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August 2003 - Is Conventional Medicine Evidence-Based? Part I

By Robert Watson

In this month’s column I want to share part of an ongoing series of comments from John Lee, MD, a recognized expert in the area of hormone replacement research, entitled “Is Conventional Medicine (CM) Evidence-Based?”
“In the September 17, 1998, issue of the New England Journal of Medicine, a gauntlet of sorts was thrown down (by editors M. Angell and J.P. Kassirer) with the claim that the difference between conventional medicine and alternative medicine was the issue of evidence. According to these self-designated pundits, Conventional Medicine (CM) is based on reliable evidence and alternative medicine is not. They state, “What most sets alternative medicine apart, in our view, is that it has
not been scientifically tested and its advocates largely deny the need for such testing.” They go on to claim that alternative medicine relies on “anecdotes and theories,” using those words with a pejorative connotation.
Since that time, I have been collecting high quality references that refute the notion that
conventional medicine is truly evidence-based. You will note that the references are mostly in the field of hormones and their application to health, which has been the focus of my study over the past 23 years. There is no reason to doubt, however, the errors of conventional medicine are confined to this particular
area. The list could be much longer, of course, but I think you will find that these references to be sufficient for their purpose.
• Conventional Medicine believes that any woman having regular monthly periods is still producing progesterone. The fact is that, in industrialized countries, anovulatory periods become common after age35. Progesterone is not produced during anovulatory periods, but estrogen production continues throughout the menstrual cycle.1,2
• Conventional Medicine believes that HRT (estrogen plus Provera) protects against coronary heart disease. The evidence from epidemiological and double blind, placebo controlled, randomized studies is that there is no difference in coronary heart disease in postmenopausal women on HRT compared to placebo.3 Also, the Framingham study finds no difference in coronary heart disease comparing women using ERT or HRT and those who do not.4
• Conventional Medicine has totally ignored progesterone, especially in relation
to prevention of atherosclerosis and coronary artery disease. The evidence is that progesterone protects against coronary artery spasm whereas medroxyprogesterone acetate (Provera) does not.
New evidence also shows that progesterone inhibits cholesteryl ester synthesis in macrophages and blocks its enhancement by glucocorticoids. Other new evidence shows that progesterone, but not Provera, inhibits vascular cell adhesion molecule-1 expression, and protects against agonist-induced vasoconstriction.5-9
• Cardiac arrhythmia (torsade de pointes) after administrations of certain drugs (erythromycin,
Mellaril, and cardiac drugs that prolong cardiac repolarization) is more common in women than in men.
CM is generally unaware that estrogen increases the likelihood of prolonged cardiac repolarization whereas progesterone (as in the luteal phase of the menstrual cycle) protects against it.10
• Conventional Medicine believes that hot flushes signify estrogen deficiency. New research finds that, in peri- and recently menopausal women, low-dose topical progesterone is very effective in relieving hot flushes, compared to placebo. During those years, estrogen production may be variable but does not become inadequate for bodily need. In progesterone deficient women, estrogen receptors are down-regulated. Restoring progesterone restores estrogen receptor sensitivity, and thereby prevents hot flushes.11
• Conventional Medicine believes that pregnancy and lactation increase the need for calcium supplementation. The evidence is that pregnancy and lactation do result in some calcium depletion in bone but this is quickly reversed back to pre-pregnancy levels regardless of calcium supplementation.12
• Conventional Medicine believes that tamoxifen has been proven to prevent breast cancer. The evidence is that breast cancer recurrence or incidence is unchanged by tamoxifen. Its supposed benefit stems
from its common use in DCIS (ductal carcinoma in situ), which rarely proceeds to true cancer if not treated at all.13,14
The FDA, on 2 September 1998, decided not to allow Zeneca to market tamoxifen for prevention of breast cancer.
Note: The New England Journal of Medicine, 26 November 1998, printed a major review article on “Drug therapy: tamoxifen in the treatment of breast cancer” that never mentioned any of the above.”
Thank you Dr. Lee! Stay tuned for more next month.
Robert Watson
President/CEO
References
1. Prior JC, Vigna YM, Schechter MT, Burgess AF. Spinal bone loss and ovulatory disturbances. NEJM 1990; 323: 1221-1227.
2. Campbell BC, Ellison PT. Menstrual variation in salivary testosterone among regularly cycling women. Hormone Res 1992; 37: 132-136.
3. Hulley S, Grady D, Bush T, Furberg C, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA, August 19, 1998; 280: 605-613.
4. Herrington DM, Reboussin DM, Brosnihan KB, Sharp PC, et al. Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. NEJM 2000; 343: 522-537.
5. Miyagawa K, Rosch J, Stanczyk F, & Hermsmeyer K. Medrorxyprogesterone acetate interferes with ovarian steroid protection against coronary vasospasm. Nature Medicine 1997; 3: 324-327.
6. Cheng W, Lau OD, Abumrad NA. Two antiatherogenic effects of progesterone on human macrophages; inhibition of cholesteryl ester synthesis and block of its enhancement by glucocorticoids. J Clin Endo & Metab 1999; 64: 265-271.
7. Otsuki M, Saito H, Xu X, Sumitani S, Kishimotoa KH, et al. Progesterone, but not medroy-progesterone, inhibits vascular cell adhesion molecule-1 expression in human endothelial cells. Arterioscler Thromb Vasc Biol 2001; 21: 243-8
8. Moura MJ, Marcondes FK. Influence of estradiol and progesterone on the sensitivity of rat thoracic aorta to noradrenaline. Life Sci 2001; 68: 881-8/
9. Barbagallo M, Dominguez LlJ, Licata G. Shan J et al. Vascular effects of progesterone: role of cellular calcium regulation. Hypertension 2001; 37: 142-7.
10. Rodriguez I, Kilborn MJ, Liu X-K, Pezzullo JC, Woosley RL. Drug-induced QT prolongation in women during the menstrual cycle. JAMA 2001; 1322-1326.
11. Leonetti HB, Longo S, & Anasti JN. Transdermal progesterone cream for vasomotor symptoms and postmenopausal bone loss. Obstet & Gyn 1999; 94: 225-228.
12. Eisman J. Relevance of pregnancy and lactation to osteoporosis. Lancet, Aug, 1998; 352: 504.
13. Verones U, Maisonneuve P, Costa A, Sacchini V, et al. Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women. Lancet July 11, 1998; 352: 93-97.
14. Powles T, Eeles R, Ashley S, Easton D. Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial. Lancet, 1998;352:98-101.

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