Sunday, July 29, 2012

Australian doctors call for hormone replacement therapy rethink

As I was critical of the HRT scare from the beginning, I am pleased to see this

It has been 10 years since an alarming US study found HRT increased a woman's risk of breast cancer, strokes and heart attack.  But a decade later, medical professionals agree that those findings were flawed.

Doctors say the pharmaceutical industry has withdrawn from sale half of all the available therapies, while extreme product warnings are unnecessarily frightening and outdated.

But there is still confusion amongst women and GPs about the best treatment.

Gynaecologist Dr John Eden, head of the Sydney Menopause Centre at the Royal Hospital for Women, says the 2002 Women's Health Initiative Study in the US changed the lives of millions of women.

"It terrified women, there's no doubt about that, it was laced with fear," he said.  "Probably the most dramatic example is that before Women's Health Initiative (WHI) I would hardly ever prescribe an anti-depressant, since WHI I've become an expert in anti-depressants, and that's because I see there's a small group of women, probably around one-in-eight, who have severe, intractable sweats and flushes day and night for the rest of their lives."

Margaret Miller is one of those with severe symptoms.  "It was pretty uncomfortable. You're sitting in a meeting room, you might have 20 other people in that meeting and all of sudden you start - it looked like your head started to leak with water and it drips down your face; it is so embarrassing," she said.

The 56-year-old endured more than two years of this before turning to Hormone Replacement Therapy.

She was aware of the WHI study linking HRT with a higher risk of breast cancer but nothing else worked.  "I was the stage where I would have taken a cyanide tablet. I didn't care as long as it stopped the sweats and this itching and this terrible feeling all the time that you weren't human," she said.

The US study saw women abandon HRT in droves but a decade on doctors say many did so unnecessarily, because the findings were flawed.

Dr Eden says the majority of participants were aged over 60, were not newly menopausal and would not normally be treated.  In fact, for many women under 60, doctors say the benefits outweigh the risks.

Australasian Menopausal Society president Dr Jane Elliott says women should have had easier access to HRT.  "I think a whole decade of women have missed out on the option of that treatment," she said.  "It's not for everyone, it's not a panacea, but it certainly should be something where women at least feel they can consider it."

Dr Elliott says the options are now limited and the warnings on products are extreme.

"The problem is the actual number of TGA (Therapeutic Goods Administration) options has decreased in Australia," she said.   "The number of PBS (Pharmaceutical Benefits Scheme) options has decreased in Australia and there are what's called black box warnings on HRT preparations that women read. They're really out date."

Dr Eden agrees.  "We've lost almost half of our hormone therapies over the last decade and the pharmaceutical industry is quite open about it, they've withdrawn them because of business reasons, sales have gone down and that means we've got fewer choices now," he said.

And the bureaucrats don't care

A spokeswoman for the Therapeutic Goods Administration says the extreme warnings on HRT products are considered current.

She says the safety information would not change without a comprehensive review, which is normally initiated by an application from the sponsor of the product.


Science May Have Just Beaten Prostate Cancer

How do you know when your new cancer drug is working better than expected? When they shut down the clinical trial so that every participating patient can receive it.

Johnson & Johnson's Zytiga is kind of a big deal. The FDA approved its use last year for advanced prostate cancer patients who had already received chemo but whose cancer had still metastasized. Prostate cancer is typically treatable for the 200,000 American men who contract it annually, as long as it is caught before it spreads. Once it does, the cancer typically goes to bones where it becomes resistant to normal testosterone-blocking hormonal therapies. Zytiga, however, is a unique cancer-fighting compound that penetrates cancerous cells and shuts down its testosterone production—quickly killing off the damaged cells and preventing their spread. What's more, Zytiga remains effective after the cancer metastasizes and other drugs lose their punch.

What the new study from the UCSF Helen Diller Family Comprehensive Cancer Center—presented yesterday at the American Society of Clinical Oncology's annual meeting in Chicago—shows is that Zytiga can be prescribed much earlier in the disease's progression, specifically before metastasization, with incredible results.

1,088 prostate cancer patients in 12 countries participated in the trial. Each man received the standard low-dose prednisone treatment, with half also getting Zytiga and the other receiving a placebo. Researchers almost immediately discovered that, in the Zytiga group, the cancer progressed at only half the speed as the control group, with patients reporting significantly less pain and a noticeable delay before they had to undertake chemo. The results are so stupendous that the trial was cancelled to allow every patient access to the drug.

"After that first bottle, my pain went away and I just felt like my life was turning around," Rodolfo Chavez, 83, a former longshoreman from San Pedro told SFGate. "I'm still taking them. I'm on my 10th bottle and supposed to get another bottle today."

The FDA has yet to approve Zytiga for earlier use and won't do so until at least next year when the study's final results are published but this could be a beacon for late-stage prostate cancer patients who have otherwise run out of treatment options.


1 comment:

Anonymous said...

"Science May Have Just Beaten Prostate Cancer"

My word, this molecule is a dirt simple variation on cholesterol in which the long terpene chain is replaced by a pyridine solvent molecule:

Question: what took them so long? This is 1800's level chemistry!