Saturday, June 18, 2005

Medical Scaremongering

Nobel prizewinners in the Royal Society attack Lancet editor over publication of flawed research, and using "scaremongering" tactics:

The letter suggests that the decision to publish such research stemmed from a desire to attract headlines and not from balanced assessment of the best evidence. “The remarkably poor editorial judgment responsible for this policy is reflected again in the present egregious, error-strewn and wholly unwarranted attack on the Royal Society,” it said.

Professor Mark Pepys, of the Royal Free Hospital, London, who drafted the letter, said: “The Pusztai and MMR papers are the two most serious examples. The MMR study was not well reviewed — it was a disgracefully bad piece of work and the decision to publish it was clearly scaremongering.

“It has had terrible effects: children have died of measles, mumps is now out there, it has ruined the vaccination programme for MMR and cost the British taxpayer millions to repair the damage.” Other signatories include Sir Paul Nurse and Sir Aaron Klug, who have won Nobel prizes for their work, Sir Walter Bodmer, one of the world’s leading geneticists, and the neuroscientist Dame Nancy Rothwell.

The article goes on to discuss the infamous Hormone Replacement Therapy (HRT) study:

In 2003 Professor David Purdie, of Hull-York Medical School, a leading authority on HRT, criticised a Lancet study suggesting that the treatment could double the risk of breast cancer as “unbalanced and inflammatory”.

An accompanying editorial that urged women to stop taking HRT in light of evidence about its health risks caused further outrage among doctors, who said that it would dissuade thousands from taking a medication with proven benefits.

I have lived in a state of mildly simmering outrage ever since the above was touted in the medical community some years ago. My own outrage stems from the fact that I was going through menopause at the time and began to get flack from my physicians about my decision to go with HRT and then ERT (Estrogen-only replacement therapy). What many of my doctors couldn't seem to understand was that I could not function without the HRT. I went for months without sleeping through the night; I had almost continual hot flashes; panic attacks, irritability and mood swings. One helpful doctor wanted to put me on antidepressants.

Why, I asked, couldn't I get back on HRT? Oh, I was told, the risks are too great. Well, I went to the original literature and read the articles--and lo and behold, it was exactly as Dr. Purdie suggested above. For example, when you are talking about a 20 in 1000 chance of developing breast cancer (which is the risk WITHOUT EITHER HRT OR ERT) doubling--you get 40 in 1000 (that's the actual risk of HRT; if you use ERT, the risk goes from 20 in 1000 to 25 in 1000). Let me tell you, that risk seemed pretty darn good to me in exchange for being able to sleep and function as a normal human being again.

I found a gynecologist who was willing to work with me and I started back on the HRT. It was a miracle--just ask my family who had to put up with my increasing irritablity and insomnia. Within two days, I was sleeping normally. The panic attacks and anxiety ceased. I haven't had a hot flash in years. And best of all, my hair (which I had always been very proud of) stopped falling out and some of it actually regrew.

I know women who decided never to take hormone replacement therapy because of these studies. Some of them have never returned to feeling as well as they did pre-menopause. Others, it doesn't seem to bother much. I suspect there is considerable individual physiological variability associated with the number of estrogen receptors and such, which probably determines how sensitive one is to estrogen depletion. But it is an individual thing, and each individual should decide for themselves whether the risk is worth it or not. Everything in life is a trade-off, after all. It is only in a culture where litigation thrives that miracle drugs like HRT, or anti-inflammatory agents (e.g., Vioxx, Celebrex, Ibuprofen etc.) are damned because they have side effects. EVERY SINGLE DRUG HAS SIDE EFFECTS. Litigation is only possible if the indiviudal abrogates his/her own personal responsibility in determining what the risk versus benefit is for each medication they are prescribed.

It is truly medical scaremongering to report the results of badly designed studies; or to report the results in a manner designed to frighten people. The only possible purpose of such studies is the self-aggrandizement of the authors and publishers--who hold their press conferences and intone seriously about the "risks" posed by this or that. In the case of vaccines, more people will die and suffer because they didn't get the vaccine, than the opposite.

We now know, for example that DDT and the hysteria over it some years ago which led to its ban, has resulted in a return of world-wide malaria and the deaths of millions. Rachel Carson has much to answer for in this area.

All I am saying here is that blowing a drug's dangers out of proportion and using the most frightening method of reporting on that danger (i.e., "doubling" or even "ten times the risk") instead of reporting on the absolute risk and letting each person decide if that risk is worth it to them, is medical scaremongering. Pure and simple.

As for me, they will have to pry my estrogen from my cold, dead hand.

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