#42 – Avrum Bluming, M.D. and Carol Tavris, Ph.D.: Controversial topic affecting all women—the role of hormone replacement therapy through menopause and beyond—the compelling case for long-term HRT and dispelling the myth that it causes breast cancer

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 protected]

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We discuss:

• 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
• More.

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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)

However…

• 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…