Jewish World Review August 23, 2002 / 15 Elul, 5762

Drs. Michael A. Glueck & Robert J. Cihak

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Consumer Reports

Should she or shouldn't she?: An alternative view on treating menopause with HRT | Too much science, especially too much "by the numbers" science, may ironically make for bad medicine. Good medicine is both science and art. Latest example:

Last month, researchers involved in the Women's Health Initiative, a U.S. government-sponsored evaluation of various forms of hormone replacement therapy (HRT) for women in menopause, cancelled one part of their medical study. The researchers, based at dozens of different medical centers, found higher rates of coronary heart disease and breast cancer among women taking one form of HRT.

Since then, our sources inform us, women are asking themselves, their doctors, their lawyers and anybody within earshot if they should stay on their hormone treatment program. Cut back dosage? Taper off? Quit? Just as concerned are younger women who are considering using the therapy as they get older.

OK, let's get a grip.

As Steve Milloy of writes in his article "Hormone Hysteria or Hype?" the "increase in heart disease occurrence... was barely statistically significant, meaning there's a worrisome possibility it was a fluke." Further, the "increase in breast cancer occurrence... wasn't statistically significant." This means the worries generated by the study may be much ado about nothing.

Let's look at the "facts." The study indicated eight more cases of breast cancer, seven more heart attacks, and eight more strokes every year for every 10,000 women receiving HRT in this part of the study compared with the group not taking this treatment. However, good things happened too. In addition to relief of uncomfortable symptoms, this same group of women suffered six fewer colon cancers and five fewer hip fractures.

Despite the tens of thousands of women involved, there simply aren't enough patients in the study to be sure that these good and bad differences are actually due to the different treatments or just a statistical fluke.

Further, even the scientific community isn't unanimous about canceling the study. According to Reuters News service "British scientists recommended on Friday that a major trial of hormone replacement therapy (HRT) involving up to 22,000 women continue despite a US study that showed the therapy increases the risk of breast cancer, stroke, blood clots and heart disease."

Both of these groups of scientists are trying to do clinical studies "by the numbers", a very valuable and worthwhile pursuit, up to a point.

Studies involving large numbers of patients, in this case totaling 46,355 women on all the treatment variations in the study, can indeed identify subtle difference between different treatments for similar conditions. But we are left with the reality of subtle differences between individual patients dissolving in the sea of data. We must remember that numbers cannot measure everything, in medicine or in life. The degree of benefit and risk from many forms of possible treatment vary greatly in the eyes of the patients who might benefit or be harmed. And it's the individual patient's benefit or risk that physicians must first consider in their analysis and recommendations.

Life and medicine are often complicated. Data also can be.

Considering the bright side of treatments available, alternatives to current hormone replacement therapy exist. For example, the American College of Obstetricians and Gynecologists, a long-established medical organization, demonstrates the diversity of treatments available in its June 2001 publication

According to Shari Lieberman, Ph.D., a nutritionist and nationally recognized women's health expert "natural, non-toxic supplements such as vitamin E, Cimicifuga racemosa, commonly known as black cohosh, soy and lifestyle changes (diet, exercise) yield equal results in terms of diminishing menopausal symptoms when compared to HRT." Further, the apparent lack of side-effects made Cimicifuga racemosa "superior to all drugs used in the studies."

Sadly, many physicians and organizations overlook optional forms of treatment because of their bias for elaborate and expensive scientific proof. Meanwhile, as the above study demonstrates, so-called scientific proof is not foolproof. Benefits or harm to real people get lost in the data. So, before we panic about how to interpret the non-results from the cancelled study, it helps to remember that good medicine is still as much of an art as a science.

As always, individuals seeking answers should educate themselves about their options, including seeking advice from their own doctor. It's also wise to remember that people are different, and that, medically speaking, what matters is what works for you, not what the statistics say works for others.

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Michael Arnold Glueck, M.D., of Newport Beach, Calif., writes on medical, legal, disability and mental health reform. Robert J. Cihak, M.D., of Kirkland, Wash., is president of the Association of American Physicians and Surgeons. Both JWR contributors are Harvard trained diagnostic radiologists who write numerous commentaries and articles for newspapers, newsletters, magazines and journals nationally and internationally. Comment by clicking here.


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