The Lie Women Believed About Hormone Therapy for 20 Years w/ Dr. Avrum Bluming & Carol Tavris

[SPEAKER_03]: breast cancer is frightening, but the current curate in the United States is better than ninety four percent, and we are denied treatment to millions of women. [SPEAKER_03]: That's unacceptable. [SPEAKER_00]: That's what people do. [SPEAKER_00]: The more harm they cause, the greater their need to justify their errors. [SPEAKER_02]: Dr. Avram Blooming, hematologist medical oncologist spend over forty years treating breast cancer patients. [SPEAKER_02]: Carol, Tavris, PhD, a social psychologist with numerous awards for promoting science. [SPEAKER_02]: They are the co-authors of estrogen matters. [SPEAKER_03]: The happens study was supposed to look at thirteen hundred women. [SPEAKER_03]: It stopped after four hundred women because they found an increased risk among twenty-two women based on that. [SPEAKER_03]: We are

denying hormones to women who had breast cancer. [SPEAKER_02]: as a social psychologist. [SPEAKER_02]: What drew you to collaborate with medical oncologists on hormone therapy? [SPEAKER_00]: What he was doing in medicine, exposing the gap between the science and clinical practice is what I had been doing in psychology. [SPEAKER_02]: Let's talk about the WHO. [SPEAKER_02]: One flawed study changed women's health care world life. [SPEAKER_00]: What is the one thing that sells most in America? [SPEAKER_00]: Fear. [SPEAKER_00]: The Women's Health Initiative did create fear in millions of women. [SPEAKER_00]: Why? [SPEAKER_00]: That's the self-justification of the money. [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 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]: I'm just going to dive right in, so basically for over two decades, women have been denied a treatment that it could extend their lives by over three and a half years. [SPEAKER_02]: Protect their hearts and strengthen their bones all because of a single flawed study that's been systematically debunked. [SPEAKER_02]: Today, we're joined by the medical oncologist

and the social psychologist who literally wrote the book on why everything you think you know about estrogen and breast cancer is absolutely wrong. [SPEAKER_02]: So, Abram, you have spent decades as a metonke telling women with breast cancer they couldn't have hormone therapy. [SPEAKER_02]: Then your wife got the diagnosis at forty-eight of breast cancer and you watched her suffer through treatment induced menopause. [SPEAKER_02]: Walk us through that moment when your clinical certainty began to crack. [SPEAKER_03]: Sure, clinical certainty, as you know, is never certainty. [SPEAKER_03]: One of my favorite lines from a movie is when Barbara Streisand and Yentel sings, the more I live, the more I learn, the more I realize, the less I know,

that is so true in everything so that we constantly adapt to new data. [SPEAKER_03]: It's just we're often not forced to do it in a critical timeframe. [SPEAKER_03]: And yes, my wife at age forty six was diagnosed with breast cancer. [SPEAKER_03]: Before that, I was advising women [SPEAKER_03]: who had gotten pregnant at the time they were diagnosed with breast cancer, that they should have an abortion because I thought that estrogen is responsible for the development of breast cancer and the more estrogen, the more dangerous it is. [SPEAKER_03]: I ought to point out that the reason I and most of the physicians thought that is the incidence of breast cancer is a hundred times as common

among women as it is among men. [SPEAKER_03]: And it is logical to assume that there's something in women that may be responsible. [SPEAKER_03]: Estrogen is a reasonable culprit. [SPEAKER_03]: In addition, about a hundred years ago, several doctors removed the ovaries of women with measurable breast cancer and their measurable breast cancer in some cases shrunk or went away. [SPEAKER_03]: Well, that's very convincing. [SPEAKER_03]: But it's over a hundred years later. [SPEAKER_03]: And the reason I was forced to confront this as you point out is I treated my wife with chemotherapy at age forty-six when she was not yet in menopause and I induced menopause. [SPEAKER_03]: and she doesn't complain. [SPEAKER_03]: So that all of the symptoms

we've discussed, the hot flushes, the insomnia, the painful urination, the arthralges, the heart palpitations, she had all of them and she didn't say a word. [SPEAKER_02]: And we should comment that induced menopause, whether it's surgical or medical, tends to be clinically a lot more severe because it happens on a shortened time frame. [SPEAKER_02]: So the fact that she didn't complain speaks volumes. [SPEAKER_03]: That's who she is. [SPEAKER_03]: but the brain fog was intolerable. [SPEAKER_03]: Martha is a very literate. [SPEAKER_03]: Books are a passion of hers and she couldn't remember what she read two pages back. [SPEAKER_03]: We would go to the symphony and she couldn't follow the music and that was terrible. [SPEAKER_03]: So I

had a young wife [SPEAKER_03]: who was markedly symptomatic with one terrible symptom. [SPEAKER_03]: And the question was, how could I treat her symptoms? [SPEAKER_03]: And clearly, and we knew this back then, and this is thirty years ago, the best treatment for the symptoms was estrogen. [SPEAKER_03]: If estrogen is responsible for the development of breast cancer, many people had written that the more estrogen a woman is exposed to, the higher her risk of breast cancer development. [SPEAKER_03]: And in support of that, there are several reports [SPEAKER_03]: that say that the earlier a women starts menstruating, the earlier she reaches menarchy and the later she reaches menopause so that the period that she's exposed to estrogen is

prolonged the higher her risk for breast cancer and I read those reports. [SPEAKER_02]: I was taught all of that through my OBGYN residency. [SPEAKER_03]: And the reports are very unconvincing for the overwhelming majority of women. [SPEAKER_03]: It really doesn't correlate. [SPEAKER_03]: If you compare women who started having periods when they were ten with women who started having periods when they were seventeen, you can see some small difference, but it is really not convincing. [SPEAKER_03]: And what is responsible for really generating high levels of estrogen? [SPEAKER_03]: pregnancy. [SPEAKER_03]: And so one would expect that the more pregnancies a woman has, the higher her risk of breast cancer. [SPEAKER_03]: Surprise, the more pregnancies a woman has, the

lower her risk of breast cancer. [SPEAKER_03]: And a woman who is pregnant and delivers a healthy child before age twenty, and we're not advocating that, but we have those data. [SPEAKER_03]: reduces her lifetime risk of developing breast cancer by seventy percent. [SPEAKER_03]: And so there is one truth that both you and I would thought that really doesn't hold up. [SPEAKER_03]: In addition, I knew but I reinforced my learning that the biggest determinant of breast cancer risk outside of gender [SPEAKER_03]: is age. [SPEAKER_03]: The older a woman gets, the higher her risk of breast cancer, even though she stops making estrogen and this is the women who are in taking hormones. [SPEAKER_03]: In addition, we were

taught since estrogen is reportedly bad that a woman who is diagnosed with breast cancer when she's pregnant, has a much worse prognosis than a woman diagnosed when she's not pregnant. [SPEAKER_03]: And as a result of that, I had encouraged some patients I had seen to have an abortion. [SPEAKER_03]: We now know that the abortion has no effect on prognosis. [SPEAKER_03]: It might in fact worsen the prognosis. [SPEAKER_03]: And so the more I read, the more I had to challenge the [SPEAKER_03]: conventional wisdom and I call it wisdom not really meaning that that estrogen is associated with breast cancer, risk and development and [SPEAKER_03]: The women's health initiative about which I suspect will speak later today,

found after twenty years of follow-up that in this prospective double-blind randomized study, 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_02]: Can you please say that again? [SPEAKER_02]: I travel the country and I feel like I'm saying that on repeat. [SPEAKER_02]: And women are still like, what? [SPEAKER_02]: Hormones don't cause breast cancer. [SPEAKER_02]: So please say that one more time because if anyone gets one thing from that today, I want them to understand that. [SPEAKER_03]: estrogen alone taken by a perimenopausal and menopausal woman decreases the risk of breast cancer

development by twenty three percent decreases decreases the risk of breast cancer death by forty percent [SPEAKER_03]: And does that mean that estrogen plays no role in breast cancer development? [SPEAKER_03]: I never talk in absolutes. [SPEAKER_03]: I don't know enough to talk in absolutes. [SPEAKER_03]: But the day-to-day decisions that we make must be based on the data that we acquire. [SPEAKER_03]: My car tells me when the traffic pattern changes and the route I'm following to reach a destination is wrong. [SPEAKER_03]: Surely I can do it when I'm dealing with something so much more important than traffic. [SPEAKER_02]: This Ohio girl is learning all about LA traffic patterns today. [SPEAKER_02]: Let me tell you. [SPEAKER_00]: We're going

to need a GPS for hormone therapy. [SPEAKER_00]: Clearly. [SPEAKER_00]: We are. [SPEAKER_00]: New direction. [SPEAKER_02]: But what I find so fascinating about this, I truly believe in storytelling. [SPEAKER_02]: I think it's what unifies us all. [SPEAKER_02]: It helps link us all and understand even through fundraising. [SPEAKER_02]: That is how I got a lot of the male investors to lock on and to invest with through storytelling. [SPEAKER_02]: Someone had a mother, a sister, a wife, a daughter that was affected by the healthcare system. [SPEAKER_02]: And so here you are an oncologist and I happen to be married to one. [SPEAKER_02]: I know how data driven you are. [SPEAKER_02]: I think almost more than any other sub-specialty

[SPEAKER_02]: And then you have induced your young wife's metaphors. [SPEAKER_02]: And she's having one of, I think, for me too, the brain fog as a navigated my own journey. [SPEAKER_02]: It's horrific. [SPEAKER_02]: When you're used to a word recall like this and being sharp as a tack and you struggle, and those are the symptoms that I started having, it is very frustrating for someone. [SPEAKER_02]: And I can't even imagine you said you couldn't follow the music. [SPEAKER_02]: So you know the data. [SPEAKER_02]: Now, right, you're reading it. [SPEAKER_02]: You commented on the conventional wisdom or the status quo is what I called it. [SPEAKER_02]: So what was next in the decision making? [SPEAKER_03]: Well, I

couldn't just decide to treat her. [SPEAKER_03]: That's irresponsible. [SPEAKER_02]: Okay. [SPEAKER_03]: I felt I had to do a study to see if what I suspected was true, which is that hormones would not affect [SPEAKER_03]: the prognosis of breast cancer survivors. [SPEAKER_03]: We now know, and I can jump to the end of this, that there are twenty-six studies that I reviewed and reported on in twenty-twenty-two in the cancer journal, that look at giving women some form of hormone replacement therapy after treatment for breast cancer. [SPEAKER_03]: Of the twenty-six, [SPEAKER_03]: Twenty-five show no increased risk of recurrence. [SPEAKER_03]: Four show a decreased risk of recurrence. [SPEAKER_03]: None show an increased risk of mortality associated with taking hormones.

[SPEAKER_03]: In fact, [SPEAKER_03]: Any decrease in mortality because of the benefit of hormones on heart disease, which kills seven times as many women as breast cancer does, is among the women who will randomize to take hormones. [SPEAKER_03]: There is one study that shows an increased risk of recurrence, and there are two points I want to make on that. [SPEAKER_03]: It's called the habit study, which is an acronym for hormones after breast cancer, is its safe. [SPEAKER_03]: It was a run by Lars Humberg, out of Sweden. [SPEAKER_03]: The habit study was supposed to look at thirteen hundred women, followed them for eight years. [SPEAKER_03]: It stopped after following four hundred women because they found an increased

risk of recurrence among the women who were randomized to take hormones. [SPEAKER_03]: The increased risk of recurrence between the two groups amounted to twenty-two women. [SPEAKER_03]: And based on that increased risk of recurrence, twenty-two women, millions and millions of women around the world are deprived of hormones after treatment for breast cancer. [SPEAKER_03]: Finding in that study was not that there was an increased risk of distant recurrence, meaning elsewhere in the body. [SPEAKER_03]: There was no increased risk of death. [SPEAKER_03]: There was no increased risk among women who had lymph node involvement at the time their breast cancer was diagnosed. [SPEAKER_03]: Women whom we would expect to have a higher risk of recurrence. [SPEAKER_03]: The only

increased risk that these twenty-two women had [SPEAKER_03]: was an increase in either local recurrence or controversial recurrence. [SPEAKER_03]: That's all. [SPEAKER_03]: And the biggest argument against, I'm sorry to say that's all. [SPEAKER_03]: That's a lot, but it's [SPEAKER_00]: I know my blood pressure is definitely up after listening to the highman interjecting. [SPEAKER_00]: Oh yes please you began by saying we think in stories and we love to to make decisions based on stories and you know a really good example and so you started by asking him about Martha. [SPEAKER_00]: Tell us Martha's story, and Auburn replied as a scientist. [SPEAKER_00]: One person, even my beloved wife, Martha, is not a scientific study. [SPEAKER_00]: We don't argue

by anecdote. [SPEAKER_00]: And so it's interesting to me that what he just did was to give you the science and the subsequent studies, the twenty-six studies, all in by the way, and Martha. [SPEAKER_00]: And Martha, who is fabulous, by the way, and has been happy and healthy ever since he treated her with hormones all those years ago. [SPEAKER_00]: But that's an important difference, not to argue by anecdote, but by evidence. [SPEAKER_03]: A very important note. [SPEAKER_03]: I just want to continue the one point. [SPEAKER_03]: The only increase in recurrence risk that the habit study found was increase in either local recurrence or in contractual breast cancer, not increased risk of death. [SPEAKER_03]: And the biggest

argument against that study is you are studying women with a history of treated breast cancer and you do not mandate imaging of the breasts for entrance to the study. [SPEAKER_03]: So you don't know how many women may have had breast cancer in the breast before they was started on hormones. [SPEAKER_03]: And you found an increased risk among twenty-two women. [SPEAKER_03]: And based on that, we are denying hormones to women who had breast cancer around the world. [SPEAKER_03]: And let's just mention that breast cancer is frightening. [SPEAKER_03]: Cancer is a frightening word. [SPEAKER_03]: But the current curate in the United States for newly diagnosed breast cancer is better than ninety four percent. [SPEAKER_03]: Now, I'm not

underplaying it. [SPEAKER_03]: My wife had breast cancer, my daughter had breast cancer, my sister-in-law had breast cancer. [SPEAKER_03]: I had many patients with breast cancer. [SPEAKER_03]: I know both personally and professionally how serious it is. [SPEAKER_03]: But let's keep perspective here. [SPEAKER_03]: Ninety-four percent curate and we are denying treatment to millions and millions of women as a result of that one study. [SPEAKER_03]: And those are women who had a history of breast cancer. [SPEAKER_03]: We're denying it to women who reach perimenopause and menopause and we're denying it. [SPEAKER_03]: for inaccurate reasons for misleading and misrepresented data. [SPEAKER_03]: And that's unacceptable. [SPEAKER_03]: And that's why Carol and I, who seem like very pleasant people. [SPEAKER_02]: Get

so passionate. [SPEAKER_02]: I love it. [SPEAKER_02]: We alternate which day we're going to be angry about these issues. [SPEAKER_02]: So as a social psychologist, who studies cognitive biases, I mean, I can see already, and when I met him and knew both, but what drew you to collaborate with a medical oncologist, who I wasn't surprised by his answer by the way, because remember, I told you I've inside, I'm married to one. [SPEAKER_02]: So he also is all about the storytelling. [SPEAKER_02]: It's why we're young and young, right? [SPEAKER_02]: It fits, but he goes to the data as well, when he explains things to me, but it's also changed his practice pattern. [SPEAKER_02]: based on what he's

seen with my patients. [SPEAKER_02]: And now he says, okay, I've induced menopause, I've induced sexual dysfunction. [SPEAKER_02]: Let me send you to someone who can fix this, but he also prepares them for it. [SPEAKER_02]: So he counsels them differently. [SPEAKER_02]: And ask ourselves, he should counsel them for that. [SPEAKER_02]: But this [SPEAKER_00]: what what drew you to collaborate with medical oncologists on hormone therapy because it seems like it's a departure from your usual work or maybe I'm wrong on critical thinking in self-justification because this is a massive example of a failure of critical thinking and self-justification that is completely misguided because that's what people do the the more wrong they are the more harm they

cause the more [SPEAKER_00]: mistakes they make, the greater they're need to justify their errors. [SPEAKER_00]: And this is what we see in medicine. [SPEAKER_00]: We see it in really every domain of our lives, which is how hard it is for people to change their minds simply because you say to them, [SPEAKER_00]: Let me show you the evidence. [SPEAKER_00]: Is this interesting? [SPEAKER_00]: They rarely say, oh, how would thank you so much, Carol, for undoing my entire belief in how a breast cancer comes about and the dangers of, thank you. [SPEAKER_00]: I'm so grateful for your evidence. [SPEAKER_00]: No, they tell you to, you know what they tell you. [SPEAKER_00]: Yeah, okay. [SPEAKER_00]: So, when I

first met Avrum, [SPEAKER_00]: We realize what he was doing in medicine, exposing the gap between what the science shows and what clinical practice is doing, is what I had been doing in psychology, the gap between psychological science and therapeutic practice in many cases. [SPEAKER_00]: The issues were quite the same, and then [SPEAKER_00]: I mean, for me, hormone therapy was frankly not much of an interest personally. [SPEAKER_00]: I sailed through menopause with no symptoms. [SPEAKER_00]: I was one of the seventeen women in America who had no symptoms. [SPEAKER_00]: What did I know? [SPEAKER_00]: And at the time that I went through menopause, the feminist point of view was to be critical of big pharma, to be

critical of the medicalization of women's normal life changes, to be critical of pathologizing menopause as if it were a disease that needs to be treated. [SPEAKER_00]: And I think many women still hold those, I say, feminist with quotation marks because feminism should be about what's best for women and healthiest for women. [SPEAKER_00]: Right. [SPEAKER_00]: But that's what it was then. [SPEAKER_00]: And it was a kind of just get on with it and live through it and you'll be fine. [SPEAKER_02]: Badge of honor, kind of thing. [SPEAKER_00]: Thank you. [SPEAKER_00]: The screen in Barrett. [SPEAKER_00]: So I thought the chance to work with Alvaram on this would be my way of atoning to my fellow women.

[SPEAKER_00]: for having been so smug about what menopausal symptoms really feel like and how they affect so many women's quality of life. [SPEAKER_00]: And I went to hear of him speak about risks of breast cancer. [SPEAKER_00]: He has the most adorable presentation on this. [SPEAKER_00]: And I sat there in my seat. [SPEAKER_00]: And here's the, you know, in the estrogen and breast cancer, twenty four percent increased risk. [SPEAKER_00]: This is not significant. [SPEAKER_00]: This is trivial. [SPEAKER_00]: And then the rest of his list was, [SPEAKER_00]: eating an extra portion of French fries as a child, being left-handed, being a finished flight attendant. [SPEAKER_00]: I remember that, right? [SPEAKER_02]: Icelandic? [SPEAKER_00]: Icelandic? [SPEAKER_00]: Icelandic? [SPEAKER_00]: Yes.

[SPEAKER_00]: It's more risky to be a finished flight attendant, and if you are a left-handed, finished flight attendant and a night shift, it's the riskiest of all, meaning the risk of estrogen and breast cancer was trivial compared to all these funny things, all of which had nonetheless managed to be published in medical journals. [SPEAKER_00]: I thought, oh, ho, this man is doing what I do. [SPEAKER_00]: I love this. [SPEAKER_00]: That's how we begin. [SPEAKER_02]: I love that so much. [SPEAKER_02]: And by the way, that's lied. [SPEAKER_02]: I agree with her because that stuck home with me too. [SPEAKER_02]: When I looked at it, I'm like, this is preposterous. [SPEAKER_02]: Why don't patients know this? [SPEAKER_02]:

And why wasn't I taught this? [SPEAKER_02]: I felt cheated after I saw that. [SPEAKER_02]: So, [SPEAKER_02]: You know where we're going to go, right? [SPEAKER_02]: We're going to go into the WHI. [SPEAKER_02]: So let's talk about the WHI. [SPEAKER_02]: So I came along a little later. [SPEAKER_02]: I don't go career. [SPEAKER_02]: So it was my think, it was my chief year or junior year. [SPEAKER_02]: And they called us all down. [SPEAKER_02]: We had an emergency conference. [SPEAKER_02]: They said that the WHI data had come out and that we were not allowed to write any more prescriptions for hormones in our clinics. [SPEAKER_02]: And that we were too strongly encouraged those that were on it to

discard and to stop immediately, not even titrate off slowly. [SPEAKER_02]: And that they wouldn't support us, our mentors and our attendings would not support us if we were going to give hormone therapy. [SPEAKER_02]: And any further lectures or any other further education that I could opt into was no longer going to be offered to me. [SPEAKER_02]: And so we were going to focus on [SPEAKER_02]: gynecology, surgery, and obstetrics, but really ignore menopause. [SPEAKER_02]: And so that's what happened to me. [SPEAKER_02]: But Carol from your psychological perspective, how did this one flawed study become what you call the persuasive juggernaut? [SPEAKER_02]: God, I love your language. [SPEAKER_02]: That changed women's health care worldwide. [SPEAKER_00]: Right, so

of course the way it was announced at a press conference, publication by press conference, which is a no-no in science just anyway. [SPEAKER_00]: They hold this very impressive press conference and announce these alarming findings of we have now learned we're stopping the study because, you know, estrogen increases the risk of breast cancer and a whole bunch of other dire things. [SPEAKER_00]: Now, what is the one thing that sells most in America, fear, fear, fear of cells? [SPEAKER_00]: If I can make you frightened, you're going to pay attention to me. [SPEAKER_00]: and you're going to follow me and you're going to want to do whatever I advise you to alleviate that fear. [SPEAKER_00]: They did two

things. [SPEAKER_00]: The women's health initiative did two [SPEAKER_00]: in terms of publicity, important things. [SPEAKER_00]: They held this press conference which got national and international headlines. [SPEAKER_00]: They said later that was our intention to break the newsy chatty news cycle with a baffo finding, a scary baffo finding, that worked. [SPEAKER_00]: So we immediately create fear in millions of women, panic among all of the physicians who have been prescribing hormone therapy to their patients for decades, [SPEAKER_00]: And what to make of this? [SPEAKER_00]: What to make of this? [SPEAKER_00]: We now know looking back just how manipulative the women's health initiative writers were only three of the primary for forty primary investigators wrote the report. [SPEAKER_00]:

It was sent to the Journal of the American Medical Association without the rest of the investigators even seeing it. [SPEAKER_00]: They had some [SPEAKER_00]: intention. [SPEAKER_00]: Everybody says to us, well, why? [SPEAKER_00]: What were they doing? [SPEAKER_00]: Why did they want to scare everybody? [SPEAKER_00]: Why? [SPEAKER_02]: Why? [SPEAKER_00]: Why? [SPEAKER_00]: Oh, and the other little small thing for anybody who cares about statistics is that none of the findings they were claiming in that first article were statistically significant. [SPEAKER_00]: Meaning in my field, you didn't get to publish a paper with six non-significant findings. [SPEAKER_02]: You couldn't. [SPEAKER_02]: Absolutely. [SPEAKER_02]: You had to establish statistical significance. [SPEAKER_00]: Exactly. [SPEAKER_00]: Well, they didn't. [SPEAKER_00]: Well, they didn't.

[SPEAKER_00]: And they got published. [SPEAKER_00]: So it was a combination of the fear, which sells the fear of breast cancer in addition, which specifically added to the fuel to the flames. [SPEAKER_00]: And just set them off on a course of, now suddenly, this was from the NIH, this study cost a billion dollars. [SPEAKER_00]: We'd better pay major attention. [SPEAKER_00]: Why? [SPEAKER_00]: Why? [SPEAKER_00]: We have hypotheses, but we don't know, but I can say that one thing is, and I know this from work and social psychology, if you're going to get something published, it has to be a shock-o-finding. [SPEAKER_00]: I studied sex differences for many decades. [SPEAKER_00]: You could never publish a paper that said,

guess what? [SPEAKER_00]: Men and women are equally talented in math. [SPEAKER_00]: Men and women are equally good at dicing celery and typing. [SPEAKER_00]: No, we don't want to know the similarities. [SPEAKER_00]: We want to know more men are better at this and women are better at that. [SPEAKER_00]: That would get published. [SPEAKER_00]: And so in the same way, how was the women's health initiative going to say? [SPEAKER_00]: Good news, everybody. [SPEAKER_00]: The hormones that we've been relying on for the last to sixty years perfectly fine. [SPEAKER_00]: They're perfectly safe. [SPEAKER_00]: Go and be healthy. [SPEAKER_00]: No. [SPEAKER_00]: Would that have been news? [SPEAKER_00]: It would not have been news. [SPEAKER_00]: So that's the self-justification of

the money. [SPEAKER_02]: And you can't, what I have remembered, I think Dr. Malone said it, you can't un-ring that bell. [SPEAKER_02]: That's what I feel like we all have been trying to do in our own way is un-ring the bell. [SPEAKER_02]: So I'll from you, already referred to the twenty-five studies that you had reviewed and how twenty-four showed no increased risk. [SPEAKER_02]: And then now we're talking about WHI and how the medical community still clings to those original findings and the press conference [SPEAKER_02]: What does this tell us all about how medicine in the medical community processes evidence and why? [SPEAKER_03]: Let's talk about the findings so that we all agree on what they found.

[SPEAKER_03]: First, the one point Carol being lady-like didn't include it in her resume. [SPEAKER_03]: People assume because the WHO I investigated say so, we walked into this, they say, thinking that we're going to confirm what people know about estrogen, that it helps heart disease, which we knew for many, many years before this study, [SPEAKER_03]: And imagine our surprise when we found out that it really does all these bad things. [SPEAKER_03]: Well, it is interesting that six years before, when the WHO came out with their first report, Jacques Russo, who was the principal investigator of the WHO, said the estrogen bandwagon is out of control. [SPEAKER_03]: It is time to put the brakes on the estrogen

bandwagon and that's published. [SPEAKER_03]: We reference that in the book that doesn't sound to us like an unbiased investigator and he certainly did the percentage of eligible women [SPEAKER_03]: who were on home owns before July of two thousand two with somewhere between twenty six and forty four depending upon which study you accept and it's fallen to less than five percent and that's where it is today [SPEAKER_03]: Twenty-three years after the publication of that first report. [SPEAKER_03]: So let's look at the first report. [SPEAKER_03]: They did it by press conference and then a week later it was published in the Journal of the American Medical Association and it said estrogen increases the risk of heart disease.

[SPEAKER_03]: Well, that isn't what the previous data had said. [SPEAKER_03]: Estrogen decreases the risk of heart disease. [SPEAKER_03]: There were papers confirming that in nineteen sixty in nineteen ninety one. [SPEAKER_03]: There was a lead editorial in the New England Journal of Medicine written by Lee Goldman and Adatostason from Harvard that said that was titled uncertainty about post-maniposal estrogen time for action not debate that was nineteen ninety one. [SPEAKER_03]: And when the WHO came out, and they said there's an increased risk of heart disease, what they have subsequently said is, well, we misspoke. [SPEAKER_03]: We did say that our findings apply to the general female population. [SPEAKER_03]: What we forgot to mention is that we purposely

chose an older population of women with a median age of sixty-three [SPEAKER_03]: because we were really testing for heart disease. [SPEAKER_03]: And if we started with women who were forty-five, we would have to do the study for twenty years longer than we expect we will have to do it. [SPEAKER_03]: And that would cost so much money, it would be completely impractical. [SPEAKER_03]: So we started with women who were already ten or fifteen years, post the last menstrual period, and they did have [SPEAKER_03]: During the first year, a small but real increased risk of cardiovascular events. [SPEAKER_03]: But they said, when we look at women who were within ten years of their last menstrual period, surprised

what we found is what people said for fifty years before, it decreases the risk of heart disease, which was the very thing we were looking to study in the report. [SPEAKER_03]: we said that it increases the risk of stroke well you know we've actually [SPEAKER_03]: loosely defined stroke, if you had temporary forgetfulness that lasted a day, we called it a stroke and in point the fact what we see is women who are on hormones before joining our study had the thirty-five percent decreased risk of that and between a twenty-five and sixty-five percent decreased risk of cognitive decline or Alzheimer's disease. [SPEAKER_03]: We say it increased the risk of breast cancer and by the way, that

was the banner headline that went around the world that was trumpeted on the front page of the New York Times by Gina Colada, a health editor [SPEAKER_03]: who very well-known, who confirmed what they had said. [SPEAKER_03]: So let's look at what they reported in two thousand two. [SPEAKER_03]: When they said it increases the risk of breast cancer, not breast cancer death, they never said that. [SPEAKER_03]: Not then, not now, but increase the risk of developing breast cancer, they said it increased the risk by twenty-six percent [SPEAKER_03]: And then they had this sentence that I have never seen in any medical article ever published in any journal that I have ever read, which was, and that

result almost reached nominal statistical significance. [SPEAKER_03]: Wait, wait, wait. [SPEAKER_03]: That means it wasn't a statistically significant result. [SPEAKER_03]: Well, statistical significance doesn't mean truth, but it means likelihood. [SPEAKER_03]: And there are [SPEAKER_03]: definitions, strong mathematical definitions of how you determine significance, how dare you take a result that almost reached statistical significance, and then in that same article say, and this is the first large-scale randomized trial to confirm that estrogen and hormones increase the risk of breast cancer. [SPEAKER_03]: That's a lie. [SPEAKER_03]: It didn't confirm it wasn't even statistically significant, but it gets worse. [SPEAKER_03]: The following year in uh, uh, two thousand three, they came out with a second delivery report saying, never mind

estrogen alone. [SPEAKER_03]: If the combination of estrogen and progesterone really statistically increases the risk of breast cancer, [SPEAKER_03]: Well, this statistical finding, and I don't think we can get into the math here, was so small it could fall in your eye and you probably wouldn't blink, but it was also wrong because if they corrected for what they're protocol demanded, even in the two thousand three paper, it was no longer statistically significant. [SPEAKER_03]: And then in case you doubt their motivation, in two thousand six, there was a report by Garnet Anderson, the Biostatitation for the Women's Health Initiative. [SPEAKER_03]: And what we and many other people around the world had written is wait a minute. [SPEAKER_03]:

The Women's Health Initiative was set up to study heart disease. [SPEAKER_03]: Breast cancer was not a primary target for the study. [SPEAKER_03]: And when you study in a randomized prospective trial, you balance the risks for heart disease so that you don't have an unbalanced risk between the two study groups. [SPEAKER_03]: And the risks for heart disease are different than the risks for breast cancer. [SPEAKER_03]: Heart disease doesn't care if your sister had breast cancer or if you carry a genetic tendency to developing breast cancer. [SPEAKER_03]: And so she said, Garnet Anderson in this two thousand six paper, and so what I did is I reviewed all the data and I balanced the risks for breast

cancer. [SPEAKER_03]: Well, I don't know that she had enough data to do that, but okay, she says, and I'll take her at a word, she balanced the risks, and her conclusion is, and it didn't make any difference. [SPEAKER_03]: And that's a lie. [SPEAKER_03]: That's a lie. [SPEAKER_03]: How dare I say that's a lie. [SPEAKER_03]: That's a lie. [SPEAKER_03]: The numbers that she published in that paper show that when she balanced the risk, it was no longer statistically significant. [SPEAKER_03]: I invited Rowan Schlabowski, the lead oncologist and the women's health initiative to come to our local hospital and talk about the women's health initiative, three years after the first paper came out. [SPEAKER_03]: And a doctor,

and we have this in the book too, at the end of Rowan's talk, a doctor raised his hand and said, I'm just an ENT physician. [SPEAKER_03]: He didn't say, but I have a PhD in math, which he did. [SPEAKER_03]: He said, and so maybe I'm not following you correctly, but it seems to me that the data you just presented to us, the data on the basis of which hormones were discarded by physicians and patients around the world, don't even add up to us statistically significant risk and breast cancer, what am I missing? [SPEAKER_03]: And Dr. Chobowski said, you know, it's very hard to collect data in large numbers over a long period of time. [SPEAKER_03]:

And it is not likely that we will ever be able to do a study of this magnitude again. [SPEAKER_03]: So if we think we have a finding and the numbers don't quite add up, the statistical police have to leave the room. [SPEAKER_00]: That's my hair on fire. [SPEAKER_00]: I'll tell you that one. [SPEAKER_03]: That's horrible, but we have that. [SPEAKER_03]: That's where we are. [SPEAKER_03]: And what we now [SPEAKER_03]: No, is the one finding that they still hold on to. [SPEAKER_03]: They've backed away from heart disease. [SPEAKER_03]: They say it's good for heart disease. [SPEAKER_03]: They've backed away from cognitive decline. [SPEAKER_03]: They say when you take it before you have cognitive decline, it's good

for that. [SPEAKER_03]: They backed away and [SPEAKER_03]: I have to mention this again, because Carol and I laugh about this all the time. [SPEAKER_03]: The year after their first blockbuster release, they said, oh, and by the way, it also hormones have no effect on quality of life. [SPEAKER_03]: And so the first reaction is what planet did you do this study of? [SPEAKER_03]: And if you read the paper, the paper in two thousand three says, [SPEAKER_03]: We knew that if we put symptomatic women on the placebo pill, they'd know they weren't taking hormones. [SPEAKER_03]: So in our wisdom, we rejected symptomatic women from joining the study. [SPEAKER_03]: And the women, all these women who didn't have

symptoms who were randomized to hormones, had no improvement in the symptoms they didn't have. [SPEAKER_03]: That's in the paper if you read the paper. [SPEAKER_02]: So they selected Carol's, because you said you had no symptoms, but show you that's very responsible for all of it. [SPEAKER_00]: I'm completely the reason that women are denied hormones. [SPEAKER_02]: I accept the responsibility. [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 DrSomeet.com to sign up for the monthly disruptor newsletter and follow us on social at DrSomeet. [SPEAKER_02]: We're not waiting for a

seat at the table. [SPEAKER_02]: We're building our own table.