In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC, and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women’s Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease and neurodegenerative disease, and osteoporosis, to name a few.
Do you have questions about this controversial topic? Dr. Bluming has graciously offered his email to take questions directly from fans of the podcast: email@example.com
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- The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45];
- The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00];
- What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15];
- Mistreatment of women leading to great skepticism [23:45];
- Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00];
- Case studies of women suffering symptoms of menopause [30:00];
- What are Carol and Avrum’s true motivations in this endeavor? [32:45];
- The changing perceptions of HRT, the impact of the Women’s Health Initiative (WHI), and the problems with the WHI [37:45];
- Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00];
- Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15];
- The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00];
- The Women’s Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45];
- Brain benefits of HRT, Alzheimer’s disease in women, and estrogen as a preventative treatment for AD [1:22:45];
- The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45];
- The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15];
- Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15];
- Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30];
- The downsides of hormone replacement therapy (HRT) [1:41:30];
- How to approach your doctor who may already have a very strong point of view about HRT [1:42:15];
- What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30];
- Cancer: Our evolving understanding and the future of treatment [1:59:15];
- Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00];
- Are there racial differences in benefits and risks with HRT? [2:04:15];
- The reactions to Estrogen Matters, and why it is a must read [2:09:15];
- HRT after a diagnosis of breast cancer [2:13:45]; and
The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45]
Figure 1. Cover of Estrogen Matters. Image credit: amazon.com
Dr. Carol Tavris, social psychologist
What’s a social psychologist writing about estrogen for?
- My lifelong interest has been in bringing good scientific research in psychology and medicine to public attention
- As a social psychologist, I have always been interested in the barriers to critical thinking and the reasons that people do not accept information when it is in their best interest to do so
- These interests culminated in her book, Mistakes Were Made (But Not by Me)
- This book was about “why it is that people resist new information that is better to know, that it’s beneficial, that improves our knowledge”
- This book is one of Peter’s all time favorites, “one of the three books I have recommended and/or gifted the most”
Dr. Avrum Bluming, medical oncologist
Why in particular has this issue become something that’s resonated with you?
- I’ve spent over 50 years as a medical oncologist and my reason for going into the field was to help people live as long and as well as possible and helping to decide how best they should be treated
- Breast cancer constitutes about 60% of my practice and I’ve watched the progress in breast cancer very happily noting how many people we now cure (about 90% of the cases are now curable)
- While I was making a lot of people better in terms of the cancer, I was making them worse in terms of the symptoms associated with the treatments they got. When you treat something for that long, you want to understand what it is so that you can treat it most effectively.
- It is important that I challenge every assumption on which my practice was based and I’ve done that continuously.
“The major assumption dealing with breast cancer is that estrogen causes breast cancer, and it doesn’t. Almost everything we’ve done in the treatment of breast cancer is based on that assumption so that women have been denied estrogen for at least the last 30 years. . . and the result is that many women have been hurt by being denied that medicine.”
The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00]
Carol and Avrum’s 2009 paper, Hormone Replacement Therapy: Real Concerns and False Alarms, has a beautiful time course of hormone replacement therapy in women:
Figure 2. HRT and Breast Cancer: A timeline of relevant events and studies. Image credit: (Bluming and Tavris, 2009)
Men vs. Women: Comparing the early history of hormone replacement therapy (HRT)
Using the example of how we treated prostate cancer in men with breast cancer in women…
Carol Tavris, Ph.D. & Avrum Bluming, M.D.
Carol Tavris, Ph.D.
Carol Tavris received her Ph.D. in social psychology from the University of Michigan. Her books include Mistakes Were Made (But Not by Me), with Elliot Aronson; Anger: The Misunderstood Emotion, and The Mismeasure of Woman. She has written articles, op-eds, and book reviews on topics in psychological science for a wide array of publications — including the Los Angeles Times, the New York Times Book Review, the Wall Street Journal, and the TLS — and a column, “The Gadfly,” for Skeptic magazine. She is a fellow of the Association for Psychological Science and has received numerous awards for her efforts to promote gender equality, science, and skepticism.
Avrum Bluming, M.D.
Avrum Bluming received his M.D. from the Columbia College of Physicians and Surgeons. He spent four years as a senior investigator for the National Cancer Institute and for two of those years was director of the Lymphoma Treatment Center in Kampala, Uganda. He organized the first study of lumpectomy for the treatment of breast cancer in Southern California in 1978, and for more than two decades he has been studying the benefits and risks of hormone replacement therapy administered to women with a history of breast cancer. Dr. Bluming has served as a clinical professor of medicine at USC and has been an invited speaker at the Royal College of Physicians in London and the Pasteur Institute in Paris. He was elected to mastership in the American College of Physicians, an honor accorded to only five hundred of the over one hundred thousand board-certified internists in this country.
Dr. Bluming has graciously offered his email to take direct questions from anyone who is interested in this topic: firstname.lastname@example.org
Facebook: Estrogen Matters
Just listened to #42 podcast with my husband who is a subscriber. I am out 12 years from breast cancer treatment for early diagnosed Stage 2. I am 65 and feeling the effects of no estrogen after chemo, radiation and 5 years of hormone therapy. I live in central Washington State and wonder if you have any referrals for doctors in the Seattle area or Central Washington who would e open to the discussion about HRT. The podcast is very informative and also upsetting for me after years of thinking I was on the right track and putting up with the consequences. Thank you for your help with this!
Estrogen Matters is excellent. I’m 3/4ths the way through. And this podcast is filled with information all mature women need to hear. Memories of my mother crying because she could not sleep – still haunt me. She defiantly got the Estrogen patch at age 82 and stayed with it untill her death at 86. I was placed on Estrogen 7 days ago. At almost 67, I have dealt with interrupted sleep patterns for 20 years. – I’ve had it. My new gynocologist said I was an excellent canidate- cervix gone but I still have my ovaries. I pray that I do well this first year, so I can take E forever.
author of Your Body is a Gift – FYI guidebook for tween & teen girls
I am so relieved I found this program. I am almost 43 and have lived perimenopause hell for the past nine months. It has taken the form of vicious mood swings; depression to the point of sudden and unexplainable suicidal impulses; weight gain (despite sometimes exercising actively for four hours per day, and walking 4-6 miles per day); crippling anxiety; mind fog; forgetfulness; acne. All at once, and all of a sudden. If not for changes in my lifelong and perfect 28-day cycle, I would have probably thought I had schizophrenia. Everyone told me to focus on a “healthy lifestyle,” but I already eat well; cut out alcohol completely; and am self-employed in a low-stress professional situation (no job to quit, but I appreciate that recommendation having made it into your show).
Today, a new NP not only believed me, but prescribed an estradiol patch and progesterone, and I was terrified to use them. Even as a PhD myself, the 2002 study was the last I’d heard. Fortunately, my husband read a December 2019 piece in The Economist about HRT, and through it I found this program. Now, thanks to the information density of this program, I have hope again, and my terror is gone. I put Estrogen Matters on hold at the library while listening. Eternal gratitude, and thank you for including stories on women in their early 40s. The ongoing statistical mastery and depth throughout the program was marvelous to hear.
I am post-hysterectomy, ovarectomy at age 39. I am now 62. I took Premarin for about 20 years, happily, until I had three Retinal Vein Occlusions. My doctors could find no reason for these, except perhaps the estrogen. So, like those who get a Deep Vein Thrombosis from hormones, I was told to go off estrogen. I did. I do NOT want to have any more RVOs. My question: Is there any way someone such as me can take any OTHER form of estrogen and not be subjected to increased RVO risk?
Thank you for this episode Dr Attia!
From London, England
Thank you so much for this podcast interview. I actually cried listening to this episode. You dispelled so many untruths that literally ruining the health of women and pointed out the lack of care women get because doctors refuse to update the research that informs their medical practice. It is really unfathomable how outdated women’s hormone care truly is. Thank you for getting this information out so we can take back the power of our health and not be lead by false information. Thank you, thank you, thank you.