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Old 28th November 2006, 07:27 AM   #93
fls
Penultimate Amazing
 
Join Date: Jan 2005
Posts: 10,226
I think the following points need to be made.

Natural and synthetic hormones act by binding to estrogen receptors. Estrone and estradiol are the hormones that are produced in humans. Exogenous hormones have an estrogenic effect by either being metabolized to Estrone or Estradiol, by sharing an identical core structure (the steroid ring plus a phenolic hydroxy group and a hydroxy group (estradiol) or a ketone group (estrone)), or by imitating the structure of the estrogens. Premarin is a conjugated estrogen which survives the process of digestion to be absorbed and converted to estrone. Phytoestrogens share the core structure or imitate the structure.

It is disingenuous (or sometimes even wrong) to claim that plant estrogens are identical to those found in humans or that they are more similar than other pharmaceuticals - Premarin in particular. Also, if one divides hormones (or any chemical) into "those derived from plants", "those derived from animals" and "those synthesized in a lab", one cannot assume any of the relevant characteristics (active, harmful, safe, etc.) can be applied to one group over the other, or to all the members of the group (even if one accepts the use of fuzzy qualifiers like "most" or "many").

There is no clinical data of any type supporting T. S. Wiley's idea. This information is critical to obtain since we know that the placebo effect will have a tremendous influence of the types of symptoms and conditions that she claims to help. The observations of doctors using the medication in an uncontrolled manner fails to be a form of evidence.

Regardless of the source, chemicals work by binding to estrogen receptors. This means that these chemicals are not exempt from the assumption that they can lead to the same kinds of harm that endogenous and exogenous estrogens lead to. Without controlled clinical data, we have no idea of the risks or benefits associated with this treatment. In particular, since there is a general concensus (admitedly controversial) that hormone replacement leads to more harm than good in menopausal and post-menopausal women, the assumption in the absence of data has to be that the Wiley Protocol is harmful until proven otherwise. There is no reason to assume that varying the doses of the hormones will avoid harm. It is a reasonable idea to test in a systematic manner, but no assumptions can be made about what the results will be beforehand.

The physicians that use the Wiley Protocol are not practising evidence-based medicine. Since the current standard of care is to use evidence-based medicine, they will be unable to defend themselves if legal or professional charges are brought against them. They have been fortunate so far, perhaps helped by the tendency of people that buy into the "natural" fallacy to be uncritical.

The credibility of T. S. Wiley is a major issue in this debate as she is making claims that are unsupported by evidence. The credibility of Bent Formby is not relevant except in his role as a witness to her expertise (or lack thereof).

Physicians are not compensated for prescribing HRT.

There's probably more, but that'll do for now.

Linda

Last edited by fls; 28th November 2006 at 08:46 AM. Reason: Wording.
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