Latest / The Dr Louise Newson Podcast / 64 – Estrogen: separating fear from fact

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64 – Estrogen: separating fear from fact · The Dr Louise Newson Podcast

• 0:02
  So Avron Blooming, I feel very excited to have you back on my
• 0:06
  podcast. So this is the third time.
• 0:08
  And we met many years ago before the podcast started.
• 0:13
  And I was in London at the Royal Society.
• 0:15
  I was giving a lecture and you were there.
• 0:18
  And you've just helped me open my eyes because sometimes in
• 0:23
  medicine, when you think differently, you have doubts and
• 0:26
  you think, hmm, really, it's so obvious, maybe I'm missing
• 0:30
  something. And then you came and you had
• 0:32
  just written your book, Easter Gym Matters, and you had some
• 0:36
  slides that just had a few sentences on very few about
• 0:41
  estrogen and heart disease and osteoporosis, dementia.
• 0:45
  And I just thought, wow, he's just speaking a language.
• 0:48
  But you're just so it's also obvious, but it's become so
• 0:52
  confusing. So, So you are from a, a very
• 0:56
  esteemed oncologist, physician, a thinker, very inspirational
• 1:01
  and actually you, you, you don't know it really, but you are a
• 1:04
  great mentor to me because you're so solid in how you are.
• 1:07
  And when I wobble, I just think about you and it really helps
• 1:10
  me. But let's just think about
• 1:14
  estrogen. It's, it's a hormone.
• 1:16
  Hormones are chemical messengers that have a role in our bodies.
• 1:21
  And somehow for the last 30 years especially or so maybe 40
• 1:26
  years, people have become very scared of our own hormone.
• 1:31
  And it just feels a bit weird almost if I didn't know any
• 1:35
  medicine at all and didn't know any politics, didn't know any
• 1:37
  history, if I'd come from outer space and I said we all have
• 1:41
  this natural hormone in our body that has lots of biological
• 1:44
  effects. We know it can be beneficial for
• 1:46
  symptoms and future health. Yet most women, when their
• 1:50
  levels are low, don't get it. They're not allowed it.
• 1:52
  They're given other medication. It just feels a bit weird.
• 1:55
  Doesn't it? As a man, I can tell you what
• 1:59
  problem I can get Hormones, and we ought to look at other
• 2:03
  hormones. Thyroid hormone saves lives
• 2:06
  because people who are deficient in thyroid die prematurely, and
• 2:12
  thyroid hormone, which they take for the entirety of their lives,
• 2:17
  allows them to live a normal lifespan.
• 2:20
  Similarly, cortisone, when used correctly, helps keep people
• 2:26
  alive. John F Kennedy was cortisone
• 2:29
  deficient. He had Addison's disease, and
• 2:31
  although we didn't know it when he was president, he was taking
• 2:36
  cortisone and that also kept him alive.
• 2:39
  Somehow estrogen hasn't been invited to the party, and it
• 2:45
  isn't a mystery. It is through the early 1990s up
• 2:52
  to, depending on which paper you read, 40% of eligible women,
• 2:57
  meaning Perry and menopausal women were given hormones and it
• 3:03
  worked. And then in 2002, there was a
• 3:08
  report that came out first as a press conference, followed one
• 3:13
  week later as an article in the Journal of the American Medical
• 3:17
  Association that said hormones, which means estrogen for
• 3:23
  perimenopausal women who don't have a uterus, and estrogen and
• 3:28
  progesterone for peri and menopausal women who do have a
• 3:32
  uterus are dangerous. They increase the risk of heart
• 3:37
  disease, stroke, breast cancer and death.
• 3:43
  Well, that's frightening. And that was a study that has
• 3:47
  cost 1000 million dollars, that's a billion.
• 3:53
  But when I say it is 1000 million, it sounds.
• 3:56
  Famous. Me.
• 3:58
  And it made headlines around the world, and it was headlined in
• 4:01
  the New York Times. And doctors were afraid to
• 4:04
  prescribe hormones and women flushed their hormones down the
• 4:07
  toilet. And everything I said about that
• 4:11
  conclusion, everything has been walked back by the people who
• 4:15
  said it, but somehow the walk back message hasn't gotten as
• 4:20
  wide an audience. No.
• 4:22
  And it's so interesting because even that study when you read
• 4:25
  it, there are some good points in it that have been completely
• 4:29
  ignored. So even the first glance really
• 4:32
  look did show that osteoporosis was lower.
• 4:36
  And osteoporosis is a condition that affects one in two
• 4:41
  menopausal women. And personally, as a menopausal
• 4:44
  woman, I'm very scared of osteoporosis.
• 4:47
  So if if I had been diagnosed as osteoporosis and had a hip
• 4:51
  fracture, my mortality would be greater than most cancers
• 4:55
  actually. But people don't see it as a,
• 4:57
  you know, but that was a good news story.
• 4:59
  They showed that bowel cancer had a reduced risk.
• 5:02
  And actually when they followed up people who were only on
• 5:05
  estrogen, there was about a 22% reduction in breast cancer.
• 5:09
  But I didn't see that on the front page of the headlines.
• 5:12
  You know it hasn't made the same headlines.
• 5:15
  No. And I remember actually, so 11
• 5:18
  years ago, I was asked to summarize our nice menopause
• 5:21
  guidance because as you know, I've been a medical writer for
• 5:24
  25 years and a lot of my work was summarizing guidelines all
• 5:28
  across medicine. And when you summarize
• 5:30
  guidelines, you don't just read the guidelines, you read the
• 5:32
  original references in the papers and you look at
• 5:35
  everything. So this was a big piece of work
• 5:38
  for me because I went back to WHI.
• 5:40
  And of course I read it in 2002, and I wrote about it then, but I
• 5:44
  wanted to look at it with a fresh pair of eyes.
• 5:46
  So I went through it all and again and again and again.
• 5:50
  And I kept thinking, well, what's the big deal?
• 5:52
  Like, why is why is everyone so scared?
• 5:55
  Actually, because the, the numbers don't add up.
• 5:58
  And even if they are, it's really small.
• 6:00
  And even if you look at the worst, like rate of breast
• 6:03
  cancer, it's still less than if I was smoking or drinking water
• 6:07
  or alcohol. You know, when you put it into a
• 6:09
  perspective, but it's the benefits that people seem to
• 6:14
  forget. And and also, even if we we'll
• 6:17
  talk about disease prevention in a minute, but we've known ever
• 6:20
  since hormones were produced, you know, in the 40s, fifties,
• 6:23
  60s, that well-being can improve.
• 6:26
  Women can feel happier. They and is that a bad thing,
• 6:29
  Avram, that we help our patients to just feel happier and better.
• 6:33
  I guess it depends in part how you feel about women.
• 6:36
  I, for one, am prejudice in favor of women.
• 6:40
  I think if women ran more things than they do, this would be a
• 6:45
  better world. I attended a talk years ago that
• 6:50
  was given by Kim Campbell, who was a woman in her 40s and she
• 6:54
  was the Prime Minister of Canada.
• 6:56
  And she said, let me tell you the difference about the way men
• 7:00
  govern and women govern. Men govern by Fiat and power.
• 7:06
  Women govern by consensus. That was such a wonderful
• 7:11
  that's. Amazing, isn't it?
• 7:13
  Yes. That really, it really is.
• 7:15
  And I know, you know, personally when I was having hormonal
• 7:19
  changes 10 years or so ago, I, I wasn't really enjoying things.
• 7:24
  I mean, my memory was terrible, my concentration, but I just
• 7:28
  didn't enjoy life. I, it was really hard to just
• 7:31
  get up and be motivated and, and really small things, like really
• 7:35
  trivial things like putting the washing on.
• 7:37
  I couldn't be bothered. And you know, like now I just
• 7:41
  put it on and it's done and, and, and it's easy And that
• 7:44
  sounds really small, but I think a lot of women listening will,
• 7:47
  will resonate with you can't measure that in a study.
• 7:50
  You're not going to have a big study looking at do women put
• 7:52
  the washing on more or or empty the dishwasher or, you know, say
• 7:56
  goodnight to their children with a loving kiss.
• 7:59
  Are they more likely to do that with hormones or not?
• 8:01
  But I know what the answer is. But that makes a big difference
• 8:04
  just day-to-day for most of us that have families or, you know,
• 8:08
  have partners. That's really important
• 8:10
  actually. And somehow that's forgotten.
• 8:12
  I I remember reading that about 40% of women in the healthcare
• 8:18
  industry in Britain are retiring early, 40% around the time
• 8:26
  between 45 and 55 as they reach menopause.
• 8:31
  Well that's terrible. That what a loss to society, to
• 8:36
  our general health. Yeah, it's, and you can see why
• 8:39
  it happens. And you know, I did some work
• 8:41
  with the police force a few years ago and we did a big
• 8:44
  survey looking at symptoms and it was the main symptoms were
• 8:47
  anxiety, fatigue, memory problems.
• 8:50
  So it's not about giving us a fan at work or changing our
• 8:53
  uniform to a wicking uniform. It's not going to work.
• 8:56
  You know, it's so we need to think about this, this hormone
• 9:01
  estrogen. I mean, I've talked on other
• 9:02
  podcasts about progesterone and so it's also, but I want to talk
• 9:05
  about estrogen because your book, which has been updated
• 9:07
  since we first met Estrogen Matters.
• 9:10
  You know, most of my patients have bought it.
• 9:12
  We've got loads of copies in the clinic.
• 9:14
  And it's a real Bible because it's just common sense, but it's
• 9:17
  a homin that affects every cell in our body.
• 9:20
  So therefore it's every organ in our body.
• 9:22
  So I've already said there are some brain effects, as in people
• 9:25
  feel better and happier and smarter and they can think and
• 9:28
  sleep and and and function. But it it affects the bones
• 9:33
  doesn't it helps keep the bones strong?
• 9:35
  What what most people here is the symptoms of menopause are
• 9:41
  really hot flushes called hot flashes.
• 9:45
  But flushes, a better word, hot flushes and difficulty sleeping.
• 9:50
  And it usually lasts a year or two and then it's gone.
• 9:55
  And that's so wrong. There are over 35 major symptoms
• 10:00
  including heart palpitations that respected cardiologists I
• 10:05
  work with aren't aware of even today.
• 10:09
  And it's obviously all the genito urinary symptoms and the
• 10:14
  loss of libido and painful sexual intercourse, even if you
• 10:18
  fake it and decide you will try it.
• 10:21
  And the brain fog, which is devastating.
• 10:26
  And it affects 80% of women between the ages of 45 and 55.
• 10:33
  And it's significant. And it lasts a median of 7.2
• 10:38
  years, not a couple of months. And for women of color, it lasts
• 10:43
  longer than that. And the single best treatment is
• 10:48
  estrogen, which works in close to 100% of women.
• 10:54
  And it's so interesting, the study that we spoke about, the
• 10:57
  Women's Health Initiative that first came out as results in
• 11:00
  2002, said in 2003 that estrogen has no effect on a woman's
• 11:09
  quality of life. So not only did it 'cause, but
• 11:13
  it doesn't heart disease and breast cancer and death, it
• 11:19
  doesn't even help symptoms. And that was a headline story
• 11:24
  also in the New York Times. And when you read that article,
• 11:29
  which obviously I've read very closely, this was a prospective
• 11:34
  double-blind randomized study. And the authors right in the
• 11:39
  article, we knew that menopausal women that were symptomatic
• 11:44
  would know within a week or two if they were getting a sugar and
• 11:49
  not the estrogen. And so we intentionally did not
• 11:53
  admit symptomatic women to the study.
• 11:57
  And they concluded by the article by essentially saying,
• 12:00
  and these women who had no symptoms had no improvement in
• 12:04
  the symptoms they didn't have if they got estrogen rather in
• 12:08
  placebo. But the headline didn't say
• 12:11
  that. It's so misleading, isn't it?
• 12:14
  And it's so confusing for women. And, you know, quite soon after
• 12:19
  I, you know, updated it and, and went through the nice guidance
• 12:25
  many years ago and started talking to doctors and also
• 12:28
  women, they were like, but that's not what I've read.
• 12:31
  That's not what I've heard. And, and in medicine, if I'm not
• 12:34
  sure about something, I'll go back to the original and I'll
• 12:37
  also go back to basic Physiology because, you know, you as I
• 12:42
  have, have prescribed all sorts of drugs.
• 12:44
  And you can't just write the name of a drug on a
• 12:46
  prescription. You have to know how it works in
• 12:48
  the body because then it helps, you know, is it going to be
• 12:51
  beneficial? Is it going to have risks?
• 12:53
  You know, you're constantly weighing up?
• 12:55
  Is it going to interact with other medication?
• 12:57
  What do I inform my patients? And so, so much of this is, is
• 13:02
  very simplistic medicine. You know, you talked about under
• 13:05
  active thyroid, it's very similar.
• 13:07
  But then there is still some people saying, but menopause
• 13:09
  isn't a hormone deficiency. And it's like, well, what is it
• 13:12
  then? Because our hormone is low, it
• 13:14
  stays low forever. And we have to be facing the
• 13:18
  consequences of these low hormones.
• 13:20
  And as, as women, we, we kind of, we should be able to choose
• 13:25
  whether we want to take hormones or not.
• 13:27
  And I wouldn't be carrying on my work if everybody who wanted
• 13:31
  hormones could easily get them because I'd be thinking, well,
• 13:33
  that's great. But the stories I hear, and I'm
• 13:36
  sure you hear them in the US as well, Avram is women are being
• 13:39
  given antidepressants, they're being in sleeping tablets.
• 13:42
  They're, they're giving treatment for their
• 13:43
  palpitations, for their migraines, for their restless
• 13:46
  legs. You know, this goes on.
• 13:48
  They're being treated for their symptoms.
• 13:51
  But if they ask for estrogen or hormones, it's almost like,
• 13:55
  well, no, that's that's you know what?
• 13:58
  We do the first edition of our book in 2018.
• 14:02
  I've gotten letters not just from around the United States,
• 14:06
  but from all over the world. The book has now been translated
• 14:10
  into Spanish and German and Chinese, and there's a Polish
• 14:14
  edition that's coming out soon. And I get letters from
• 14:17
  Bangladesh and Senegal all over the world.
• 14:21
  And it's the same thing. Women are facing that same
• 14:25
  problem and it's worth pointing out that you and I can banter
• 14:30
  back and forth and say we've known each other now for over 7
• 14:35
  years and we've been in agreement since the first minute
• 14:38
  we met and that has just gotten stronger.
• 14:43
  And so people listening saying well fine, these two people
• 14:47
  agree, but I hear people who are respected disagreeing.
• 14:51
  And the answer is there really isn't that kind of disagreement.
• 14:57
  And it's important to know that although the Women's Health
• 15:01
  Initiative came out first and said it increases the risk of
• 15:05
  heart attacks and death from heart attacks, their population
• 15:11
  was had a median age of 63. Less than less 70% of the women
• 15:20
  were over 60, between 60 and 70. Very few were in the target
• 15:26
  population that we're talking about.
• 15:28
  More than half were markedly overweight. close to half were
• 15:34
  smokers or previous smokers. This is a population that had a
• 15:38
  much higher risk of heart disease than the one we're
• 15:41
  talking about now. And what the Women's Health
• 15:43
  Initiative now says and has published, but the New York
• 15:47
  Times hasn't reported, nor the London Times, is that when taken
• 15:54
  within 10 years of the last menstrual period, it actually
• 15:58
  decreases the risk of heart disease.
• 16:01
  And that's what so many studies over the years, long before 2002
• 16:07
  have confirmed. You mentioned osteoporosis.
• 16:11
  Yes, a hip fracture from osteoporosis, which can affect a
• 16:16
  significant number of post menopausal women is associated
• 16:20
  with death within one year of the hip fracture that mirrors
• 16:25
  the incidence of death from breast cancer.
• 16:27
  And the best treatment is estrogen, much better than
• 16:32
  calcium, which alone doesn't work in a post menopausal women.
• 16:37
  And the other drugs that are used for osteoporosis that when
• 16:41
  they work in prevention work for five years but after that are
• 16:46
  associated with an increased risk of hip fracture.
• 16:50
  Estrogen you can keep on on using and it works as long as
• 16:55
  you use it. And although they originally
• 17:01
  published in 2003, it has no effect on quality of life.
• 17:05
  They've now walked that back and said estrogen is the single best
• 17:09
  treatment for menopausal symptoms.
• 17:13
  And they initially said that our findings apply to women of all
• 17:18
  ages. And they've walked that back and
• 17:23
  now said no, are the bad findings really were for women
• 17:28
  who were long past menopause. And now they said, we're so
• 17:33
  sorry that Perry and menopausal women weren't started on
• 17:38
  estrogen. That wasn't what our intention
• 17:40
  was. Well, that's what you wrote, but
• 17:42
  you've walked it back. Let's publicize that.
• 17:45
  You've walked it back and when challenged, the disagreement
• 17:52
  isn't there. When people say, I don't know
• 17:54
  who to believe, these two people now who I'm listening to or
• 17:58
  other people, well, we all agree.
• 18:00
  It's just we're saying it out loud.
• 18:02
  Yeah, and that's so important. But, but actually, you know, a
• 18:05
  few weeks ago now the the FDA did their lovely announcement
• 18:09
  about removing black box warning.
• 18:11
  And you know, it's it's really lovely when you hear other
• 18:14
  people saying the same things as well, because it's very
• 18:17
  reassuring. You know, a lot of my patients
• 18:20
  and other people I speak to are confused because they've had
• 18:22
  mixed messages for so many years about hormones.
• 18:27
  But I often think in different ways.
• 18:30
  And one of the things I think about is the risks of not having
• 18:34
  estrogen. So we can talk and we'll be
• 18:36
  still talking for decades to come about the potential risk.
• 18:39
  But just to be clear, they are small risks if they are there
• 18:43
  depending on the dose, the formulation that the person
• 18:46
  that's been having the medication.
• 18:48
  But the risks are very small. But the risks of not having
• 18:51
  hormones you've already alluded to, if we don't have hormones,
• 18:54
  we've got an increased risk of all inflammatory conditions.
• 18:57
  So heart disease, osteoporosis, diabetes, dementia, even
• 19:02
  depression, schizophrenia, chronic kidney disease, you
• 19:06
  know, the list is quite long actually.
• 19:09
  And women are living so much longer.
• 19:12
  So women need to be involved in their decision making about, are
• 19:17
  they prepared to take a risk? It's the same as, you know, am I
• 19:20
  prepared to take a risk if I don't exercise or if I eat
• 19:24
  processed foods? I need to be educated as a, as a
• 19:27
  person about that. But I think we need to, as as
• 19:31
  women and patients, take responsibility and think about
• 19:35
  the risks of not having hormones.
• 19:36
  And let's talk about risk again for just a minute.
• 19:41
  As you pointed out, the black box warning, which was put on
• 19:45
  all estrogen containing drugs, warned increases the risk of
• 19:49
  heart disease and breast cancer. Estrogen alone in this very big,
• 19:54
  prestigious study decreased the risk of breast cancer, decreased
• 19:58
  the risk of breast cancer by 23%, and even more importantly,
• 20:03
  decreased the risk of death from breast cancer by 40%.
• 20:08
  And nobody argues with that. That's what the Women's Health
• 20:12
  Initiative published. So the only thing that they're
• 20:15
  left with of everything they were waving red flags about is
• 20:19
  they say, but when you add progesterone to estrogen for
• 20:24
  women with a uterus, because estrogen alone does increase the
• 20:29
  risk of uterine cancer, well, the risk is small.
• 20:31
  Actually. That risk is non existent.
• 20:34
  That's a non risk and it doesn't increase the risk of death from
• 20:41
  breast cancer. And I've written numerous
• 20:43
  articles saying that that one extra woman per thousand is
• 20:50
  based on a misrepresentation of their own data.
• 20:55
  When you analyze the data and balance it per their own
• 20:59
  protocol, even that risk disappears.
• 21:02
  But what women say when they hear me say that is, well, I
• 21:06
  don't want to be that one in 1000.
• 21:09
  Well, I it's, it's not a real number.
• 21:14
  It's an artificially generated incorrect number.
• 21:19
  And women are still staying away from hormones because.
• 21:22
  Of it. And it's such a shame because,
• 21:24
  you know, breast cancer is common.
• 21:26
  It's far more common now than it was when the WHI was first
• 21:30
  launched. Yeah.
• 21:31
  HRT and estrogen prescribing is so much lower.
• 21:35
  So there are lots of reasons, you know as well as I do why
• 21:38
  people have cancer. But the you've already said also
• 21:42
  that women who only have estrogen have a lower instance
• 21:45
  of breast cancer. But women will get breast cancer
• 21:48
  whether they take hormones or not, whether they do exercise or
• 21:52
  not, whether they drive their car or not.
• 21:54
  You know, we have a risk. And the problem is, is that
• 21:58
  because of some women who take HRT develop breast cancer, it's
• 22:02
  very easy and quick sometimes for other doctors to say, oh,
• 22:05
  well, of course it's your hormones, especially because
• 22:08
  you've got an estrogen receptor positive breast cancer.
• 22:12
  And that causes still now a lot of confusion, which is such a
• 22:15
  shame. Well, confusion usually is
• 22:18
  associated with ignorance. And as I told you before we
• 22:22
  started talking, I say I don't know many times every day.
• 22:28
  You said, well, of course we know there are many reasons for
• 22:32
  cancer development. I'm a medical oncologist.
• 22:35
  I've been a medical oncologist for close to 60 years.
• 22:39
  And I don't know what cancer is. I know how to treat it based
• 22:44
  largely on trial and error studies, so that now a newly
• 22:49
  diagnosed breast cancer carries a cure rate of close to 90, 5%.
• 22:56
  I don't take breast cancer lightly.
• 22:59
  It is still a disease I don't wish on anybody and I've spent a
• 23:03
  large portion of my career treating it, but it's very small
• 23:11
  in terms of a risk for a shortened lifespan.
• 23:16
  And if the numbers don't even show that it increases the risk,
• 23:22
  then putting the black box warning and preventing women
• 23:25
  from taking it is a huge disservice.
• 23:28
  And that's what Doctor Marty Macri, who was the FDA
• 23:33
  commissioner, said when he said. And we therefore, after looking
• 23:37
  at all the data are removing the black box warning on all
• 23:42
  estrogen containing products, not just vaginal estrogen, which
• 23:46
  nobody has really challenged, but on all estrogen containing
• 23:51
  products. Bravo.
• 23:53
  The next battle is what about breast cancer survivors, even as
• 23:58
  receptor positive breast cancer survivors?
• 24:02
  And the short answer to that is, of course, we need more data,
• 24:06
  but there are 26 studies in the medical literature looking at
• 24:13
  what happens when breast cancer survivors are given hormones,
• 24:17
  including estrogen receptor positive breast cancer
• 24:21
  survivors. And of those 26 studies, 25 say
• 24:26
  there's no increased risk of recurrence.
• 24:30
  In fact, four of the five prospective randomized studies
• 24:34
  say there was a decreased risk of recurrence.
• 24:39
  And the one study that said there's an increased risk of
• 24:42
  recurrence, which not surprisingly is the one most
• 24:46
  quoted in the medical literature, called the habits
• 24:49
  study for hormones after breast cancer.
• 24:52
  Is it safe? A study done in Sweden said
• 24:55
  there was no increased risk of distant recurrence, meaning
• 24:59
  metastatic tumor. There was no increased risk of
• 25:02
  death. But what we saw is an increased
• 25:05
  risk of local recurrence in the affected breast or in the
• 25:10
  contralateral breast. Well, this particular study did
• 25:15
  not mandate imaging of the breasts before these breast
• 25:20
  cancer survivors were admitted to the study.
• 25:23
  So you don't know if the hormones increased the risk of
• 25:29
  breast cancer. And of the several hundred women
• 25:32
  followed, the actual difference between the women who were
• 25:36
  randomized to nothing and the women who got hormones were 22,
• 25:43
  an absolute number of 22 women. And it's on the basis of those
• 25:49
  22 women where imaging wasn't required as a prerequisite, that
• 25:55
  millions of breast cancer survivors are being denied
• 25:59
  hormones. And so that's another issue that
• 26:03
  we now have to face and deal with.
• 26:05
  Absolutely. And the stories we've, we've
• 26:07
  published some data looking at the stories people are given
• 26:11
  actually from health healthcare professionals about menopause
• 26:15
  when they've had breast cancer, or rather they're not given
• 26:18
  information. But also some of the stories
• 26:20
  where women are just refused any hormones.
• 26:24
  And you know, I see a lot of women in my clinic who've had
• 26:26
  breast cancer 1020 years ago, they're more worried about their
• 26:29
  personal risk of osteoporosis than they are of a recurrence.
• 26:33
  And, and so it's, it's so, and we've spoken about the studies
• 26:36
  in depth before, but it's, it's very much about individualized
• 26:39
  choice. And I think that's where we all
• 26:42
  agree actually, or we should all agree, but I think we do as
• 26:46
  clinicians that our patients should be allowed to choose.
• 26:50
  And we need to be able to have grown up conversations because
• 26:53
  because we're not going to have all the studies, we'll never
• 26:55
  have all the studies. And even if we do, you know,
• 26:58
  those women in the WHI are not me.
• 27:00
  They're different. Then they'll eat differently,
• 27:02
  they'll exercise differently, they'll have different genetics.
• 27:05
  So I, you know, even then that risk is not my risk.
• 27:08
  So we have to be taking responsibility and sharing
• 27:11
  uncertainty. So we've we've got a long way to
• 27:14
  go. One of the most enlightening
• 27:19
  talks I have heard within the past several years was by Doctor
• 27:23
  Eric Weiner. Doctor Weiner is a former past
• 27:28
  president of the American Society of Clinical Oncology.
• 27:32
  He ran the breast cancer program at the Dana Farber Harvard
• 27:38
  Cancer Center for years, and several years ago he moved to
• 27:42
  Yale, where he's now the director of oncology.
• 27:46
  And the title of his talk was Physician patient partnership,
• 27:52
  the cornerstone of medical treatment and research.
• 27:56
  Physician patient partnership. When a doctor says we're not
• 28:02
  going to talk about it, and if you insist on even discussing
• 28:07
  estrogen, you'll have to find a different oncologist.
• 28:10
  That's the wrong doctor. That's an inadequately informed
• 28:13
  Dr. but that's the wrong doctor. And you have to know that Doctor
• 28:17
  Weiner was born with hemophilia, that he got factor 8 to treat
• 28:25
  his hemophilia, and that gave him AIDS as a young boy.
• 28:32
  And in spite of that, he's gone on to be this incredibly
• 28:36
  impressive, inspirational leader.
• 28:39
  And he's been on the patient's side of the desk.
• 28:43
  He knows very well what it's like to be dealing with
• 28:47
  physicians who are less supportive than they should be
• 28:51
  and less informed than they must be.
• 28:54
  It's so important. So I'm very grateful for you
• 28:57
  coming today and I hopefully you'll be on in a fourth time in
• 29:01
  the future. But before I end up am I just
• 29:04
  always ask for three take home tips so three ways that women
• 29:09
  can be better advocates for themselves.
• 29:12
  And you know, I think this is really important because a lot
• 29:15
  of my work is reaching women and letting them choose.
• 29:18
  So what? What are your 3 tips for being
• 29:20
  better advocates for your health?
• 29:22
  Well, the first is humility, both on your part and on the
• 29:28
  part of the physician, because you're not going to go into a
• 29:33
  store and buy this off the shelf.
• 29:36
  You've got to work with the physician.
• 29:38
  So humility is appropriate, but humility is not shyness it you
• 29:45
  must be educated, which is why we wrote Estrogen Matters.
• 29:49
  Carol Tavras and I wrote the book so that women can have up
• 29:55
  to date information, as can the men who care for them, as can
• 29:59
  physicians. We wrote the book the way we
• 30:02
  write papers, clinical papers. Everything we say in the book is
• 30:07
  extensively referenced so that you can say to the physician,
• 30:13
  well, what about this? This isn't just some crazy
• 30:16
  doctor in Southern California. This is referenced work that
• 30:20
  comes from academic institutions around the world, and I need you
• 30:24
  to look at this and work with me.
• 30:27
  That's one part of it. The second part of it is
• 30:31
  certainly in the United States, we live in a litigious society
• 30:36
  and nobody wants to be sued. And if a doctor is going to give
• 30:41
  a breast cancer survivor of estrogen, regardless of whether
• 30:47
  it was an estrogen receptor positive or estrogen receptor
• 30:50
  negative tumor, some women are going to recur because stuff
• 30:55
  happens. And to avoid suit, the physician
• 31:00
  can be offered by the patient an informed consent form which we
• 31:05
  have put up online on our Instagram site in which I can
• 31:09
  send you if you want, so that the patient can say, look,
• 31:14
  doctor, I understand the fear of being sued and I am willing to
• 31:19
  sign an informed consent form saying you spoke to me about
• 31:24
  this and we will share responsibility.
• 31:27
  And I will assume that risk, which based on everything I know
• 31:33
  is minimal if if present at all. So that's number two.
• 31:42
  And the third is we said that women rule by consensus.
• 31:47
  Well, fortunately there is a consensus that you have helped
• 31:51
  generate now of women around the world that says when we work
• 31:57
  together, we are stronger and and so those are my three
• 32:03
  suggestions for how to deal with this in the.
• 32:06
  Future. That's lovely, but we do allow a
• 32:07
  few men and we work closely and stronger together, Reverend, so
• 32:11
  you are very much included in what we're doing.
• 32:14
  I'm an honorary member of the Menopassing Which?
• 32:18
  Is very powerful it's lovely to have others that we support
• 32:23
  because that's what's needed to make a difference so yes, thank
• 32:26
  you so much it's been. Brilliant.
• 32:27
  It's always a pleasure, Louise.