Ever since the results of the Women’s Health Initiative study into the safety of HRT were published in 2002, people have sought safer alternatives to synthetic pharmaceutical drugs. That this should have happened is understandable. This massive study showed that women taking prescription or synthetic HRT were at an increased risk of developing breast cancer, stroke and blood clot, than were women not on such treatment.
The increased risk was small but real. Of 10,000 women not on HRT one could statistically expect 30 new cases of breast cancer to develop among them every year. If a similar group of 10,000 women were studied, only this time looking at those taking prescription HRT, one could expect 38 new cases of breast cancer to develop among them. Eight extra cases out of 10,000 women -- not very many but real nonetheless.
From this relentless yet understandable quest to find safer alternatives to synthetic pharmaceutical grade HRT has sprung an alternative industry that is a strange mixture of cult, religion and quasi-science. This is medical pseudoscience. At its heart is a Holy Grail of products called Bioidentical Hormones -- a largely meaningless term designed to impress and reassure all those attempting to Google their way to perfect health.
In establishing a religion it is always useful to instil fear at an early stage. To do this Bioequivalentologists call on the results of the Women’s Health Initiative study and talk about prescription approved HRT causing cancer, stroke and blood clot. All of which is correct of course. However there is an inference here is there not? In saying that there is an increased incidence of breast cancer for those taking FDA approved HRT it is inferred that there is no such increased risk for those taking unapproved, unproven concoctions compounded by the local chemist. Yet there is not a shred of evidence that that is the case.
On the contrary in fact. Wren and his colleagues conducted a double-blind, randomized, controlled trial on a “natural” chemist concocted progesterone cream and found that it had no effect and was not bio-available. Therefore women using this preparation while also using oestrogen are receiving no protection from developing endometrial cancer.
As with any other religion it is a matter, not of science but of faith. All you are asked to do is to believe that Bioidentical Hormones are safer, better and more effective than their FDA approved pharmacological counterpart. This is, if you will, a central tenet of this religion, an article of faith. Bioidentical Hormones, individually run off by an approved (of course) Compounding Pharmacists are superior to those produced by an FDA approved Multinational Pharmaceutical Companies. You do not have to prove anything or produce any evidence in support of this. Like all good religions, all that is required of you is that you make an Act of Faith.
We need a few evangelists and a liturgy too of course. We need a few Gospels according to Celebrity if you like. So we are given scribes Suzan Somers and her Sexy Forever: How to Fight Fat After Forty to be follower by Hormone Balance Made Simple by Dr John Lee and for a little bedtime read you may have The Natural Superwoman by Dr Uzzi Reiss. Now parade all these authorities out in front of a global TV audiences on a regular bases and have Oprah Winfrey and Dr Christian Northrop nodding sagely in the background and you have a potent blend as good as any Bible or Koran or Torah, being beamed across the planet.
How about a little hocus pocus then as well while we are at it, a little voodoo perhaps? Yes, Bioidenticalology has that too. They call it Saliva Hormone Assay. This is to appear to bring a bit of science to the party. The only problem is that, like most things to do with this subject, it is pseudoscience. Hormone levels in saliva are notoriously unreliable, expensive, bear no relationship to serum hormonal levels and throw no additional light on the diagnosis of menopause. Patients might feel reassured by them and doctors may feel justified in charging additional fees for them but that is as far as it goes.
Now lets create a few devils, lets get a few Lucifer’s around here – the personification of evil if you like. All religions have that don’t they? How about Horse’s Urine? Doesn’t that sound nice and nasty, kind of evil if you like? Well the next time you are riveted to some Bioidentical devotee rabbiting on about Natural Hormones check your watch and see how long it will take her to mention Horse’s Urine. What she will fail to mention is that the estrogens produced from non-vegetable sources, as for example equine estrogens, are converted in the human body into human estrogens, they are in fact Bioidentical at their point of action. In any case most prescription HRT is manufactured from vegetable sources such as the yam the so-called “natural” source the Bioequivalentologists would like to claim as their very own.
Another useful hate figure for this religion is the Multinational Pharmaceutical Industry. And while I’m no apologist for them, it is a bit rich I think to be wagging a finger at them while at the same time eulogising the activities of a network of compounding chemists and saliva analysers who collectively also constitute a similar Multinational Pharmaceutical Industry. The only real difference is that the former are required by law to comply to stringent rules and regulations while the latter are free to do whatever they like.
At the end of the day the choice is yours. I carry no brief for anyone. Which would you prefer? To visit a doctor well versed in the art of hormone replacement therapy for women. To take under professional supervision a range of substances manufactured to strictly enforced GMP, proven in clinical trials to be absorbed into your body, proven in clinical trials to be effective, proven in clinic study to have a definitive range of dangers and made from “natural” ingredients.
Or would you perhaps prefer to trust a zealot and have your saliva analysed? Would you then take the word of some stranger in an unregulated laboratory to diagnose your menopausal condition? Would you then be happy to commit to a range of substances compounded without supervision or regulation, with no established bio-availability, no proven efficacy, no definitive range of dangers or side effects and made from the self same “natural” ingredients? Now you tell me.