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Expert resigns over HRT warning http://news.bbc.co.uk/1/hi/health/3290979.stm Jonathan On Thursday, Dec 4, 2003, at 19:21 Europe/London, William D Fraser wrote: > The recent stampede against HRT seems to have swept across the UK > following > the strongly negative reaction from the USA. The RCP statement and now > the > CMO statement have a consistent message that short term use of HRT is > acceptable for symptom relief but in the long term HRT is to be > avoided. > This is unfortunate for those women who may benefit from long term > treatment with HRT and ignores all the data supplied (or not supplied) > in > the WHI and Million Women studies. It should be noted that the > oestrogen > only limb of the WHI study (a randomised placebo controlled study) is > still > progressing and the independent review board did not ask for this > limb of > the study to be stopped. The CMO recommendation on oestrogen alone > therapy > is presumably based on the Million Women study which is not randomised > placebo controlled. > The average age of entry into the WHI study was well in to the sixties > but > this was not a study looking at patients with proven osteoporosis. The > significant reduction in hip and vertebral fractures is therefore of > greater significance than may at first be appreciated from a glance at > the > WHI study. Use of HRT in a high risk group with reduced bone mass may > result in greater benefits. The current licensed osteoporosis > treatments > were all tested using patients with proven fracture and significant > reductions in bone mass (a high risk group) which may have helped them > obtain a beneficial outcome. It is interesting that in one study where > the > BMD measurements were re-aligned following the study according to > NHANES > data there was no significant difference in fracture efficacy between > the > bisphosphonate (alendronate)and Ca+vit D in patients with osteopenia > on BMD > (a large group in the WHI study). > I can fully appreciate the concerns that the recent studies have raised > regarding thrombotic events, myocardial infarction and breast cancer > but > the outright condemnation of all forms of long term HRT seems > misplaced. > The MI and vascular events in WHI were mainly in the early years of the > study suggesting a subset of women exist who are sensitive to these > effects, overall mortality was not significantly different between the > two > groups so does HRT actually have a cardiovascular benefit in a subset > of > women? > There is a lot more that could be discussed and although I was never a > major advocate for HRT I am surprised by the current reaction. The > recent > data should have helped to promote a better understanding about HRT and > define those who would benefit from such treatment and those who should > avoid this treatment. Alas I very much doubt if Ethics Committees will > be > prepared to condone any future research into the value of HRT. > > Bill Fraser > > --On 04 December 2003 15:23 +0000 "Iversen, Andrew (Dr.)" > <[log in to unmask]> wrote: > >> Is everyone convinced that HRT is such a bad thing? Admittedly the >> short-term prothrombotic effect in patients with CHD is adverse, but >> the >> curves in HERS do tend to converge after a few years. Gallstones are >> a >> nuisance. The million women study was not randomised and I'd be >> surprised >> if HRT can cause cancer so quickly (i.e. was it there before in a >> denser >> breast). The lipid results are still appealing, and the QALY score >> for >> some (non-CHD) patients might be quite good. Are the alternatives for >> osteoporosis as palatable and effective? Or are we now against HRT? >> >> Andrew >> -----Original Message----- >> From: Mainwaring-Burton Richard (RGZ) >> [mailto:[log in to unmask]] >> Sent: 04 December 2003 11:17 >> To: [log in to unmask] >> Subject: Re: CMO Advice on HRT in the over 50s with osteoporosis >> >> It is a bit like the reccomendation "Employ a teenager NOW while he >> still >> knows everything" >> >> with best wishes >> >> Richard >> >> Richard Mainwaring-Burton >> Consultant Biochemist >> Queen Mary's Hospital >> Sidcup, Kent >> DA14 6LT >> 020-8308-3084 >> >> >> -----Original Message----- >> From: ablumsohn [mailto:[log in to unmask]] >> Sent: 04 December 2003 08:27 >> To: [log in to unmask] >> Subject: Re: CMO Advice on HRT in the over 50s with osteoporosis >> >> >> As they say: >> >> "Use a new drug while it's still effective" >> >> Aubrey >> >> >> GMA> This document became available at 15:00 >> GMA> today relating to the use of HRT in women over 50 >> GMA> years old. >> >> GMA> Malcolm Gray >> >> ------ACB discussion List Information-------- >> This is an open discussion list for the academic and clinical >> community working in clinical biochemistry. >> Please note, archived messages are public and can be viewed >> via the internet. 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Views expressed are those of the individual and >> they are responsible for all message content. >> >> ACB Web Site >> http://www.acb.org.uk >> List Archives >> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html >> List Instructions (How to leave etc.) >> http://www.jiscmail.ac.uk/ >> >> >> This message and any attachments to it is intended only for the >> individual >> or company to which it is addressed and may contain information which >> is >> privileged, confidential or prohibited from disclosure or unauthorised >> use. If the recipient of this transmission is not the intended >> recipient, or the employee or agent responsible for delivering such >> materials to the intended recipient, you are hereby notified that any >> use, any form of reproduction, dissemination, copying, disclosure, >> modification, distribution and/or publication of this e-mail message >> or >> its attachments other than by its intended recipient is strictly >> prohibited by the sender. If you have received it in error, please >> notify >> us immediately using the address [log in to unmask] and destroy >> the >> message and all copies in your possession >> >> ------ACB discussion List Information-------- >> This is an open discussion list for the academic and clinical >> community working in clinical biochemistry. >> Please note, archived messages are public and can be viewed >> via the internet. Views expressed are those of the individual and >> they are responsible for all message content. >> >> ACB Web Site >> http://www.acb.org.uk >> List Archives >> http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html >> List Instructions (How to leave etc.) >> http://www.jiscmail.ac.uk/ > > > > Professor W D Fraser > Department of Clinical Chemistry > The University of Liverpool > 4th Floor, Duncan Building > Daulby Street > Liverpool > L69 3GA > > Tel: 0151 706 4247/4257 > Fax: 0151 706 5813 > > ------ACB discussion List Information-------- > This is an open discussion list for the academic and clinical > community working in clinical biochemistry. > Please note, archived messages are public and can be viewed > via the internet. Views expressed are those of the individual and > they are responsible for all message content. > > ACB Web Site > http://www.acb.org.uk > List Archives > http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html > List Instructions (How to leave etc.) > http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/