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“Estrogen linked to GI bleeding,” and probably helps sell the newspaper?

May 26, 2015

Dr. Fox responds to the following article:

OK I have to say it…..”What next??” Hormone replacement for women has been under a irrational siege for 12 years now. What next, if you took or are taking hormones, will lightning be more likely to strike or Aliens visit your home? These guys in Boston continue to crank out “Data” from the NHANES study that simply interviewed 74,000 nurses and followed them over time. Yes it is a large sample but the data is merely cross sectional epidemiological data and is by personal report. These studies are great to start a thought process on a subject but in no way are conclusive or determine the causative agent for a problem. The associations should then be studied in a more controlled fashion to attempt to prove causation.

The way these studies work is the researcher gathers hundreds of data points, height, weight, blood pressure, new diagnosis of disease and need for medication, nutrition facts (very fraught with misreporting), medication use, habits, smoking, exercise, work hours, sleep history, vitamin use, etc, etc. With all these data points say 25-50, individual comparisons are matched and run to look for associations. Many statisticians would argue if an association does not produce a 100% increase (doubling) of the associated outcome it is likely not significant. For example, smoking and lung cancer has a relative risk of over 100, that is 100X more likely in the smoker. High blood pressure and stroke 4-7X increased risk. Those associations represent a 10,000% and a 400-700% increase respectively. Those associations would suggest the need for further study and that there is possibly a real causative association. In this association, we see 50% increase which many would throw out as non significant, yet it makes “National News?” If you read the article you walk away believing that hormones cause GI bleeding – NOT.

In other words, even if the association in the NHANES study was 5 times stronger, it doesn’t in any way prove that estrogen was the cause. It could be that everyone put on estrogen also was told to take aspirin prophylaxis to lower heart disease and it really was the aspirin that was the factor. Can you see how this data is merely suggestive and a marginal suggestion at best. Unfortunately this is how all “medical news” gets reported. Sounds dramatic, “Estrogen linked to GI bleeding,” and probably helps sell the newspaper? Sadly, however, due to the incessant attack on hormone replacement, an entire generation of aging females have opted out of replacement much to their bodies severe and significant health decline. My own mother frightened away from “steroids” by a few newspaper reports she read in her early life, did not take hormones and suffered terribly with osteoporosis and other health decline as a result. This trend has been fueled by just such studies. It is so sad how our media is now promoting mostly misinformation, all for sensationalism. For medicine, there should be tight controls on how scientific information is presented to the public by the media.

I hope everyone will be much more critical of the information they receive thru the media about medicine. Don’t change your doctor’s recommended treatment based on anything you hear in the news. Remember on any given subject, there are hundreds of similar studies in existence and usually there are very conflicting results. It is only after thoroughly evaluating all the available information that any rational conclusions can be made.

Sorry for the intensity of this post but it is a pet peave!!

Dr. Fox

Michael D. Fox, MD
Jacksonville Center
Reproductive Medicine

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