Talk:Bioidentical hormone replacement therapy/Archive 3
 | This is an archive of past discussions about Bioidentical hormone replacement therapy. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
| Archive 1 | Archive 2 | Archive 3 | Archive 4 | Archive 5 | → | Archive 7 |
European Specialists
Recent article: Maturitas. 2009 Oct 15. [Epub ahead of print] Use of dydrogesterone in hormone replacement therapy. Mueck AO, Seeger H, Bühling KJ. University Women's Hospital of Tuebingen, Germany. According to the Women's Health Initiative study, the most important risks during combined hormone replacement therapy (HRT) are breast cancer, stroke and venous thromboembolism. To date, combinations of estradiol with natural progesterone or its retroisomer dydrogesterone are the only combined HRT regimens for which large case-control or cohort studies show no increase in any of these three risks... PMID 19836909
Estradiol and progesterone are the bioidentical hormones, right? Even if the author doesn't say "bioidentical"? If top European experts can make this statement in a top peer-reviewed journal, then shouldn't we modify our view of the "mainstream" opinion? Shouldn't women be informed in this Wikipedia article on bioidentical hormones that many top experts believe that all "hormone" regimens are not alike, and that bioidenticals are safer? Why is WLU suppressing all mention of, and studies documenting, the greater safety of transdermal estradiol regarding thromboembolism and stroke and the greater safety of progesterone regarding breast cancer? Shouldn't this information be included in this article? Why not? 74.47.116.22 (talk) 22:17, 31 October 2009 (UTC)Hillinpa
- Because I'm evil. Actually, in this case I wouldn't cite this study because of WP:OR and because of WP:SOAP. These studies and compounds aren't treated as a class of "bioidentical hormones", they're treated as separate molecular compounds with no special properties merely because they are identical to endogenous molecules. I've said this before. WLU (t) (c) Wikipedia's rules:simple/complex 21:23, 2 November 2009 (UTC)
- Evil? Well certainly ignorant and unable to distinguish drug-industry propaganda from science. The article as it stands is chock full of contradictions, falsehoods, and misleading statements. But no one should try to help you improve it as long as you maintain your anti-bioidentical bias. Let people read it and know that it is just a hachet job that doesn't represent anything close to a reasoned scientific opinion. Let them know that Wikipedia is just another mouthpiece for establishment propaganda.
Do try and think responsibly for a moment: If you were a woman facing the loss of your quality of life and your health due to the loss of estradiol and progesterone, would you want to replace the missing hormones with identical molecules (original parts) or with any FDA-approved alien molecules? Would you want to use the molecules--whether commercially-made or compounded--that were perfected by eons of evolutionary selection, or those invented by a drug company to get a patent and profits? Would you want to use the correct molecules that produce all the benefits of the originals and have never been proven to be harmful, or would you want patented alien molecules that have been proven to be dangerous? Would you want to take estradiol in a gel, cream or patch knowing that it won't increase your risk of blood clots? Or would you want oral Premarin or ethinyl estradiol that are known to increase your risk of clots and stroke? Would you want to use progesterone which has been shown in large studies to NOT increase the risk of breast cancer, or would you want to use Provera that has been shown to definitely increase the risk of breast cancer? It's really that simple, it's just commonsense, and the evidence is there in spades too.Hillinpa (talk) 14:22, 8 November 2009 (UTC)- See WP:MEDICAL - we don't give advice. See WP:SOAP - we don't advocate for specific ideas. See WP:FRINGE and WP:REDFLAG - claiming there's a conspiracy that is keeping knowledge from being freely shared is a reason to mistrust both the source and the idea. My step mother is currently going through menopause. If she asked, I would recommend she talk to her doctor, who I would hope would use the best and most scientifically proven evidence available to decide her course of treatment. Not throw some magic pixie dust at the problem and claim everything is better. Those "perfect molecules" crafted by evolution are in many cases more likely to promote tumours; evolution doesn't seek "perfection" - evolution seeks to reproduce genes. Just because something is natural doesn't make it good. Dying in child birth is very, very natural. Fortunately science uses evidence to demonstrate when "common sense" is actually harming people. When bioidenticals have been researched and proven to be more effective, then I'll happily edit the page in that direction. WLU (t) (c) Wikipedia's rules:simple/complex 10:56, 20 November 2009 (UTC)
- Oh you must be right, no sane person would believe that any interested parties, least of all multinational corporations, would ever attempt to manipulate the free flow of high quality information--about anything! Wow, you must be extremely naive. I do agree that "Natural" doesn't automatically mean "better", but on the other hand, molecules that belong in the human body should be considered "better" than any altered molecules until proven otherwise. That's just physiological common sense. Would you like important molecules to be removed from your body and replaced with randomly altered substitutes? Hillinpa (talk) 18:22, 22 November 2009 (UTC)
- Pharmanoia, the belief that drug companies are evil while the honest, hard-working individuals selling unproven bioidenticals can be trusted. It's a fallacy and unconvincing, and it's insane to believe that there is no conflict of interest from T. S. Wiley, Dr. Erika or others who promote bioidenticals and make a profit from their prominence. Incidentally, the non-bioidentical molecules used are in some cases used because their effects are known (and therefore not "random"). The less-specific effects are desired because it allows for modulation of effects as the mismatch between hormone and receptor can lead to attenuated effects in humans. As in, why use a powerful human estrogen when a porcine or equine one can provide the same benefits at a reduced level, just enough to reduce or eliminate vasomotor symptoms without causing endometrial hyperplasia? That seems like a more nuanced understanding that places emphasis on safety and known risk/benfit ratios rather than an a priori assumption that what's good for a 20-year-old is good for a 60-year-old. But none of this matters - no sources means no changes. Please, please, please review WP:OR - we can't adjust pages based on what we think is true. WLU (t) (c) Wikipedia's rules:simple/complex 18:00, 23 November 2009 (UTC)
- You attribute an opinion to me that I did not express and do not hold. I said that all interested parties should be expected to be biased, I did not exclude bioidentical hormone advocates. You show once again that you're interested scoring cheap points, not in getting to the truth. I allow that it is possible that some non-bioidenticals could someday be devised that would provide all the benefits and no risks, but if you knew the complexities of the biochemistry you would understand how unlikely this is. Furthermore the evidence so far is quite the opposite: Oral Premarin and ethinyl estradiol increase risks of clots, strokes and heart attack, transdermal estradiol does not. (primary studies and reviews already provided). Many or most non-bioidentical progestins increase the risk of breast cancer, bioidentical progesterone does not (see below). So far, in scientific studies, the non-bioidenticals we actually have have been proven dangerous, the bioidenticals have not. Funny how your article seems to completely evade this simple fact! Hillinpa (talk) 13:24, 24 November 2009 (UTC)
- Pharmanoia, the belief that drug companies are evil while the honest, hard-working individuals selling unproven bioidenticals can be trusted. It's a fallacy and unconvincing, and it's insane to believe that there is no conflict of interest from T. S. Wiley, Dr. Erika or others who promote bioidenticals and make a profit from their prominence. Incidentally, the non-bioidentical molecules used are in some cases used because their effects are known (and therefore not "random"). The less-specific effects are desired because it allows for modulation of effects as the mismatch between hormone and receptor can lead to attenuated effects in humans. As in, why use a powerful human estrogen when a porcine or equine one can provide the same benefits at a reduced level, just enough to reduce or eliminate vasomotor symptoms without causing endometrial hyperplasia? That seems like a more nuanced understanding that places emphasis on safety and known risk/benfit ratios rather than an a priori assumption that what's good for a 20-year-old is good for a 60-year-old. But none of this matters - no sources means no changes. Please, please, please review WP:OR - we can't adjust pages based on what we think is true. WLU (t) (c) Wikipedia's rules:simple/complex 18:00, 23 November 2009 (UTC)
- Oh you must be right, no sane person would believe that any interested parties, least of all multinational corporations, would ever attempt to manipulate the free flow of high quality information--about anything! Wow, you must be extremely naive. I do agree that "Natural" doesn't automatically mean "better", but on the other hand, molecules that belong in the human body should be considered "better" than any altered molecules until proven otherwise. That's just physiological common sense. Would you like important molecules to be removed from your body and replaced with randomly altered substitutes? Hillinpa (talk) 18:22, 22 November 2009 (UTC)
- See WP:MEDICAL - we don't give advice. See WP:SOAP - we don't advocate for specific ideas. See WP:FRINGE and WP:REDFLAG - claiming there's a conspiracy that is keeping knowledge from being freely shared is a reason to mistrust both the source and the idea. My step mother is currently going through menopause. If she asked, I would recommend she talk to her doctor, who I would hope would use the best and most scientifically proven evidence available to decide her course of treatment. Not throw some magic pixie dust at the problem and claim everything is better. Those "perfect molecules" crafted by evolution are in many cases more likely to promote tumours; evolution doesn't seek "perfection" - evolution seeks to reproduce genes. Just because something is natural doesn't make it good. Dying in child birth is very, very natural. Fortunately science uses evidence to demonstrate when "common sense" is actually harming people. When bioidenticals have been researched and proven to be more effective, then I'll happily edit the page in that direction. WLU (t) (c) Wikipedia's rules:simple/complex 10:56, 20 November 2009 (UTC)
- Evil? Well certainly ignorant and unable to distinguish drug-industry propaganda from science. The article as it stands is chock full of contradictions, falsehoods, and misleading statements. But no one should try to help you improve it as long as you maintain your anti-bioidentical bias. Let people read it and know that it is just a hachet job that doesn't represent anything close to a reasoned scientific opinion. Let them know that Wikipedia is just another mouthpiece for establishment propaganda.
Undent. That all sounds like excellent information to be added to the premarin, estradiol andprogestin pages. Again, there is a difference between "a hormone that happens to be bioidentical" (which should be dealt with on that particular pages) and "bioidentical hormones" (which should be dealt with here, using sources that explicitly discuss bioidentical hormones as a class). If you believe bioidentical hormones are unfairly maligned, then you should being a research protocol addressing them as a class, publish your results in a scientific journal, then raise the results here for integration into the page. I've explained the issues on original research, medical sources, neutrality and expressing the views of relevant majorities before. If you haven't yet read those documents, please do so. It will save both of us a lot of typing. WLU (t) (c) Wikipedia's rules:simple/complex 14:07, 24 November 2009 (UTC)
Quoting Boothby on Progesterone and Breast Cancer
You speak of evidence. Let us take one of the Boothby 2008 opinions you have chosen to highlight in the article:
"Claim |'Normal' levels of progesterone maintained with BHRT protects against breast cancer |False |The claim is based on a single study of infertile patients; there is some evidence to support a link between hormonal treatment for infertility and a reduced risk of breast cancer, but these benefits are not expected to translate to women seeking relief from the symptoms of menopause|"
Against Boothby's opinion, see this large study that clearly related inadequate progesterone production in pre-menopausal women with a higher risk of breast cancer:
Micheli A, Muti P, Secreto G, Krogh V, Meneghini E, Venturelli E, Sieri S, Pala V, Berrino F. Endogenous sex hormones and subsequent breast cancer in premenopausal women. Int J Cancer. 2004 Nov 1;112(2):312-8.
Because of large intra-individual variation in hormone levels, few studies have investigated the relation of serum sex hormones to breast cancer (BC) in premenopausal women. We prospectively studied this relation, adjusting for timing of blood sampling within menstrual cycle. Premenopausal women (5,963), recruited to the Hormones and Diet in the Etiology of Breast Tumors (ORDET) cohort study, provided a blood sample in the 20-24th day of their menstrual cycle. After 5.2 years of follow-up, ....Progesterone was inversely associated with adjusted RR for highest vs. lowest tertile of 0.40 (95% CI = 0.15-1.08, p for trend = 0.077), significantly so in women with regular menses, where adjusted RR was 0.12 (95% CI = 0.03-0.52, p for trend = 0.005). These findings support the hypothesis that ovarian hyperandrogenism associated with luteal insufficiency increases the risk of BC in premenopausal women. (in plain English, women with regular menses and the highest mid-luteal progesterone levels had 1/8th the risk of breast cancer compared to those with low progesterone levels.)
Now have a look at the only large-scale study directly comparing the risk of breast cancer in women taking estradiol with progesterone vs taking estradiol with progestins:
Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat. 2008 Jan;107(1):103-11.
Large numbers of hormone replacement therapies (HRTs) are available for the treatment of menopausal symptoms. It is still unclear whether some are more deleterious than others regarding breast cancer risk. The goal of this study was to assess and compare the association between different HRTs and breast cancer risk, using data from the French E3N cohort study. Invasive breast cancer cases were identified through biennial self-administered questionnaires completed from 1990 to 2002. During follow-up (mean duration 8.1 postmenopausal years), 2,354 cases of invasive breast cancer occurred among 80,377 postmenopausal women. Compared with HRT never-use, use of estrogen alone was associated with a significant 1.29-fold increased risk (95% confidence interval 1.02-1.65). The association of estrogen-progestagen combinations with breast cancer risk varied significantly according to the type of progestagen: the relative risk (for breast cancer) was 1.00 (0.83-1.22) for estrogen-progesterone, 1.16 (0.94-1.43) for estrogen-dydrogesterone, and 1.69 (1.50-1.91) for estrogen combined with other progestagens. This latter category involves progestins with different physiologic activities (androgenic, nonandrogenic, antiandrogenic), but their associations with breast cancer risk did not differ significantly from one another. This study found no evidence of an association with risk according to the route of estrogen administration (oral or transdermal/percutaneous). These findings suggest that the choice of the progestagen component in combined HRT is of importance regarding breast cancer risk; it could be preferable to use progesterone or dydrogesterone.
See graphical representations of the results of both studies on page 19 and 20 at [1] Given this evidence, one must say that it is not only possible, but probable that sufficient progesterone is naturally protective against breast cancer, and that progesterone replacement is safer in regard to breast cancer risk than progestin use. Am I not correct? (Of course one would like to look at all the relevant evidence, and there's lots more supporting this position.) Given the evidence cited above, we can say that Boothby's opinion is at least misinformed, and that any doctor or institution that claims that there is no evidence that breast cancer risk differs between progesterone and any progestins is simply wrong, no matter how "mainstream" they are! Do you agree? Will you now alter YOUR article accordingly? Hillinpa (talk) 18:22, 22 November 2009 (UTC)
- Hillenpa - Good luck with your arguments. WLU does not seem to distinguish between progestins and progesterone, since he has used the terms interchangeably while "re-phrasing" data from his sources. And of course, he does not acknowledge that the term bio-identical hormone therapy can significantly be applied to any but compounded hormones, even though Cirigliano clearly thinks differently. I think it is Fugh-Berman that references the study you are writing about, but WLU can't seem to find it mentioned anywhere, most likely because he's not looking.
- Meanwhile, the FDA and others are now distancing themselves from use of the term hormone replacement therapy by using the term menopausal hormone therapy, probably to open up the space between Conventional HRT and Compounded HRT.
- Though, I will suggest to you, hoping that you will take it as well intentioned, that it is not productive to blame the repression of information on establishment propaganda. In this case, the repression of information can clearly be traced to WLU. Plenty of information is out there, most people will react as I did when I first saw this article and immediately realize how biased it is. My first reaction was to place a POV tag on it, as the article is so blatantly biased as to render it nearly harmless. Riverpa (talk) 19:39, 22 November 2009 (UTC)
- Hillinpa - see WP:OR, WP:SYNTH, WP:MEDRS and WP:MEDMOS. You can not "debunk" secondary sources with primary studies. If you think you have a claim to expertise and can therefore better interpret the literature than Boothby, may I suggest Citizendium as an appropriate on-line venue. Here it is verifiability, not truth while Citizendium has more flexibility in this regard. If I've misrepresented Boothby, then we can talk but otherwise this discussion is a waste of time.
- Riverpa - I don't distinguish between progestins and progesterone unless the sources do. If I'm doing so incorrectly and the source is clear on this, please feel free to correct or let me know with a quote from the appropriate section. I, just like both of you, shouldn't be distinguishing between concepts unless the sources do. Also consider the FDA may be changing terminology because hormone replacement therapy can refer to the treatment many types of HRT, not just menopause. It can be used with male-to-female and vv. transexuals, to treat individuals whose sex organs have been removed, and myriad other reasons. I doubt it's because of bioidenticals, which pretty clearly are not seen as miracle cures that are expected to sweep and revolutionize the fields. And as a general comment, my evil ways aside the literature doesn't support BHRT, at least not without a lot of qualification and original research from editors. WLU (t) (c) Wikipedia's rules:simple/complex 17:53, 23 November 2009 (UTC)
- WLU -- You have made it abundantly clear that you intend to maintain the anti-bioidentical bias of the "establishment" no matter how much common sense, evidence, and expert reviews contradict it. You highlight the silly, proven-false opinion of a pharmacist--Boothby--about progesterone and breast cancer, yet ignore a thorough review of the evidence concerning progesterone, progestins, and breast cancer by top physician-specialists in the field. [2] The studies I mentioned are highlighted in that review--so they are not "merely" primary studies. The studies and review don't merely debunk the views you highlight in your article, they directly and incontrovertibly disprove them. To claim "there is no evidence" the progesterone differs from progestins or offers relative protection against breast cancer, when in fact there is evidence and also published expert opinion is a what we call a "lie". Show me the Wikipedia policy concerning lying, if you will. If, as you claim, neither an expert review nor the primary sources they quote are admissible in a Wikipedia article, then we have a situation where someone has decided which statements are true or false on the basis of bias alone, with complete disregard for the truth. Riverpa is right. That's not Wikipedia, that is YOU. Hillinpa (talk) 12:20, 24 November 2009 (UTC)
- By the "establishment" I assume you mean the relevant majority of experts as expressed in medically reliable sources? You bet your ass I do. Face it Hillinpa, your views are a minority, that are not accepted by people who publish in the literature. The reality of wikipedia is, we express
onlyprimarily that majority view. If you want to promote bioidenticals, go somewhere else. Read WP:SOAP - you do not get to do it here. Your article doesn't mention bioidentical hormones at all. It places no emphasis on the fact that these molecules may be bioidentical. Therefore, it is a synthesis to use it here. So it shouldn't be here. If it were a situation where there was minimal discussion in the scholarly literature of BHRT, then we could judiciously use some studies to refute specific claims. However, there is voluminous information and publication on BHRT and it is primarily critical. There are numerous expert reviews, all focussed on bioidenticals specifically that discuss the problems and issues with the current perception and use of BHRT. The fact that both you and Riverpa think that you have the truth that is somehow being kept from the great masses by evil doctors and drug companies is apparently keeping you both from reading and understanding our core policies. So please read them and make your arguments based on those policies. Your arguments concerning inappropriate and irrelevant sources are wasting my time. What would not waste your time would be you writing and publishing a series journal article demonstrating the utility of bioidenticals, such that it changes the perception of the medical and research fields regards BHRT. It may take a while, so there's no point wasting your time here. Continuing to ignore the policy-based objections to your edits helps neither you, nor me. WLU (t) (c) Wikipedia's rules:simple/complex 14:14, 24 November 2009 (UTC)- This article starts by defining bioidentical hormones as "molecularly identical to the endogenous hormones". Yet you refuse to include any reviews or studies that bear on the safety of estradiol and progesterone--the "molecularly identical" hormones! You can't reject expert opinion and scientific information regarding estradiol and progesterone just because the authors don't use the word "bioidentical" in the paper! I don't know if there's a Wiki Policy that deals with the problem of bait-and-switch--of saying the article is about one thing, then making it about something else. If not there should be. I will offer some ideas about making this article objective and neutral below. Hillinpa (talk) 13:33, 26 November 2009 (UTC)
- By the "establishment" I assume you mean the relevant majority of experts as expressed in medically reliable sources? You bet your ass I do. Face it Hillinpa, your views are a minority, that are not accepted by people who publish in the literature. The reality of wikipedia is, we express
- WLU -- You have made it abundantly clear that you intend to maintain the anti-bioidentical bias of the "establishment" no matter how much common sense, evidence, and expert reviews contradict it. You highlight the silly, proven-false opinion of a pharmacist--Boothby--about progesterone and breast cancer, yet ignore a thorough review of the evidence concerning progesterone, progestins, and breast cancer by top physician-specialists in the field. [2] The studies I mentioned are highlighted in that review--so they are not "merely" primary studies. The studies and review don't merely debunk the views you highlight in your article, they directly and incontrovertibly disprove them. To claim "there is no evidence" the progesterone differs from progestins or offers relative protection against breast cancer, when in fact there is evidence and also published expert opinion is a what we call a "lie". Show me the Wikipedia policy concerning lying, if you will. If, as you claim, neither an expert review nor the primary sources they quote are admissible in a Wikipedia article, then we have a situation where someone has decided which statements are true or false on the basis of bias alone, with complete disregard for the truth. Riverpa is right. That's not Wikipedia, that is YOU. Hillinpa (talk) 12:20, 24 November 2009 (UTC)
undent Wikipedia does not say "we express only that majority view". Please re-read WP:DUE. You seem to think that it supports you, when in fact, it requires you to accommodate minority views when they are supported by a reliable source, which you will not do. See WP:STEAM. You have never allowed any meaningful discussion toward WP:Consensus to take place, since you are the only arbiter of WP:Truth in this discussion. As I have said before, you use constant WP:WL to support your lack of WP:NPOV.Riverpa (talk) 17:34, 24 November 2009 (UTC)
- Actually you have some valid points there, I've revised my above comments. The page should reflect the minority viewpoint that bioidenticals have some merit while still conveying the idea that most experts are skeptical. I'll try to find time to review Holtorf, Shwartz and Moskowitz and include their views as well in a judicious manner. WLU (t) (c) Wikipedia's rules:simple/complex 18:41, 24 November 2009 (UTC)
- You do not need to make the changes. You do not WP:Own the article, and are not the only editor qualified to make changes. I am sure that someone else can come up with a suitable phrase or sentence, with cite, and place it in a proper location. Riverpa (talk) 19:51, 24 November 2009 (UTC)
In Pursuit of Objectivity and Neutrality
Suggested changes to improve this article:
1. The definition of bioidentical hormones at the beginning of this article--as the "molecularly-identical molecules", estradiol and progesterone--must be strictly observed. The evidence for and against estradiol and progesterone in FDA and internationally-approved pharmaceutical forms vs. the patented drugs (Premarin, ethinyl estradiol, and progestins) must be presented as such.
2. The statement by ACOG, NAMS and Endocrine Society that there is "no evidence" that even FDA-approved estradiol and progesterone products are superior to non-bioidenticals must be countered with statements from published reviews stating that there are significant differences. Review articles about the safety of transdermal estradiol vs orals regarding blood clotting risk, and of progesterone vs. progestins regarding breast cancer risk should be mentioned and linked as this is the primary issue of concern to women. The majority view of the drug-company funded organizations can be given more prominence, but the minority view and counter-evidence must be clearly presented also--perhaps a 2/3rd--1/3rd split in space alloted.
3. The issue of compounding must not be mixed into the debate about estradiol and progesterone vs. patented molecules. All discussion concerning pharmacy compounding of hormones including all statements critical of compounded hormones and other practices of compounding pharmacies, should be confined to a separate section titled "Pharmacy-Compounded Bioidentical Hormone Therapy" or similar. For balance, that section must also contain pro-compounding minority views, justifications, etc. from official sources like the Professional Compounding Centers of America.[3]
4. The same standards must apply to both anti- and pro-bioidentical statements and evidence. Only high-quality reviews or studies, or statements from prominent organizations should be invoked both for and against bioidenticals, non-bioidenticals, and compounded bioidenticals. For example: Boothby's "Claim-Refutation" chart must be removed. The anecdotal report of a few endometrial cancers on bioidentical hormones must be removed. These kinds of low-quality information, similar to hearsay, have no place in the article, on either the pro- or anti- side.
Please offer opinions/arguments concerning these ideas. If we can some to some agreement on principles, then actual cooperative editing can begin. Hillinpa (talk) 13:33, 26 November 2009 (UTC)
- I do believe in relative weight and direction here. Most of the published research literature reviews, etc, are referring to compounded bioidentical hormones, you can't escape that. You can't impose other divisions. I agree, you can't mix the compounding into the debate about bioidenticals, but it does need to be addressed, strongly, as the compounding issue is extremely significant here, and is the most popularly known face of bioidenticals, and is certainly controversial, and mostly negative. If the PCC has peer-reviewed articles, samples or surveys that support their position, fine, but I don't think we can use just the text on their website to support anything.
- Unfortunately there does not seem to be a great deal of evidence that differentiates between FDA approved CEE and BioI, there is some, but very little, as several of the reviews have pointed out. I think that is the point that should be conveyed, that what little evidence there is shows differences, but that not enough research has been done.
- Happy Thanksgiving to all, if you are so inclined to celebrate.Riverpa (talk) 17:21, 26 November 2009 (UTC)
- I replaced the lede, not trying to stir anything up, but trying to get more neutral. The second para could actually go further down in the article, to provide some historical context, as can the sentence about bioidentical being a marketing term (which already appears further down in the article, I think). Countered by the statement by Cirigliano? saying that it is not. Riverpa (talk) 17:42, 26 November 2009 (UTC)
- I think my direction in re-structuring this article might be to put everything that is already there under the paragraph heading Compounded BHRT, remove the extraneous info and clean it up, and add a separate heading to address the FDA approved bioidenticals, and research on mode of use, ie: topical vs oral. Riverpa (talk) 18:09, 26 November 2009 (UTC)
- The more I look at this the more I think that we need to distance the lede from using the term menopause relief, and limit that to the section on FDA approved bioidenticals. Compounded BHRT seems more directed at using hormone therapy for general wellness in addition to menopause relief and should indicate that. Riverpa (talk) 20:25, 26 November 2009 (UTC)
- All edits must be supported explictly by sources. Unless the article is explicit on being about bioidentical hormones, it is a synthesis to use it in this article. All sources must be represented fairly and proportionately. The fact that there are essentially only three "pro" sources, and many, many "anti" sources, means the "anti" sources get more weight, more emphasis, more text and final say.
- Please drop the distinction between "drug company" and "good" sources. It's an alt-med nonsense distinction and one of several issues that makes both of you look more like pro-BHRT boosters than neutral editors. If you can't support your edits on the page without breaking policies and guidelines, it shouldn't be here. The fact that there is so much criticism and skepticism about bioidenticals means the article should be both critical and skeptical.
- None of the majority critical sources say "compounded bioidentical hormones are full of unacknowledged risks and unproven claims, but non-compounded bioidentical hormones are actually wonderful and far more helpful than conventional". So it's therefore inappropriate to continue splitting hairs and portraying it that way. If an article is explicitly critical only of bioidenticals that are compounded but says nothing about uncompounded, it's still original research and not neutral to qualify the comment by "helpfully pointing out" that these criticisms only apply to compounded hormones. At best the sentence could lead with "compounded bioidentical hormones can..." if the article in question is very, very explicit.
- As I've said before, the articles usually define their terms with "bioidentical hormones, which are usually compounded and use salivary testing". In those rare instances when the article only refers to bioidentical hormones sans compounding or just compounded bioidentical hormones, this distinction can be made leading into the text.
- Riverpa - the fact that a comment appears later in the article does not mean it is not repeated in the lead. The lead summarizes the article, including representative and relevant criticisms. Cirigliano doesn't claim that it's not a marketing term, but someone else does - I don't remember who. As for the lead discussing "menopausal relief", that's the goal of HRT for menopause. It is only fringe bioidentical pushers that claim hormones should be titrated to the blood level of a 20 year old rather than just to the point of making lives more comfortable. Further, orthodox practice of HRT for menopause is not meant to be chronic, it's a short-term fix until vasomotor symptoms settle down. The wild and exagerrated claims about bioidenticals have not been proven and are widely regarded as suspect.
- If you are going to significantly restructure the article, may I suggest you do so in your userspace using a subpage to avoid edit wars and allow for suggestions. What sources would this re-write be based on? The three outliers? Would it give equal weight to both sides, despite the fact that the criticisms come from major organizations and professional bodies, as well as appearing in a far greater number of journal articles?
- Also note that I've done a search on pubmed and have requested nine more sources. Based on the titles and abstracts, of the first twenty that show up using the search term "bioidentical", the vast majority are negative and critical. It's for reasons like this that I am reluctant to support qualifiers and explicit statements that dilute the message that bioidentical hormones are seen by the majority of practitioners as unproven, potentially dangerous and certainly not worth the hype. The more I look at this the more I think that we need to maintain such a critical direction, with only small amounts of text dedicated to those minority sources that promote bioidenticals as a panacea. WLU (t) (c) Wikipedia's rules:simple/complex 13:54, 27 November 2009 (UTC)
- You cannot have it both ways. Either BHRT in some ways follows FDA guidelines and is used primarily to relieve menopausal symptoms, or it is a treatment modality primarily outside of FDA guidelines that includes saliva testing and blood levels, and is often used as a lifestyle improvement treatment not just for menopausal symptom relief. Which is it? Symptom relief is a goal for FDA approved orthodox use of HRT, but not so much for the BHRT that you want to make this article about. You can't treat it one way when it suits your bias, and the other way when you want to. You have made it quite clear that this article does not discuss CHRT.
- Please make up your mind and stick to it.
- And re-read my response in Seeking input on terminology above - it makes it quite clear that most sources but Mayo differentiate between compounded BHRT and non-compounded, and the Mayo article is not nearly as credible as Cirigliano, who quite specifically differentiates.
- You are the only one who is suggesting the use of uncited statements, mainly because you don't want to accept any citations that do not support your POV. Stop with the Straw men. Try replying to the questions that were presented. Riverpa (talk) 15:50, 27 November 2009 (UTC)
undent Your statement "The fact that there is so much criticism and skepticism about bioidenticals means the article should be both critical and skeptical." is patently against WP:NPOV which says "Assert facts, including facts about opinions—but do not assert the opinions themselves. ", and at more length,
- "The neutral point of view neither sympathizes with nor disparages its subject, nor does it endorse or oppose specific viewpoints. It is not a lack of viewpoint, but is rather a specific, editorially neutral, point of view. An article should clearly describe, represent, and characterize all the disputes within a topic, but should not endorse any particular point of view. It should explain who believes what, and why, and which points of view are most common. It may contain critical evaluations of particular viewpoints based on reliable sources, but even text explaining sourced criticisms of a particular view must avoid taking sides".
Which means, basically, that the article should not be critical and skeptical, it should present those criticisms and allow the reader to reach his own conclusion. You do not abide by this basic foundation of WP in your editing of this article: as you have stated above, you intend for the article to be critical and skeptical, not just to present to the facts and allow independent conclusions to be rendered.Riverpa (talk) 17:18, 27 November 2009 (UTC)
Revert
I've reverted for a couple reasons:
- hormones haven't "long been identified as bioidentical". The FDA used the word "bioidentical" in it's packaging inserts. Aside from that the term had minimal use until the BHRT craze kicked in after the WHI.
- terminology should come before uses - terminology is one of the most controversial aspects of BHRT, and it is important to lead the article with this very important section.
- the uses edit removed mention of the vigorous promotion of BHRT in favour of emphasizing the risks of conventional HRT found in the WHI. The WHI also wasn't "shut down", it was a study prematurely terminated for ethical reasons.
- seems like a good idea to keep the contrast between the goals of BHRT and CHRT in the lead. The criticisms and questions about BHRT should also stay prominent in the lead, certainly coming before the WHI mention. Also, given the many publications expressing doubts about BHRT, the pseudoscientific neologism and marketing term notes are appropriate. WLU (t) (c) Wikipedia's rules:simple/complex 21:07, 26 November 2009 (UTC)
- In general, it's considered good form to discuss before reverting. But, given that you explained your reasons, I have addressed them in the new revision of the lede. Not that I agree with them necessarily, but as a compromise for now I think it suffices.
- You think the WHI study was shut down for ethical reasons? I would be interested in hearing what ethical standards were breached in the study and where it is reported.
- It would be a good thing if you respond to Hillenpa's proposal above, and enter the general discussion on revisions to this article. Riverpa (talk) 04:58, 27 November 2009 (UTC)
- Being bold is also supported, and I provided reasons for my revert here. I still have issues with the new version and will address it shortly.
- The WHI was terminated prematurely for the same reason that the study of the timing and dose of insulin injections (keep bolus injections few and large, versus many smaller ones) was shut down prematurely. The early results were so unexpected, unequivocal and clearly demonstrating previously unknown risks, that the results were released early in order to change practices as rapidly as possible to save lives and suffering. It's proactive ethics due to the obligations of practitioners of evidence-based medicine to practice using the best evidence they have. See here (noting the blanket line "Hormones should not be prescribed for primary or secondary prevention of coronary heart disease", here and the horse's mouth. Far from the "researchers want to kill patients, as long as it keeps their drug company overlords well-paid" line spouted by most CAM practitioners, it demonstrates a candid willingness to do what is best for patients.
- Responded, still consider the reasoning for rewriting fallacious and explicitly pushing an unsupported, undue conclusion. Further emphasized by my search of pubmed for more sources. I don't see why you both believe that the minor sources that are positive outweigh the many sources that are not, including the many critical position statements. You can play the "they're only talking about compounded bioidenticals" card all you want, but that doesn't mean they're endorsing non-compounded bioidenticals. If there were unequivocal, widely accepted evidence that noncompounded bioidentical hormones were safer and more effective than either nonbioidentical or compounded bioidentical hormones, you don't think this would be mentioned in the many critical articles and position statements? If it's that hard to get endorsements of bioidenticals from reliable sources, that clearly demonstrates to me that they are not considered useful. I simply can not see how any other position can be sustained without breaking the policies and guidelines. Weaknesses in conventional HRT like those revealed in the WHI study only mean that the case for the specific intervention studied is weakened. It says nothing about the strengths of other interventions. WLU (t) (c) Wikipedia's rules:simple/complex 14:07, 27 November 2009 (UTC)
- The rewrite you proposed again placed emphasis on the fact that bioidenticals are fine, it's the compounding that is the problem. Not true. Bioidenticals are expected to have the same risks and benefits of conventional hormones, and there's no evidence to support extravagant claims of miracles and benefits. Criticsms have been ventured against compounding, saliva and blood testing, celebrity endorsements, wild claims and a lack of evidence. What the articles haven't done is followed these criticisms up with extravagant praise of the current evidence base for bioidentical hormones when they aren't compounded, testimonialized, tested or unjustly praised. The article keeps trying to push the idea that if only bioidenticals could get away from testimonials, endorsements, testing and wild claims, then their pure and beautiful benefits can be recognized. This is not the approach or perspective of most sources.
- Experts do not qualify their criticsms of BHRT. Most sources do not suggest BHRT has unappreciated benefits. Neither should we. WLU (t) (c) Wikipedia's rules:simple/complex 14:25, 27 November 2009 (UTC)
- This article purports in its title to be about bioidentical hormone therapy using the molecularly-identical molecules, yet WLU refuses to admit the relevance of reviews and studies regarding the benefits and safety of the molecules concerned, estradiol and progesterone, on the basis of synthesis, unless the authors have thrown in the word "bioidentical" somewhere. It's like writing an article on Russia and refusing to include any sources about "Soviet Union" for fear of synthesis! In fact the WP:NOR policy on synthesis specifically states that "Carefully summarizing or rephrasing source material without changing its meaning is not synthesis—it is good editing." Including studies and reviews on estradiol and progesterone replacement in an article on "bioidentical hormone replacement therapy" involves no synthesis whatsoever. There is no change in meaning. There are no additional conclusions drawn or implied--there are simply facts about the concerned bioidentical hormones. WLU asks, "If there were unequivocal, widely accepted evidence that non-compounded bioidentical hormones were safer and more effective than either nonbioidentical or compounded bioidentical hormones, you don't think this would be mentioned in the many critical articles and position statements?" Powerful evidence does exist; it has been pointed out. The need to ask this question stems from WLU's previously stated belief that the funding of professionals and professional organizations is irrelevant--they are to be trusted no matter who pays their bills. ACOG, NAMS, and the Endocrine Society are considered authoritative by most physicians. They set the policies and most physicians just follow along rather than risk being considered quacks or troublemakers. That these are private organizations that rely upon funding from companies that make hormone substitutes is a matter of public record. That pharmaceutical corporations routinely commission professionals to do studies and write review papers is also well known. That most "experts" in all fields of medicine receive money from pharmaceutical and equipment manufacturers is well-known. Realizing these facts doesn't require irrational paranoia and "evil-good" splitting as WLU implies. One simply must consider the nature of the source in all cases. That pharmaceutical companies make much more money on their non-bioidenticals, and are defending themselves from thousands of lawsuits over the harm caused by their non-bioidenticals is well-known. That compounded bioidenticals are a direct competitor to drug companies' bioidentical and non-bioidentical products is obvious. Connect the dots. Bottom Line: There is no substitute for looking at the evidence, the primary studies, and the reviews on both sides, and making up one's own mind. Reviews and primary studies that do show the efficacy and greater safety of estradiol and progesterone over animalian or invented molecules also belong in this article, especially when they contradict the positions statements of other "experts" and "professional" organizations. Wikipedia is about information, not passive participation in the control of information.Hillinpa (talk) 16:24, 27 November 2009 (UTC)
Undent - WLU, if you don't think that compounding is the main issue, why do you keep restoring the statement "Much of the criticism of BHRT addresses the pharmacy compounding process, celebrity endorsements, marketing practices, saliva testing, and the claimed health benefits." to the lede? Also, the WHI study was shut down early because the negative results hit the point which had been pre-defined as requiring the end of the project due to unsuccessful outcomes. Please stop manufacturing information, it could be perceived as libelous. Riverpa (talk) 22:42, 27 November 2009 (UTC)
- Your arguments about the use of OR might have merit if there weren't an explicit and voluminous body of literature discussing the use and appropriateness of bioidentical hormones and the claims made about them. There's no need to cite an article about estriol's effects on the body then cite a second paper about estriol being a bioidentical hormone and then stating that therefore bioidentical hormones (or estriol specifically) have X effect on the body when there are specific whole articles about bioidentical hormones. That you have to keep invoking the pharmanoia gambit (and see WP:REDFLAG - purported conspiracies are not a reason to edit a page) means your arguments shouldn't be taken seriously. Also, if bioidenticals were unequivocally better, don't you think that researchers would be doing research on them to make a name for themselves and to do what's best for their patients? Or are all doctors too greedy and busy taking money from Wyeth to bother? If they are doing the research right now, when they've published it we can cite it. Unless you've got explicit, specific evidence that the researchers publishing critical documents about BHRT are doing so because they're paid to do so by Big Pharma, stop bringing it up. How fruitful would this debate be if I claimed that YOU were being paid by Big Bioidentical to edit this page, or that we can't trust Erika Schwartz or Kent Holtorf because they make money much more directly from the sales of bioidentical hormones? Not at all. You can't dismiss a priori like that, you need a citation. Please stop arguing that because these organizations are mainstream they are therefore getting paid for their opinions and can't be trusted. Because they are mainstream, they are exactly the sources we should be using. Wikipedia is exactly a passive means of reproducing the mainstream. We are not an advocacy, a crystal ball or purveyor of the latest and newest news. We report the plodding mainstream. We also don't get to make up our minds based on primary sources - see WP:MEDRS, specifically respect secondary sources.
- Riverpa, compounding is one of the many problems cited by sources about bioidenticals. I don't have opinions, I cite the opinions of sources. Since most of the sources mention compounding, so should we. The main issue is that BHRT isn't well supported. Compounding is one reason why, as is lack of research, saliva testing, extravagant claims and unacknowledged risks.
- I'm not sure what the purpose of your WHI comment is, nor do I appreciate the implied legal threat. The WHI resulted in increased interest in less-risky alternatives. BHRT was marketed as such an alternative. The field in general doesn't agree with this assessment. This is sourced and in the page, so I see no issue. WLU (t) (c) Wikipedia's rules:simple/complex 17:08, 30 November 2009 (UTC)
- WLU, there is no implied legal threat in my statement "Also, the WHI study was shut down early because the negative results hit the point which had been pre-defined as requiring the end of the project due to unsuccessful outcomes. Please stop manufacturing information, it could be perceived as libelous." It was in response to the misuse of words in your statement "The WHI also wasn't "shut down", it was a study prematurely terminated for ethical reasons." Saying that a study is shut down for ethical reasons is just about saying that it was shut down because of unethical behavior. You twisted the words wrong that time, and it could get WP into trouble if you truly think that your statement could not be construed as defamatory. Riverpa (talk) 23:55, 1 December 2009 (UTC)
- Ethical reasons can mean two things - the common one of an ethical violation on the part of the study's researchers. Or, in this case, it was considered unethical to continue without publishing results, due to previously unappreciated risks. Predefined end points are included for this very ethical reason. I think my statement above (starting with "The WHI was terminated prematurely") makes this pretty clear - there's no libel, only possible misunderstanding. A very low risk I believe, given my discussion of why it was ethical to end the study. I'm not twisting words, you misunderstood. WLU (t) (c) Wikipedia's rules:simple/complex 03:41, 2 December 2009 (UTC)
- WLU, there is no implied legal threat in my statement "Also, the WHI study was shut down early because the negative results hit the point which had been pre-defined as requiring the end of the project due to unsuccessful outcomes. Please stop manufacturing information, it could be perceived as libelous." It was in response to the misuse of words in your statement "The WHI also wasn't "shut down", it was a study prematurely terminated for ethical reasons." Saying that a study is shut down for ethical reasons is just about saying that it was shut down because of unethical behavior. You twisted the words wrong that time, and it could get WP into trouble if you truly think that your statement could not be construed as defamatory. Riverpa (talk) 23:55, 1 December 2009 (UTC)
Intro Edit
I have edited the introductory paragraphs. I believe that result is objective and properly balanced. It is more accurate in many particulars. Please edit it if you see the need, but do not simply revert without discussion. Most importantly, the statements of the organizations have been represented more accurately than before, and a mention is made that there exists literature which disagrees with the organizations' position.Hillinpa (talk) 20:44, 27 November 2009 (UTC)
- I would be extremely happier if there were another source besides Schwartz. I put her on a level with Boothby - not the most neutral source. I like Cirigliano because of that - I think he is very balanced in his views and review of the literature existing when he wrote. Is there anyone else besides Schwartz? If there is no other cite, I do not think it should go into the lede, I think it should be introduced further down in a pros and cons section. Riverpa (talk) 22:30, 27 November 2009 (UTC)
- Schwartz/Holtorp deserves mention because it was published in a peer-reviewed journal. I've added Moskowitz to the lead as an addition dissenting paper.
WLU simply reverted the lead, again attempting to own the article and refusing to actually participate in the editing process. I have reverted back. Let us discuss the problems with WLU's lead:
It states that BHRT is given only to treat symptoms--not true. BHRT practitioners, like all doctors for the last 40 yrs have used HRT to treat the serious disorders of menopause also--osteoporosis, vaginal atrophy, depression, etc. So the reference to disorders should stay.
WLU removed the information identifying the bios as estradiol and progesterone. Why?
WLU writes that the organizations claim that "that there is no research that has demonstrated any benefit to using bioidentical hormones". This is false and I have corrected it--they claim only that the benefits and risks are identical to any and all non-bios. Everyone knows that estradiol has benefits, and that progesterone given with it prevents uterine cancer. It's the safety profile compared to the known dangers of non-bios that's at issue here.
WLU edited out my inclusion of the simple fact that there are published reviews that disagree with the organizations mentioned. On what basis? Shouldn't the reader know up-front that this is an area of controversy, that there are published authors disagreeing with the idea that bios are not safer than non-bios? To exclude this data from the lead is an act of bias, trying to make it look like there is no controversy in the medical community. The organizations' view is given more weight in my lead, as reflecting the "majority" position. This is appropriate.
After stating Suzanne Sommers' claims of greater "naturaless and better match to the endogenous hormones, WLU states, "There is no evidence to support these claims." This is WLU's opinion. It is false and comes across as non-objective. Of course the bios are both more natural and more like the endogenous hormones than non-bios! If WLU wants to counter Suzanne's statement, then a reference is needed for each of Suzanne's claims that WLU wishes to dismiss. WLU's constant chorus "There is no evidence" after every slightly positive statement about bios is one of the things that betrays WLU's bias.
WLU informs the reader that "the term bioidentical has also been called a pseudoscientific neologism when referring to endogenous hormones, and a clever marketing concept that lacks any scientific support." These statements were made, but are obviously prejudicial, not to mention illogical, and they contradict the first sentence of the article which begins with a perfectly good and scientifically useful definition of bioidentical hormones as those hormones that are molecularly-identical to the endogenous hormones. So which is it, does the term bioidenticals have a clear definition and use or not? Such irrational anti-bio attack quotes don't belong in the lead of an objective article. They can be placed in the section on criticism of BHRT.
WLU seeks to promote fear by including in the lead the statement "possibly dangerous level of hormones in the blood". This criticism is leveled by critics only at the Wiley Protocol. It belongs in that section and not in the lead. Likewise WLU tries to give an impression of irrationality of those who believe that bios are safer by mentioning "the many unsubstantiated claims made for bioidentical molecules". This is just more slander. To be objective, WLU should say what claims, made by whom, and proven unsubstantiated by whom.Hillinpa (talk) 12:13, 28 November 2009 (UTC)
- Realistically, I'd rather not get into a pissing match about what is wrong with WLU's lede. I would rather take a more constructive approach on developing a more neutral lede that is not modeled on the current version.
- I mentioned above that some of the reading that I have done has indicated that BHRT is being used as lifestyle medication (I have not read any of Somers' books, but from a couple of excerpts I see this is indicated), not just for menopause relief, and I think that distinction needs to be made somewhere.
- I don't think we need to get into details about the controversy in the lede, just indicate that there is a controversy and expand on it with ref's later in the article.
- What seems to be lacking most here is an unbiased discussion of the overall goals of hormone replacement therapy, and how they differ between the conventional medicine proponents and the more experimental usage. Whether there is scientific foundation or not needs to be discussed, but the first step needs to be some explanation of the theory in order for this to be a complete article.
- JMHO Riverpa (talk) 17:04, 28 November 2009 (UTC)
- Yes, bioidentical hormone replacement practitioners generally do not believe they are just relieving symptoms. They are replacing a hormone lost prematurely due to our extended human life spans. They see menopause as a deleterious hormone deficiency state and prescribe estradiol for its known benefits of maintaining mood and energy, maintaining bone mass, improving memory, reducing skin and vaginal atrophy, reducing atherosclerosis, etc. Since BHRT has these greater goals, it does seem important they they should be discussed here. Estradiol and progesterone are among the most studied molecules in all biology--the scientific literature is full of research on the benefits of estradiol, and also the risks regarding breast and uterine cancer. Progesterone is known to prevent the latter risk, and there is significant evidence that progesterone protects against breast cancer also--see discussion of above. So BHRT doctors think that women can safely enjoy the benefits better estradiol levels throughout their lives. This is very different than the "5 years and no more, just to reduce symptoms" view with conventional HRT post WHI. Prior to WHI, doctors prescribed PremPro with the same idea of long-term treatment for health benefits. I think that Holtorp, Schwartz, and Moskiwitz could be sources for a presentation of the goals of BHRT.Hillinpa (talk) 11:49, 30 November 2009 (UTC)
- I tightened up the language in the lede, corrected grammar, and made more readable. Did not change content significantly, though I think it should be changed to get away from the argument.Riverpa (talk) 17:29, 28 November 2009 (UTC)
- Bioidentical hormones are more "natural" than nonbioidentical? How? They are produced the same way. Many citations point this out. What does "natural" even mean? And why would we ignore the many criticisms of the way "natural" bioidentical hormones are marketed as "natural" without defining the term or saying why "natural" is better? Also, someone prescribing progesterone isn't a bioidentical practitioner, unless they only prescribe bioidentical hormones. Again, I see significant original research that promotes the truth that BHRT is better, in the face of dozens of references that are unequivocally critical. Claiming that progesterone and estriol are "better" ignores the nuance of medicine - how is it applied? How long is it taken? Does it help with bone density but cause, say, endometrial cancer? Also, because of the number of criticisms and critical articles, weight should be given to the criticisms. Even mentioning that there are those who support BHRT in the lead may be a weight issue - how prominent are they? What journals are they published in? How often are these opinions cited? How seriously are they taken? Since it's mainly three people, Holtorf, Schwartz and Moskowitz, are they representative? Are they important? Are they well-regarded? Are they career researchers, or general practitioners (who in this case make a direct profit for every bioidentical hormone package they sell)? Not all opinions, source and publications are equal. I can find numerous citations that creationism is taken seriously by Kent Hovind, Ken Ham and Kirk Cameron, does that mean there is serious debate about creationism? Just how much controversy is there? Given who is making the "pro" claims and how big the names are for the "anti" claims, it's pretty close (in my mind) to being no real debate. WLU (t) (c) Wikipedia's rules:simple/complex 17:30, 30 November 2009 (UTC)
- I don't get why you are suddenly attacking the "naturalness" claim of bioidenticals - you have edited to include mention of those claims multiple times, including a section on refuting those claims. The claims are made by most (all?) compounding advocates, they are documented, and the article presents them, as well as criticism of the claims. What is the problem with that?
- Why is Somers and her claims of "naturalness" in the lede? Reference to her has been removed from there several times, and I believe that you replaced it several times. No one else supports the inclusion of someone with absolutely no credentials in the lede but you. Your vision of weight would have no mention of credentialed proponents of compounded BHRT in the article that is purportedly about compounded BHRT, and indeed, there is little rational description of their theories at all.
- However unsupported the theories are, they should at least be presented coherently before they are flogged to death. Riverpa (talk) 18:52, 30 November 2009 (UTC)
- Hillinpa's comment "Of course the bios are both more natural and more like the endogenous hormones than non-bios" found above, and echoed by many proponents of BHRT, inspired my reaction. Itself the result of many articles pointing out that BHRT isn't any more "natural" than any other yam-derived hormone. It's a bit of pique at an absurdity frequently used by proponents to pimp BHRT. I stand by the idea that BHRT is no more "natural" than any other synthesized hormone, and it's a good deal less natural than Premarin derived from filtered but otherwise unmodified horse urine. I have no problem with the article's current way of dealing with "natural" hormones, I think it's verifiably an absurd claim. Somers is in the lead simply because she is a highly, highly visible proponent. Should be in the body as well. WLU (t) (c) Wikipedia's rules:simple/complex 23:03, 30 November 2009 (UTC)
- Bioidentical hormones are more "natural" than nonbioidentical? How? They are produced the same way. Many citations point this out. What does "natural" even mean? And why would we ignore the many criticisms of the way "natural" bioidentical hormones are marketed as "natural" without defining the term or saying why "natural" is better? Also, someone prescribing progesterone isn't a bioidentical practitioner, unless they only prescribe bioidentical hormones. Again, I see significant original research that promotes the truth that BHRT is better, in the face of dozens of references that are unequivocally critical. Claiming that progesterone and estriol are "better" ignores the nuance of medicine - how is it applied? How long is it taken? Does it help with bone density but cause, say, endometrial cancer? Also, because of the number of criticisms and critical articles, weight should be given to the criticisms. Even mentioning that there are those who support BHRT in the lead may be a weight issue - how prominent are they? What journals are they published in? How often are these opinions cited? How seriously are they taken? Since it's mainly three people, Holtorf, Schwartz and Moskowitz, are they representative? Are they important? Are they well-regarded? Are they career researchers, or general practitioners (who in this case make a direct profit for every bioidentical hormone package they sell)? Not all opinions, source and publications are equal. I can find numerous citations that creationism is taken seriously by Kent Hovind, Ken Ham and Kirk Cameron, does that mean there is serious debate about creationism? Just how much controversy is there? Given who is making the "pro" claims and how big the names are for the "anti" claims, it's pretty close (in my mind) to being no real debate. WLU (t) (c) Wikipedia's rules:simple/complex 17:30, 30 November 2009 (UTC)
undent WLU, Hillinpa's comments on this page do not have to rise to the level of quality needed for inclusion in the article. He can expose his bias on this page with no problem, as you are doing. It is preferably done here rather than in the article. Attacking comments made on the Talk page is not at all useful, and exposing your contempt for the topic when you have asked for a Neutrality review is, well, I'm not sure what it is, but rational is not the word that comes to mind. Maybe you should just take a break from editing this topic.
Hillinpa, I will tell you that WLU did not do that revert on the lead, another editor did. You should have checked that on the Article History page before assuming. And your constructive comments are much more appreciated rather than dissecting every problem with the article. I agree there are many. Riverpa (talk) 05:03, 1 December 2009 (UTC)
- Wikipedia is not a forum. We shouldn't be idly chatting about the topic, the talk page is meant to discuss improvements and issues with the page. There's a warning about chatting on talk pages - {{uw-chat1}}. I spend enough time reading and responding to the same points on this page, so I have become rather curt. WLU (t) (c) Wikipedia's rules:simple/complex 21:20, 1 December 2009 (UTC)
- I have found the relevant WP Policy paragraph about minority opinions, and since you have not been able to find it, as experienced an editor as you are, I will insert it here to make sure you have access to it:
- "In articles specifically about a minority viewpoint, the views may receive more attention and space. However, such pages should make appropriate reference to the majority viewpoint wherever relevant, and must not reflect an attempt to rewrite content strictly from the perspective of the minority view. Specifically, it should always be clear which parts of the text describe the minority view, and that it is in fact a minority view. The majority view should be explained in sufficient detail that the reader may understand how the minority view differs from it, and controversies regarding parts of the minority view should be clearly identified and explained. How much detail is required depends on the subject: For instance, articles on historical views such as flat earth, with few or no modern proponents, may be able to briefly state the modern position, and then go on to discuss the history of the idea in great detail, neutrally presenting the history of a now-discredited belief. Other minority views may require much more extensive description of the majority view in order to avoid misleading the reader. Wikipedia:Fringe theories and the NPOV F.A.Q. provide additional advice on these points."
- It's odd, since it's part of WP:DUE and you keep citing that to everyone else, I would have thought you would be more familiar with this content. I can't tell you how cranky it makes me when you try throwing policy at everyone else when you are not complying with it yourself. They have a term for that too WP:WL. Riverpa (talk) 23:34, 1 December 2009 (UTC)
- This page isn't about a specific minority viewpoint. This page is about the majority viewpoint - bioidentical hormones are unsubstantiated. That paragraph is about the creationism viewpoint in the evolution article. If this article were great things about bioidentical hormones then the critical viewpoint would be the majority referred to in that article. Bioidenticals are a chemical, not a viewpoint (like flat earth, creationism or AIDS denialism). There's only one article about bioidenticals, this is it, and it should be substantially critical. WLU (t) (c) Wikipedia's rules:simple/complex 02:46, 2 December 2009 (UTC)
- It's odd, since it's part of WP:DUE and you keep citing that to everyone else, I would have thought you would be more familiar with this content. I can't tell you how cranky it makes me when you try throwing policy at everyone else when you are not complying with it yourself. They have a term for that too WP:WL. Riverpa (talk) 23:34, 1 December 2009 (UTC)
Another interesting research paper
I came across this - http://pharmrev.aspetjournals.org/content/60/2/210.full.pdf+html which doesn't really cover menopausal relief but does have some interesting observations about the use of bioidentical estrogen orally vs transdermally. It is primarily concerned about vascular effects. Riverpa (talk) 22:20, 28 November 2009 (UTC)
- Uses the word "bioidentical" twice - once in the lead as a reason for renewed interest in nonreproductive estrogen and once in the body "These latter preparations have gained popularity as more natural, bioidentical formulations, but data supporting their superiority over other estrogenic formulations are scant in regard to specific measures of vascular physiology." These are the only parts that could be used in the article and both cite ideas that are already covered. WLU (t) (c) Wikipedia's rules:simple/complex 18:29, 29 November 2009 (UTC)
- Please read the discussion of this issue above. Using one's brain to associate "bioidentical" with estradiol and progesterone is not original research or synthesis. Bioidentical hormones are defined as molecules identical to the endogenous hormones. "Bioidentical" HRT means using estradiol and progesterone exclusively as opposed to alien molecules (non-bios, whatever you want to call them). BHRT advocates assume that the molecules that belong in the body may have greater benefits and safety than arbitrarily altered molecules, or variant molecules found in other animals--until proven otherwise. Therefore all research regarding estradiol and progesterone replacement is relevant to this article. The word "bioidentical" does not need to appear in the research or review. Hillinpa (talk) 12:00, 30 November 2009 (UTC)
- Yes it does, otherwise it is promoting a synthesis - per that section of the OR page, "In other words, that precise analysis must have been published by a reliable source in relation to the topic before it can be published in Wikipedia by a contributor." If it's an article about estriol or estrogen, put it on those pages. If it addresses the specific properties of a specific compound, use it in that page. If it addresses a specific property of a specific compound as a bioidentical hormone, as demonstrated by an extensive discussion of the importance of its "bioidenticalness", then it belongs here. WLU (t) (c) Wikipedia's rules:simple/complex 16:46, 30 November 2009 (UTC)
- Please read the discussion of this issue above. Using one's brain to associate "bioidentical" with estradiol and progesterone is not original research or synthesis. Bioidentical hormones are defined as molecules identical to the endogenous hormones. "Bioidentical" HRT means using estradiol and progesterone exclusively as opposed to alien molecules (non-bios, whatever you want to call them). BHRT advocates assume that the molecules that belong in the body may have greater benefits and safety than arbitrarily altered molecules, or variant molecules found in other animals--until proven otherwise. Therefore all research regarding estradiol and progesterone replacement is relevant to this article. The word "bioidentical" does not need to appear in the research or review. Hillinpa (talk) 12:00, 30 November 2009 (UTC)
undent It's an interesting paper, somewhat tangential to the topic at hand, which is allowed content on the Talk page. I did not put it here to be used as a citation for the article, but it does use some interesting citations itself, and it is interesting to people who are more concerned with that actual topic of bioidentical hormones instead of just concerned with criticizing the concept. The fact that the author uses the term bioidentical in a clearly unrelated paper is also of interest, since you have contended that the term is not used except in relation to compounded BHRT and its treatment methods. If you need references to those conversations, please see your past history of posts to this page. Riverpa (talk) 17:53, 30 November 2009 (UTC)
NPOVN
Note thread. WLU (t) (c) Wikipedia's rules:simple/complex 17:15, 30 November 2009 (UTC)
- Deleting properly cited information from the article because you do not agree with it without discussing it first is not a good way to work toward Consensus. I placed a POV tag on the article. I trust that you will not remove it this time, and allow the process to move forward since you initiated it. Riverpa (talk) 17:56, 30 November 2009 (UTC)
FDA Regulation
WLU, twice you have put an inaccurate statement in the article regarding the FDA forbidding compounding pharmacies from using the term bio-identical. It is not supported in the news release that you cite. If you want to put it back in the article you need to quote the specific statement that supports it in that cite, since I cannot find it. You should post it here before changing the article again. Riverpa (talk) 12:57, 1 December 2009 (UTC)
- Supply the statement and the diff, or correct it. I've made a lot of edits today, and a lot of them due to the FDA FAQ. I don't believe the current version says this but I could be wrong. WLU (t) (c) Wikipedia's rules:simple/complex 21:18, 1 December 2009 (UTC)
- Maybe you should occasionally check the Talk page before making wholesale changes to the article since there are two other editors involved here, and some points of contention - Oh, I forgot! - that apparently doesn't apply to you....Riverpa (talk) 22:42, 1 December 2009 (UTC)
- I'm busy reading and re-reading sources, to justify edits that are converged upon by multiple sources. What applies to all of us are the policies and guidelines, which no-one else on this talk page seems interested in following. We go where the sources tell us. The sources are critical. About 90% critical. So it's inappropriate to talk about how great BHRT is at any length. WLU (t) (c) Wikipedia's rules:simple/complex 02:42, 2 December 2009 (UTC)
- Maybe you should occasionally check the Talk page before making wholesale changes to the article since there are two other editors involved here, and some points of contention - Oh, I forgot! - that apparently doesn't apply to you....Riverpa (talk) 22:42, 1 December 2009 (UTC)
Uncited statement
WLU, your recent edit to add a sentence regarding saliva testing, with the {{proveit}} tag included, should either be properly cited, or deleted immediately. If you have no cite for the statement you should not have added it to the article, instead of putting it in with the tag. I cannot imagine what your intent is by doing this, other than to try to disparage the other editors working on this piece. Riverpa (talk) 16:00, 1 December 2009 (UTC)
- I added that sentence to the article in the first place. It's a {{fact}} tag. I placed it there because I know this fact came from one of the articles, but I'm not sure if it's the one immediately following the prose. It's a placeholder to remember to try to find the citation when I make the time. If you're really upset by it, you are allowed to remove it, but I don't see it as tremendously controversial. So, I'm not trying to disparage my own work, I've just got other things to do, but I did find a citation for it here. I'll look for a better one when I have time, and you are also welcome to do so. My efforts are to improve the page, not disparage other editors.
- Please do not use the {{fact}} or other mainspace tags on talk pages. These tags add the pages to wikipedia-specific categories in order to improve citations. WLU (t) (c) Wikipedia's rules:simple/complex 21:10, 1 December 2009 (UTC)
- I'm not sure that storing your work-in-progress in the article is a good idea. Anyway, I checked the source, and it did not support the statement, so I deleted it as you suggested. Riverpa (talk) 00:02, 2 December 2009 (UTC)
- Sure, I'll add six more to substantiate the point. If you had read the greater majority of the sources (i.e. the critical ones) you would see this point made repeatedly. WLU (t) (c) Wikipedia's rules:simple/complex 02:38, 2 December 2009 (UTC)
- How unfortunate that you were apparently unable to find a cite that supported the statement that I deleted, since you seem to have replaced it with substantially different content. Riverpa (talk) 04:15, 2 December 2009 (UTC)
- The current content supports the idea that practitioners try to titrate to a specific level of hormones using saliva testing, and that this level is considered dangerous, unnecessary, and based on dubious science that has no real merit. It's also based on many, many sources that converge on this point. It's something that's extraordinarily easy to both find and justify using any of the freely-available sources, including the Harvard Health Watch page. The time you spent complaining about it could easily have been spent finding sources to justify the text and expanding the page, as I did. But you instead spent it criticizing. I don't mind making the page better, I really don't, but it doesn't need to be this aggravating, particularly for such easily addressed points. WLU (t) (c) Wikipedia's rules:simple/complex 11:30, 2 December 2009 (UTC)
- Your previous statement did not say that so I deleted it. Riverpa (talk) 15:51, 2 December 2009 (UTC)
- The current content supports the idea that practitioners try to titrate to a specific level of hormones using saliva testing, and that this level is considered dangerous, unnecessary, and based on dubious science that has no real merit. It's also based on many, many sources that converge on this point. It's something that's extraordinarily easy to both find and justify using any of the freely-available sources, including the Harvard Health Watch page. The time you spent complaining about it could easily have been spent finding sources to justify the text and expanding the page, as I did. But you instead spent it criticizing. I don't mind making the page better, I really don't, but it doesn't need to be this aggravating, particularly for such easily addressed points. WLU (t) (c) Wikipedia's rules:simple/complex 11:30, 2 December 2009 (UTC)
- How unfortunate that you were apparently unable to find a cite that supported the statement that I deleted, since you seem to have replaced it with substantially different content. Riverpa (talk) 04:15, 2 December 2009 (UTC)
- Sure, I'll add six more to substantiate the point. If you had read the greater majority of the sources (i.e. the critical ones) you would see this point made repeatedly. WLU (t) (c) Wikipedia's rules:simple/complex 02:38, 2 December 2009 (UTC)
- I'm not sure that storing your work-in-progress in the article is a good idea. Anyway, I checked the source, and it did not support the statement, so I deleted it as you suggested. Riverpa (talk) 00:02, 2 December 2009 (UTC)
undent WLU, you have no right to criticize me for not trying to improve this article. I have added content, properly cited, I have corrected grammar and spelling, I have made it more readable without changing content, and your response in all these cases has been to overwrite my contributions or revert to your version. The only time you must acknowledge my contributions is when they directly disprove statements that you make in the article and you have no choice but to keep them. So you don't leave me much choice if I want to work on this article that you seem to own - I make the only contributions that you are compelled to allow to exist. Riverpa (talk)
- What were my objections based on?
- What policies did I use to justify them?
- When a policy was presented for discussion, did I discuss that policy and give opinions based on that policy?
- Are my edits supported by sources?
- Are yours?
- Which point of view appears to be the majority opinion?
- How substantial is that majority opinion?
- Is there evidence that overall, the scholarly community and the relevant governing and governmental bodies believe that BHRT is a good thing?
- If your edits have been supported by good sources, and add accurate refinement to the page, have I deleted them? Keeping in mind, say, this edit?
It's late, but the short answer to that would be yes, you do delete them. I don't know, maybe this one where you didn't even bother to document why you removed my addition? [4]
Here where you removed POV tags, twice, with no Talk ? [5] [6]
Here, where I guess you didn't like the way I cleaned up the lede and so you reverted it, complete with grammatical and spelling errors, and no discussion? [7] Riverpa (talk) 05:36, 3 December 2009 (UTC)
- Though I appreciate the vote of confidence that I'm an utter genius who makes only deliberate mistakes, it's not actually true. I make errors, frequent ones, some major, some minor, some due to overgeneralization, some due to misunderstandings. If it can be demonstrated that my edit was in fact a misrepresentation of the source, I will not object to it being corrected. Of course, with the caveat that it does not give undue emphasis on a minority opinion, or fly in the face of what most scholars think about BHRT. WLU (t) (c) Wikipedia's rules:simple/complex 20:39, 2 December 2009 (UTC)