Medicine on the Move

We got word this week thatestrogentherapy, which was bad, is good again. Possibly. In some cases.

This was not quite as confusing as the news last year thatcalciumsupplements, which used to be very good, are now possibly bad. Although maybe not. And the jury’s still out.

Or the recent federal study that suggested women be told to stop checking their breasts for lumps. Or the recommendations on when to get amammogram, which seem to fluctuate between every five years and every five minutes.

We certainly want everyone to keep doing studies. But it’s very difficult to be a civilian in the world of science.

“It’s very difficult to be a woman,” said Dr. Leslie Ford of theNational Cancer Institutewryly.

Back in the day, estrogen was prescribed only for women who were experiencing serious problems withmenopause. Then a 1966 book called“Feminine Forever” argued that estrogen therapy was good for almost every middle-aged female on the planet who wanted to avoid morphing into a crone. The idea grew in popularity even after evidence mounted that the author had been paid by an estrogen manufacturer.

“The mantra among gynecologists was: as soon as you got to be 49, almost automatically put women on estrogen. It was supposed to be a fountain of youth,” said Dr. Ford.

To reduce the danger ofuterine cancer, estrogen was mixed with progestin and the result was, among many other wonderful things, supposed to lower the risk of heart disease. Then a report from the Women’s Health Initiative, a long-running study by theNational Institutes of Health, found that it did no such thing. Also, it raised the risk ofbreast cancer.

“It’s been a real culture shift for gynecologists,” said Dr. Ford.

Now comes a new study— from the very same Women’s Health Initiative— that appears to show that for some women, estrogen alone may actually reduce the risk of breast cancer andheart attack. As long as you take it when you’re in your 50s.

“It’s‘Back to the Future,’” said Dr. Emily Jungheim ofWashington UniversitySchool of Medicine, who co-authored an editorial raising a red flag about the new report.

The new findings, which come with many qualifications, apply only to women who’ve had ahysterectomy. But that’s quite a population; about one-third of all American women have their uterus removed at some point in their lives.

You cannot contemplate this information for too long without asking whether the medical profession has a tendency to get carried away.

“There’s a pill for every ill,” said Dr. Sidney Wolfe, director of the Public Citizen Health Research Group and the co-author of“Worst Pills, Best Pills: A Consumer’s Guide to Avoiding Drug-Induced Death or Illness.”

He worries a lot about overmedication.“There’s just a massive overprescribing in this country,” he said.“Also elsewhere. France comes to mind.”

Finally, we have found some part of medicine in which our system is as efficient as France’s.

Americans should know by now that you can’t put a pill in your mouth without risk. Television is full of commercials for wonder drugs that will perk up your spirits, soothe yourallergiesor lower yourcholesterol, improving life altogether except in the cases where they lead to vivid dreams, suicidal thoughts,hair loss, stabbing pains or sudden death.

But it still feels as if we need to be on guard against medical overoptimism.“Doctors are far more knowledgeable about the benefits of drugs than the risks,” said Dr. Wolfe. There isn’t always much talk about the possible downside of drugs on which all the evidence is yet to come in, like many fertility treatments.

Dr. Wolfe believes that most doctors prefer writingprescriptionsto having lengthy discussions with their patients about things like long-term behavior modification therapy. My own theory is that they just tend to want to satisfy their patients. Let’s face it, few of us go to the doctor with hopes of getting advice on behavior modification. They’re medical practitioners, and their instinct is to solve your problems with medicine.

I once had a gynecologist who put me on estrogen therapy at age 49 when I had no medical complaints whatsoever, and I still remember how pleased he was to be giving me this wonderful drug that would stave off so many undesirable effects of aging.

I did get breast cancer, although it was not a major-league case. Obviously, I should have asked more questions. But I don’t blame the doctor, who seemed to have the best of intentions. Actually, I don’t blame anyone. Except maybe the guy who wrote that“Feminine Forever” book. 

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