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American medicine has lost its way. In Bioidentical Hormones 101, author Dr. Jeffrey Dach uncovers the ills in today’s health care system and suggests ways to get it back on track.
Through a series of articles that originally appeared on his Internet blog, Dach provides evidence that bioidentical hormones are safer and more effective than synthetic hormones. He describes how to win the information war and take control of your health. Questioning the prevailing medical dogma, he covers a wide range of topics related to health and health care:
Dispensing the truth about drugs, health care, and medicine, Bioidentical Hormones 101 uses information to empower America to embrace a more holistic approach to health care.
A shocking "medical heresy" was quietly stated in a mainstream medical journal. "Less health care is better than more health care", says Dr. Deborah Grady in her editorial in the May 10, 2010 Archives of Internal Medicine which is critical of mainstream medicine. We assume and expect that health care should offer some health benefit. And yet, Dr Grady points out that health outcome studies show that more health care leads to worse outcomes. This revelation isn't new, and is actually old news, like a worn and familiar old shoe. The real news story is that this "medical heresy" somehow eluded censorship by the editorial board and appeared in print in a mainstream medical journal. Are mainstream doctors getting fed up? Is this the opening salvo of a medical revolution?
Examples of Harmful Medical Care
Dr Grady cites specific examples of treatments that result in harm, with adverse effects outweighing the benefits. The first example is synthetic "monster" hormone therapy used by the mainstream medical system, which was found to cause cancer and heart disease in the famous 2002 Women's Health Initiative study. It seems incredible, but true. The mainstream medical system used synthetic "monster" hormones for years until the WHI (Women's Health Initiative) study finally convinced millions of women to switch to safer and more effective bioidentical human hormones. See the articles on the safety and importance of bioidentical hormones which discusses this at length.
Dr. Grady's second example is the discredited practice of arthroscopic surgery for osteoarthritis. Millions of these useless procedures were performed in the late 90's until it was abandoned after randomized trials showed no benefit. See the article on the power of the placebo which discussed this.
A third example is the case of SSRI antidepressant drugs which have little benefit for patients with mild to moderate depression. These studies show that the benefits of SSRI drugs are equivalent to placebo pills. Dr. Grady points out that in cases of mild depression, the known adverse effects of SSRI antidepressants clearly outweigh the benefits. My previous article on SSRI antidepressants discussed this.
A fourth example is screening mammography. "The adverse effects of mammography—false-positive findings, biopsies, anxiety, and over diagnosis and treatment of latent cancers may overwhelm the benefit." My article on screening mammography discussed this.
Dr Grady's final example is the over-use and misuse of antacid drugs called proton pump inhibitors (PPI's), which have serious adverse effects of increased rates of fractures, Clostridium difficile infection, and increased risk of pneumonia.
Reducing Medical Care Opposed as "Rationing"
Dr Grady reminds us that the term "rationing" is frequently misused and abused in health care debates. In politics, those who want more health care oppose those who propose less health care. Less health care is called "rationing", a term originating in the wartime practice of rationing food, fuel and other scarce goods, and services, and may not apply to over use of health services which causes harm rather than benefit.
A False Hope—Bone Marrow Transplantation for Breast Cancer
A perfect example of misuse of the term "rationing" is the discredited bone marrow transplantation for breast cancer. Starting in the 1980's, thousands of procedures were done costing up to 400,000 dollars each. While many women stricken with advanced illness clamored for the "lifesaving" procedure, their health insurance companies balked at paying for an experimental and unproven treatment. A media and legal campaign ensued claiming the insurance companies were cruel tyrants. They were withholding or "rationing" a "lifesaving" treatment. After a couple of decades of harming thousands of severely ill women with an unproven procedure, medical studies were eventually done, and these showed the procedure had no merit, causing it to be discredited and abandoned. Clearly, the term "health care rationing" is misused when applied to a sham procedure that causes more harm than good. This incredible story of bone marrow transplantation for breast cancer can be found in an excellent article by Nicholas Gonzalez MD, and also in a book which documents the story called False Hope.
More Examples: Drugs that Don't Work
The misguided use of the term "health care rationing" applies to blockbuster drugs developed over the last few decades that are in fact, Bad Drugs. These patented drugs are expensive, yet have marginal effectiveness, and horrendous adverse side effects. In spite of this, thanks to Drug Company advertising, the television viewing audience clamors for these "lifesaving drugs", complaining that high cost and lack of insurance coverage amounts to "health care rationing". See my article on Protect Your Family from Bad Drugs. An excellent book on this topic entitled, "Drugs that Don't Work, Natural Therapies that Do", is available from Dr. David Brownstein.
Solution: Less Health Care
When the health care system is dominated and corrupted by huge corporations that place profit over people, the end result is a health care system that produces more harm than good. Hence, the sage old doctor's advice, "Doing Nothing" is frequently the best treatment plan, and one offered by my medical school advisor, Dr Neil Kurtzman, as the title for his first novel.
Of course, the real solution involves liberating the practice of medicine from the shackles of corporate and government control. Although somewhat draconian, an excellent first step would be the elimination of the entire health insurance industry. Don't hold your breath, as this is unlikely to happen any time soon, judging by the "health care reform" signed into law by President Obama. This latest "health care reform" effort amounts to a giant government subsidy for the health insurance industry with very little in return.
For hyperlinked references, see web site: www.bioidenticalhormones101.com
Chapter One References: Less is More, Mainstream Goes Alternative
(1) http://archinte.ama-assn.org/cgi/content/full/170/9/749 Less Is More, How Less Health Care Can Result in Better Health, Deborah Grady, MD, MPH; Rita F. Redberg, MD, MSc, Editor, Arch Intern Med. 2010;170(9):749-750.
(2) http://www.annals.org/content/138/4/288.abstract Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending, part 2: health outcomes and satisfaction with care. Ann Intern Med. 2003;138(4):288-298.
(3) http://www.annals.org/content/138/4/273.abstract Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending, part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138(4):273-287.
(4) http://jama.ama-assn.org/cgi/content/abstract/288/3/321 Rossouw JE, Anderson GL, Prentice RL; et al, Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA. 2002;288(3):321-333.
(5) http://jeffreydach.com/2008/06/27/the-safety-of-bioidentical-hormones-by -jeffrey-dach-md.aspx The safety of bioidentical Hormones by Jeffrey Dach MD
(6) http://www.drdach.com/BioIdentical_Hormones.html The Importance of bio-identical Hormones by Jeffrey Dach MD
(7) http://content.nejm.org/cgi/content/abstract/347/2/81 Moseley JB, O'Malley K, Petersen NJ; et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002;347(2):81-88.
(8) http://jeffreydach.com/2007/05/22/the-power-of-the-placebo —by-jeffrey-dach-md.aspx The Power of the Placebo by Jeffrey Dach MD
(9) http://jama.ama-assn.org/cgi/content/abstract/303/1/47 Fournier JC, DeRubeis RJ, Hollon SD; et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303(1):47-53.
(10) http://jeffreydach.com/2010/01/21/jama-says-ssri-antidepressants -are-placebos-by-jeffrey-dach-md.aspx Antidepressants Found to Be No Better Than Placebo.
(11) http://jama.ama-assn.org/cgi/content/full/303/2/164 Woloshin S, Schwartz LM. The benefits and harms of mammography screening: understanding the trade-offs. JAMA. 2010;303(2):164-165.
(12) http://jeffreydach.com/2009/11/17/mammogram-guideline-reversal-by -jeffrey-dach-md.aspx Mammogram Guideline Reversal by Jeffrey Dach
(13) http://archinte.ama-assn.org/cgi/content/abstract/170/9/7659 Gray SL, LaCroix AZ, Larson J; et al. Proton pump inhibitor use, hip fracture, and change in bone mineral density in postmenopausal women: results from the Women's Health Initiative. Arch Intern Med. 2010;170(9):765-771. FREE FULL TEXT
(14) http://archinte.ama-assn.org/cgi/content/abstract/170/9/784 Howell MD, Novack V, Grgurich P; et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med. 2010;170(9):784-790.
(15) http://archinte.ama-assn.org/cgi/content/abstract/170/9/772 Linsky A, Gupta K, Lawler EV, Fonda JR, Hermos JA. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med. 2010;170(9):772-778.
(16) http://www.annals.org/content/149/6/391.abstract Sarkar M, Hennessy S, Yang Y-X. Proton-pump inhibitor use and the risk for community-acquired pneumonia. Ann Intern Med. 2008;149(6):391-398.
(17) http://jama.ama-assn.org/cgi/content/abstract/301/20/2120 Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid suppressive medication use and the risk for hospital acquired pneumonia. JAMA. 2009;301(20):2120-2128.
(18) http://archinte.ama-assn.org/cgi/content/full/170/9/747 Katz MH. Failing the acid test: benefits of proton pump inhibitors may not justify the risks for many users. Arch Intern Med. 2010;170(9):747-748.
(19) http://jeffreydach.com/2009/09/14/heartburn-and-acid-blockers-by -jeffrey-dach-md.aspx Heartburn and Acid Blockers by Jeffrey Dach MD
(20) http://www.dr-gonzalez.com/bias.ht(20) m Academic Bias and Fraud: The cases of bone marrow transplantation for breast cancer, and HIV-nevirapine By Nicholas J. Gonzalez, M.D.
(21) http://www.amazon.com/False-Hope-Marrow-Transplantation-Breast/ dp/0195187768 False Hope: Bone Marrow Transplantation for Breast Less is More, Mainstream Goes Alternative, and Medical Heresy Cancer. Richard A. Rettig (Author), Peter D. Jacobson (Author), Cynthia M. Farquhar M.D. (Author), Wade M. Aubry M.D. (Author)
(22) http://www.jcojournal.org/cgi/content/full/26/1/11 Journal of Clinical Oncology, Vol 26, No 1 (January 1), 2008: pp. 11-12 EDITORIAL A Dramatic Story of Hope and Reality Edward A. Stadtmauer
(23) http://medicine-opera.com/doing-nothing-reviews Neil A Kurtzman MD is the Grover E Murray Professor and University Distinguished Professor, Department of Internal Medicine at Texas Tech University Health Sciences Center in Lubbock. He has combined careers in clinical medicine, education, basic research, and administration for more than 30 years. Dr Kurtzman was my research advisor in medical school.
(24) http://whcrc.ucsf.edu/people/bios/grady_deborah.html Deborah Grady, MD, MPH is Professor of Medicine, Associate Dean for Clinical and Translational Research and Director of the UCSF Women's Health Clinical Research Center. Dr. Grady is an international expert on menopause and the risks and benefits of postmenopausal hormone therapy. Dr. Grady has trained and mentored over 40 young researchers interested in women's health and received the Chancellor's Award for the Advancement of Women and the UCSF Mentor of the Year award.
(25) https://www.drbrownstein.com/bookstore_NaturalT.php Drugs that Don't Work, Natural Therapies that Do, is available from Dr David Brownstein (26) http://jeffreydach.com/2007/08/26/protect-your-family-from-bad -drugs-by-jeffrey-dach-md.aspx Protect Your Family from Bad Drugs by Jeffrey Dach MD
Suzy is a 59 year old post menopausal woman with low thyroid function. About three months ago, she started her bio-identicalhormoneprogram which included natural thyroid pills. After starting the program, she was doing well with more energy, better sleep, improved appearance of skin and hair, and resolution of her menopausal symptoms of flashes and sweats. However about 12 weeks into her program, Suzy had a visit with her primary care doctor who did a follow up thyroid panel. Her primary care doctor informed Suzy that her TSH test result was below the lab normal range, and therefore, her thyroid dose was too high, and should be reduced. (Note TSH stands for Thyroid Stimulating Hormone and is made by the pituitary gland)
Too Many Doctors Spoil the Soup
Suzy called me at the office distraught and confused. Two doctors were telling her two different things and she didn't know who to believe. Her primary care doctor was telling her one thing and I was telling her another. I explained to Suzy that her primary care doctor was incorrect in relying slavishly on the TSH test. Even though her TSH test was 0.15 which is below the lab reference range of 0.3, this was perfectly acceptable and indicated her thyroid medicine was suppressing the TSH to a low level which was perfectly fine. This test interpretation means she is taking thyroid pills, and the pills are working. It does not mean she is "hyperthyroid" by any stretch of the imagination.
No Clinical Evidence of Thyrotoxicosis
I also informed Suzy that her Primary Care Doctor is mistakenly relying on the TSH test to determine her thyroid dosage. The TSH test is an indirect measure of thyroid function and can be unreliable to monitor thyroid dosage. A more accurate indicator of thyroid function is the free T3, which in her case was 375, well within the normal range of 240 to 420. The Free T3 lab test together with the absence of any signs or symptoms of thyroid excess indicates she is using the correct dosage of natural thyroid medication. Symptoms of thyroid excess are rapid heartbeat or palpitations, and Suzy reported no such symptoms. In fact, Suzy said she felt fine and now that she understands it, she didn't want to go back to feeling tired and sluggish. Suzy was relieved to find out that the low TSH result was perfectly acceptable and there was nothing to worry about. This TSH scenario is a recurring event at my office.
Conventional Docs Slavishly Rely on the TSH
Conventional primary care doctors use an older thyroid lab panel which does not include the Free T3 test, the most informative thyroid lab test. Instead, mainstream endocrinology relies on the TSH test which is not a direct measure of thyroid function, and can, in fact, be unreliable. Most conventional doctors are unfamiliar with the use of natural thyroid which contains both T3 and T4, and instead use Synthroid which is quite different, containing only T4. Since the Primary care doctors bill the health insurance for the office visit and payment is only a few dollars, the office visit is brief, 3-5 minutes. In this short time, Primary care doctors can provide only the most basic care, which is a quick look at the TSH lab test. If the TSH is below the lab reference range the doctor gives a new prescription for Synthroid with a reduced dosage. If the TSH is above the reference range, the primary care doctor will increase the Synthroid dosage.
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Excerpted from BIOIDENTICAL HORMONES 101 by JEFFREY DACH Copyright © 2011 by Jeffrey Dach MD.. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Overview
American medicine has lost its way. In Bioidentical Hormones 101, author Dr. Jeffrey Dach uncovers the ills in today’s health care system and suggests ways to get it back on track.
Through a series of articles that originally appeared on his Internet blog, Dach provides evidence that bioidentical hormones are safer and more effective than synthetic hormones. He describes how to win the information war and take control of your health. Questioning the prevailing medical dogma, he ...