samuel Clements said (paraphrasing) - "It is easy to fool people, but impossible later on to convince them they were fooled..."

Too bad, so sad though - for all the women who the WHI frightened. Many docs were fooled too - but even those who weren't cannot really make much headway to help women who are stampeding away from 'hormones' like frightened cattle heading towards a cliff.

- - - - References - - - -

First a commentary on the great flaws in the Women's Health Initiative, which did NOT show that “estrogen causes breast cancer” (tended to show the opposite), but led to 50,000 or more women dying needlessly due to the irrational fears the media flamed by taking the data out of context and failing to use hormone properly, or even at all.

Podcast #1 - http://peterattiamd.com/caroltavris-avrumbluming/ - long but quite worth listening to...!

Lest you think that Dr. Attia is too 'controversial', because he dares go against the mainstream - even the Principal Investigator of the WHI study, Dr. JoAnn Manson, goes into how deeply flawed the WHI was, and how incredibly distorted and sensationalized not only the 'news' media coverage was, but the 'prestigious' medical journals like NEJM and JAMA went obligingly along with the party-line.

Podcast #2 - http://www.youtube.com/watch?v=8bRuzA-qd0s

This is a very good talk, although more 'clinical', because it gets into the more updated knowledge on hormone subtleties, and potentially being proactive to actually reduce breast cancer incidence and risk, instead of just relying on predicting risk and trying to intervene early.

Podcast #3 - https://dutchtest.com/video/an-integrat ... st-cancer/

Heck, even iodine may help reduce breast cancer risk (although it may alter your thyroid hormone dose if you're on that).

Article #6 - https://www.jpands.org/vol11no4/millerd.pdf - a more scholarly article on the potential for iodine to reduce breast nodularity, pain, and potentially perhaps breast cancer itself (or at least help us find it earlier by making the breast tissue easier to examine and mammograms more clear to read).

Article #7 - https://jeffreydachmd.com/breast-cancer ... th-iodine/ - a more optimistic, but not too far-out, article on iodine and breast cancer risk.

Podcast #8 - https://youtu.be/Oix26uuBfZg - an overall ‘talk’ on iodine affecting health in a broader sense.

One more thing I wonder (but don't know if anyone else is wondering)....

There are generally three groups of people with regards to breast cancer risk - and their hormone levels are as follows:

Young women - high estrogen, medium testosterone - medium breast cancer risk
Older women - low estrogen, no testosterone - high breast cancer risk
Men - low estrogen, high testosterone - extremely low breast cancer risk

Since estrogen stimulates uterus and prostate, and we know progesterone protects uterus (and maybe prostate?) from cancer, the parallel is that estrogen stimulates breast, and we know testosterone to some degree blocks that effect (there was a drug called Estratest that was used to help reduce breast pain in women given estrogen) - you just have to wonder if we could keep the breast cancer risk for women as they age from rising so much if we didn't just keep their estrogen levels from dropping, but ALSO maintained them at a normal 40-year-old woman's level of testosterone as well. Something to think about.

I wish the NIH would research stuff like this (even just doing survey to find breast cancer rates in women on full HRT with E,P,& T versus just E & P), instead of studying whether chimpanzees given LSD prefer to masturbate with their left hand or whatever stupid stuff they fund. If just replacing men's progesterone would cut prostate cancer rates, or just replacing women's testosterone would cut breast cancer rates, that would be AWESOME. We already know that replacing women's progesterone reduces uterine cancer tremendously, and replacing men's testosterone doesn't reduce the incidence of prostate cancer, but DOES reduce the lethality.

[AJMD429]

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Not to be beating the urine out of a dead horse (a 'Premarin' joke), but I've seen several women the past few months who have suffered unnecessary hip fractures (2), vertibral compression (3), worsening of cardiovascular disease (probably a couple dozen), depression (another dozen), fatigue ('many'), low libido (which is NOT 'just normal aging'), and cancers (uterine-1, and breast-3), all of which the risks would have been less had their physicians prescribed hormone replacement when they were hitting menopause.

With some issues, even a 'late start' may help - depression and low libido, 'brain fog', and insomnia/fatigue - may be improved even if replacement isn't started until 20 years or so after menopause 'hit'. For the full benefits an earlier start is necessary.

Anyway, it is sad to see the victims of the fear-mongering of 2002 or so, as many of these women are of 'my vintage', and seeing their health suffer from something that could have been prevented in many cases is frustrating.

Hormone Replacement is NOT the best path for everyone, but nobody can make a proper choice if they aren't given solid information, and both patients and physicians were pretty much duped by the misrepresentation of the Women's Health Initiative, compounded by the flawed design of the study itself. Even many gynecologists and breast surgeons still tell patients that 'estrogen causes breast cancer' or 'estrogen increases cardiac risk', when the only way you could twist the data to support those assertions is to change the definitions of words like 'causes' or 'increases' to mean the opposite.

I think before women make the choice to do, or not do, hormone replacement, they should all at least listen to this podcast (cited above in my verbose post)...

https://peterattiamd.com/caroltavris-avrumbluming/

I'd recommend sharing that link with any women in your life, who of course should then discuss the issue with their personal physician.

The problem with the medical system (and human nature) is that a small amount of uncertain danger will be remembered for a long time, and takes a HUGE amount of very-certain reassurance, to counter. Having a sensationalist 'news' media and a pharmaceutical industry that has captured the regulatory agencies and medical journals, doesn't help matters.

[AJMD429]

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Finally the government is coming to it senses on this issue (to the extent government ever can do that... )...

https://x.com/MAHA_Action/status/1987936037591515271

[Pisgah]

One of the main problems in medicine today is the universal lack of informed consent -- for both patients and physicians. What has become clear is that medical research is so compromised by the profit motive that the doctors do not know what they are prescribing, and the patients mostly hear only the sales pitch that they've already seen on TV, or that some drug company rep has given to the physician. Even though I love and respect my physician, I am better-read and informed of my particular health concerns than she is. Fortunately, she is the type of physician that they all should be and actually LISTENS to what I tell her, and goes and actually READS the articles I bring her. Unlike my former physician, who loved to tell me HE had a degree and KNEW what he was talking about -- two statements that seem almost mutually exclusive today...

[mickbr]

its dissappointing to me the damage the Pharm companies have done to peoples confidence in medicine. Medicine turned the world around.. but the water is so muddy now, who knows what is safe and what to believe. And good doctors like doc AJMD429 are left holding the ball trying to 'make it make it sense' to people.
I feel quite confident in saying corporate greed now has its fingers into everything we have created the last 100 years. Politics, science, medicine, even history doesnt miss out

[AJMD429]

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"...Even though I love and respect my physician, I am better-read and informed of my particular health concerns than she is..."

SO TRUE - physicians are usually fairly intelligent, and certainly have the endurance to survive the rigors of training. HOWEVER, many non-physicians are just as intelligent or more so, and if they have access to ALL the journal literature that physicians do, like now with the internet, there is no reason that they can't contribute heavily to their own care.

After all, the physician has had to learn about a BUNCH of things, and spent only their educational years and years in practice doing that. On the other hand, the patient may have spent THEIR ENTIRE LIFE learning about ONE thing - whatever it is they have - and can easily know FAR MORE about it than any physician, no matter how smart that physician is.

The difference is that the physician has more CONTEXT, and has more they can bring into the equation from 'outside', whereas the patient has more of their own experience, their own fears, their own goals, and it is their own body and money at risk.

The SOLUTION is not a paternalistic physician, nor politicians and regulators, nor even really smacking the insurance companies (they are simply doing what ANY middle-man would do in a situation). The solution is the physicians coming down off their high-horse, and earning the respect of the patients by taking them seriously, and working as a TEAM to help the patient feel better.

The only way for that to really happen though, is for the government to quit over-regulating, and for the patients to pull their money out of the employer-provided insurance system, and pay DIRECTLY for health care, only involving 'insurance' for unexpected and high-cost things. As long as we expect insurance to be the middle-man, the physicians will NOT prioritize the patient, but instead the insurer, because that's who signs their paycheck.

[JimT]

So far I have been blessed with doctors who listen, pay attention to what I am concerned with and work with me. I have spent the better part of 79 years avoiding doctors and was concerned whether they would listen to me or not. My VA Primary doctor, after we met and she went over everything and all the tests, said, "I am not going prescribe anything for you. What you are doing is working for you and I don't want to mess that up." The only thing I forgot to ask her was if she was single! I really like her.

[piller]

My genetics are hard for most to understand. Fortunately, U.T. Southwestern has a good number of Physicians who can recognize a zebra, and will look to see what is making the hoofbeats behind them in the pasture. When I was hospitalized from a major stroke caused by the Covid shot, the Pharmacist assigned to the floor came in with the Neurology team to see the first living specimen that she had ever known of with genetically missing 2C19 and 3A4 enzymes. She helped to get a Docor to get me a blood thinner which would work. They all wanted to give me Eliquis. Eliquis requires a deacetylation reaction to become effective. My liver does not deacetylate. I can take a bottle of aspirin and a bottle of Eliquis without any change in my blood at all. Most people would bleed to death after taking that.

All of that is my loquacious way of saying that Medical Science is not a perfect science. It is sort of like having an Engineer design something while witholding necessary material data needed for the design. Sort of like demanding to know how strong a brick wall will be when a totally unknown number of papier mache bricks are in the wall hidden among the real bricks.

[earlmck]

My late wife was scared off her hormone replacement by the hype. GRRR HATE HATE!