Fuzzy Science

Hormone therapy to prevent disease in menopausal women has come under scrutiny in a study called, “International Position Paper on Women’s Health and Menopause”, sponsored by the National Institutes of Health and the private Giovanni Leren Zini Medical Science Foundation of Italy.¹ The findings are shocking to the medical community and the public who believed in the veracity of the initial hormone replacement studies. Nanette K. Wenger, MD, chief of cardiology at Grady Memorial Hospital in Atlanta, editor of the paper, and chairwomen of the panel, said the report compiled all recent pertinent information to be used by doctors globally.

The New York Times reporter Denise Grady1 wrote that, “...the cautious approach to hormones is based on the findings of recent studies and on its authors’ decision to emphasize ‘evidence-based medicine’—that is, treatments tested in randomized controlled trials...[which] are considered the gold standard in medical research. By contrast, observational studies...are considered less reliable.”

Wenger added, “Given the fact that hormone replacement therapy has been around for half a century, it’s really only in the last decade that we’ve begun to get stringent scientific evidence, from randomized controlled trials. In many areas, there have been enormous surprises.”

What is shocking to me is the hubris of the medical community in propagating a hypothesis as proven scientific fact to an unsuspecting public and even their colleagues! Traditional Western medicine demands from the chiropractic profession scientific proof that subluxations exist, but yet do not hold the same standards for themselves. The motivation in delegating chiropractic to quackery, as I see it, is monetary. Is the motivation of this travesty visited on menopausal women also financial—having a paper published to gain a prestigious position?

Susan M. Love, MD, adjunct professor of surgery, University of California at Los Angeles Medical School, wrote in a recent July 2002, New York Times opinion-editorial, titled, “Preventive Medicine, Properly Practiced,” “What happened is that medical practice, as it so often does, got ahead of medical science. We made observations and developed hypotheses—and then forgot to prove them...There is a tendency, driven by wishful thinking, combined with good marketing and media hype, to jump ahead of the medical evidence.”

Love also mentioned other instances: the drug given to pregnant women to prevent miscarriages in the 1950s, but was later found to increase risk in developing vaginal cancer; bone marrow transplants to treat breast cancer was found to be no more effective than the standard therapy with more side effects; and arthroscopic surgery for osteoarthritis was just recently shown that it had no “objective benefit.”

Deborah Grady, MD, (not to be confused with the reporter previously mentioned) professor of epidemiology and medicine, University of California at San Francisco, was the lead author of the 1992 guidelines on hormone replacement therapy.1 In her original report, she said, “I thought preventive hormone therapy should probably be prescribed to most menopausal women, except those at high risk for breast cancer.” Today, Grady says, “...rather than prescribing it for most postmenopausal women, I prescribe it for symptoms, for which it is far and away the best treatment.”
Love noted that, “the study really questions the idea that we need to replace hormones in postmenopausal women for the long term. Menopause is normal. We need high levels of hormones to reproduce, but we shift down to a lower level for the second half of life. The symptoms of menopause are really not the symptoms of low estrogen, but the symptoms of hormonal change—puberty in reverse.”

This can be an opportunity for chiropractic to step forward and offer alternatives to drugs. According to Shirley Watson, DC, in her article, “Natural vs Non-nurturing” (Chiropractic Products, March 2002, page 20–22), “As chiropractors, our role is to help women understand and implement how to move effectively through this phase of their lives with grace, composure, and health.” Watson wrote that many women prefer natural supplements, such as bioflavonoids with vitamin C to help relieve hot flashes and chasteberry to normalize the balance between estrogen and progesterone. Improve the quality of this phase of life for your patients with natural solutions that will answer the questions and assuage the fears resulting from the recent study. Also, hopefully this controversy will help the public realize that the medical community is fallible and that scientific evidence can just be a hypothesis. CP

Miwon Seo
mseo@medpubs.com

Reference
1. Grady D. Scientists question hormone therapies for menopause ills. The New York Times. April 18, 2002.