The Deconstruction of the Hormone Replacement Therapy Myth Continues

Regular readers of this column are fully informed about the dramatic research findings of the past year relating to hormone replacement therapy (HRT).  Far from being the miracle rejuvenator promised, for decades, by drug manufacturers, prolonged use of HRT following menopause has now actually been shown to increase the risk of heart disease and stroke, as well as the risk of several cancers.  In the latest update from the huge Women’s Health Initiative (WHI) study, as reported in the current issue of the New England Journal of Medicine, 8,506 postmenopausal women were randomized to receive estrogen and progesterone pills for their menopausal symptoms.  An additional 8,102 women in the study received only placebo (sugar) pills.  Quality-of-life (QOL) factors were then assessed at the beginning of the study, as well as one year and three years later.  QOL parameters assessed included the patients’ sense of their overall general health, vitality, mental health, depressive symptoms, and sexual satisfaction.  Bottom line: none of these parameters were significantly different between the two groups of women in this study.  A small improvement in flushing and hot flashes was noted among women 50 to 54 years of age with particularly severe symptoms of menopause, but this finding was not clinically significant between the two groups of women. 

I strongly believe that the pendulum is swinging away from the ubiquitous use of HRT in postmenopausal women.  In a forthcoming book, I have laid out the conflict between the claims of drug manufacturers (and their physician patrons), on the one hand, and the growing evidence of the potential harm caused by HRT (and the minimal beneficial effects) on the other hand.

Vaccinations & Multiple Sclerosis

There has been much controversy regarding the potential risks associated with routine vaccinations against communicable diseases.  Some people have previously ascribed an increased risk of multiple sclerosis (MS) in patients who received multiple vaccinations during childhood, although this has not been substantiated by any major research studies.  Still, anecdotal reports of the occurrence of MS following vaccinations, or the exacerbation of preexisting MS after vaccinations, have been published.  In the current issue of the Archives of Neurology, 440 patients with known MS (or a related demyelinating disease, optic neuritis) and 950 control subjects without demyelinating diseases were evaluated.  The vaccination histories for all study participants were carefully obtained and analyzed, as well as their health history at less than one year, one-to-five years, and greater than five years after vaccinations.

Following statistical analysis of the results, the risks of developing MS following vaccination against hepatitis B, influenza, tetanus, measles, or rubella were assessed.  This study determined that there was no statistically significant increase in the development of MS, or optic neuritis, within five years following vaccination against any of these five diseases.

Emergency treatment of Bleeding Esophageal Varices

Patients with chronic liver disease, and cirrhosis in particular, are at increased risk of bleeding from enlarged veins in the esophagus and stomach.  These varicose veins, called varices, arise because of increased resistance to blood flow through damaged livers.  When these varices rupture and bleed, death may occur in close to 30% of cases.  Those patients who survive their first hemorrhage have a very high subsequent risk of rebleeding and death.  Traditionally, bleeding varices have been treated with either intravenous drugs, or with drugs injected directly into the bleeding veins (sclerotherapy).  Sclerotherapy involves the use of a video endoscope that is inserted into the mouth and passed down the esophagus, and has been the mainstay of initial therapy for bleeding varices.  When the bleeding varices are identified with the scope, they are then injected with various drugs that cause constriction of the dilated veins, causing them to clot off.  Various intravenous drugs have also been utilized to treat bleeding varices, either alone or in conjunction with sclerotherapy.  These intravenous drugs act in different ways to stop the bleeding, but they all generally act to reduce the flow of blood into the abnormally dilated and bleeding veins. 

In the current issue of the journal Gastroenterology, 15 prior studies of sclerotherapy and intravenous drug therapy for bleeding varices were analyzed and compared.  The study determined that sclerotherapy was associated with significantly more complications than the intravenous drugs, and was no more effective than the intravenous drugs in halting hemorrhage.  Indeed, the intravenous drugs were able to control hemorrhage in 83% of patients.  Therefore, the authors concluded that sclerotherapy should no longer be used as the initial therapy in patients with acute esophageal variceal bleeding.  The so-called vasoactive intravenous drugs are at least as effective as sclerotherapy, but are associated with far fewer complications

Dr. Robert A. Wascher