Every year I struggle with the decision as to what topic would be the most appropriate for the next APIM Annual Summit. Three years ago, at Hormones & Beyond Symposium 2019, we reviewed diabetes, fasting, treatment options, and pathophysiology. Two years ago, we covered How Estrogenics are making you Fat, Sick, and Infertile. Last year, we reviewed cancer, hormones, cardiovascular disease, and prostate cancer. So, now what? Fortunately, the FDA has recently approved the first and only treatment for Alzheimer’s Disease. This was extremely political and controversial. Also recently, I attended a lecture by Dale Bredesen from U.C.L. A., a world’s expert on dementia and Alzheimer’s Disease. As a result of the foregoing, the topic for this year’s symposium was easy.
Previously, we discussed how patients are taking more medications and experiencing an endless conundrum of health issues. The systemic failure to address the root causes of disease is a huge part of the problem. Along with the proven benefits of a healthy diet, exercise, and stress management, we can greatly improve health outcomes by utilizing another evidence-based strategy: bioidentical hormone replacement therapy, or BHRT.
We continue to prescribe medicines that make IR, DM, CVD, and cancer worse, but we ignore the harm due to the therapeutic illusion that the benefits outweigh the risks. Yet we continue to ignore the plethora of data and studies demonstrating how to avoid these risks and protect against DM, CVD, and cancer.
Recently, a new cholesterol lowering drug was approved in the U.K. The press-release heralded Inclisiran, simply another PCSK-9 inhibitor, to be a game changer as it will save thousands of lives by lowering cholesterol. No, there are no outcome studies yet, only studies that demonstrate it lowers serum cholesterol 50% more than statins alone. The authors assume and extrapolate that lowering LDL cholesterol with this drug will result in thousands of lives saved. That is termed therapeutic illusion.
CVD: Could all the Medicines that we Prescribe, Including Statins, be Increasing the Risk of Cancer?
CVD is the # 1 killer in the U.S. and worldwide. The medical literature and pharmaceutical industry has led us to believe in the cholesterol-centric model in preventing CVD. Unfortunately, utilizing cholesterol-lowering medication has only led to a 1-3% absolute risk reduction (ARR) in CVD and mortality. Not very impressive for all the money and effort put forth in lowering cholesterol with medication. And if the cholesterol-centric model for CVD was 100% correct, then why don’t we witness a more definitive reduction in CVD morbidity and mortality? Is there something else that could be at the root of this disease that we are missing?
As clinicians we try to be problem solvers. It is part of our training, try to figure out what’s wrong, and then to fix it. Problem solved. However, what should we do if what we are doing isn’t working? Keep doing the same thing? What if the patient does not get better? What if the patient doesn’t feel better? What if the incidence of CVD continues to increase despite all the medications we prescribe? What if the incidence of cancer continues to increase even though cancer treatments themselves once you get cancer have improved? It is often said that insanity is doing the same experiment over and over again expecting to see and hoping to see different results.
Why is there increased morbidity and mortality in those that don’t take ERT? This is simply because there is an increase in breast cancer recurrence in prior cancer survivors, around 350/10,000 women (that don’t take HRT). This does not mean, though, that taking estrogen increases the risk. However, those that do take BHRT do benefit from HRT despite the resistance from oncologists. The increase in breast cancer recurrence at baseline should not be extrapolated to what happens with treatment. In every study, treatment with estrogen decreases breast cancer risk. Observation at baseline does not prove causation. The most recent issue of JAMA proved that the only drug to decrease breast cancer mortality was estrogen! It was not a SERM or AI.
Since the 2002 report known as The Women’s Health Initiative (WHI) Trial, Prempro sales have fallen to $161 million annually and more than 10,000 lawsuits have been filed against Pfizer by women, who declared the company’s HRT drug lead to their development of breast cancer and other health ailments. Pfizer Inc. recently set aside $772 million to settle these cases.