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Interview with Dr. Bernadine Healy, Physician, Cardiologist, Professor, former Director of the National Institute of Health and President of the American Red Cross
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CBS CARES: If there have been no scientific studies of natural, bio- identical hormones, on what basis do some doctors say that are safe and effective...or at least, safer and more effective than synthetic hormones?
DR. HEALY: I don't have the answer. But, it's probably their assumption that natural is better. I think one of the problems with some of the bio-identicals is that you're not quite sure about the dose. Even with something like soy, we don't know what impact soy estrogen has on the uterus, how long to take it, and how much. There has been no long-term study on the taking of soy and how much soy could actually get you into potentially negative territory.
CBS CARES: Do the levels of estrogen and progesterone in blood correlate to safety and efficacy of hormone therapy?
DR. HEALY: The problem is that blood tests don't always tell you what's happening at the organ site, because a lot of the conversions of bio-active estrogen happens in the organ, for example, in the brain. So what's circulating in the blood is not always representative of what's going on in the organs.
So, if you look at the medical literature, you'll find that there really isn't much information correlating the level of hormones in the blood with, for example, something like the development of breast cancer. That is because that correlation hasn't always been done. But, secondly, when it has been done, it hasn't been conclusive, unlike cholesterol, which studies show is always associated with negative effects at certain levels.
CBS CARES: Are there any uniform standards that guide physicians who recommend or prescribe bio-identical hormones?
DR. HEALY: There really isn't much clinical guidance for physicians. I mean, it doesn't exist. I think that's one of the unfortunate dilemmas today, that doctors don't have that guidance. Instead, it's a little bit of trial and error for an individual woman. One cannot diminish the importance of the woman's own analysis of this.
The internet has made a lot of information readily available. I think that individual women are going to have to be part of the decision of whether or not they wish to take hormone therapy, and if so, what they want to try. A woman could try one and she may not like it. We're not talking about an irreversible decision, which I think is another important thing to remember.
CBS CARES: It seems that, until more studies are done to resolve some lingering issues, some points will remain open to debate. But, are there any clear cut answers right now?
DR. HEALY: Yes, there are some clear-cut answers. I think if you're a woman over the age of 60 and you went through menopause without any problems, didn't use any hormones and you feel perfectly fine, stay away from hormones. Don't let any doctor talk you into taking them, period. And if there are issues about bone loss and osteoporosis, for which estrogen might be useful, there are alternatives.
As I mentioned earlier, women are not all the same. What is a beneficial medicine in one woman could be either neutral or even harmful in another. Take a woman who has a very strong family history of osteoporosis. She and her doctor might look very differently at hormone therapy than someone who has a very strong family history of breast cancer.
CBS CARES: Do you anticipate, in the foreseeable future, any more studies being done on hormone therapy?
DR. HEALY: They'll only be done if women continue to put pressure on the NIH and CDC. These are not strictly pharmaceutical studies, so NIH and CDC need to drive these studies.
CBS CARES: If NIH or CDC were to undertake these studies, which ones do you think are the priorities?
DR. HEALY: The study that absolutely must be done, should have been started right after the Women's Health Initiative came out with its findings, and should be started tomorrow is a comparison of the different hormone formulations. In other words studying Premarin as well as plant formulations, looking at oral versus transdermal, natural versus synthetics, etcetera. Remember that even natural hormones like estradiol are different from the phytoestrogens you'll find in soy/plants like wild yams. And then you also need to look at dosages. There needs to be some science placed into the area of natural hormones, which has not been done.
CBS CARES: Do homeopathic and other alternative therapies have potential?
DR. HEALY: Yes, they should definitely be explored and tested. I have to give Senator Harkins credit for his idea to look at alternative therapies to see if they provided any kind of benefit or even sometimes caused harm. A lot of the multivitamins and therapies like acupuncture fell into that class. Senator Harkins kept putting pressure on NIH and started an office of alternative therapy that's now grown into a center for alternative therapy. It has a modest budget. But that should really be the place where research is done on some of these promising but still not very well understood treatments out there. If people are consuming lots of soy with the hope of helping their health, or taking these over-the-counter hormones, or raiding the shelves of nutraceutical shops, it seems that we have an obligation to research those treatments, which have every bit as much impact on people's lives and well-being as an approved drug from the FDA.
CBS CARES: What is the most important thing that you want women and the men who care about them to take away from this interview?
DR. HEALY: That medicine must be personal. This makes it harder for women, but this is also reality based. Women have to understand that their health and well-being is affected and determined by personal choices. That includes personal medical choices. There's not one medication or one practice that suits all. Women are not all albino rats from the same litter reacting predictably to the same medications.
Rather than being discouraged, women should be liberated by the fact that they are not all the same. It's more complicated, but it's real.
CBS CARES: What should a woman look for in choosing a doctor to help her through menopause and post menopause?
I think it's important to get a doctor who is going to spend time with a woman to inform her and answer all her questions. And someone who is open-minded about these issues. The individual doctor needs to deal with the patient as an individual. Don't choose a doctor because you say, oh this is a doctor who loves hormones, or this is a doctor who likes the natural stuff, or this is a doctor who won't even consider a pharmaceutical product. Open-minded doctors who will treat patients as individuals are out there in your community, but you might have to go through a little trial and error in asking around to find such a person.
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