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Bioidentical Hormones According to Chris Woolston LA Times

Posted Jun 10 2010 5:39am

Chris Woolston medical WriterLA TImes Bioidentical Hormones According to Chris Woolston of the LA Times

An article caught my attention on bioidentical hormones appearing in the  June 7 Los Angeles Times .  The writer, Chris Woolston (left image), is a medical journalist with a master's degree in biology, and a surprising command of the topic.  I found his article more balanced than a previous  article  by AP writer Marilynn Marchione which could be described as  junk journalism.    Nonetheless, Woolston's article contains a number of omissions, errors and falsehoods that deserve correction: 

He writes: "Over the decades, millions of women have taken some form of hormone therapy to relieve symptoms of menopause... The treatment typically included Premarin, estrogen isolated from the urine of pregnant mares, combined with Provera, a synthetic version of the hormone progesterone."

Woolston correctly states that millions of women have taken hormone preparations to relieve symptoms of menopause.  However Woolston presents the biased and narrow viewpoint that all of these women took "synthetic" chemically altered hormones in the form of Provera and Premarin.  These are chemically altered hormones sold by the major drug companies.  The reality is that millions of women have taken and continue to take human bioidentical hormones for relief of menopausal symptoms.

The Women's Health Initiative Study 

Woolston then discussed the Women's Health Initiative Study, halted early because the study showed that synthetic, chemically altered hormones (Premarin and Provera) cause cancer and heart disease.  In this, he is quite correct.

"But when a six-year study of more than 16,600 postmenopausal women that was part of the Women's Health Initiative found that the combination of Premarin and Provera seemed to increase the risk of breast cancer, stroke and heart disease, doctors and patients suddenly had to consider other options."

Although this is correct, I would remove the word, "seemed" from the text.  The synthetic hormones, Premarin and Provera didn't "seem" to cause cancer and heart disease.  They DID cause cancer and heart disease in the WHI study.  That's why the study was terminated early, a small fact Woolston conveniently left out of the story.

"Soon after the WHI made headlines, some pharmacies, alternative health clinics and a few outspoken doctors started heavily promoting so-called "bioidentical hormones" for the treatment of menopausal symptoms. Unlike Premarin or Provera, bioidentical hormones — which are produced in laboratories using yam and soy phytoestrogens as a starting point — exactly match the hormone made by human ovaries."

NEJM HRT Prempro Breast Cancer Incidence
After the revelations of the WHI study were made public in 2002, millions of smart women abandoned synthetic hormones and switched to bioidentical hormones.  This switch was not a product of a massive advertising campaign of the type we see on television for drugs like Lipitor and SSRI antidepressants.  As a matter of fact, there was no TV advertising for bioidentical hormones, so I would disagree that bioidentical hormones were "heavily promoted".  They weren't.  The massive switch was more a product of the rank and file American Physicians who stopped writing prescriptions for Medroxyprogesterone (MPA), also called Provera, the synthetic hormone used in the WHI study. What Woolston conveniently left out of the story is that this sudden drop in MPA prescriptions in 2003 created a sudden drop in breast cancer rates. (see diagram at left) Blue arrow shows sudden drop in breast cancer rates. Red arrow shows drop in prescriptions for PremPro, synthetic hormones.

Above left image: Source from Figure 2 in  The Decrease in Breast-Cancer Incidence in 2003 in the United States  NEJM Volume 356:1670-1674  April 19, 2007  Number 16 by Peter M. Ravdin et al.  In Panel A (upper chart), Quarterly Incidence of Breast Cancer in Women between the Ages of 50 and 69 Years, (2000–2004).Panel B (lower chart) shows the number of prescriptions reported in the United States for the combined estrogen–progestin preparation Prempro and the conjugated equine estrogen Premarin, according to year.

Woolston is quite correct in the statement that bioidentical hormones are exactly the same as the hormones made by the ovaries.  

FDA Approved Bioidentical Hormones

"The Food and Drug Administration has approved several prescription-only drugs that contain bioidentical hormones, including Estrace pills, Estrasorb topical cream and the Alora patch. But many health clinics and pharmacies also sell non-approved creams that contain bioidentical estrogen and/or progesterone. These creams are often custom-made — or "compounded" — for each patient, sometimes based on the results of a saliva test that measures a woman's hormone levels."

Here Woolston is partially correct.  FDA approved bioidentical hormone preparations are available at the corner drugstore. However, Woolston omits the fact that compounding pharmacies are regulated at the state level, not by the federal government, so FDA approval is not required or even desired for compounded hormone preparations.  Insisting on FDA approval for compounded hormone preparations is similar to insisting that your state driver's license is invalidated because it was not issued by the federal government. 

FDA approval is sometimes waved about like a majestic frond, as if it grants magical qualities to a drug. In reality, FDA approval does not automatically mean the drug is effective or desirable.  Ten percent of all FDA approved drugs are later recalled or banned and designated as " bad drugs ".  Another ten per cent of FDA approved drugs later receive black box warnings.  FDA approval means a major drug company has paid a lot of money for studies showing efficacy over placebo.  Sometimes these studies are fudged .   

Catch 22 for Natural Substances

Another important fact omitted by Woolston is that the FDA approval process is so expensive that it makes financial sense only for patented drugs with prospects for large returns.  It is unlikely that any drug company will invest the millions for FDA approval studies when the drug in question is a natural substance such as a bioidentical hormone that cannot be protected by a patent.  Even the publicly financed Women's Health Initiative study sponsored by the NIH was done with patented hormones, Premarin and Provera, not the natural non-patentable bioidentical hormones.  This no doubt reflects drug company control over NIH research dollars.  The NIH should be studying natural substances like bioidentical hormones, and they are not doing it. 

In One Corner, We Have: Dr Kent Holtorf

Kent Holtorf MD Cites 196 studies showing safety and efficacy of Bioidentical Hormones "Dr. Kent Holtorf, a physician and proponent of bioidentical hormones ...The website for Holtorf's clinic says that women using bioidentical hormones "feel great" without suffering any of the side effects of "synthetic hormones," said to include fatigue, depression and weight gain, along with the increased risk of breast cancer and heart disease.  In a phone interview, Holtorf said that bioidentical hormones are more effective and safer than traditional treatments. "Over and over, women have told me that they feel much better" after taking the bioidentical hormones, he says."

In the Other Corner, We have Dr. Nanette Santoro Representing Mainstream Medicine and Synthetic Hormones

"Bioidentical hormones have an obvious appeal to women seeking relief for menopausal symptoms, says Dr. Nanette Santoro, chair of the department of obstetrics and gynecology at the University of Colorado Health Sciences Center in Denver and vice president of clinical science for the Endocrine Society. After all, it just seems to make sense that anything that exactly mimics a woman's own hormones must be better than mare's urine or a man-made compound that doesn't exist in nature."

"But Santoro says there is no proof that bioidentical hormones are any safer or more effective than traditional treatments. "All of the evidence that we have suggests that all of these hormones should be painted with the same brush," she says."

Nanette Santoro MD Chair Dept OB Gyne U of Colorado Dr Santoro represents mainstream medicine and synthetic hormones sold by the major drug companies, and as such uses coded language which requires translation.  "Traditional Treatments" means synthetic chemically altered hormones sold by the drug companies.  Painted with the same brush is the usual attempt to confuse the difference between chemically altered hormones and bioidentical hormones, claiming they are all the same thing.  They are not the same thing.  Chemically altered hormones are "Monster Hormones" that cause cancer and heart disease.  Bioidentical hormones have the same chemical structure as the hormones in the human body and are safe and effective.

Dr Kent Holtorf Article

Dr Kent Holtorf's article in Postgraduate medicine quotes 196 articles showing bioidentical hormones are safer and more effective than synthetic altered hormones. Chemically altered hormones are  MONSTERS that should never have been approved for human use.  Lehninger's  textbook  of biochemistry uses the word hormone which means a "bioidentical" hormone. Synthetic chemically altered hormones do not exist in the human body.  The sole purpose of chemically altering a hormone chemical structure is to obtain a patent to protect profits of the drug industry. These chemically altered monster hormones are a recent invention in the history of medicine and are MONSTERS that should never have been approved for human use.  Alternatively, bioidentical hormones and other natural substances by definition, cannot be patented and therefore not profitable for the drug industry. 

Dr. Nanette Santoro Has Concerns

"She has many concerns about bioidentical hormones that don't have FDA approval. For one thing, she says, it's impossible to know if unapproved creams have the promised amounts of hormones. "I've seen patients on these compounds actually losing bone mass because they were getting an insufficient dosage," she says. "Why take that chance?"

We already discussed the FDA approval issue above.  Compounding pharmacies are regulated by the states, not the federal government, so FDA approval is neither required nor desired for compounded preparations.  The issue of quality control and proper dosage is a real consideration that applies to ALL TYPES of medications whether FDA approved or not.  To get the best quality, I recommend working with a knowledgable physician familiar with the best compounding pharmacies with the highest reputation for quality and service.

"Why take a chance ?"  says Santoro.  This is typical drug company propaganda and fear mongering that is usually seen with drug company television advertising.  This is a snide attempt to plant doubts in the mind of the reader.  The reality is that synthetic hormones are the monsters, and the bioidentical hormones are the safe and effective choice.
 

Cynthia Stuenkel MD President of North American Menopause Society Dr. Cynthia Stuenkel, clinical professor of medicine at UC San Diego

"Dr. Cynthia Stuenkel, clinical professor of medicine at UC San Diego and president of the North American Menopause Society, shares this concern. "Some progesterone creams may contain little or no progesterone, while others contain so much that they definitely should be available only with a prescription," she says. Taking hormones without the careful guidance of a doctor is risky business, Stuenkel says. Among other things, too many hormones can potentially cause blood clots and endometrial hyperplasia, a precursor to uterine cancer."

Dr Steunkel is correct in that progesterone creams are safe, and available without a prescription. She is also correct in that the OTC progesterone creams may vary in potency, and that the highest quality progesterone creams are made by compounding pharmacies, freshly prepared according to the prescribed dosage written by the physician.  This is all OK.

Blood Clots and Endometrial Hyperplasia and Uterine Cancer - Omitting History

Dr. Stuenkel is right that certain hormones cause blood clots and uterine cancer.  But not progesterone. Jumping from progesterone to blood clots and endometrial hyperplasia is somewhat misleading and reveals a lack of understanding of the history of medicine.  Progesterone does not cause blood clots, endometrial hyperplasia or uterine cancer. Progesterone is protective. This is taught to first year medical students.  Blood clots, endometrial hyperplasia and uterine cancer are all caused by oral estrogen tablets, called Premarin, given without progesterone, which historically was the usual practice from 1950 to 1975.  This medical practice was halted with the publication of a  NEJM report  revealing that Premarin causes uterine cancer .   To prevent uterine cancer, a synthetic progesterone called provera was added to the regimen, hence Prempro the drug used in the WHI study.  This is a little history that Woolston omitted from the story. 

Woolston also omitted to tell you that oral estrogen tablets cause increased coagulability and increased risk of blood clots. For example, oral estrogen in birth control pills is the cause of  blood clots, deep venous thrombosis, pulmonary emboli and stroke in young women.  On the other hand, Bioidentical Estrogen in topical cream form is safe, and not associated with increase risk of blood clots.

On the Payroll of Wyeth

Woolston also omits to tell his readers that his two hormone experts, Steunkel and Santoro are both on the payroll of Wyeth and other drug companies that make synthetic chemically altered "Monster'" hormones.  These financial ties are publicly disclosed.

In addition, The North American Menopause society has financial ties to Wyeth and other synthetic hormone makers. This is publicly disclosed on the NAMS position statement in which many of the advisory panel have financial ties to the drug companies.

"Holtorf says there is strong evidence that bioidentical hormones are superior to other hormone treatments. In 2009, he published a review article in the journal Postgraduate Medicine that described dozens of studies of bioidentical hormones, many with positive results. And he notes that a survey of 176 postmenopausal women published in 2000 found that 65% said that bioidentical progesterone worked better than the hormone found in Provera...Nothing is ever proven in medicine," he says. "You just try to look at the evidence and find the best treatment for your patient."

"Holtorf claims that doubters of bioidentical hormones are generally either slow to accept change or are tainted by funding from the pharmaceutical industry. But Stuenkel counters that she and other physicians are simply following the evidence. Although some FDA-approved bioidentical hormones may, in fact, be improvements over traditional treatments, she says, the unapproved products have never been carefully studied. She points out that the biodentical progesterone used in the 2000 survey was almost certainly an FDA-approved product, not a compounded hormone put together in some clinic or pharmacy.

Stuenkel says that doctors paid close attention to the results from the Women's Health Initiative, a powerful study with a huge size and scope. By using smaller doses and different methods of delivery, they are continuing to give women safe relief from menopause symptoms without resorting to unapproved and untested treatments, she adds. "We have women's best interest at heart," she says.

Boxing Match

In a form of late night boxing match, Woolston brings us Holtorf on one side representing bioidentical hormones,  and Stuenkel on the other representing synthetic hormones.  Let the two go at it.  What we have is an article with just enough spin and wiggle room to keep Woolston employed as a journalist.  After all, Woolston's employer is the corporate media that depends on drug company advertising.  

boris karlov frankenstein jeffrey dach mdUsing Modern Science to Create Frankenstein

Woolston conveniently omits important historical information about synthetic hormones starting with the first synthetic hormone invented in 1938, DES, Diethylstilbestrol. This monster hormone drug was used from the 1940s until the late 1980s, as an FDA-approved estrogen-replacement therapy.  In 1972, the first  reports   of cervical cancer in the daughters of DES treated women was published in the New England Journal, and the drug was banned in 1975 after millions of women had been exposed.  Another early synthetic hormone was Bisphenol A, originally invented in 1936, and now used as a plastic component with six billion pounds per year manufactured and used as plastic for baby bottles, water bottles, and children’s toys. 

These early "monster" hormones gave us a preview of coming attractions with the pharmaceutical industry continuing to sell chemically altered hormones to the American Public.  It's all about money , not health.  Above left image: Boris Karloff as Frankenstein's Monster in 1931 film.

The take home message is that smart women are avoiding the "monster hormones".   Heroic doctors like Jonathan Wright, Kent Holtorf, Erika Schwartz, Bruice Kenton and David Brownstein provide their patients with the safer and more effective bioidentical hormones. 

Links to Articles with Related Content
The Importance of Bioidentical Hormones

The Safety Of Bio-Identical Hormones by Jeffrey Dach MD

The Battle for BioIdentical Hormones by Jeffrey Dach MD

Breast Cancer Prevention and Iodine Supplementation by Jeffrey Dach MD


Links and References

http://articles.latimes.com/2010/jun/07/health/la-he-skeptic-20100607  
Bioidentical hormones for menopausal symptoms
Proponents boast improvement over older treatments; others say there isn't enough evidence yet. The Healthy Skeptic June 07, 2010|By Chris Woolston, Special to the Los Angeles Times– Chris Woolston, M.S., is a health and medical writer with a master’s degree in biology. He is a contributing editor at Consumer Health Interactive, and was the staff writer at Hippocrates, a magazine for physicians. He has also covered science issues for Time Inc. Health, WebMD, and the Chronicle of Higher Education.

Marilyn Marchinone AP News Writer

http://jeffreydach.com/2009/11/01/bioidentical-hormones-trashed-by-marilynn-marchione-ap-news.aspx
BioIdentical Hormone Disinformation From AP Medical Writer, Marilynn Marchione

http://www.usatoday.com/news/health/2009-10-29-menopause-herbal_N.htm
Bioidenticals: Estrogen without FDA approval for menopause? By Marilynn Marchione, The Associated Press

DES

http://en.wikipedia.org/wiki/Diethylstilbestrol

DES was first synthesized in early 1938 by Leon Golberg, at the University of Oxford and a report of its synthesis was published in Nature on February 5, 1938.  From the 1940s until the late 1980s, DES was FDA-approved as estrogen-replacement therapy for estrogen deficiency states such as ovarian dysgenesis, premature ovarian failure, and post-oophorectomy.

In 1971, a report published in the "New England Journal of Medicine" showed a link between DES and vaginal clear cell adenocarcinoma in girls and young women who had been exposed to this drug in utero. Later in the same year, the FDA sent a FDA Drug Bulletin to all U.S. physicians advising against the use of DES in pregnant women. The FDA also removed prevention of miscarriage as an indication for DES use and added pregnancy as a contraindication for DES use.[11] On February 5, 1975, the FDA ordered 25 mg and 100 mg tablets of DES withdrawn, effective February 18, 1975.[12] The number of persons exposed to DES during pregnancy or in utero during 1940-1971 is unknown but may be as high as 2 million in the United States. DES was also used in other countries, most notably France, the Netherlands, and Great Britain.

http://www.cancer.org/docroot/CRI/content/CRI_2_6x_DES_Exposure_Questions_and_Answers.asp
DES Exposure: Questions and Answers- What is DES? Amer Cancer Society


http://www.medscape.com/viewarticle/450670_2
Diethylstilbestrol (DES) Update: History of DES

Bisphenol A

http://www.ourstolenfuture.org/newscience/oncompounds/bisphenola/bpauses.htm
Bisphenol A

http://www.environmentcalifornia.org/environmental-health/stop-toxic-toys/bisphenol-a-overview

Bisphenol A Overview - Originally produced for use as a synthetic hormone in 1936, today bisphenol A (BPA) is manufactured in excess of six billion pounds per year.  BPA is most commonly used as the building block of polycarbonate plastic for products such as baby bottles and water bottles, epoxy resins (coatings that line food containers), and white dental sealants.  It is also an additive in other types of plastic used to make children’s toys.

Bruice Kenton MD

http://www.kentonbruicemd.com/blog/Tag/synthetic-hormones

The problem with using synthetic hormones to treat symptoms of menopause is that the body doesn’t always recognize the artificial hormones, doesn’t always readily absorb these, and sometimes even rejects them altogether.  Your body may actively work against these hormones causing more problems than you originally bargained for. Some results from this can be increased weight gain, water retention, lack of sex drive or discomfort during sex, or even ovarian cancer.  These are all mainly due to the fact that as the body does not recognize these artificial hormones, it attacks them as foreign entities.

So you might be asking yourself, why would companies still be using synthetic hormones if there is a better, and safer hormone replacement therapy?  Well, the answer is simple. Money.  Isn’t that always the reason?  Because the FDA does not allow drug manufacturers to get a patent on natural materials, drug companies must use artificial substances in the making of their medicines.  That means that the drug companies do not make one dollar, if they have to sell drugs containing natural ingredients, because they cannot patent them, and make any money off them.  This means that the general public is led to buy something that can be potentially harmful to them, all for the betterment of the drug companies.

Frankenstein

http://www.wsu.edu/~delahoyd/frank.comment3.html
Frankenstein: The Man and the Monster- Suzanna Storment October 2002 - The future of science, if uncontrolled, could be disastrous. The book serves to warn readers, both past and current, of our own powers. It was almost as if Mary Shelley in 1818 could see nearly 200 years into the future, recognizing that our scientific discoveries of nuclear weapons and cloning could eventually be our demise.

http://en.wikipedia.org/wiki/Frankenstein
FRANKENSTEIN; or, The Modern Prometheus, generally known as Frankenstein, is a novel written by Mary Shelley. Shelley started writing the story when she was 18 and the novel was published when she was 19. The first edition was published anonymously in London in 1818. Shelley's name appears on the second edition, published in France. The title of the novel refers to a scientist, Victor Frankenstein, who learns how to create life and creates a being in the likeness of man, but larger than average and more powerful. In popular culture, people have tended incorrectly to refer to the monster as "Frankenstein". Frankenstein is infused with some elements of the Gothic novel and the Romantic movement, and is also considered to be one of the earliest examples of science fiction. It was also a warning against the expansion of modern man in the Industrial Revolution, alluded to in the novel's subtitle,


http://en.wikipedia.org/wiki/Frankenstein_(1931_film )
Frankenstein is a 1931 American horror film from Universal Pictures directed by James Whale and adapted from the play by Peggy Webling which in turn is based on the novel of the same name by Mary Shelley.

Prometheus 

">upload.wikimedia.org/wikipedia/commons/9/9f/Prometheus_Adam_Louvre_MR1745.jpg

 

http://jeffreydach.com/2008/06/27/the-safety-of-bioidentical-hormones-by-jeffrey-dach-md.aspx   jeffrey dach md

Cynthia A. Stuenkel, MD, NCMP

http://www.medpagetoday.com/pdf/IndiciaME03/  
Cynthia A. Stuenkel, MD, NCMP  Dr. Stuenkel has disclosed the following relationships: She is a consultant for Eli Lilly, Upsher-Smith, and Wyeth. Dr. Stuenkel's spouse has disclosed the following relationships: He is a consultant for Boston Scientific, Gambro Renal Products, and Thoratec; he is on the speaker's bureau for GlaxoSmithKline and Thoratec; and he receives research grant support from Boston Scientific.

http://www.clinicianschannel.com/pik/1833/index.cfm  
Cynthia A. Stuenkel, MD, has received honorarium from Wyeth Pharmaceuticals, Upsher-Smith Laboratories, Inc, and Ally Pharma Options Pvt. Ltd.

http://cme.medscape.com/viewarticle/709447  
Cynthia A. Stuenkel, MD, NCMP
Clinical Professor of Medicine, University of California, San Diego, La Jolla, California Disclosure: Cynthia A. Stuenkel, MD, NCMP, has disclosed the following relevant financial relationships:  Owns, stock, stock options or bonds from: Abbott Laboratories; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.  Served as an advisor or consultant for: Eli Lily and Company; Upsher-Smith; Wyeth Pharmaceuticals, Inc.  Served on the speakers bureau for: Boston Scientific; CHF Solutions; GlaxoSmithKline; J&J Scios; Medtronic, Inc.

Financial Ties to Wyeth

http://www.drugs.com/news/american-association-clinical-endocrinologists-north-american-menopause-society-fail-disclose-7750.html

American Association of Clinical Endocrinologists and North American Menopause Society Fail to Disclose Financial Ties to Wyeth Pharmaceuticals - Half of NAMS's Board of Trustees for 2007-2008 receives consulting fees or research support from Wyeth, including Dr. Utian.

http://www.iacprx.org/site/PageServer?pagename=Press_Releases_2007  
Wyeth funds research, awards, annual meetings, lectureship funds, educational programs and other activities of NAMS.  This includes:

•Endowing a $200,000 fund for the NAMS/Wyeth Wulf H. Utian Endowed Lectureship;
•Providing “generous grants to help support not only the Society’s Mission, but also the special activities of the 17th Annual Meeting;” and
•Contributing at least $8,000 a year in partnership fees for NAMS’s “2006 Partner in Menopause Education.”

http://www.menopause.org/donorlist.pdf

Corporate Supporters (donations, grants and fees)
Alliance for Better Bone Health
Amgen USA
Ascend Therapeutics
Bayer HealthCare Pharmaceuticals Inc.
Boehringer Ingelheim Pharmaceuticals, Inc.
BioSante Pharmaceuticals, Inc.
CVS Pharmacy
Depomed, Inc.
Eli Lilly and Company
Endo Pharmaceuticals
Medscape
Novogyne Pharmaceuticals
Novo Nordisk, Inc.
Penn State College of Medicine
Proctor & Gamble Pharmaceuticals
Solvay Pharmaceuticals, Inc.
Teva Women's Health
Ther-Rx Corporation
Upsher-Smith Laboratories, Inc.
Warner Chilcott
Wyeth Pharmaceuticals

http://www.menopause.org/PSht10.pdf
Menopause: The Journal of The North American Menopause Society
Vol. 17, No. 2, pp. 242/255 2010 by The North American Menopause Society
POSITION STATEMENT - Estrogen and progestogen use in postmenopausal women: 2010
position statement of The North American Menopause Society
Financial DISCLOSURE For the Advisory Panel,
Dr. Bachmann reports: Research
SupportVAstellas, Bayer, Bionovo, Boehringer Ingelheim, Boston
Scientific, Covance, Duramed, Femme Pharma, GlaxoSmithKline,
Hormos, Johnson & Johnson, Merck, Novartis, Novo Nordisk, Pfizer,
Procter & Gamble, QuatRx, Roche, Wyeth, Xanodyne; Speaker_s
BureauVBayer, Boehringer Ingelheim, Duramed, Johnson&Johnson,
Merck, Novartis, Novo Nordisk, Pfizer, Procter & Gamble, Roche,
Wyeth.

Ms. Battaglino Cahill reports: No significant financial relationships.
Dr. Gallagher reports: ConsultantVBarr; Grants/Research
SupportVWyeth; SpeakerVRoche, Wyeth.
Dr. Grodstein reports: Research SupportVWyeth.
Dr. Heiman reports: ConsultantVBoehringer
Ingelheim, Zestra; Grants/Research SupportVBayer, Pfizer.
Dr.
Henderson reports: Consultant/Advisory BoardVAlexander Foundation
for Women_s Health, Council on Menopause Management,
Geriatric Neurology Section of the American Academy of Neurology,
John Douglas French Alzheimer_s Foundation, National Aphasia
Association.

Dr. Hodis reports: No significant financial relationships.
Dr. Karas reports: Consultant/SpeakerVWyeth.
Dr. Manson reports No significant financial relationships.
Dr. Morfin-Martin reports: No
significant financial relationships.
Dr. Reid reports: Advisory BoardV
Bayer, Schering-Plough, Wyeth; Grants/Research SupportVBayer,
Ferring, Schering-Plough; Speaker_s BureauVBayer, Novo Nordisk,
Wyeth.
Dr. Santen reports: Consultant/Advisory BoardVMeditrina,
Novo Nordisk, Wyeth.
Dr. Schmidt reports: No significant financial
relationships.

Dr. Stuenkel reports: No significant financial relationships.
Dr. Utian reports: Advisory Board/ConsultantVBarr/Duramed,
Bionovo, Depomed, Hygeia, KV Pharmaceuticals, Eli Lilly, Merck,
Novartis, QuatRx. Dr. Waxman reports: No significant financial relationships.
Ms. Wysocki reports: Advisory BoardVBayer, Boehringer
Ingelheim, Duramed, Endo, Eli Lilly, Merck, Ortho Women_s Health,
Pharmaderm, Qiagen, Upsher-Smith, Wyeth; Speaker_s BureauV
Bayer, Duramed, Organon, Ther-Rx, Upsher-Smith, Wyeth.
For the NAMS Board of Trustees, Dr. Clarkson reports Consultant/Advisory BoardVWyeth; Grants/Research SupportV
Wyeth. Ms. Contestabile reports: No significant financial relationships.
Dr. Freedman reports: Consultant/Advisory BoardVAlexza
Pharmaceuticals, Depomed, Duramed, Eli Lilly, GlaxoSmithKline,
Novartis, Organon, Pfizer, Wyeth, Vela Pharmaceuticals, Procter &
Gamble; Royalties/PatentsVBMiniature, Hygrometric, Hot Flash
Recorder[ USPTO pending. Dr. Gass reports: No significant financial
relationships. Dr. Goldstein reports: Board of Directors/TrusteesVNYU
School of Medicine Alumni Corporation; Director, SonoSite; Consultant/
Advisory BoardVBoehringer Ingelheim, Cook Ob/Gyn,
Eli Lilly, GlaxoSmithKline, Merck, Novo Nordisk, Pfizer, Philips
Ultrasound, Upsher-Smith; Speaker_s BureauVEli Lilly, Pfizer, Wyeth.
Dr. Kagan reports: Consultant/Advisory BoardVAventis, Depomed,
Eli Lilly, Medtronic, Procter & Gamble, Wyeth; Grants/Research
SupportVBoehringer Ingelheim, Depomed, Eli Lilly, Novartis, Procter
& Gamble; Speaker_s BureauVEli Lilly, GlaxoSmithKline, Novartis,
Novogyne. Dr. Maki reports: Consultant/Advisory BoardVCouncil
on Menopause Management; Grants/Research SupportVWyeth. Dr.
Manson reports: No significant financial relationships. Dr. Pace
reports: Consultant/Advisory BoardVBayer, Novo Nordisk, Wyeth;
Speaker_s BureauVBayer, King Pharmaceuticals, Novo Nordisk,
Pfizer, Wyeth.

Dr. Pinkerton reports: Board of Directors/TrusteesV
HealthyWomen (formerly the National Women_s Health Resource
Center); Consultant/Advisory BoardVAmgen, Boehringer Ingelheim,
Eli Lilly, Novo Nordisk, Wyeth; Speaker_s BureauVMerck; Research
SupportVWyeth. Dr. Schiff reports: No significant financial relationships.
Dr. Shifren reports: Consultant/Advisory BoardVBoehringer
Ingelheim, Eli Lilly, New England Research Institutes; Grants/Research
Support: Procter & Gamble. Dr. Speroff reports: Consultant/Advisory
Board: Warner Chilcott. Dr. Stuenkel reports: No significant financial
relationships. Dr. Utian reports: Consultant/Advisory BoardVBene
Therapeutics, Bionovo, Depomed, Duramed, KV Pharmaceuticals,
Eli Lilly, Merck, Novartis, Orcas Therapeutics, QuatRx. Dr. Warren
reports: Consultant/Advisory BoardVBradley, Council on Menopause
Management, Duramed, National Cattleman_s Beef Association,Warner
Chilcott, Wyeth, Yoplait; Grants/Research SupportVBlackwell
Publishing, Ferring, Novartis, Solvay, Wyeth; Speaker_s BureauV
Duramed, Novartis, Novo Nordisk, Wyeth.

Nanette Santoro, M.D. Financial Ties to Wyeth

http://www.revolutionhealth.com/articles/nanette-santoro-m.d./article.2006-11-27.4097812445
Nanette Santoro, M.D., is a Professor and Director of the Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics, Gynecology and Women’s Health at the Albert Einstein College of Medicine of Yeshiva University in New York City.
Disclosures: Grants/Research Support: Ferring Pharmaceuticals Inc., Serono SA. Consultant/Advisory Board: Ferring Pharmaceuticals Inc., Serono SA, Wyeth, Pfizer Inc. Speakers’ Bureau: Wyeth, Pfizer Inc., Berlex Inc.

http://www.uchsc.edu/obgyn/
Chair   -  Nanette F. Santoro, M.D.
Dr. Santoro was appointed Chair of the Department of Obstetrics and Gynecology in September 2009. She received her medical degree from Albany Medical College of Union University in Albany, New York, and completed her residency in obstetrics and gynecology at Beth Israel Medical Center in New York, New York, followed by a fellowship in reproductive endocrinology at Massachusetts General Hospital and Harvard Medical School in Boston, Massachusetts.

http://www.clinicianschannel.com/pik/1833/index.cfm
Nanette F. Santoro, MD, has received grant support from Ferring Pharmaceuticals, Inc; has received consulting fees from and served on the advisory board for Wyeth Pharmaceuticals; and served on the advisory board for QuatRx.
Cynthia A. Stuenkel, MD, has received honorarium from Wyeth Pharmaceuticals, Upsher-Smith Laboratories, Inc, and Ally Pharma Options Pvt. Ltd.

Premarin Causes Endometrial Cancer 

http://www.ncbi.nlm.nih.gov/pubmed/171569
N Engl J Med. 1975 Dec 4;293(23):1167-70.
Increased risk of endometrial carcinoma among users of conjugated estrogens.
Ziel HK, Finkle WD. Abstract = The possibility that the use of conjugated estrogens increases the risk of endometrial carcinoma was investigated in patients and a twofold age-matched control series from the same population. Conjugated estrogens (principally sodium estrone sulfate) use was recorded for 57 per cent of 94 patients with endometrial carcinoma, and for 15 per cent of controls. The corresponding point estimate of the (instantaneous) risk ratio was 7.6 with a one-sided 95 per cent lower confidence limit of 4.7. The risk-ratio estimate increased with duration of exposure: from 5.6 for 1 to 4.9 years exposure to 13.9 for seven or more years. The estimated proportion of cases related to conjugated estrogens, the etiologic fraction, was 50 per cent with a one-sided 95 per cent lower confidence limit of 41 per cent. These data suggest that conjugated estrogens have an etiologic role in endometrial carcinoma.

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