We refer you to our original write-up on previous papers. What you are seeing is a "refinement" of the previous papers on the same study released to the public over the last 2 years. Large studies such as the WHI (Women's Health Initiative) are able to spin off prodigious numbers of papers. This is done for scientific and well as for "publishing" motivations. More publishing improves status. This study does not really add anything materially different
The reader is once again referred to ongoing criticisms from within the hormone research community. These vital discussions, coming from well respected researchers, are not being published in the popular press. Please see The Scientist review of August 2003.
We will most briefly summarize:
The women in this study were started on hormones at age 65 to 79 years of age. We already know that starting women on hormonal therapy at a later age is far more difficult and less likely to produce benefits than at earlier ages.
The study once again, like so many before it, uses relative vs. absolute risk statistics. So their conclusion that the HR (hazard ratio) was 1.49 meaning that you would have a 49% increased chance of developing dementia or mild cognitive impairment. But the absolute difference is only 0.23%. That is less than 1% chance. Meaning that the chance of these cognitive events not occurring was 99.7%. Is the glass half full or half empty? In this case, is the glass 99% full or 1% empty would be more apt.
This again, as has been emphasized in the past, is a Premarin Study and not an estrogen study. The authors write a short discussion and then conclude that conjugated estrogens "may contain estrogens with negative side effects" compared to the bioidentical 17-ß-estradiol. But then go on to dismiss this as an unnecessary distinction with these comments:
Unless other studies demonstrate that different compounds bestow benefit, these data would generalize to all estrogens.
A very poor assumption, and at the heart of our contention that these are Premarin Studies. No one seems to mention the previously well-constructed PEPI studies that actually used natural progesterone. It also shows a profound lack of understanding of estrone metabolism and the well known differences between estradiol, estriol and estrone.
The clear market evidence is that more and more women are being treated with Climara, Vivelle, Estrace and other bioidentical forms of estradiol, and not Premarin. Premarin is a drug of the past. We use pure bioidentical hormones (NHRT-BHRT) in our practice.
The remainder of this discussion would devolve into a very detailed statistical analysis, which will wait for a later time.
You will never see the final and "definitive" estrogen or progesterone study. Medicine is always "in process." You make your own decisions based on other serious and validating readings.
We again refer you to Suzanne Somer's books The Sexy Years and Ageless containing far more helpful and validating information. I have never seen so many new patients come see us in their late 50's, 60's and 70's who have been on HRT for 20-30 years. They are all so vibrant and youthful ... and healthy. Our new book, a complete guide to Anti-Aging Medicine, being co-authored with the LEF, will be released in the early Spring of 2005.
Philip Lee Miller, MD
Director and Founder, Los Gatos Longevity Institute
