Estrogen & Breast Cancer: What Every Woman Deserves to Know w/ Dr. Avrum Bluming & Dr. Carol Tavris

[SPEAKER_00]: Women who were randomized to estrogen alone if they didn't have a uterus had a twenty three percent decreased risk of developing breast cancer and a forty percent decreased risk of dying of breast cancer. [SPEAKER_00]: people say we need more studies. [SPEAKER_00]: The women's health initiative was a billion dollar study. [SPEAKER_00]: That set us back thirty years. [SPEAKER_01]: The most competent people are at greater risk of self-justification rather than changing their minds when the evidence dictates. [SPEAKER_00]: whom can you believe? [SPEAKER_00]: They say that the combination of estrogen and progesterone increases the risk of breast cancer. [SPEAKER_00]: Really? [SPEAKER_00]: No. [SPEAKER_02]: If the evidence is clear, then why is this black box RNA still on

estrogen products? [SPEAKER_01]: It's very hard to un-ring the bell. [SPEAKER_02]: Once the FDA comes up with a conclusion about something, how does women's health care look for the next generation? [SPEAKER_00]: Hopefully treated and taken as seriously as men. [SPEAKER_01]: Women have to start by informing themselves and be [SPEAKER_02]: Expert care for menopause and sexual health now just to click away. [SPEAKER_02]: Virtual care by her MD offers longer visits, personalized treatment plans, and trusted providers all from the comfort of the home. [SPEAKER_02]: Learn more at her MD.com. [SPEAKER_02]: This episode was sponsored by her MD. [SPEAKER_02]: Content of the disruptor podcast is for informational purposes only and does not constitute medical advice, please consult your healthcare

provider for personalized guidance regarding hormone therapy and all your medical decisions. [SPEAKER_02]: So they selected Carol's, because you said you had no sense of depth, so you had to find responsible for all of it. [SPEAKER_01]: I'm completely the reason that women are denied their means. [SPEAKER_01]: I accept the responsibility. [SPEAKER_01]: No, but Nasi, this is really interesting, because you said before, what was their motivation? [SPEAKER_01]: What was their motivation? [SPEAKER_01]: So you had mentioned my interest in cognitive biases and the confirmation bias, the kind interpretation of what these researchers have been doing, the kind. [SPEAKER_02]: I like the interpretation. [SPEAKER_01]: Yes. [SPEAKER_01]: Kind. [SPEAKER_01]: is that they really, truly, deeply believed in their heart of

hearts that estrogen was harmful to women. [SPEAKER_01]: And so when you have a, you're holding this paradigm, it's just clear in your mind and you don't get the results that support that. [SPEAKER_01]: So now you say, okay, I'm going to just, [SPEAKER_01]: maneuver my numbers around here a little. [SPEAKER_01]: I'm going to massage them here. [SPEAKER_01]: I'm going to turn them upside down and sideways until I get a finding that confirms what I already believe about estrogen. [SPEAKER_01]: That's the kind interpretation that they really thought they were doing the best kind of research for women's health. [SPEAKER_01]: There's an unkind interpretation. [SPEAKER_01]: I'd love to hear that. [SPEAKER_01]: Well, the unkind one is, [SPEAKER_01]: I'm

going to say this. [SPEAKER_01]: They have been committing scientific fraud for twenty-three years. [SPEAKER_01]: The way they have distorted their numbers, distorted their samples, leaving out symptomatic women. [SPEAKER_01]: If it affects the symptoms of women in menopause, that is malpractice. [SPEAKER_01]: That's scientific malpractice. [SPEAKER_01]: At minimum. [SPEAKER_01]: At minimum. [SPEAKER_01]: And the way they have held to, as Abram just said, the only claim that they originally made that survives is that increases the risk of breast cancer, even though they now have the evidence that it does not increase the risk of breast cancer in their own numbers, but they still claim it. [SPEAKER_01]: They still claim it. [SPEAKER_01]: Now, why? [SPEAKER_01]: Because otherwise they might

have to say those awful words, [SPEAKER_01]: We were wrong. [SPEAKER_01]: We were wrong. [SPEAKER_01]: Twenty-three years and all of the harm we've caused and we were wrong. [SPEAKER_01]: They could claim as a true scientist would. [SPEAKER_01]: Science moves on. [SPEAKER_01]: We learn new things every year. [SPEAKER_01]: We thought this then. [SPEAKER_01]: We think this now. [SPEAKER_01]: But no. [SPEAKER_01]: They've never had a press conference to say, we're sorry. [SPEAKER_01]: We alarmed everybody in two thousand and two. [SPEAKER_01]: The good news is all of the things we have learned that we can now convey to you about estrogen. [SPEAKER_02]: Because the party line and what I was taught is, well, menopause is not going to kill

her, well, hold on a second. [SPEAKER_02]: When you look at the data and you see that hormone use dropped significantly, right? [SPEAKER_02]: Like a cliff, what did we start prescribing? [SPEAKER_02]: Sleep medications, antidepressants, anxiolytics, and I, as a woman who has lost her grandmother, multiple aunts, and nearly my mother at forty-five to cardiovascular disease, [SPEAKER_02]: I want to pull my hair out, knowing the benefits that we withheld from women, and who designs a prevention study with people in their seventh almost eighth decade of life when we know that the cardiovascular changes, that the lipid changes start to occur in three decades earlier than that. [SPEAKER_01]: And then we all said it was a tag along

it was a tag along goal as Offram said they started out where we were really interested in heart disease So we need some older women older women who with with so many of whom had a history of smoking and so many of whom were way over way to our obese who had other risk factors for hard issues But then you don't get to say okay, we're changing our minds and now we're gonna study We're gonna discuss Perry menopausal women. [SPEAKER_01]: You know, no, you don't get to do that [SPEAKER_01]: We're not annoyed at all. [SPEAKER_02]: I love the best. [SPEAKER_02]: That's how you disrupt. [SPEAKER_00]: You hear us talk. [SPEAKER_00]: And we're reasonably convincing. [SPEAKER_00]:

I say that from experience, but we welcome challenges and we don't claim to have absolute truth. [SPEAKER_00]: And then you hear somebody interviewed who says exactly the opposite. [SPEAKER_00]: And whom can you believe? [SPEAKER_00]: And so what I think [SPEAKER_00]: We had to do is point out, and we've done this in publication, where we agree with the Women's Health Initiative. [SPEAKER_00]: What we agree with now is women who start with in ten years of the last menstrual period have a decreased risk of heart disease, which kills seven times as many women as breast cancer in this country. [SPEAKER_00]: They have a longer life by about three and a half years than women who don't. [SPEAKER_00]:

They have a decreased risk of neurologic dysfunction, cognitive decline in Alzheimer's and by the way, they now say that, oh yeah, symptomatic women, the best treatment is estrogen. [SPEAKER_00]: Fine. [SPEAKER_00]: And estrogen alone, they say, decreases the risk of breast cancer and decreases the risk of death from breast cancer. [SPEAKER_00]: So we agree, we agree on all of that. [SPEAKER_00]: The one point we still disagree with is they say that the combination of estrogen and progesterone when given to women [SPEAKER_00]: randomized to women who still have a uterus, which is the reason they get purchased around for the great majority. [SPEAKER_00]: They say that increases the risk of breast cancer. [SPEAKER_00]: Really? [SPEAKER_00]: Really will

first, does it increase the risk of death from breast cancer? [SPEAKER_00]: No, not even after twenty years. [SPEAKER_00]: What is that increased risk? [SPEAKER_00]: Well, it amounts to about one in a thousand women who are taking it. [SPEAKER_00]: Come on. [SPEAKER_00]: If we were all congenitally, genetically identical mice, maybe you could say that, but we're not. [SPEAKER_00]: We're all different. [SPEAKER_00]: And a difference of one in a thousand in a human population is not worth talking about. [SPEAKER_00]: But more than that, the data don't even say that when you look at their reports throughout the years and they say the combination increases the risk of breast cancer development, wait a minute, the risk of breast

cancer development on the graphs that they publish for the combination are identical to the risk for estrogen alone. [SPEAKER_00]: And I just told you they say the risk for estrogen is decreased by twenty three percent. [SPEAKER_00]: Yes, correct. [SPEAKER_00]: But those curves are the same. [SPEAKER_00]: How can you say that? [SPEAKER_00]: Well, the difference isn't among the treated patients. [SPEAKER_00]: It's among the control arm, the women who are given the placebo. [SPEAKER_00]: the women in the combination hormone study who got placebo had an unexpectedly and unexplained lower risk of breast cancer development. [SPEAKER_00]: And when you look at the difference and there is a difference, it's very small one in a thousand but [SPEAKER_00]: There

is a difference. [SPEAKER_00]: The difference is that the risk of breast cancer is higher. [SPEAKER_00]: It's that the control population had a lower risk and that's why it looks bad. [SPEAKER_00]: And so the question is, wait, wait, why should they have a lower risk? [SPEAKER_00]: And there are two answers. [SPEAKER_00]: The first answer is, I don't know. [SPEAKER_00]: But I say that quickly because the second answer is, [SPEAKER_00]: A significant number of women in that control arm were taking estrogen before they enter the study and will randomize to placebo. [SPEAKER_00]: How interesting. [SPEAKER_00]: What happens if you remove all the women who were taking hormones on both arms before starting the study? [SPEAKER_00]: What happens

is that control risk [SPEAKER_00]: goes up to what was expected. [SPEAKER_00]: And the reported increased risk disappears. [SPEAKER_00]: And they know that. [SPEAKER_00]: They know that because I've told them that I've written it in the medical literature. [SPEAKER_00]: I've debated them on radio. [SPEAKER_00]: And they know that. [SPEAKER_00]: And it's not just me. [SPEAKER_00]: A paper that I wrote with Howard Hodis [SPEAKER_00]: Professor of cardiology at USC University of Southern California and Robert Langer or Professor of Family Medicine at UC San Diego and by the way one of the original women's health initiative investigators who wrote a paper in twenty fifteen talking about what was wrong with the women's health initiative and what was done

that was misleading wrote a paper called tiz but a scratch [SPEAKER_02]: Okay. [SPEAKER_00]: And that's a whole lot of the story. [SPEAKER_00]: The point of Tizba to scratch is we've leveled and you've heard legitimate criticisms against the study and when we confront them with it, [SPEAKER_00]: the way they treated is either by simply ignoring it, which they did for the first seventeen or eighteen years, and then by recoding the incorrect statistics that they have to know are wrong. [SPEAKER_02]: I feel like you need to talk to every single patient in America, because what did one of you say? [SPEAKER_00]: Yeah, what we're doing? [SPEAKER_00]: Yes, we are. [SPEAKER_02]: As soon as, yes, Spotify, everything. [SPEAKER_02]:

But the total population that is eligible for taking hormone, I think only four percent of women are on it. [SPEAKER_02]: But you referred to what was the [SPEAKER_02]: phenomenon that was going on the estrogen band. [SPEAKER_02]: What did you say, estrogen bandwagon? [SPEAKER_00]: Oh, that was Russo. [SPEAKER_00]: Yeah, Russo said that. [SPEAKER_00]: Yeah. [SPEAKER_02]: And yet even today, and when we started filming the M factor, I mean, you were there the night that we premiered. [SPEAKER_02]: It was a one point eight percent. [SPEAKER_02]: So people who think we've gone rogue and everyone's getting hormone therapy, it's still only about four percent. [SPEAKER_02]: I mentioned I saw patients this morning, got up at five o'clock in

the morning here, saw patients. [SPEAKER_02]: Every single one of them had come to me to her MD because she had been denied hormone therapy. [SPEAKER_02]: And they're still being told. [SPEAKER_02]: The old findings, the ringing of the bell, it's going to give you cancer. [SPEAKER_02]: It's not going to help you that much. [SPEAKER_02]: Why would you want to take that risk? [SPEAKER_02]: These women are crying. [SPEAKER_02]: They are suffering. [SPEAKER_02]: One of them said every day she gets up at one, fifteen in the morning, mind racing, hot flashing. [SPEAKER_02]: She can't sleep. [SPEAKER_02]: She's not productive at work. [SPEAKER_02]: And she's like, I think I've gone mad. [SPEAKER_01]: We've gotten so many letters from women

around the world saying this. [SPEAKER_01]: Help, help, help, or thank goodness for you. [SPEAKER_01]: I felt so alone. [SPEAKER_01]: I thought nobody else was suffering in silence the way I am. [SPEAKER_01]: Thank goodness to know that I'm not crazy and that there is a solution to this. [SPEAKER_01]: These anguish letters from [SPEAKER_02]: many women who have had breast cancer many others who have not with with doctors who won't listen to them who won't talk to them who won't reconsider their own points of view or haven't taken the time to learn because then because of what happened to me all of my menopuzzle education happened afterwards through preceptor ships through CMEs through going to courses reading

papers on my own learning the data and understanding [SPEAKER_02]: Oh my gosh, there's such an opportunity to help women to validate them and to treat them and prevent disease. [SPEAKER_00]: And as you know and don't be misled, we are not solitary voices here. [SPEAKER_00]: There are physicians and laypeople around the world who are carrying this message, both to medicine and to the lay population. [SPEAKER_00]: and we are banding together to try to get the black box warning on every estrogen product. [SPEAKER_00]: That was put into place. [SPEAKER_00]: Six months after the first women's health initiative paper was published in two thousand two that bans every estrogen that warns every woman taking an estrogen-containing product that

this could cause a variety of things. [SPEAKER_00]: You can die. [SPEAKER_00]: You can die horrible things will happen to you. [SPEAKER_02]: So what if the evidence is clear and I agree with you, then why is this black box warning still today on our estrogen products? [SPEAKER_00]: Well, we're we're looking to change that things. [SPEAKER_00]: Yes, we are. [SPEAKER_00]: Slowly. [SPEAKER_00]: We've been working on this for several years now and we is all of us. [SPEAKER_00]: There is an FDA commissioner now, Marty Macarrey, who in the current administration whom I believe has the same goal. [SPEAKER_00]: and we'll have to see what happens. [SPEAKER_01]: It's very hard to un-ring the bell as you put it, you

know, which is once the FDA comes up with a conclusion about something, getting it undone is a little more of a daunting task. [SPEAKER_01]: What's the time is right? [SPEAKER_02]: So then you answer my question. [SPEAKER_02]: What is this reveal about our regulatory systems and how they respond or fail to respond to when it comes specifically to women's health? [SPEAKER_00]: You know, there's something that we would taught when we were in medical school, which is the prime directive in medicine, is pre-mime known as there. [SPEAKER_00]: First, do no harm. [SPEAKER_02]: Yes. [SPEAKER_00]: Sure. [SPEAKER_00]: I think that's a very good bit of advice. [SPEAKER_00]: But it can't be answered [SPEAKER_00]: with ignorance. [SPEAKER_00]: Melody Koble,

who's a professor of medicine in Chicago in nineteen ninety four wrote a wonderful paper about hormones and she said she wants to retire first do no harm and exchange it for first understand then advice and I agree with that [SPEAKER_00]: In addition, Eric Weiner, who is a recent past president of the American Society of Clinical Oncology, in his presidential address two years ago, [SPEAKER_00]: spoke to a worldwide audience, but it's the largest group of oncologists in the world, but now it's been distributed worldwide. [SPEAKER_00]: And he called it partnering with patients and spoke about how important that is to carry medical care forward. [SPEAKER_00]: It's worth pointing out that Dr. Weiner, who's currently the director

of oncology at Yale, was born with hemophilia. [SPEAKER_00]: that in early in his childhood he got Factor eight which also gave him AIDS. [SPEAKER_00]: This is a very impressive man who knows what it's like to be on the other side of the desk dealing with doctors on whom your survival depends. [SPEAKER_00]: And so his partnering with patients lecture, I recommend everybody listen to, take a tea doctor, and make your doctor listen to it as well. [SPEAKER_02]: Absolutely. [SPEAKER_02]: So, Carol, in your research on cognitive dissonance, you've shown how people justify bad decisions. [SPEAKER_02]: And we've talked about this a little bit today. [SPEAKER_02]: You haven't been shy. [SPEAKER_02]: How do you see this playing out

in the medical establishments resistance to updating their position on hormone therapy? [SPEAKER_01]: How do I see this? [SPEAKER_02]: How do you see it playing out? [SPEAKER_02]: Like, we've established how we've gotten here thus far. [SPEAKER_01]: Okay, what we know from how self-justification works, as I said before, the greater the harm you've caused, the greater the mistake you've made. [SPEAKER_01]: The more incorrect your belief is, the harder it is going to be for you to change your mind because what cognitive dissonance means is, I am a smart, competent, compassionate physician. [SPEAKER_01]: I am therefore incapable of doing something foolish, incompetent, or wrong. [SPEAKER_01]: Now you're giving me information that I've just done something foolish and competent

and wrong. [SPEAKER_01]: What should I do? [SPEAKER_01]: Change myself, opinion? [SPEAKER_01]: or change my ability to hear what you say. [SPEAKER_01]: Guess which is the easier route to follow. [SPEAKER_01]: And in fact this is the danger because in fact it is the smartest people, the most competent people who are at greater risk of self-justification rather than changing their minds when the evidence dictates. [SPEAKER_01]: That's the surprising thing. [SPEAKER_01]: We're used to thinking, oh, foolish stupid incompetent people will always justify their mistakes. [SPEAKER_01]: The greater danger comes from the people who should know better, but can't hear it precisely because they see themselves as good competent informed physicians. [SPEAKER_01]: Now, what happens? [SPEAKER_01]: I'm sympathetic. [SPEAKER_01]:

We're all sympathetic to physicians and the pressures on their time and how difficult it is to keep up with research. [SPEAKER_01]: It's just easier to stay with the guidelines that my specialty tells me or the regulations of my provider. [SPEAKER_01]: I'm not allowed to prescribe hormones. [SPEAKER_01]: How can I give hormones to a woman who's had breast cancer? [SPEAKER_01]: If she gets breast cancer, I'll be sued. [SPEAKER_01]: All of those [SPEAKER_01]: legal and professional restraints on changing their minds. [SPEAKER_01]: That's very significant. [SPEAKER_01]: So that's one area of change that has to happen. [SPEAKER_01]: And we hear from so many women who go see their doctors who dismissed them. [SPEAKER_01]: Oh, they're there, little lady.

[SPEAKER_01]: What you brought me a book to read of. [SPEAKER_01]: Great, you know, just go off with your nice book. [SPEAKER_01]: You can't tell me I'm the doctor. [SPEAKER_01]: So what this means for women is women have to start by informing themselves of what the evidence shows and be insistent and kind and persistent in conveying this to their physicians. [SPEAKER_02]: So these are gonna be rapid fire questions and either one of you can go. [SPEAKER_02]: If you could change one thing about how medicine treats women, what would it be? [SPEAKER_02]: Listen. [SPEAKER_02]: I love that. [SPEAKER_02]: Yes. [SPEAKER_02]: This one's gonna be hard for both of you because you're so elegant and eloquent speakers, but

describe the current state of hormone therapy in just three words. [SPEAKER_01]: Oh, good grief. [SPEAKER_00]: be a participant. [SPEAKER_02]: Yeah. [SPEAKER_02]: I like that. [SPEAKER_00]: I never stop questioning. [SPEAKER_02]: It's not too late. [SPEAKER_02]: It's not too late. [SPEAKER_02]: But that's for words, but it's one of which I'm in a trap. [SPEAKER_02]: All right. [SPEAKER_02]: All right. [SPEAKER_02]: A fun one, because you guys, I don't know if you know this about me, but when I'm not working, I'm traveling. [SPEAKER_02]: I love to travel. [SPEAKER_02]: I feel like I'm a forever student. [SPEAKER_02]: I feel like the globe is the world's biggest classroom. [SPEAKER_02]: And so, favorite vacation destination. [SPEAKER_00]: The next one. [SPEAKER_02]: Love that

answer. [SPEAKER_00]: which we're doing together. [SPEAKER_00]: We're going to Laos and Cambodia in October. [SPEAKER_00]: with friends and family. [SPEAKER_02]: Fun. [SPEAKER_00]: Yeah. [SPEAKER_02]: Fun. [SPEAKER_02]: I would say Botswana for me fell in love with the people, and how close I was. [SPEAKER_02]: But I just spent a week in Dominica, not Dominican Republic. [SPEAKER_02]: That's what everyone thinks. [SPEAKER_00]: That's right. [SPEAKER_02]: I went to go try to swim with the sperm whales, but they didn't, one of the few places in the world you can. [SPEAKER_02]: Dolphins made appearance, got to swim with wild dolphins, but I didn't see the sperm whales. [SPEAKER_02]: I will go back, but I did canyon down some incredible waterfalls. [SPEAKER_02]:

jumped off some cliffs and had some fun with my kids. [SPEAKER_00]: I spent two years in Uganda running a lymphoma treatment center and that changed our lives. [SPEAKER_00]: We travel extensively as a result of that, not to [SPEAKER_00]: built up places mostly to explore cultures very different than our cultures or as you do to see outdoor environments that we simply don't encounter. [SPEAKER_00]: Here it's a wonderful world full of wonderful people and you won't know it if you don't get out and explore. [SPEAKER_01]: And when I get exasperated by people, the animal vacations have been spectacular. [SPEAKER_01]: The Galapagos was just a monumental experience for me traveling with the wolves in Yellowstone in winter. [SPEAKER_01]:

Sometimes just being away from people is very therapeutic, I find. [SPEAKER_02]: It's magical. [SPEAKER_02]: And I think for me, I remember how small my problems are. [SPEAKER_02]: And for my children, I think it's given them a greater understanding of other cultures and people and realize how many more similarities they have. [SPEAKER_02]: They spent a day at a school in Tanzania. [SPEAKER_02]: And neither group of children understood each other's language, right? [SPEAKER_02]: It was Swahili and English. [SPEAKER_02]: And I was just looking at the videos this week. [SPEAKER_02]: And they were dancing and singing and playing with cell phones and taking photos and they played soccer and they ate candy together. [SPEAKER_02]: And it was like,

[SPEAKER_02]: It didn't matter that they came from opposite ends of the globe. [SPEAKER_02]: It was so beautiful. [SPEAKER_02]: I mean, our two guys were actually crying. [SPEAKER_02]: They were like, we've never seen this. [SPEAKER_02]: And I said, I've, when they were little, I dragged them on planes and traveled with them across the world because I wanted them to be global citizens. [SPEAKER_02]: It was very important to me. [SPEAKER_00]: One of my favorite poems is by Regard Kippling. [SPEAKER_00]: East is east and west is west and never the twain shall meet. [SPEAKER_00]: To earth and sky stand presently at God's great judgment seat. [SPEAKER_00]: But there is neither east nor west, border, no breed, no birth,

when two strong men stand face to face, though they come from the ends of the earth. [SPEAKER_02]: I love that goose bumps. [SPEAKER_02]: All right, that was your little break now. [SPEAKER_02]: You write that women have been denied estrogen for thirty years, based on a false assumption. [SPEAKER_02]: What do you say to a woman whose doctor tells her she's not a candidate for hormone therapy because of breast cancer risk? [SPEAKER_00]: That really gets us to a very practical question, which I'd like what most people say almost as a reflex is, we need more studies. [SPEAKER_00]: Right? [SPEAKER_00]: Well, not so right. [SPEAKER_00]: The women's health initiative was a billion dollar study. [SPEAKER_00]: That's not going

to happen again. [SPEAKER_00]: And look what that gave us. [SPEAKER_00]: That said, us back thirty years. [SPEAKER_02]: At least. [SPEAKER_00]: What we need is more data, absolutely. [SPEAKER_00]: So you go to your doctor and you say to your doctor, look, please read this review of the literature that shows that the overwhelming majority of studies looking at this found no increased risk if I had breast cancer. [SPEAKER_00]: But look, I know we live in a litigenous culture and I don't blame you for being afraid. [SPEAKER_00]: So why don't we do this? [SPEAKER_00]: I have in my hand an informed consent form doctor that I'm willing to sign saying that you've explained to me all the risks

and I will shoulder the risks with you and will partner with this and maybe I will learn and you will learn [SPEAKER_00]: and let's collect these data so that they could be sent to a central repository and let's learn as we proceed the article that I wrote in twenty twenty two in the cancer journal about hormones after breast cancer has in the appendix an informed consent form an equality of life questionnaire which can be adapted to any practice [SPEAKER_00]: And if that's done, I'd like to know about it so that we can centralize the collected data. [SPEAKER_00]: And let's be smarter and better informed when we meet in a year to talk about where we

stand. [SPEAKER_02]: I love that so much because it gives the patient autonomy, decision-making, makes her partner and her care. [SPEAKER_02]: And it's no different than when you chose to give chemotherapy or I operated on a patient, right? [SPEAKER_02]: I had to take that informed consent and you understand risk of anesthesia, damage to other, you know, organs, everything, but we're still opting because we believe that the surgery, the benefit outweighs the risks, right? [SPEAKER_02]: But we made that decision together. [SPEAKER_02]: I offered you medical options, I offered you surgical options, but here we are on surgical day, and we are still reviewing this again, and we're gonna sign it today, right? [SPEAKER_02]: So I love that.

[SPEAKER_02]: But for women who are listening, there are absolute contraindications, right? [SPEAKER_02]: So for, we're talking not localized, but systemic hormone therapy, who are candidates that you would say now, like, given your history, or is there no one, you would say that? [SPEAKER_00]: There is no one I would say that to. [SPEAKER_00]: That doesn't mean go out and buy it at the local drug store without a prescription. [SPEAKER_00]: There are pros and cons to every medical interaction, and we have to approach it carefully. [SPEAKER_00]: But in the beginning, we were talking about arguments about estrogen being a breast cancer risk. [SPEAKER_00]: Before we had chemotherapy, and before we had drugs like Tamoxifen, which is only

since [SPEAKER_00]: uh... the nineteen early nineteen eighties we used estrogen to treat breast cancer right and uh... it was a form of high dose estrogen it wasn't quite estrogen it was diethyl still best role and it was a fifteen milligrams but it was an estrogen like drug [SPEAKER_00]: and it showed up to a forty percent reduction in measurable breast cancer at the time patients got it and when I brought that up in debates with people who think estrogen is bad what they say not because it's convincing but because it's a fallback position well that's high dose estrogen and what we're concerned about is low dose physiologic estrogen [SPEAKER_00]: Really? [SPEAKER_00]: Is that a convincing argument?

[SPEAKER_00]: But okay, let's look at standard low-dose estrogen. [SPEAKER_00]: Craig Jordan is credited with developing tamoxifen. [SPEAKER_00]: The first, it was called an estrogen blocker. [SPEAKER_00]: It's not, it's a specific estrogen receptor, but it was the first hormonal interaction in the treatment of breast cancer. [SPEAKER_00]: What Craig Jordan has reported on [SPEAKER_00]: And by the way, in the same issue of the cancer journal, in which I wrote My Article in twenty twenty two, he contributed this article taken from a Karnowski lecture, which is a prestigious lecture given at Ask Go Conventions. [SPEAKER_00]: He wrote that women who become resistant to tamoxifen, often respond to low dose estrogen. [SPEAKER_00]: Well, we have other things that we

use now that have a more established track record. [SPEAKER_00]: But I can't imagine treating a patient with lung cancer by telling them to smoke more cigarettes. [SPEAKER_00]: And yet, that's what this is. [SPEAKER_01]: You know, you ask who shouldn't take hormones. [SPEAKER_01]: And at electric, I gave a woman in the audience, said, OK, I'm fifty. [SPEAKER_01]: I have no symptoms. [SPEAKER_01]: A sister, I said, all right, another one. [SPEAKER_01]: Anyway, she said, I have no symptoms. [SPEAKER_01]: Should a woman in menopause who has no symptoms take HRT? [SPEAKER_01]: What an interesting question, which I have, of course, discussed with Avrum. [SPEAKER_01]: No symptoms, everything's fine. [SPEAKER_01]: Why would you take medication? [SPEAKER_01]: Well, the answer

would seem to be [SPEAKER_01]: If you want the benefits of hormones in your older years against heart disease and osteoporosis and cognitive decline, you may not need estrogen now in your fifties, but I sure as hell bet that you will benefit from it when you're an old woman. [SPEAKER_01]: That was not something we sort of set out to think about when we're another, but I think it's really a useful and important issue for women to consider in terms of that their mothers have dementia or osteoporosis or heart disease. [SPEAKER_02]: Especially given longevity and women we know they live longer, but in poor health. [SPEAKER_02]: And so if we can do things to truly prevent disease

and to live quality of life and those, although it said it didn't make a difference, I'm joking. [SPEAKER_02]: But to live those lives better, you know, those years healthier, I think that we should. [SPEAKER_02]: And that's how I answer that for patients who come to me, very few are asymptomatic. [SPEAKER_02]: My mother also was asymptomatic. [SPEAKER_02]: She nearly died of cardiovascular disease at forty-five, but she can't understand how I built a whole practice in business on menopause. [SPEAKER_02]: She's like, I don't understand. [SPEAKER_02]: I just stopped having my period. [SPEAKER_02]: I go, mom. [SPEAKER_02]: Most people are not like you, like that is not the uniform or, you know, experience for everybody. [SPEAKER_02]: So imagine

that we're sitting here in ten years. [SPEAKER_02]: Okay. [SPEAKER_02]: I would love to be sitting here in ten years with you guys. [SPEAKER_02]: The medical establishment has finally accepted the evidence. [SPEAKER_02]: And now we are locked up agreed on every single point. [SPEAKER_02]: How does women's healthcare look different? [SPEAKER_02]: And what does it mean for the next generation of women? [SPEAKER_00]: Well, for one thing, hopefully it will mean that people are treated comparably and taken as seriously as men. [SPEAKER_00]: If we were having this discussion about [SPEAKER_00]: some treatment for men. [SPEAKER_00]: And men said, you know, I have these hot flushes and I can't sleep and my bones are getting thinner and I don't

think well. [SPEAKER_00]: And I'm having palpitations. [SPEAKER_00]: Sex has no appeal to me. [SPEAKER_00]: And even if I force myself, it's painful. [SPEAKER_00]: If I would say to a man, you know, a buck up, it's only going to last about seven and a half years to get with it. [SPEAKER_00]: Man up, that would never happen and it doesn't happen now. [SPEAKER_00]: and women have to be treated the way we would treat men. [SPEAKER_00]: And the problem is it's not male against female. [SPEAKER_00]: Women doctors can be a strongly anti-chromo-ruby therapy as as male doctors. [SPEAKER_00]: I think it would mean that women will have a more active [SPEAKER_00]: role in in society. [SPEAKER_02]: Absolutely. [SPEAKER_00]:

At women if you I think there's a paper in the back of my mind that I have notes on for thirty years and it's called enough and it's kind of like the [SPEAKER_00]: looking at women's status throughout history and saying it hasn't been good for women compared to men throughout history and almost all civilizations except for small exceptions and hopefully this will be a way of [SPEAKER_00]: changing that. [SPEAKER_01]: The male norm in law and medicine and science and in pretty much every domain of our lives in which if women are different from men they are by definition ab normal right deficient in some way in medicine of course talked about the male norm in

medicine the male body is the norm and then we generalize not just a women but to older people and other ethnicities and so forth [SPEAKER_01]: So this is a long war, this is a long battle. [SPEAKER_01]: And I am hoping that with, I can't just say with the rise of women in medicine, because as Abram just said, they are doctors first and women second for the most part, you know? [SPEAKER_01]: As they should be. [SPEAKER_01]: As they should be, no, as they should be. [SPEAKER_01]: It's why, you know, we hope that women politicians would be all sweetness and light and cooperation in love and beauty. [SPEAKER_01]: Well, no, they're political affiliation. [SPEAKER_01]: Trump's their gender

as it were. [SPEAKER_01]: Okay. [SPEAKER_01]: That said, I think we're in for a long haul here, but I think you asked what will be in ten years. [SPEAKER_01]: My hope will be through more [SPEAKER_01]: more of women's willingness to educate themselves and stand up for their rights for better treatment of their symptoms for being heard in a medical setting. [SPEAKER_01]: That's the best we can hope for and it won't be easy with our medical system in the kind of state that it is now in. [SPEAKER_01]: So women have to be advocates for their health and sanity and relationships. [SPEAKER_02]: So we're saying, challenge your doctor with evidence-based data and questions. [SPEAKER_00]: And politely. [SPEAKER_02]: Politely.

[SPEAKER_00]: Read us. [SPEAKER_00]: Work with your doctor. [SPEAKER_02]: Sometimes you can't, though, if not in a change, they'll find another doctor. [SPEAKER_02]: Read estrogen matters. [SPEAKER_02]: I just thought of a funny story. [SPEAKER_02]: I was getting interviewed for a podcast and they coily asked me like, what's on my nightstand? [SPEAKER_02]: You're a sexual health doctor. [SPEAKER_02]: And of course, they wanted, you know, those kind of answers. [SPEAKER_02]: And I wasn't going to go there. [SPEAKER_02]: And I was like, estrogen matters. [SPEAKER_02]: I'm like oh you need this is a book that you need to read so make sure you read the book understand that the overwhelming majority of women who take hormone therapy don't develop

breast cancer know that estrogen alone actually decreases breast cancer and if you are a provider understand that you are continually [SPEAKER_02]: learning. [SPEAKER_02]: Humility is a really good thing and you have to listen to your patients and you're allowed to change your stance on the practice of medicine as new data and treatments unfold. [SPEAKER_02]: And so you're exactly right. [SPEAKER_02]: They need to be their own advocates and not accept because you're a woman as the answer. [SPEAKER_02]: And so I want you both to tell the listeners how they can follow you, what projects you're up to, and where they can find you. [SPEAKER_01]: Instagram. [SPEAKER_01]: We are at estrogen underline matters. [SPEAKER_01]: We post not

only all the supportive messages that we get from women, but all the new data findings, uh, scare stories in the media. [SPEAKER_01]: We immediately deal with them and respond to them. [SPEAKER_02]: Thank you both so much for all of your time today. [SPEAKER_01]: So welcome. [SPEAKER_01]: Thank you. [SPEAKER_02]: This is more than a conversation. [SPEAKER_02]: It's a call, a call to build something better. [SPEAKER_02]: Subscribe, share, and bring more disruptors into this room. [SPEAKER_02]: For unfiltered insights and bold ideas, go to drsome.com to sign up for the monthly disruptor newsletter and follow us on social at drsome. [SPEAKER_02]: We're not waiting for a seat at the table. [SPEAKER_02]: We're building our own table.