Talk:Bioidentical hormone replacement therapy

See below

I've removed references to Wiley. There are at most a few thousand women on the Wiley Protocol, and a few MILLION on other forms of BHRT, and millions more on HRT. Stick to the subject. If you want to malign Wiley, do it on her page. This entries are just an attempt by someone to advance their anti-Wiley agenda in as many places as possible. Neil Raden 23:17, 23 April 2007 (UTC)

The "discussion" below is blatant advertising, which even includes the phone number of the promoter. I don't think that the article itself is advertising. --KeepItClean 23:10, 16 November 2006 (UTC)

[Advertisement removed per Wikipedia:Talk page guidelines and Wikipedia is not a soapbox.]

It is not acceptable to use Wikipedia as a medium for blatant advertising. This is as true of talk pages as it is of articles. Talk pages, per the guidelines, are for discussion related to creating a better encyclopedia, not for self-promotion. See also Wikipedia:Conflict of interest.--Srleffler 06:29, 20 November 2006 (UTC)

There isn't anything on Wikipedia:Talk page guidelines that suggests that advertising is forbidden in the Talk pages. In fact, the word "Advertising" doesn't appear on Wikipedia:Talk page guidelines at all. What DOES appear on Wikipedia:Talk page guidelines is "Do not edit other's comments." Robertwharvey 01:31, 3 January 2007 (UTC)

You missed the part of Wikipedia:Talk page guidelines, where it says "A talk page is research for the article, and the policies that apply to articles also apply to talk pages." The policy What Wikipedia is not makes it clear that advertising is not acceptable on Wikipedia. This policy takes precedence over the guideline that one should not edit others' talk page postings. --Srleffler 02:47, 3 January 2007 (UTC)

POV

While not completely biased, this article does not appear to comply with Wikipedia's policy on Neutral Point of View. The article does not seem to discuss the views of critics of this therapy, and does not put it in context. What is the mainstream medical view of this type of therapy vs. the conventional type?--Srleffler 06:32, 20 November 2006 (UTC)

Looking at the number of people using this type of therapy vs a conventional form of therapy, I'd hazard a guess that the POV of the article does represent the mainstream medical view of this type of therapy. A new form of therapy promoting itself should be able to show tests, data, nonobjective facts that support choosing the new form of therapy over any previous form. As the article states, such has not yet created for this form of therapy. However, there is data showing that oral adminstration of these types of hormones is, generally, ineffective. Thus, a neutral POV would seem to indicate that advertising along is driving this form of therapy, since positive factual support is (by and large) absent but negative factual support has already been documented. 97.93.88.4 (talk) 05:07, 8 June 2008 (UTC)

I find the POV of this article to be clearly biased against mainstream treatments, particularly as it seems to imply that horse derived hormones and "conventional" non-bioidentical hormones are inferior to those used in BHRT, as if bio-identical hormones were hard to obtain except through special treatment programs using individually compounded preparations. Many mainstream treatments use exact copies of human hormones, such as Estrace and Estrogel. Clearly, some providers of so-called BHRT are making great amounts of money, and are trying to protect their financial interests by misrepresenting the availability of exact copies of human estrogens. This situation appears to be affecting the POV of this article. Janice Vian, Ph.D. 137.186.253.216 (talk) 18:59, 18 April 2009 (UTC)

Advertising in Page

Several of the links in the lower body of this article go directly to a site that is selling creams and other items for hormone replacement therapy. The site, hormoneprofiles.com, is essentially using this wiki page as a forward for thier products.—The preceding unsigned comment was added by Rompingreason (talk • contribs) 22:52, November 26, 2006.

References

I notice that a bunch of references were removed, including the books by Suzanne Somers. While I approve of attempts to clean up the article and reduce POV, I wonder if this went too far. Whatever the merits of her arguments, it seems that Ms. Somers is a notable spokesperson for bioidentical hormone replacement therapy and has written several books promoting it. This probably deserves some mention in the article. Additionally, removal of references should always be handled with some care. If it's possible that some of the material still in the article was drawn from or inspired by her books, they should remain as listed references for the article.--Srleffler 03:28, 4 January 2007 (UTC)

True, but the Somers books are more about personal experiences instead of scientific data - they're secondary references at best. I will add back in a reference to her most relevant/well-known book. --Marumari 21:30, 4 January 2007 (UTC)

It should also be noted that Wyeth Pharmacueticals, one manufacturer of HRT has filed a "citizen petition" with the FDA over their concern over the use of bioidentical hormones. Wyeth has urged the FDA to stop compounding pharmacies from using estriol in alternative HRT, which many women switched to after the result of the WHI study results. Bioidenticals are cutting into the market share of "big pharma," and they are holding fire to the FDA to pull all other products that may complete with them. The FDA's actions are nothing more than pharmaceutical companies pulling their puppet strings, and, once again, have nothing to do with sciencePharmacy01 (talk) 21:09, 23 January 2008 (UTC)

FDA APPROVAL

In the small caveat posted in this article regarding the FDA status of BHRT treatments, the author suggests that bioidentical hormones are not approved by the FDA and that there is no substantive clinical research suggesting their safety or efficacy. This is patently false. There are, in fact, numerous studies which suggest clinical efficacy of 17-Beta Estradiol in combination with noresthisterone acetate (as opposed to MPA as the active progesterone) - several of which actually demonstrate possible cardiovascular advantages well above that of traditional HRT.

It should also be noted in this article that 17-Beta Estradiol accounts for the vast majority of treatment models used in Europe for HRT in menopausal patients.

On the issue of FDA approval, there are quite a few BHRT products that carry FDA approval... Vivelle, Estrogel, Estrace, Prometrium, etc., all have FDA approval, and, I believe are listed in the Physicians Desk Reference (PDR). Bortsky 15:03, 19 January 2007 (UTC)Bortsky —The preceding unsigned comment was added by Bortsky (talk • contribs) 15:01, 19 January 2007 (UTC).

I see that the "caveat" section has been discussed somewhat here. I hope that debate continues, but, however, also I wanted to let you all know I deleted the current text of the "caveat". The format is not appropriate for the article or an encyclopedia; the information NEEDS to be SYNTHESIZED into the rest of the article. Also, the text must be presented in an unbiased way. The "caveat" cannot act as a disclaimer, cautionary warning before the main text, etc. Please create a section titled "FDA Approval", "Controversy", or something else appropriate. Thanks! JeffreyN 20:28, 29 January 2007 (UTC)

The FDA has issued a warning to several compunding pharmacies, that estriol is not approved for human use, and that the term "bio-identical" is unscientific and misleading. Referrence added to the article. Pustelnik (talk) 12:12, 10 January 2008 (UTC)

You might be interested to know that the Wiley Protocol has never used estriol, believing it to be useless in HRT. Estriol is however the most widely used estrogen in other BHRT, such as biest. Wiley has also begun to use the term biomimedic instead of bioidentical, a point she made in testinony to the US Senate in 2007. Neil Raden (talk) 00:14, 28 January 2008 (UTC)

Wiley protocol

There's a lot of flack for and against the Wiley protocol, rather than bunging up this page, I created one for it. WLU 19:31, 25 April 2007 (UTC)

There are literally thousands of variations of BHRT and Wiley is just one of them. The number of women on Wiley is statistically insignificant. Why is it here? Also, by citing it as controversial, it leaves one with the impression that other BHRT regimens are NOT controversial, which is false. I removed it once. Please take it out.

72.205.193.253 17:32, 3 May 2007 (UTC)

I'm going to ask again. Please remove the Wiley Protocol section unless you intend to describe the 15 or 20 more widespread protocols used too. There is no logic to highlighting Wiley here. There are literally millions of people using BHRT but only a few thousand using Wiley. Neil Raden 05:03, 6 May 2007 (UTC)

The Wiley protocol is a type of BHRT, it should be on the page, and if you know of 15-20 other protocols, feel free to add them to the page as well. There is perfect logic to highlighting Wiley here, or at least pointing to the main article. The fact that there is not information about other types of BHRT means the page should be expanded, not truncated. Should you be informed of these other protocols, feel free to add sourced information to the page. Wiley and the Wiley protocol is a well-known type of BHRT because of Somers public, televised advocacy of the protocol, so it is quite natural that there would be considerable interest and more information about it on this page than other types of protocols. WLU 17:15, 6 May 2007 (UTC)

Again, I must protest this editor's postion here as well as on the Wiley-related articles. Why is Wiley singled out here when there are many varieties of BHRT? And why, in particular, is it stated that the Wiley Protocol is "sharply criticized" when, in fact, ALL BHRT is sharply criticized by the FDA, the NIH, the Endocrine Society and, especially, the pharmaceutical industry? I insist on balance. Remove the reference to Wiley completely, or clearly point out that ALL BHRT is controversial. 72.205.193.253 06:54, 27 August 2007 (UTC)

Sorry, forgot to sign the above. Neil Raden 06:56, 27 August 2007 (UTC) —Preceding unsigned comment added by Nraden (talk • contribs)

Aren't there any editors here to fix this? This whole page is sort of a mess, but I object, once again, to singling out the Wiley Protocol as being controversial. ALL BHRT is controversial. Why not just say that? There is no reason for the Wiley Protocol to have its own section unless the article details the myriad other protocols that are used with BHRT. I would be sufficient to say that the WP is significantly different and refer people to the WP article, but it is also devoid of detail until we can hopefully get it straightented out, but it's been hacked up by the same editor WLU who inserted it here. I am unable to make these changes because I am COI. Neil Raden 00:04, 15 October 2007 (UTC)

Bioidentical

To the best of my knowledge, there are no commercials by Suzzane Somers promoting BHRT. There have been, I think, commercials promoting her books, but they are episodic with a release. I think this sentence is misleading, as if she is constantly pitching BHRT on television. She talks about it when she is an invited guest. 72.205.193.253 17:38, 3 May 2007 (UTC)

Patents

This article says "Because bioidentical hormones are natural, they are not patentable." Is this true? If it is, a source should be cited. I'm pretty sure there are a large number of natural compounds patented in some way or another...e.g. epo, taq polymerase, etc. — Preceding unsigned comment added by Mauvila (talk • contribs)

That's because something else about the compound has been patented instead--like the delivery method, or something it's bound with, that kind of thing. For example, in the case of bioidentical estrogen via patch delivery, it's the patch delivery system that's patented. If you could patent bioidentical things, then you could do things like patent hemoglobin and charge people money for it, and nobody else could supply it. QuizzicalBee 16:01, 25 July 2007 (UTC)

Editor Needed

I am COI so I won't edit this article.However, Suzanne Sommers does NOT promote the Wiley Protocol and is not a spokesperson for it. In the december 2007 issue of Discover magazine, she said, "I do not endorse Wiley. I do not get my hormones from her." I've asked before, but will someone please remove this statement from this article as well as Wiley Protocol and [T.S. Wiley]]. Thank you. Neil Raden (talk) 00:10, 28 January 2008 (UTC)

Estriol

All of the comments in this article about estriol, with the exception of the FDA not approving it, are highly speculative. There are no studies that estriol "protects the breast," only that it binds to ERbeta receptor, which doesn't prove anything. For example, to say that there is no proof that BHRT is safer because there are no long-term clinical trials, then to speculate on the role of estriol based on an observed effect at the molecular level, is just bad science. Estriol (E3) is a spent metabolite of estradiol (E2). If E2 is present in serum at appropriate levels, it is used and estriol results. There is no need to "supplement" it. Please note that estriol is the most widely (biest) used estrogen in compounded BHRT, except the Wiley Protocol, which uses only estradiol. Neil Raden (talk) —Preceding comment was added at 16:20, 1 February 2008 (UTC)

support for BHRT

For all those adding evidence in favor of the bioidentical hormones, I suggest using PMID 18928825 which summarizes everything (fulltext here) Mathityahu (talk) 17:07, 8 February 2009 (UTC)

Major Edit

The article has undergone a major re-edit since the comments above were posted.Hillinpa (talk) 12:37, 15 February 2009 (UTC)

recent deletions

This page has been cleared from 40k+ to about 10k in the past few days, after accusation of COATTRACK and SYNTHESIS. While there was possibly a synthesis of many sources, the current content does not reflect at all the many scientific publications that showed the superiority of BHRT compared to traditional (synthetic) HRT. To avoid synthesis but still be loyal to the great amount of evidence in support of BHRT compared to HRT I suggest using the recent publication I referred to above under "support for BHRT". Since it references probably most if not all of the previously deleted references, the entire text can be restored and a reference can be added to this publication. This way it won't be synthesis anymore, since it's all specified in this peer-reviewed publication. Mathityahu (talk) 09:48, 20 February 2009 (UTC)

Please review WP:PROVEIT and WP:OR. The references I removed fundamentally didn't talk about BHRT and accordingly did not belong on the page. The comparisons were unsourced, making it original research. Also inappropriate. Wikipedia is an encyclopedia, not a soapbox. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:34, 27 February 2009 (UTC)

Destructive Edit

I am new to Wikipedia and am learning about how it works. I am very disappointed at the deletions by WLU. He/she has violated the Wiki policy of PRESERVE. One should retain all useful and relevant information AND edit the text to conform to Wikipedia policy. I accept that I have may have produced some SYNTHESIS in places. That's what thinkers do. Please point out where and how there is SYNTHESIS and I will correct it by linking the idea to published authors (as recommended by Mathityahu). A tremendous amount of explanatory information and over 20 references were deleted on the basis of the COATRACK policy. A COATRACK involves bringing in or overly emphasizing issues that are not related to or are minimally related to the topic. However, the debates over bioidentical hormones involve all the issues that were removed. To illustrate, WLU leaves unopposed the quote from the Mayo doctor that "There is no evidence to support the safety or superiority of bioidentical hormones over standard hormone replacement approaches.[1]" However, that same physician makes it clear in that link that she really means "no evidence to support...compounded bioidentical hormones. So one has to expose this careless use of words and one has to discuss the compounding of bioidentical hormones and why compounds have not been studied in trials, not just link to a Wiki page about compounding. Likewise the standard (FDA-approved pharmaceutical) treatments include oral estrogens. BHRT practitioners do not generally give bioidentical estradiol orally for the reasons stated, so one must discuss delivery method and estrogens and not just link to a generic Wiki page on delivery method that doesn't touch on the issue at all. Most BHRT practitioners restore testosterone, but there is no FDA-approved testosterone for women, so testosterone is not prescribed for women in "standard HRT", so the brief discussion of testosterone is relevant also. Standard FDA-approved policy does not recommend progesterone or a progestin for a woman who has no uterus, but BHRT docs insist on replacing progesterone because they believe that it can protect against breast cancer (John Lee wrote a few popular books about progesterone). So the discussion of progesterone and breast cancer is not a COATRACK but is vital to the topic. This relatively simple medical issue (BHRT) has become a hotbed of controversy with physicians holding opposite opinions. Women are being given mixed messages--about a topic that is vital to their health and quality of life. I think that a good article on BHRT needs to explain why that controversy exists by pointing out the obvious interests of the groups and persons who are declaring positions. Therefore the "Vested Interests" section is not a COATRACK either. Indeed, I'd like WLU to explain how any of the sections removed constitutes a COATRACK. I am open to discussion on these issues from WLU and any other persons before restoring an improved version of the article that was removed, so that we don't get into a pointless edit war.Hillinpa (talk) 19:15, 21 February 2009 (UTC)

To keep it short, I suggest for WLU to restore all deleted texts, and mark the appropriate sections with whatever it is he thinks (need citation, coattrack, whatever). If these marks remain unchanged for about a month and a consensus is not reached here, the corresponding sections will be deleted. Mathityahu (talk) 21:35, 21 February 2009 (UTC)

If you would like to improve the page, include citations to articles that specifically mention bioidentical replacement therapy, that specifically compare it to other types of hormone replacement therapies, and doesn't go into excessive details about non-BHRT interventions. The version I trimmed from spent large amounts of text discussing topics other than BHRT (i.e. was a coatrack), contained unsourced information (which can be removed per WP:PROVEIT) and synthesized information about bio and nonbioidentical hormones (making it a synthesis of original research). WLU (t) (c) Wikipedia's rules:^simple/_complex 22:27, 27 February 2009 (UTC)

I have reverted but gone through the subsequent edits and replaced the information that wasn't a coatrack, original research, excessive detail or otherwise inappropriate. The citations greatly helped the page, which is a good thing, but we must verify all the information with the appropriate sources and not make the page about something other than its topic. The other articles should be linked and referred to so if the interested reader is so inclined, they can seek greater detail elsewhere. I'm not required to tag unsourced information (see WP:PROVEIT), and WP:OR is a policy, therefore mandatory.

Regards John Lee, if he has written stuff in reliable sources, then we should cite those. His website is not a medically reliable source and as this is about a medical topic, we shouldn't be citing it. Woman may be giving mixed messages, but the evidence itself is mixed. We shouldn't be 'sorting it out for them', we should be pointing to both sides of the controversy and not overreaching what the mainstream sources say. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:39, 27 February 2009 (UTC)

Until this point, I've not commented on the specific issues above. I will now:

• WP:PRESERVE specifically states exceptions, including original research and unverifiable claims. In addition, WP:COAT doesn't match up with WP:PRESERVE; I am not deleting information from wikipedia, I am removing it from this page because it is appropriately discussed elsewhere.
• If you admit that you are creating a synthesis, but still don't see a problem, you do not understand the policy in question. Wikipedia is not a publisher of original thought. By stating you have created a synthesis, but don't see a problem, well, if you keep it up it is a fairly clear blockable issue. See {{uw-nor4}}, there's a specific template for warning about original research, and it does say it will result in a block.
• Consider that collectively, you have 67 edits (Mathityahu) and 61 edits (Hillinpa). I have nearly 32,000 so about 266 times more than you collectively. Now, quantity isn't a guarantee of quality, but consider that I may know what I'm doing. Hillinpa, you have included some good sources, and I have done what I can to integrate the appropriate ones.
• Explanatory power is not a good argument unless it's all explaining the core article. This is the bioidentical hormone replacement therapy page. Why would it then spend large amounts of text explaining menopause, when menopause has its own page? If you're concerned over the use and description of compounding, edit the compounding page. The Mayo Clinic page is pretty clear - "However, there's no evidence that bioidentical hormones are safer or more effective than standard hormone replacement therapy." Adding "compounding" to the statement on the main page is dubious OR in my mind.
• If John Lee wrote popular books, per WP:MEDRS, they are not suitable for the page.
• I agree that BHRT is controversial, but the answer is not "the FDA is a phramacompany patsy and the objectors object because they are making money too". BHRT itself isn't a very strong evidence-based medicine, it's not quite fringe but it's certainly not mainstream. In time, if or as the evidence accumulates, the evidence can be added here but wikipedia is not done and the strongest evidence and claims should be included when reported in reliable sources (i.e. JAMA, NEJM or The Lancet). But in the mean time, casting aspersions on the objectors using vague claims, weasel words and original research based on conspiracy theories is not a good option. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:58, 28 February 2009 (UTC)

Wikiproject:Medicine

Note that I've requested input from the medicine wikiproject. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:59, 28 February 2009 (UTC)

Edit conflict

The issues involved in BHRT and the information warfare surrounding it are complex, and can only be unraveled by an expert in the field who is familiar with the original research. I appreciate WLU's editing expertise. I too want a clear, concise article that conforms to Wiki's standards. I understand the goal of having a shorter article which links to explanatory material elsewhere in Wikipedia. I also want an article that clearly defines BHRT and clearly explains the issues and controversies involved. Rather than revert to my previous article, I have edited WLU's brief article with attention to scientific clarity and balance, leaving out most of the material deleted by WLU, for now. I will be interested to see if WLU finds any of current text objectionable, and why. Regarding specific points:

• Much of the information WLU deleted is not available elsewhere, but I agree that some of it may be more appropriately placed elsewhere. For instance, detailed information on research into breast cancer would be best placed under that topic.

Yup, please expand that page if it is missing detail. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:52, 28 February 2009 (UTC)

• I did not admit to creating a SYNTHESIS in some parts of the article, but said that it was possible that I did and that I would like to know precisely where and how. Such information was not provided so I remain sadly unenlightened.

Everywhere you cite a specific study that does not mention BHRT but does mention one or more drugs involved in BHRT, that's a synthesis. Every time you cite a study that does not specifically deal with BHRT but deals with HRT in general. Every citation that gives the impression conventional HRT is not safe and the BHRT is (which also is a problem with WP:NPOV). WLU (t) (c) Wikipedia's rules:^simple/_complex 19:52, 28 February 2009 (UTC)

Again, you have this idea that BHRT is a package deal that should correspond to what you have read in some places. BHRT is the use of bioidentical hormones as opposed to non-bioidenticals. Can we stick with that definition? If we do, then we can produce a top-notch article. Every study involving bioidentical hormones can be used to support/inform the BHRT article. Right? So that's not synthesis. As to which is safer, we have to let the evidence speak for itself. The fact is that right now Prempro has been proven unsafe, bioidentical hormones have not--and we have lots of studies that tells us why this is so. So there's a problem with POV if you're trying to say that molecules that don't belong in the body are as safe as those that do while common sense and the evidence are both against you. Women are slowly figuring this all out. From my perspective, emphasizing testing, compounding, etc in a BHRT article is coatracking. To eliminate coatracking, we have to focus on the issues surrounding bioidentical vs non-biodentical hormones. Hillinpa (talk) 22:58, 28 February 2009 (UTC)

• The Mayo doctor that WLU finds to be clear in her opinion is actually adding to the confusion. She states, "there's no evidence that bioidentical hormones are safer or more effective than standard hormone replacement therapy." In the next sentence she defines "bioidentical hormones"; "Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body." So she is defining BHRT as the use of pharmacy-compounded hormones, which is different from WLU's own definition at the start of the article. This confusion dogs all discussions of BHRT. Much of the argument over BHRT is merely verbal, based upon varying definitions of what BHRT is. Perhaps WLU would like to start a new Wiki in which BHRT is clearly defined from the start as "the use of bioidentical hormones made by compounding pharmacies, combined with the use of saliva testing for sex hormone levels, the use of transdermal progesterone and whatever other things that are not liked by drug companies and some medical authorities".

Nope, I'll stay here. Incidentally, comment on content, not commentator. Your comments are not a personal attack, but it is important to recognize that I am only one of many contributors who have, will or may ever contribute to the page. Point out specific instances of issues, but please leave the "WLU says..." out of it. It's a common mistake made by new editors but you'll be much better off to drop the habit right away.

OK. I just thought is more accurate and polite than saying "you". I'm learning.Hillinpa (talk) 22:58, 28 February 2009 (UTC)

The Mayo doctor is one citation used twice, and the second citation is merely to justify the North American Menopause Society's statement. I've adjusted the page to reflect that BHRT =/= compounding, but most sources seem to conflate it.

Most sources, like the poor Mayo doctor, conflate BHRT and compounded hormones/saliva testing... for the simple reason that lots of money is being spent to keep the two conflated. I explain below--some of which material was carefully presented and sourced in my original edit. Our job is to present the truth as best we can, not to just repeat propaganda.Hillinpa (talk) 22:58, 28 February 2009 (UTC)

• WLU states that "BHRT itself isn't a very strong evidence-based medicine, it's not quite fringe but it's certainly not mainstream." This statement again reveals confusion about what BHRT is. WLU is defining BHRT as a "package deal" including compounded hormones, compounding pharmacies, Suzanne Somers, saliva testing for hormones, etc. This is inaccurate and confusing. BHRT means just what it says--Bioidentical hormone replacement. It means using the right molecules--no matter who makes them, how the need for them is determined, how the levels are monitored, who promotes them, what the therapeutic goals are, etc. Who should have to defend using the correct molecules? BHRT IS strong, evidenced-based medicine. The molecules involved are among the best-studied molecules in medical science. Many studies on hormone replacement have used estradiol and progesterone in FDA-approved hormone products. I hope that the latest edit has helped to clarify the nature of BHRT and will help Wiki readers see through some of the haze. Hillinpa (talk) 15:58, 28 February 2009 (UTC)

Nope, I'm pretty much going by what the sources say. So far the only strong one I've seen that really supports it is Holtorf. I'll try reading through the study and seeing what springs to mind. Really, that's the only source I would begin to trust for strong claims about BHRT. The rest of the sources show a pretty clear consensus of skepticism on the issue. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:52, 28 February 2009 (UTC)

Why the confusion and sceptism everythwere? The editor of the top medical journal, NEJM, Marcia Angell, resigned in protest over pharm. corp's influence on the journal. Wyeth makes Prempro. After the WHI study, Women dropped Prempro and are flocked to bioidenticals. Wyeth petitioned the FDA to essentially ban the compounding of bioidentical hormones--which often sharply undercut commercial bioidenticals in price. Also Wyeth is facing thousands of lawsuits over the harms done by Prempro. Any good lawyer would tell Wyeth to use the defense that "all hormones are alike". Wyeth is a major contributor to NAMS, ACOG, and the FDA (not to mention the resolving door problem). So pharm. corps with their billions exert undue influence on medical information from the top down, and they are interested in non-bioidenticals as they can be patented. The poor doc at the bottom hasn't got a chance unless he's willing to spend hundreds of hours doing his own research. Of course, all this information needn't go in the article, but the article should stick to bioidentical HRT, and not be sidetracked by coatrack issues added on by drug companies and their many mouthpieces.Hillinpa (talk) 22:58, 28 February 2009 (UTC)

All information for the NEJM page, but all original research on this page and inappropriate. Unless you have a reliable source stating that drug companies are responsible for all the skepticism about BHRT, it's not appropriate for the page. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:05, 1 March 2009 (UTC)

Destructive Edit--Again

See the discussion above. Much explanatory material has again been removed, by the same author, with no reasonable cause or explanation. The resulting article is far less informative. The last edit by myself should be restored and a discussion of particulars should ensue to produce a better article. The recent edits not only remove information, but reveal an attempt to define BHRT narrowly as a "package deal" of saliva testing, compounded hormones, and marketing practices. This is a distortion of the facts, albeit quit common in the literature and a contributing cause of the terrible confusion that persists regarding hormone replacement for menopause. "Bioidentical" does not equal "pharmacy-compounded". If one wants to define BHRT in this restricted way, one should create a new Wikipedia article entitled "Pharmacy-Compounded Bioidentical Hormone Replacement". The charge of Synthesis needs to be explained, not just mentioned as an excuse to eliminate factual and explanatory material. The charge of coatracking is not applicable. BHRT is, as still defined at the beginning of the article, the use of bioidentical molecules in hormone replacement as opposed to non-bioidentical molecules. The latter is only a subset of bioidentical hormone therapy, as clearly evident by the availability of FDA-approved bioidentical hormones and their use by all physicians. All issues related to the differences between bioidentical hormones and non-bioidentical hormones are relevant to this topic. All studies showing differences between bioidentical and non-bioidentical molecules are relevant. Studies showing differences between oral estrogens and transdermal estradiol are relevant as BHRT practitioners use transdermal estradiol preferentially, whereas conventional HRT indiscriminately uses oral estrogens which are known to increase blood clotting tendencies. Discussing what hormones are bioidentical and what hormones are not is relevant to the topic--so why was that material removed? Resolving the "synthetic" vs "natural" confusion is important--the recent edit is confused and confusing on this point. All matters relating to how BHRT is administered by practitioners who define themselves as doing "BHRT", in contrast to how conventional HRT is administered according to ACOG and NAMS guidelines, are relevant to the topic. Let us stick to the facts, and to scientific explanation and clarity.Hillinpa (talk) 05:54, 25 August 2009 (UTC)

Based on more reading, what people think of when they ask about "bioidentical hormones" is not what is scientific. It is what is promoted by Suzanne Somers, which has more to do with compounding than it does with the chemical nature. The area is unclear and equivocal, so a split may be needed between bioidentical hormones, which could really be a redirect to hormone replacement therapy, and bioidentical hormone replacement therapy (marketing term) which is what laypeople think of when bioidentical comes up - compounded dosing with a hefty dash of conspiracy mongering and salesmanship. None of this is helped by compounding pharmacists and marketing companies doing a runaround of the peer-reviewed literature. A refocus of the page may be warranted so it's specific to the marketing term, with only a brief note needed to say "there are currently many hormone preparations which are identical in molecular structure to those found in the human body, and are a part of conventional hormone replacement therapy." In this case I'd still place most of the emphasis on the peer-reviewed literature that the claims made by marketers are unfounded, lack evidence, and in many cases are more expensive than conventional hormone replacement. My objections about excessive discussion of menopause, syntheses and original research are still present - the page would not need a lengthy discussion of how hormone replacement therapy is bioidentical already, merely a brief note. Most of the sources include sections discussing compounding, which should make things easier. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:23, 25 August 2009 (UTC)

The definition of "bioidentical" hormone is clear--it means that the molecule has the same chemical structure as the endogenous hormone. There is no other term one can use as an alternative. In fact the term had to be invented because alien molecules (Premarin, Provera, ethinylestradiol, etc.) are called "hormones" in spite of the fact that they are not human hormones. So the term "bioidentical" is essential to scientific discussion of hormone therapy. Furthermore, the professional organizations making statements on this issue--ACOG, NAMS, and the Endocrine Society take the position that there is no difference in effects in the human body between bioidentical molecules and alien molecules. This is from the Endocrine Society statement linked at the article,

"No medical or scientific evidence exists to support the idea that the adverse and/or beneficial effects found in the WHI resulted from the molecular structure of the synthesized hormones, nor is there any sound scientific evidence to show that a different or “customized” dose of hormones would have changed the outcome. If dosage and purity were equal, then all estrogen-containing hormone therapies, “bioidentical” or “traditional,” would be expected to carry essentially the same risks and benefits. Therefore, regardless of the source or structure of the hormone administered therapeutically, all hormone therapy regimens—even those that are so-called “customized”—must be carefully controlled."

This statement defines "conventional hormone therapy"--it makes no distinctions between any molecules or routes of delivery. All "hormones" are alike. Since this is conventional HRT, what do we call the practice of doctors who use only molecules that are identical to those that belong in the human body? The "conventional" position is not only contrary to common sense, it is contradicted by a vast body of published evidence--some of which was recently removed from this article about bioidentical hormone therapy. Doesn't the public deserve to know about this evidence? Where does it belong? The way that this gross conflict between drug-company funded organizations' positions and the facts is evaded is by confounding the science of bioidentical hormones with the issue of compounded bioidentical hormone products. Drug companies obviously have a vested interest in suppressing the compounding of hormones, as drug companies wish to sell their own versions, which are much more expensive in general, in contradiction to what the current article states. So this page has a conflict over the definition of "bioidentical hormone therapy". You join drug-company-funded organizations in labeling BHRT as a marketing term, yet is not this biased labeling itself a drug-company marketing and legal-protection strategy? Confining the discussion of bioidentical hormone therapy to certain marketing/compounding practices is a position which is incompatible with clarity, with the scientific evidence, and with the need for public understanding of the issues involved. We need to include both views of BHRT in this article--the "compounding-pharmacy-Suzanne Somers marketing" view and the "best science" view. The previous article did this--however imperfectly. We should reinstate that article and work on it together--with appropriate discussion of any major changes in advance. I do agree with not including descriptions of menopause and its disorders and any other topics which should be covered elsewhere.Hillinpa (talk) 12:12, 26 August 2009 (UTC)

Briefly, note that pharmanoia, the idea that pharmacology companies are suppressing, preventing, or otherwise being evil about information, is not a way to get anything justified on a page. Without a specific discussion, of this specific topic, in a medically reliable source, of the actions of specific companies, there should be no impact on the main page. If there is actually a concerted effort of such companies regarding a specific compound, it should be justified and demonstrable using reliable sources. I'm not going to address such points further without the relevant sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:32, 26 August 2009 (UTC)

FDA source

[1] WLU (t) (c) Wikipedia's rules:^simple/_complex 15:23, 25 August 2009 (UTC)

POV tag

Hillinpa (talk · contribs), your tagging of the article as POV is unjustified. First, please read WP:TLDR and confine your arguments and discussion on this page to that which can be understood vis-a-vis Wiki policies. Second, please read WP:TALK and WP:BATTLEGROUND. Third, please read and digest WP:MEDRS, WP:UNDUE, and WP:NPOV. In order to justify the POV tag, the burden is on you to explain where the article fails to meet the NPOV policy, using reliable sources to back up your claims. Long diatribes of opinion not backed by sources isn't helpful. SandyGeorgia (Talk) 15:16, 26 August 2009 (UTC)

Notes about discussions

A note that we can not create our own definitions and conceptions of what BHRT is. We can only use what is verifiable in medically reliable sources. We can not decide to admit or discard sources because they are about "real" BHRT, or "real" bioidentical hormones. We have a couple sources that point out valuable information like:

• there are many FDA approved bioidentical hormones, and they have been researched extensively
• BHRT as used by advocates is mostly about marketing, not a novel molecule or set of molecules
• much of the confusion is over the failure to distinguish compounded-versus-bioidentical practices and advocacy
• the heavily-marketed concept of bioidentical hormones as understood by women seeking a relief from symptoms of menopause is a separate issue from the science behind actual "bioidentical" hormones (in the sense of molecularly identical rather than marketing term)
• part of the problem is the confusion between compounding, which is how the "marketing approach" really differs from the "science approach", and premixed hormone delivery systems. Much of the criticism in the scientific literature is about compounding rather than bioidentical issues.

These points should be heavily featured in the lead and start of the page, as well as any other reliable clarifications. I believe the page should focus mostly on the "marketing" approach with whatever clarifications we can verify. I think Hillpna and I are in agreement over this, though it only was clarified to me recently after reviewing some new sources. I'm now going to try to wade through the sources with these points in mind and see where that leads me. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:17, 26 August 2009 (UTC)

I have removed the POV tag as I think it is agreed that this article will not try to pigeonhole BHRT as a marketing scheme. I agree with the points made by WLU (talk · contribs) above, although I would emphasize that the scientific issues--what studies show about the benefits and risks of bioidenticals vs. non-bioidenticals--be fully exposed in this article. As I've argued above, there's really no other place that this information belongs. I've rewritten the first paragraph only and have not changed any other part. I hope editors will discuss any major changes they believe necessary here in the discussion page, first. Let us work together to create a great article on this most controversial and confusing topic--which is of the greatest importance to 1/2 of the human population, and very important to the other half as well.Hillinpa (talk) 22:35, 27 August 2009 (UTC)

Point:

Bioidentical hormone replacement therapy is indeed a marketing scheme, one that links up bioidentical hormones, pharmanoia, compounding, appeals to uninformed women who are frightened by the perceived risks of conventional treatment and seeking an alternative, and are marketed to by various parties who seek to sell individually compounded products which are more expensive than conventional ones, to no demonstrated benefits, accompanied by a media package and packaging. That's what the peer-reviewed journals are up in arms over, that's what people are drafting consensus statements against. There are a variety of sources that make these points. They do not clearly delineate between this concept, and my next point.

Bioidentical hormone replacement therapy is very different from hormone therapy using bioidentical molecules. As Schwartz & Holtorf discuss, this is simply one set of molecules that form a subset of the many treatment options available to doctors and patients. This page should focus on the unsupported marketing gimmick. Specific discussions of specific molecules and specific forms of post-menopausal hormone replacement therapy should go on those specific pages. Doctors do not seem to distinguish bioidentical hormones for treatment from nonbioidentical ones - they use the best evidence available and the preferences of their patients to decide what to prescribe. It is like distinguishing between medicine and alternative medicine - once an "alternative" is proven to work, it becomes simply "medicine". Alternative medicine is a marketing gimmick used by unproven treatments (with approaches remarkably similar to those used by BHRT) to try to drum up demand for unproven products. S&H make the valuable point that bioidentical molecules are different and often confused with BHRT, and specific claims about specific molecules and combinations of molecules should go on those pages. The "bioidentical hormone replacement therapy" that S&H discuss is not the same one discussed by the various governing bodies and other sources. They discuss the science-based ones. Until there is evidence, verifiable in a variety of different medically reliable sourcess that these molecules are addressed in a generic fashion rather than as individual molecules, we should treat "bioidentical" claims as the marketing term. If a large number of sources crop up discussing "bioidentical molecules" in a collective fashion, then it would be appropriate to have two pages, the marketing one and the scientific one. With just one paper that does this, that has no citations I could see on google scholar, it makes a single valuable point but not one that should be used to rewrite the whole page and ignore the other citations. We do not report the cutting edge, we report the blandly mainstream. There are lots of sources, the best kind of sources, that indicate the mainstream views BHRT dimly. So we should stick with that. One thing I did not like about this edit was that it portrayed a variety of organizations as essentially giving a blanket endorsement to the use of BHRT ("Each of these organizations have issued statements claiming that there is no difference in the benefits or in the risk profiles of hormone replacement therapies using bioidentical molecules compared to those using non-bioidentical molecules") when much more accurately, those organizations could be described as urging caution on the use of BHRT because the claim benefits which are not scientifically proven. Some quotes:

“ “Bioidentical hormones,” particularly estrogen and progesterone, have been promoted as safer and more effective alternatives to more traditional hormone therapies, often by people outside of the medical community. In fact, little or no scientific and medical evidence exists to support such claims about “bioidentical hormones"...Hormone customization is very difficult to achieve, because blood hormone levels are difficult to measure and regulate accurately due to normal physiologic variations. Nonetheless, proponents of “bioidentical hormones” assert that simple tests of saliva can provide the information necessary to customize hormone doses. They also allege that customized “bioidentical hormones” are safer and more effective than modified hormones synthesized under close FDA supervision. These claims are not supported by scientific data...The Endocrine Society is concerned that patients are receiving potentially misleading or false information about the benefits and risks of “bioidentical hormones.” [2] ”

“ In response to recent media attention being given to so-called bioidentical hormones, The American College of Obstetricians and Gynecologists (ACOG) reiterates its position that there is no scientific evidence supporting the safety or efficacy of compounded bioidentical hormones...Some of these pharmacies claimed that compounded hormones were superior to FDA-approved hormone therapies and that they also prevented or treated serious diseases, such as Alzheimer's disease, stroke, and various cancers. The FDA stated that the pharmacies' claims of safety and effectiveness were false, misleading, and a violation of federal law...Despite celebrity testimonials touting scientifically unfounded benefits of compounded bioidentical hormones, the bottom line is that most have not undergone rigorous clinical testing for safety or efficacy, nor are they approved by the FDA. ACOG also stresses that salivary testing of a woman's hormone levels is not useful because they vary within each woman depending on her diet, time of day, the specific hormone being tested, and other variables [3] ”

“ ...the term [Bioidentical hormones] is most often used to describe custom-made HT formulations (called "bioidentical

hormone therapy," or BHT) that are compounded for an individual according to a healthcare provider`s prescription...Use of BHT has escalated in recent years, often with the dose determined by salivary hormone testing, a procedure that has not been proven accurate or reliable...Custom-compounded drug formulations are not approved by any regulatory agency, although some active ingredients meet the specifications of the United States Pharmacopeia. Expense is also an issue, as many custom-compounded preparations are viewed as experimental drugs and are not covered by third-party payers, resulting in higher cost to the patient...There are individual women for whom the positives outweigh the negatives, but for the vast majority of women, regulatory agency-approved HT will provide appropriate therapy without assuming the risks and cost of custom preparations. [4]

”

These are the exact sources which were supposed to verify the statement "Each of these organizations have issued statements claiming that there is no difference in the benefits or in the risk profiles of hormone replacement therapies using bioidentical molecules compared to those using non-bioidentical molecules". I consider this disingenuous and though perhaps true, it is not verifiable and can only be jumped to through misrepresenting the overall thrust of the sources, making some significant original research conclusions and steering the page well-clear of what most people believe to be the ultimate topic of BHRT. I believe this is very much within the mainstream interpretations of the relevant policy, and am willing to go to the appropriate board for confirmation if there is disagreement. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:22, 28 August 2009 (UTC)

Verbal Argument

We have here a merely verbal argument. We have to resolve the verbal disagreement, not endlessly argue from the viewpoints of our different definitions of BHRT. You insist basing this article on a perjorative definition of BHRT--as a marketing term invented by an industry/movement that is unscientific and delusional (pharmanoia?). This is a package deal fallacy. Your definition is not representative of the wording of the title of the article. Your definition paints anyone using the term "bioidentical" as ignorant, greedy, and deluded. Your definition is not neutral, nor supported by the facts. To support your definition, do attempt to find any case where a physician or celebrity states that FDA-approved bioidentical hormones should not be used. This is not about compounding. "BHRT advocates" advocate the use of the proper molecules, not just compounded preparations. Do attempt to prove that all advocates of the use of bioidentical molecules also agree with Suzanne Somers in all particulars, use saliva testing exclusively, etc.. Do prove that all persons who are convinced of the superior safety and efficacy of the correct endogenous molecules are involved in a marketing scheme intended to mislead the public. Your definition, however mainstream, is illogical and misleading. Your use of language like "BHRT advocates claim..." throughout your edit is perjorative and prejudicial. Neither side in the debate should be represented in such ways. I'm sure Wikipedia does not exist either to take one side in a debate or to "blandly represent the mainstream", especially when the "mainstream" view is itself a pharmaceutical corporation marketing scheme and law-suit protection racket. (I see that I need to demonstrate this so that you understand from where this farcical "mainstream" view is emanating. See below.) I insist that BHRT should be taken to mean just what it says--hormone therapy using bioidentical molecules. "BHRT" is a necessary, highly accurate, and specific term that properly differentiates bioidentical from conventional hormone replacement. The article should represent all views of BHRT, including the view of drug-company funded organizations--the view you are presenting. Wikipedia certainly exists to try to expose the truth, and should present both sides of a controversy, and should also present the evidence so that the reader can decide. In this case, the use of bioidentical hormones IS supported by evidence, lots of it. There is much more evidence from verifiable sources that I had added to this BHRT article in the past--which you deleted since it did not accord with your agenda. Some if it is mentioned in the current Wikipedia HRT page--which by the way also defines BHRT as I am advocating. I think that Wikipedia's BHRT page should go into more detail concerning all aspects of BHRT than the Wiki page on HRT--marketing and , controversies, and scientific aspects. What BHRT detractors mean when they say "there is no evidence" is that the individualized compounded products, made by thousands of different pharmacies, have not been studied in the same way that FDA-approved bioidentical and non-bioidenticals have been studied. This is true in a a certain sense, but it ignores the fact that a hormone that is blended into a cream or tablet by a compounding pharmacy IS logically and scientifically considered to have the same effect as the same hormone blended into a cream or tablet by a pharmaceutical company--until proven otherwise. The science applies to both, what will differ is the level of quality control and the amount of hormone needed in the different products to produce the same hormone absorption. This is why compounding is legal and persists. BHRT using FDA- or non-FDA-approved products is not alternative medicine--it is a best medical practice until proven otherwise--until it is proven that alien molecules work better than endogenous molecules, hard to do when the evidence points the other way. Authors of most peer-reviewed articles on this subject are not "up in arms" about BHRT, they are generally much more careful and specific in their treatment of the issues as compared with the statements of physicians and organizations that are funded by drug companies (see below). Please do a little research on the increasing corruption of medicine by pharmaceutical corporations, it is a major issue and much-discussed in books and the media.

Regarding evidence, there are many peer-reviewed articles that show that bioidentical estradiol delivered transdermally does not cause the increase in blood clotting seen with FDA-approved oral estrogens, and that progesterone does not increase the risk of breast cancer in the way that FDA-approved alien progestins do--yet these facts have not made their way into the position statements of drug-company funded organizations (see below). They continue to insist that "all FDA-approved hormones and delivery methods are alike". WHY? Is not this voluntary blindness to the evidence dangerous to women? Perhaps the millions of "uninformed" women seeking BHRT are in fact much better informed than most physicians? The Wikipedia article on BHRT should deal with the scientific evidence, not take one side in a debate. The vast majority of the research showing harms caused by hormone replacement therapy (like the WHI) involved the use of non-bioidentical molecules (references can easily be provided). This fact alone, and the thousands of lawsuits pending over Prempro explains the pharmaceutical industry's motivation in slamming BHRT as unscientific and a marketing term (See below). Because the evidence in favor of bioidentical molecules is impressive (references available), maintaining this distinction is of extreme importance to the health of women. Anyone attempting to distort this debate with fallacious definitions and perjorative language is putting the health of all women at risk. To illustrate the inappropriateness of your definition--BHRT practitioners include all doctors who, based upon their own interpretation of the evidence, prefer to use bioidentical hormones only--and the number of such doctors is growing by the day. Many of them routinely use FDA-approved bioidentical hormone products (Estrogel, estradiol patches, Prometrium-progesterone, etc). So are they part of your BHRT package deal? Is their practice merely a part of a "marketing gimmick". Should using the scientifically-valid term "bioidentical" automatically brand a doctor as an insane quack? Can you create a better, more objective and accurate term than "bioidentical". Give it a try, I can't. The best alternative is "alien" but that clearly has negative connotations. "Natural" and "non-synthetic" are inaccurate.

Regarding compounding, it is in fact hard for doctors to avoid the compounding of hormones as there is no FDA-approved product to provide testosterone to women; it must be made by a compounding pharmacy. Also any doctor trying to use only bioidentical molecules finds that compounding pharmacies provide progesterone in many forms that can be better tolerated than oral Prometrium, and can provide estradiol in creams and gels to women at a fraction of the cost of pharmaceutical products. I repeat, compounded hormones can be made and sold at a fraction of the cost of pharmaceutical versions, making them much more affordable to those persons who need them. No doubt there are some compounding pharmacies or HRT boutiques that are inflating the costs. But in most cases, compounded hormones are even less expensive than the insurance co-pays for the pharmaceutical versions. Numbers can be provided based on costs at a local compounding pharmacy. Any person or organization who claims that BHRT is a marketing scheme to pawn off more expensive products is lying. Wyeth, other pharmaceutical corporations, and physician and womens' organizations that they fund have been pressuring the FDA to essentially stop the compounding of hormones, which would deny women access to this less expensive alternative and would increase the sales and profits of the pharmaceutical corporations. Wyeth is not only losing market share, it has been hit with thousands of lawsuits over Prempro> Surely is it only logical for Wyeth to promote the view that "all hormones are alike" in their risks.

You talk of pharmanoia. The position statements made by the Endocrine Society, ACOG, and NAMS influence all other physicians and commentators in a top-down fashion, so to get to the source we must look at who is influencing these statements. Apparently you are assuming that these organizations are free from bias and do represent the best interpretation of the current evidence. However, each of these organizations is private and relies upon funding by the same pharmaceutical corporations that have invented and now market non-bioidentical hormones (that have been proven to be harmful) and other drugs to treat the disorders caused by menopausal hormone loss, including the bisphosphonates for osteoporosis. This corporate funding is a matter of public record--in most cases the information can be accessed via the organization's own websites. See the sponsors of ACOG, and NAMS. Notice that Wyeth pharmaceuticals appears on each list. The Endocrine Society has no information on their funding at their site, that I could find, however they are listed by a citizen group among professional organizations that receive corporate funding.

It is not "pharmanoia" to question the objectivity of organizations that are funded by one party to a dispute, it is basic commonsense and jurisprudence. There is an obvious conflict of interest here. These are the organizations promoting the package deal definition of BHRT that you find not only in their publications, but in the writings of many other physicians who accept the statement of these organizations as authoritative. Notice that I am not saying that any of this discussion of pharm. corp motivations or influence needs to be included in the article. The article needs only to present the facts--no matter who is presenting them or why. My point is that the Wikipedia article should not represent BHRT as a perjorative package deal--a misleading definition that is itself a pharmaceutical corporation marketing and law-suit protection scheme. Surely Wikipedia does not exist to repeat corporate propaganda or to maintain ignorance and naivety, however "mainstream" it may be.

Regarding the statement and references you removed from the first paragraph--I wrote "each of these organizations have issued statements claiming that there is no difference in the benefits or risk profiles of hormone replacement therapies using bioidentical molecules compared to those using non-bioidentical molecules." Yes, this statement is true, and I can see how it could be misinterpreted by someone who equates "bioidentical" with "compounded". So I have altered it to be more specific--"each of these organizations have issued statements claiming that there is no evidence that either FDA-approved or compounded bioidentical hormone products have superior benefit/risk profiles to FDA-approved non-bioidentical hormone replacement products, and that compounded bioidentical hormone products may have additional risks related to compounding." The key point is that the "conventional" opinion is that there is no difference between bioidentical molecules and xenobiotic or invented molecules--as long as the FDA has approved them they are all alike. Many, many physicians have looked at the evidence and decided otherwise--and such evidence should be discussed in this article.Hillinpa (talk) 15:09, 29 August 2009 (UTC)

Please read WP:TLDR, and propose concrete wording changes based on WP:MEDRS without the long debate. SandyGeorgia (Talk) 18:03, 29 August 2009 (UTC)

Sorry for the long post, but this is a discussion about how to define BHRT and all the points addressed were raised by another editor. Maybe this is not a subject that lends itself to Haiku or twittering. I have edited the introduction--which was reverted before--giving it what I think is a good compromise wording for now. It avoids the attempt to judge BHRT as a marketing scheme, but mentions that this opinion is held--someone may want to attribute it to some person or group, as it was unattributed previously and still is. I also removed the unattributed and imprecise "there is no evidence supporting BHRT" line. The reality is far more complex and needs to be better presented in this article.Hillinpa (talk) 19:09, 29 August 2009 (UTC)

Good lord that's too long. Please be more concise. Most sources are critical of BHRT and treat it as the marketing term. One source correctly distinguishes that bioidentical hormones are not new. But per WP:NPOV and WP:OR, we do not define the terms. We take use the most reliable sources to verify what the most mainstream use of the term is and use that. The majority of the sources, by far, are critical and see it as an inappropriate sales pitch and portraying the opinions several organizations as neutral or positive about BHRT when they are clearly, clearly critical and warning caution in their use is certainly wrong. Please read WP:OR and WP:NPOV thoroughly - they are core policies and until we are all editing with an eye on those main policies, the page will continue to create disputes. Also, citing the sponsors of a study does not reduce its reliability. Articles critical of other articles and specifically discussing BHRT are useful. Please cite them to indicate the relevant medical community does not approve of the other sources. Simply claiming the studies are biased is not helpful. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:33, 29 August 2009 (UTC)

Hillinpa, please spend some serious time digesting Wp:TALK, WP:BATTLEGROUND, WP:MEDRS, WP:V and WP:NOR, and try to propose text cited to reliable sources rather than using the talk page for long debates. No one enjoys reading through long pages of editor opinion; please find reliable sources that conform with WP:MEDRS, and propose text that conforms to those sources. Are primary sources being used in this article, or does it more correctly use only reviews? See WP:MEDRS. SandyGeorgia (Talk) 15:27, 30 August 2009 (UTC)

Consistency and Evidence

The article currently correctly defines BHRT as HRT using molecules that are molecularly identical to the endogenous hormones. Then it is said that BHRT is more frequently used to describe compounded HRT. OK. However, the following statements are then made "advocates for BHRT portray it as superior to conventional hormone replacement therapy by being tailored to the individual women seeking symptom relief. There is no evidence to support BHRT being superior to conventional hormone replacement therapy." (Notice there is no attribution for either statement.) Clearly "BHRT" is being used to refer to "compounded BHRT", in contradiction to the opening definition. Since there is actually a great deal of evidence that bioidentical hormones, in pharmaceutical form, are safer than non-bioidentical hormones, the latter statement in the article is false. See the Holtorp article for a summary of the studies comparing bioidenticals to non-bioidenticals. So I suggest that for consistency, the phrase "compounded BHRT" be used when this is what is meant, and that the distinction between BHRT and compounded BHRT be maintained throughout the article. Mixing the two together is a common error seen in the statements of "experts" and physician organizations. Mixing the two meanings obviously creates confusion and obscures the public's ability to understand the important research on bioidentical molecules vs. non-bioidentical molecules. Can we agree upon maintaining this distinction? Can we also agree that the evidence that bioidentical hormones are safer than many non-bioidentical hormones is relevant to, and can be presented in this page--of course from verifiable sources and without violating NOR? Hillinpa (talk) 13:28, 30 August 2009 (UTC)

Can you please base your arguments on review sources that conform with WP:MEDRS? After another long expression of opinion, I went looking for the source you mention above, and found only citation errors in the article. Also, text in the lead need not be cited if the corresponding text is cited in the body of the article; the lead is a summary. SandyGeorgia (Talk) 15:31, 30 August 2009 (UTC)

It appears that you do think it can be said that there is no evidence that pharmaceutical bioidentical hormone products are safer than non-bioidenticals. OK, see info. below. However, the problem remains that the current article's intro. states "no evidence for superiority of BHRT", then refers to BHRT being "tailored to the individual woman seeking relief"--the latter clearly meaning "compounded BHRT". I think it is imperative that the editors clearly state "compounded BHRT" when that is what is meant and "BHRT" when all bioidenticals including FDA-approved products are meant.
Regarding the evidence for the superiority of BHRT in regard to blood clotting: It is well established that transdermal estradiol does not increase blood clotting like oral equine estrogens or ethinyl estradiol[5]--therefore there is strong reason to believe, and some evidence from studies, that much of the increase in DVT's,[6] strokes, and heart attacks[7] seen with conventional oral HRT can be avoided by using estradiol via the transdermal route, which is just what most BHRT practitioners prescribe. A very good review article dealing with bioidenticals vs. non-bioidenticals, from leading specialists in Europe, is here.[8] Unfortunately the abstract is merely an introduction and does not reflect the content, and the full article is not on the web. Let me quote some conclusions reached by the authors after a review of the evidence:
"Oral estrogen therapy activates blood coagulation [16,17,24,26] and increases the risk of venous thromboembolism (VTE) in postmenopausal women [1,7,9,15]. Transdermal estrogen has little or no effect on haemostasis [24,26,49]p.3,...For symptomatic postmenopausal women willing to start or continue an HT, non-oral estradiol could be the considered for first-line prescription, especially in women at high risk of cardiovascular disease." p.5
Regarding the risk of breast cancer, which is more closely linked to progestins than estrogens, see this link for a free copy of a review article out of Europe which concludes that progesterone does not have the breast-cancer promoting effect of many of the progestins.[9] It deserves to be read in full. Again quoting from the Modena paper:[10]
"The hypothesis of progesterone and some progesterone-like progestins decreasing the proliferative effect of estradiol in the postmenopausal breast remains highly plausible and should be, until the coming of new evidences, the first choice for symptomatic postmenopausal women."p.7
Given these papers and statements from top researchers, in peer-reviewed journals, it really cannot be maintained that "all FDA-approved hormone products are alike". The evidence for the superiority of bioidenticals would include these review articles. Some of the actual results from primary research articles referenced in these papers would be presented also. Just to mention: there are many tens if not hundreds of primary research articles showing differences between bios and nonbios in cell cultures, animals, bioassays in humans subjects, symptoms in humans, etc. In the vast majority, the bios have more of the beneficial effects and less of the negative effects.Hillinpa (talk) 02:48, 31 August 2009 (UTC)

I don't think the quotes you have used to prove your point are well-suited to the purpose. For example, in the Modena paper, it says "The hypothesis of progesterone and some progesterone-like progestins decreasing the proliferative effect of estradiol in the postmenopausal breast remains highly plausible." This means that bioidentical progesterone might be superior to certain non-bios, but the addition of the words "some progesterone-like progestins" clearly means that the author believes there to be some non-bioidentical hormones that are on a par with bioidentical progesterones in this regard. Also, as it says at WP:MEDRS, "Neutrality and no original research policies demand that we present the prevailing medical or scientific consensus, which can be found in recent, authoritative review articles or textbooks and some forms of monographs. Although significant-minority views are welcome in Wikipedia, such views must be presented in the context of their acceptance by experts in the field. The views of tiny minorities need not be reported. (See Wikipedia:Neutral Point of View.) Make readers aware of any uncertainty or controversy. A well-referenced article will point to specific journal articles or specific theories proposed by specific researchers." The issue of bioidenticals is controversial right now, and the consensus is in flux. Wikipedia is not the place to seize the initiative to say what the consensus is. While you may be convinced of bioidentical superiority, as far as medical science is concerned, the jury is once again out. As a result, I think the best you can do right now is to discuss the controversy, and the claims of each side, without stating either side as definitive. I do fully expect that in the next 5 years, a much stronger case for bioidenticals and against things like MDA and CEE will be made. But that time is not yet. By picking out articles that support your point, I'm sure you can make a convincing case. But that's just not Wikipedia policy--it constitutes original research and is an NPOV violation.QuizzicalBee (talk) 07:35, 31 August 2009 (UTC)

Refactored citations - straight urls are more useful on the talk page. I think I've said it before, but I'll repeat. Taking individual citations about individual compounds and extrapolating to the whole of all bioidentical hormones is inappropriate. The specific citations for specific hormones should go on those specific pages. What should be on this page is information about BHRT the concept as described in reliable sources, which mostly deal with the marketing of the hormones as somehow better, more tailored, unique and lucrative (the former three aimed at women, the latter aimed at pharmacists and doctors). Doctors don't seem to distinguish between bioidentical and non, they seem to go more on "is this the best choice for my patient based on the evidence. But I really have to re-read the articles when I have the time for a more solid opinion. I am pretty sure that at least one article specifically referred to BHRT as a marketing term, I've removed that from the lead for now but may return it if it seems appropriate.

Also, Hillpna, you need to review WP:LEAD. The first paragraph is a summary of the whole article, and there is debate over whether footnotes in the lead are a good thing. So long as an idea is sourced in the body, it is generally acceptable to mention it in the lead without citation. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:38, 31 August 2009 (UTC)

My point has been missed, and it is quite simple: The article defines BHRT as "the treatment of symptoms of menopause using hormones that are molecularly identical to the endogenous hormones found in the human body." Then it states "There is no evidence to support BHRT being superior to conventional hormone replacement therapy." Given the preceding definition, the latter statement is false as I've demonstrated above. It is falsified by many studies that show that transdermal estradiol does not increase blood clotting, DVT's and heart attacks as do oral estrogens. Ergo, all hormone therapies are not alike. It is also falsified by studies showing that progesterone does not increase the risk of breast cancer as do Provera and other progestins. See the above links for the verifiable sources--and more are available. I urge editors to read the Campagnoli review of the evidence regarding progesterone and breast cancer [11], consider just one of the studies it reviews--the largest study to date comparing progesterone with progestins--the E3N-EPIC study [12]. Tens of thousands of women were followed for 5 years, and the study has now gone out 8 years. The results are clear: transdermal estradiol plus progestins causes a 40% increase in breast cancer over baseline. Transdermal estradiol plus progesterone produces NO (that's zero%) increase in breast cancer over baseline. So, any person or organization that is stating that "there is no evidence...all hormone therapies have the same risks" is lying to women and putting their health at risk. There is indeed abundant evidence that the bioidentical hormones, pharmaceutically-produced transdermal estradiol and oral progesterone (Prometrium), are safer than other forms of "HRT" (all other oral estrogens and progestins). If the "mainstream" would recognize this and provide the safer bioidentical treatment, at low cost, then women wouldn't have to go runnning to "BHRT" compounding pharmacies, now would they? Their own family doctor or OB/GYN could correct their hormone deficiencies. However, the "mainstream" cannot recognize that bioidenticals are more safe because the market for non-bioidentical "hormones" would collapse, the Prempro and BCP lawsuits would escalate, and the compounding pharmacies and celebrities would be vindicated. I propose only that this Wiki article must clearly present both sides of this debate, the scientific evidence for using the bioidentical molecules, plus the "mainstream" view of BHRT (irresponsible compounding pharmacies, "intense" marketing, greedy doctors, uninformed female victims, etc.). Let all views be represented and let the reader decide. Can this be agreed?Hillinpa (talk) 07:40, 1 September 2009 (UTC)

If your point has been missed, it could be because your posts are too long and stray from WP:MEDRS; please see the next section about definitions of the term. Please read WP:NOTSOAPBOX and WP:TALK and WP:V; Wiki reports what reliable sources say, not anecdote or opinion. SandyGeorgia (Talk) 07:53, 1 September 2009 (UTC)

Undent. That's a pretty big dump of WP:OR as well from what I can see. The category of "bioidentical hormones" as a form of treatment pretty much doesn't exist in mainstream medicine, it exists within those groups who sell them. Again, if estriol is better than premarin at treating certain symptoms and reducing adverse events, put it in those pages or the main article on HRT where specific compounds, which were compared in specific sources against specific outcomes can be legitemately reviewed. But the consensus seems to be bioidentical hormones are only treated as a class by entities that manufacture, sell and compound hormones, not by the medical community as a whole. Also, I certainly agree with Sandy that there is a considerable amount of advocacy to be read in your statements, which is extremely inappropriate for wikipedia. Consider conducting a program of research and publishing the results in a series of peer-reviewed journal articles. If enough of the medical and research community agree with you, you will have done a far greater service than merely adjusting the wikipedia page, since there would be proof and a shift within the relevant communities. Going here first just creates a lot of popular demand for something that is very obviously not considered kosher within mainstream medicine. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:34, 1 September 2009 (UTC)

Sources used

I've just checked the recent reviews at PubMed, and see that this article still relies heavily on some older, non-review sources, while most of the current reviews are cited only once or twice. The article should reflect current reviews, and primary sources should only be used according to WP:V and WP:MEDRS. I also noticed that PMID 18075509 is not covered, and that several of the most recent reviews include working definitions of BHRT that might be useful for this article. For those who don't know how to locate PMID-indexed reviews, go to PubMed, type in the search term (Bioidentical hormone replacement therapy), and once the results are returned, click on the "Review" tab to show only reviews. Also, Hillinpa, please read this page: Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. SandyGeorgia (Talk) 14:24, 31 August 2009 (UTC)

Sandy, do you have full text? Could you e-mail me a copy? Rosenthal does have a couple of similar articles published, some are cited at Wiley Protocol. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:52, 31 August 2009 (UTC)

No, I don't. But I did notice working definitions of BHRT in several of these reviews, and think they will help cut through the opinion. Reliably-sourced definitions should be used, and they are available. SandyGeorgia (Talk) 20:02, 31 August 2009 (UTC)

'K, I'll start trolling for sources from TimVickers and the like when I find the time. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:26, 31 August 2009 (UTC)

Dr. Erika

Interesting fact, Dr. Erika Schwartz, who authored or coauthored a couple of the sources on this page, is a "patient health advocate and leading expert on bioidentical hormones" [13]. I believe Schwartz is a main author on many of the main "pro" papers too. Interestingly, she also sells a variety of creams, vitamins, and a popular book. So, if we take the "drug companies are evil and can't be trusted because they are trying to protect their profit margins" as a means of eliminating sources, then any authored by her would be out as well.

Which is why reliable sources are only discounted because of criticism in other reliable sources. Individuals promoting nonmainstream medical products can be just as biased as shareholders at Pfizer. Something often forgotten when those same individuals decry the biased state of modern medicine to popular audiences. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:57, 1 September 2009 (UTC)

Sources

In response to a request from WLU I have collected a set of the most recent academic reviews on this topic. If any other editors wish to get copies of these articles, please e-mail me here. Requests for other sources are also welcome. Tim Vickers (talk) 23:58, 2 September 2009 (UTC)

The sources in question are:

• Sites, CK (2008). "Bioidentical hormones for menopausal therapy". Womens Health 4 (2): 163-71. PMID 19072518.
• Boothby LA, Doering PL (August 2008). "Bioidentical hormone therapy: a panacea that lacks supportive evidence". Curr. Opin. Obstet. Gynecol. 20 (4): 400–7. doi:10.1097/GCO.0b013e3283081ae9. PMID 18660693.
• Cirigliano M, (2007) Bioidentical hormone therapy: a review of the evidence. J Womens Health (Larchmt). 16(5):600-31. PMID 17627398
• Rosenthal MS (2008). Ethical problems with bioidentical hormone therapy. Int J Impot Res, 20(1) 45-52 PMID 18075509
• Rosenthal MS (2008). The Wiley Protocol: an analysis of ethical issues. Menopause, 15(5) 1014-22. PMID 18551081.
• McBane SE. (2008). Easing vasomotor symptoms: Besides HRT, what works? JAAPA, 21(4), 26-31 PMID 18468366.
• Panay N. (2007). New products and regimens (since 2003). Climacteric. 10 Suppl 2:109-14 PMID 17882685. Panay mentions bioidenticals only once, tangentially - WLU

I'll need a while to read and digest them before adding anything to the page based on them. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:41, 3 September 2009 (UTC)

WLU, for starters, we should get a reliably sourced definition of what BHRT is, and then be sure to include mention of FDA-approved bioidenticals, for which there is some evidence. SandyGeorgia (Talk) 20:46, 3 September 2009 (UTC)

I've edited the first paragraph to distinguish between "BHRT" and "compounded BHRT", whereas the two were being confused previously. I've added a more clear definition of "BHRT" vs. "conventional therapy". I've also added a statement about the findings of studies using pharmaceutical bioidentical products along with references--which is superior to the previous blanket statement that "there is no evidence of the superiority of BHRT". The confusing section on "natural" vs. "synthetic" was cleaned up.Hillinpa (talk) 14:45, 10 September 2009 (UTC)

Your changes, particularly to the lead, put too much emphasis on the alleged benefits, when the mainstream opinion is clearly skeptical. You also placed a series of three articles in which synthesized various sources into an opinion that was against the specific statements by sources that BHRT has no advantages. Your definition muddied things, and did not clear it, and seems to show a distinct bias (like many of your edits) which are at odds to what seems to be the prevailing opinion (BHRT is unproven and no evidence has shown that it offers an advantage over properly prescribed conventional HRT, which already uses bioidentical molecules anyway). I did keep one change, the movement of the "bioidentical" definition to the Terminology section, and moved "administration" down lower in the page. Some of your edits also appeared to be sourced to references that did not actually verify the text they accompanied. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:55, 10 September 2009 (UTC)

I have left your lead as it is for now. I have placed the discussion of the research in the research section. There is no synthesis there--do try to point it out if you can. It is not synthesis or bias to present high-quality evidence, in an objective fashion, that contradicts the mainstream view. No additional connections are made nor theories presented. Please read the papers linked, and do reconsider the propriety of using this page as an anti-bioidentical rant. Since there is powerful evidence against the mainstream view--then what should we think of the mainstream view? Certainly Wikipedia does not merely parrot mainstream views, but also presents the evidence.Hillinpa (talk) 12:25, 18 September 2009 (UTC)

Find me the reference to bioidentical hormone replacement therapy in, for example, this article. You're also overlinking dates in citation templates, and referring to ongoing studies - we don't do that (WP:RECENTISM) as well as there being millions of ongoing studies and it is inappropriate to look at all of them. And again, you can't refer to x study that looks at y hormone and say it's about bioidentical hormones. Re-read my previous comments, they apply to all of your recent contributions. Your recent edits contained myriad flaws I have already pointed out and numerous inappropriate additions just enumerated. I have accordingly reverted all of them. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:21, 18 September 2009 (UTC)

In the review article cited [14], the authors conclude that transdermal estrogen carries less thrombotic risk than oral estrogen. The Canonico paper comes to the same conclusion--and there are several others. The abstracts refer only to "estrogens", you have to be familiar with the literature in general or read the articles to realize that the transdermal estrogen they refer to is always estradiol--the bioidentical estrogen, while the oral estrogen referred to in almost all cases is Premarin. Only estradiol is available in transdermal form for menopausal HRT (patches, gels, creams). BHRT practitioners overwhelming use estradiol transdermally--either FDA-approved forms or compounded forms. The point is that all HRT is not alike, in contradiction to the false claims you repeat ad-nauseum. This is significant, is it not? So shouldn't this article include this information? Why did you also remove the references to progesterone being associated with a lower risk of breast cancer than non-bioidentical progestins? What's your problem with including that information in an article on BHRT? The section is about research into bioidenticals; mentioning that studies are underway and linking info. about them is valuable information on the topic and simply keeps the article current. Such information does not violate the guidelines in (WP:RECENTISM) as far as I can tell--it deals with very different issues. 207.7.178.116 (talk) 15:19, 26 September 2009 (UTC)

Bioidentical is not mentioned once in that article. It is original research. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:33, 28 September 2009 (UTC)

You're getting in a kind of catch-22 situation here. Since "bioidentical" is not a term usually employed in medical journals, you're not going to find much research with that actual term. Yet it's undeniable that in that article just mentioned, the data pertains to bioidentical hormones. It's not original research to call it bioidentical--it's just a difference between colloquial terminology vs. medical terminology. That's a semantic difference, not an inclusion of original research.QuizzicalBee (talk) 19:34, 28 September 2009 (UTC)

Actually there's tons of publications explicitly on bioidentical hormones, but they are treated as a marketing term used by compounding pharmacies, not as a novel way of administering hormone therapy. Hormones that are molecularly identical to those produced in the body have been used for decades, they've just never been lumped into a category before. Each hormone is researched and published on its own merits. Calling these molecules "bioidentical" and treating them as if they were God's gift to peri- and post-menopausal women is the novelty. Pretty much all publications treat them as problematic, except for the non-peer reviewed ones published by sales agencies and a minority from advocates like Dr. Erika. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:40, 28 September 2009 (UTC)

"God's gift"? Sounds like you have quite an axe to grind against bio-identical hormones, and that kind of non-neutral point of view has no place in Wikipedia. YOU are defining bioidentical in the way YOU want to define it. That is the way some people define it, but it's NOT how everyone defines it, and it is not the way it is being defined in this Wikipedia page. We came to that agreement after much discussion. It is against Wikipedia policy for people to just come in and redefine a page and ignore all of the discussion that has preceded it.QuizzicalBee (talk) 06:04, 29 September 2009 (UTC)

Undent. I see it as more an informal summary of the statements by multiple bodies - The Endocrine Society [15], The American College of Obstetricians and Gynecologists [16], the Mayo Clinic and North American Menopause Association [17], the Australian Menopause Society [18] [19], the American Association of Clinical Endocrinologists and the FDA [20], the chief medical editor of Endocrine Today [21] - and multiple peer-reviewed articles [22], [23], [24], [25]. The majority opinion of most scholars seems to be that bioidentical hormones are indeed a marketing concept (and an expensive, dangerous one) rather than a radical new approach to the treatment of the symptoms of menopause. As stated above, "While you [referring to Hillinpa I believe - WLU] may be convinced of bioidentical superiority, as far as medical science is concerned, the jury is once again out." That's exactly how I would also summarize it, with appropriate references to reliable sources. Researchers seem to dislike that they are being promoted as something new and miraculous when it's merely a repackaging of something that already existed. I really do not think it is a good idea to take a bunch of citations that never use the term "bioidentical" once, and cite them in the page to validate the idea that bioidentical hormones are superior to nonbioidentical ones, particularly not when there are multiple explicit sources that deal with bioidentical hormones and express considerable caution and criticism. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:20, 29 September 2009 (UTC)

I reiterate: you are using a definition of "bioidentical" that the editors of this page have agreed is too narrow a definition. You are then refusing the inclusion of articles that are about bioidentical hormones according to the broader definition. And you're listing a whole long list of impressive organizations--which are only talking about bioidentical using that narrower definition. As long as the broader definition stands, then those medical journal articles are relevant. A distinction can and should be made that those articles pertain not to the entirety of things referred to as bioidentical, but only to a specific type. But they should not be deleted on the grounds you have named. It doesn't matter that the word "bioidentical" is not used in the article; again, it's a semantic distinction. "Bioidentical" is not a medical term. No one is disputing that. It's a colloquial term and therefore not necessarily used in medical articles. QuizzicalBee (talk) 07:45, 30 September 2009 (UTC)

Who decides what is a bioidentical hormone? If it's in one of the tables used by a source here? What about when the bioidentical hormone is modified by the liver after being taken orally? Is it still bioidentical? Is it only transdermal or vaginal lozenges that are then called bioidentical, making the delivery more important than the molecular structure while it's in the packaging? To define x hormone as bioidentical then claim a bunch of benefits for it is inappropriate. A review article like the BMJ one linked above should be cited on the estrogen page. Otherwise, should we read the meta-analysis, then find the source studies and review them to make sure they are all talking about bioidentical hormones? Who has the expertise to do this? Am I allowed to dispute that y study should be used because it's not bioidentical based on my personal knowledge? The individual properties of individual hormones should be dealt with on those individual pages. There is ample evidence to state that doctors and the FDA don't treat hormones differently whether they are molecularly identical or not, they deal with them individually based on their unique risk and benefit profiles without lumping them into categories which are semantically and molecularly meaningful without being biologically and medically meaningful or relevant. The science does not support the identical/nonidentical distinction and many responsible groups object.

My sole question becomes then, when do we decide a hormone is bioidentical and can therefore its risks and benefits discussed on this page? WLU (t) (c) Wikipedia's rules:^simple/_complex 10:39, 30 September 2009 (UTC)

"Who decides what is a bioidentical hormone?"--The answer is simple, in this context: NOT US. Editors on Wikipedia are not here to make the decision about what is a bioidentical hormone, and what is not. That would be a NPOV violation, and an OR violation. We are just here to provide the information as it is being used by others. Since there are a variety of different definitions of the term, the purpose of this page is to not favor one over the other, but to explain the distinctions, the arguments, the critiques. So, there are several different versions of the word out there, and this article makes these distinctions clear in its intro paragraph. Because you don't like it being called bioidentical is not enough to not include it here. Think of it like this: you might believe that creationism is bunk. But that doesn't mean that there should be no creationism entry on Wikipedia. What it means is that there will be a creationism entry, and that entry will explain what proponents of creationism believe, as well as what critics of it believe, and how it fits into the larger debates about religion and science in the US and the world. And in discussions by editors of what to include and what not to include, the argument of a "young earth" creationist that "old earth" creationism shouldn't be mentioned on the page, is not indulged. And the argument of the world's most highly respected scientists are not sufficient to cause the creationism entries to be deleted, because the entries do not represent an endorsement of the idea of creationism and a rejection of evolution. Their purpose is to inform people about what the concept is. Wikipedia is an information source, and it's the mission here to collect the information, with a neutral point of view.QuizzicalBee (talk) 07:37, 2 October 2009 (UTC)

Yes, that's a very mainstream interpretation of WP:OR that I agree with. The problem has been editors who say "this article is about bioidentical hormones and the information in it should be included in the page", but a review of the article finds that the word "bioidentical" or even "identical" isn't found in the article at all. Accordingly, I think it is inappropriate to use that article as a source. I have created a table that shows the FDA-approved existing hormone combinations that are bioidentical, because the Harvard Medical Watch article was explicit on which hormones are bioidentical. I would resist any attempt to say "X compound is on the table, Y article is about that compound (but doesn't call it bioidentical), therefore the page should include this article talking about the many benefits of using X compound". That reads as a synthesis to me, as well as an undue weight issue considering how many articles are explicitly critical about the claims made about bioidentical hormones. There are many sources in the article discussing the problems with BHRT and why the claims made are problematic, if you looked through a couple (and if they are not linked in the references section, I could probably e-mail you a copy). The problem cited in most if not all critical articles has been promoters of bioidentical hormones have been making extravagant claims about these compounds when there is no scientific evidence to suggest that their risks and benefits are any different from the hormones used today. BHRT is presented to pharmacies as a fantastic new stream of revenue (because custom-compounded bioidentical hormones are much more expensive than the conventional ones) meanwhile many bodies and researchers are saying there is no proof of benefits and many reasons for caution. That "fantastic revenue stream" is also probably why there are significant efforts made on this page to present the idea that these hormones are safe, effective, and better than what is currently used. I have no proof, but it seems a very likely idea. But we shouldn't be "neutral" in our presentation, we should present the information to the degree and proportion it is reflected in mainstream medical publications - most of which is critical. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:57, 2 October 2009 (UTC)

External links

I can't concieve of any reason why this link would count as a valid external link and several reasons not to WP:ELNO points 2, 4, 5, 14 as well as WP:COI. It's not just the drug companies that have conflicts of interest, it's places like these who bitch and moan about the drug companies and their conflicts of interest while trying to sell you unproven and expensive treatments.

This link from the American College of Obstetricians and Gynecologists should be lniked as an inline citation, it's far too brief to be used as a EL. I'll get to that shortly. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:44, 18 September 2009 (UTC)

This article is about both the scientific and social aspects of BHRT, so it would seem quite reasonable to let the reader see who these doctors advocating HRT are, otherwise the article is nothing but a bunch of link to drug-company funded naysayers. Linking pro-BHRT sites brings some balance. Another such link that would be useful is the statement by the International Hormone Society here. —Preceding unsigned comment added by 207.7.178.116 (talk • contribs) 11:19, September 26, 2009

Is there any research to indicate that the BHI is respected? That it is a WP:MEDRS? That its presence in the EL section does anything but present undue weight issues and efforts to promote it? Particularly since their literature reviews have been called biased? The references are to medically reliable sources, pulling out the paranoia card against peer-reviewed journals is absurd when the counter-claim is pushing dangerous and expensive compounds that the counter-claimants make money from. Why is it that only those who base their claims on science are biased when the ones pushing the potential dangerous and unresearched treatments are noble searchers for the truth? If they really want to find the truth, they should apply for grant funds and undertake clinical trials to demonstrate the safety and superiority of their products, then publish in the peer-reviewed literature. Making claims of censorship, bias and conflict of interest is a classic tactic of pseudoscience, and quack medicine. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:10, 2 October 2009 (UTC)

Definitions

• "BHT is the practice of individualizing hormone therapy based, in part, on salivary hormone concentrations, and perhaps more importantly on the assessment of individual patient symptoms [2]. The hormones that are subsequently prescribed and dispensed for individual patients are those hormones that are said to be ‘bioidentical’ to the hormones circulating in the body (i.e., identical in structure and function to endogenous hormones)[3]. These hormones, in various combinations typically include estrone, estradiol, estriol, progesterone, and testosterone. According to the proponents for BHT, ‘bioidentical’ hormones differ from ‘synthetic’ hormones in that synthetic hormones are manufactured into standardized dosage forms in various combinations and concentrations by large pharmaceutical companies, whereas ‘bioidentical’ hormones are individualized and often compounded extemporaneously for patients based upon an assessment of both salivary hormone levels and the patient’s symptoms [3]. Sometimes BHT proponents use the terms ‘bioidentical’ and ‘natural’ interchangeably, as they believe that traditionally manufactured hormones are unnatural and harmful, but ‘bioidentical’ hormones are natural and helpful."

Boothby LA, Doering PL (2008). "Bioidentical hormone therapy: a panacea that lacks supportive evidence". Curr. Opin. Obstet. Gynecol. 20 (4): 400–7. doi:10.1097/GCO.0b013e3283081ae9. PMID 18660693. {{cite journal}}: Unknown parameter |month= ignored (help)

• "Commonly referred to as natural HRT, bioidentical HRT consists of individually compounded hormones that are chemically identical to those secreted by the female body...Advocates of bioidentical HRT frequently recommend salivary testing to quantify circulating hormones and guide the formulation of bioidentical HRT...All these publications champion bioidentical HRT as safer and more effective than traditional, commercially manufactured HRT preparations."

McBane, SE (2008). "Easing vasomotor symptoms: Besides HRT, what works?". Journal of the American Academy of Physicians Assistants. 21 (4): 26–31. PMID 18468366.

• "Bioidentical hormones (BHs) are molecularly identical to the endogenous hormones found in women that can be derived from a variety of sources, such as plants (soy or yams) after chemical modification, animals (pigs and horses) after purification, or through de novo synthetic production...Although rarely promoted as such, many commercially available CHTs, primarily estradiol and progesterone products, are in fact bioidentical, and almost all CHTs are made from the same plant sources as found in compounded and over-the-counter (OTC) BHTs." The table on page 606 also describes Esradiol, Estradiol, Estriol, Progesterone, Testosterone and Testosterone propionate as "compounded [and] customized for each patient, criteria vary; saliva, sera levels, or symptoms."

Cirigliano, M (2007). "Bioidentical hormone therapy: a review of the evidence" (pdf). Journal of Womens Health. 16 (5): 600–31. PMID 17627398.

• "the FDA has now concurred with The Endocrine Society that the term bioidentical is a marketing term and not one of scientific or medical merit...proponents of bioidentical hormones (including many physicians in private practice) began to use the WHI trial results as a marketing tool to promote bioidentical hormones as safer" The paper also discusses the Wiley Protocol specifically, which is a form of bioidentical hormone replacement therapy that uses compounded hormones and blood tests.

Rosenthal, MS (2008). "The Wiley Protocol: an analysis of ethical issues". Menopause. 15 (5): 1014–22. PMID 18551081.

• "The term bioidentical is a pseudoscientific neologism that refers to endogenous hormones, including estriol, estrone, estradiol, progesterone, testosterone, DHEA, thyroxine, and cortisol. Natural alludes to the fact that these are native human hormones. In fact, these hormones are synthesized or semisynthesized. Stigmasterol from soybeans (Glycine max) and diosgenin from an inedible Mexican yam (Dioscorea villosa) can be converted to progesterone in the laboratory,¹ but there is no evidence that plant sterols convert to progesterone endogenously. Many bioidentical hormone products that require a prescription are prepared by compounding pharmacies...Saliva testing for hormones has been promoted to individualize the dosing of bioidentical hormone treatment...these hormones are no more natural than (and in many cases are identical to) commercially available drugs...No reliable data support the claim that bioidentical hormones are safer than other hormones, and natural, bioidentical, and compounded preparations must be assumed to have the same risks as commercial hormone preparations."

Fugh-Berman, A (2007). "Bioidentical Hormones for Menopausal Hormone Therapy: Variation on a Theme". J Gen Intern Med. 22 (7): 1030–4. PMID 17549577. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

• "Bioidentical hormone replacement therapy (BHRT) is defined by Boothby et al.¹ as ‘hormone treatment with individually compounded recipes of certain steroids in various dosage forms, including dehydroepiandrosterone, pregnenolone, testosterone, progesterone, estrone, estradiol, and estriol...the use of the term ‘natural’ refers to steroid hormones occurring naturally in women and does not refer to phytoestrogens or similar substances.’ Fugh-Berman and Bythrow² state that bioidentical hormones, a ‘pseudoscientific neologism...refer to endogenous hormones, including estriol, estrone, estradiol, progesterone, testosterone, DHEA, thyroxine, and cortisol [which are] synthesized or semisynthesized...Throughout the 1990s, the term used to describe compounded hormones from botanical sources was ‘natural hormone therapy’...BHRT is often prescribed to individuals based on the analysis of a person’s salivary hormone levels, however these tests are criticized for being unreliable because there is no correlation between symptoms and hormone levels"

Rosenthal, MS (2008). "Review: Ethical problems with bioidentical hormone therapy". International Journal of Impotence Research. 20 (1): 45–52. PMID 18075509.

• "NAMS recognizes that one area of confusion in clinical practice is so-called Bioidentical^ hormone preparations. This term has been used to refer to many well-tested, regulatory agency-approved, brand-name HT products containing hormones chemically identical to hormones produced by women (primarily in the ovaries), such as 17A-estradiol or progesterone. However, the term is most often used to describe custom-made HT formulations (called "bioidentical hormone therapy," or BHT) that are compounded for an individual according to a healthcare provider`s prescription...Use of BHT has escalated in recent years, often with the dose determined by salivary hormone testing, a procedure that has not been proven accurate or reliable."

The Board of Trustees of The North American Menopause Society (2008). "Position statement - Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society" (PDF). Menopause: The Journal of The North American Menopause Society. 15 (4): 584–603. doi:10.1097/gme.0b013e31817b076a. PMID 18580541.

• "Many women assume that “natural” hormones would be better or safer — but the term “natural” is open to interpretation. Any product whose principal ingredient has an animal, plant, or mineral source is technically natural...The interest in a more natural approach to hormone therapy has focused attention on bioidentical hormones — hormones that are identical in molecular structure to the hormones women make in their bodies. They’re not found in this form in nature but are made, or synthesized, from a plant chemical extracted from yams and soy. Bioidentical estrogens are 17 beta-estradiol, estrone, and estriol. (Estradiol is the form of estrogen that decreases at menopause.) Bioidentical progesterone is simply progesterone...Much of the confusion about bioidentical hormones comes from the mistaken notion that they must be custom-mixed at a compounding pharmacy. But custom compounding is necessary only when a clinician wants to prescribe hormones in combinations, doses, or preparations (such as lozenges or suppositories) not routinely available...Some clinicians who prescribe compounded hormones order saliva tests to monitor hormone levels. Most experts say these tests are of little use because there’s no evidence that hormone levels in saliva correlate with response to treatment in postmenopausal women...There is no scientific evidence that the compounded preparations Biest and Triest, which are largely estriol, are safer or more effective than other bioidentical and FDA-approved formulations."

"What are bioidentical hormones?". Harvard Women's Health Watch. Harvard Medical School. 2006-08-01. Retrieved 2009-02-27.

• "Even the term “bioidentical hormones” has taken on a different meaning. The FDA has approved hormones that are bioidentical, or having the exact structure as those produced in the body. However, marketing of compounded hormone therapies as “bioidentical hormones” may lead to confusion over what the term refers to...Alan Garber, MD, PhD, chief medical editor of Endocrine Today, said that “bioidentical hormone replacement is a clever marketing concept devoid of scientific underpinnings, and preys upon the patient’s desire for better hormonal replacement therapies that are both safe and effective, properties totally unproven by the proponents of such agents”...Advocates of bioidentical hormones tout them as tailor-made mixtures that replicate the normal estrogen and progesterone profile of a women’s body lost to menopause, without the risks posed by synthetic HT. Proponents emphasize the natural aspect...Bioidentical hormone therapy typically contains various forms of estriol, estradiol, estrone, micronized progesterone and, sometimes, testosterone and dehydroepiandrosterone. These hormones are compounded for various routes of administration – oral, topical, transdermal or suppository...Saliva testing to determine the amount of hormones in a woman’s body has not been proven accurate or reliable....Salivary hormone testing creates a dubious basis for making any such hormonal determination, Cirigliano said. “What [bioidentical hormone advocates] are doing is selling an expensive test and repeat prescriptions that are very expensive,” Utian said. “They are actually selling a fallacy there.”"

Kalvaitis, K (2008). "Compounded hormone therapies: unproven, untested - and popular" (web reprint). Endocrine Today. 6 (5).

• "The term “bioidentical HRT” refers to the use of hormones that are exact copies of endogenous human hormones, including estriol, estradiol, and progesterone, as opposed to synthetic versions with different chemical structures or nonhuman versions, such as CEE. Bioidentical hormones are also often referred to as “natural hormones,” which can be confusing because bioidentical hormones are synthesized, while some estrogens from a natural source, such as equine urine, are not considered bioidentical because many of their components are foreign to the human body."

Holtorf K (2009). "The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?" (PDF). Postgrad Med. 121 (1): 73–85. doi:10.3810/pgm.2009.01.1949. PMID 19179815. {{cite journal}}: Unknown parameter |month= ignored (help)

• "Bioidentical hormones are identical to hormones produced endogenously."

Moskowitz, D (2006). "A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks" (PDF). Alternative Medicine Review. 11 (3): 208–23. PMID 17217322.

• "'Bioidentical hormones' is a term created by the lay media to refer to chemicals derived from plants that are modified to be structurally identical to endogenous human hormones." (from abstract, need full text)

Sites, CK (2008). "Bioidentical hormones for menopausal therapy". Womens Health. 4 (2): 163–71. PMID 19072518.

• "The pharmacy operations improperly claim that their drugs, which contain hormones such as estrogen, progesterone, and estriol (which is not a component of an FDA-approved drug and has not been proven safe and effective for any use) are superior to FDA-approved menopausal hormone therapy drugs and prevent or treat serious diseases, including Alzheimer's disease, stroke, and various forms of cancer...The pharmacy operations receiving warning letters use the terms "bio-identical hormone replacement therapy" and "BHRT" to imply that their drugs are natural or identical to the hormones made by the body. FDA regards this use of "bio-identical" as a marketing term implying a benefit for the drug, for which there is no medical or scientific basis."

"FDA Takes Action Against Compounded Menopause Hormone Therapy Drugs". FDA. 2008-01-09. Retrieved 2009-02-17.

• "“Bioidentical hormones,” particularly estrogen and progesterone, have been promoted as safer and more effective alternatives to more traditional hormone therapies, often by people outside of the medical community. In fact, little or no scientific and medical evidence exists to support such claims about “bioidentical hormones.” Additionally, many “bioidentical hormone” formulations are not subject to FDA oversight and can be inconsistent in dose and purity. As a result of unfounded but highly publicized claims, patients have received incomplete or incorrect information regarding the relative safety and efficacy of hormone preparations that are referred to as “bioidentical.” “Bioidentical hormones” are defined as compounds that have exactly the same chemical and molecular structure as hormones that are produced in the human body. Though any hormone can be made to be “bioidentical,” the term is often used to describe formulations containing estrogens, progesterone, and androgens...proponents of “bioidentical hormones” assert that simple tests of saliva can provide the information necessary to customize hormone doses. They also allege that customized “bioidentical hormones” are safer and more effective than modified hormones synthesized under close FDA supervision. These claims are not supported by scientific data. Patients can obtain “bioidentical hormones” in two ways—as FDA-approved preparations that are formulated with strict oversight and dispensed by retail pharmacies; or from compounding pharmacies, where the hormones are changed from their original form into another form, purportedly for individual customization. Often these contain combinations of different forms of estrogen and/or progesterone with different potencies."

"The Endocrine Society- Position Statement: Bioidentical Hormones" (pdf). The Endocrine Society. 2006-10-01. Retrieved 2009-02-29. {{cite web}}: Check date values in: |accessdate= (help)

• "In response to recent media attention being given to so-called bioidentical hormones, The American College of Obstetricians and Gynecologists (ACOG) reiterates its position that there is no scientific evidence supporting the safety or efficacy of compounded bioidentical hormones." (obviously not a definition, but rather relevant; also treats bioidentical and compounded bioidentical hormones as synonymous)

"ACOG News Release: ACOG Reiterates Stance on So-Called "Bioidentical" Hormones". American College of Obstetricians and Gynecologists. 2009-02-03. Retrieved 2009-09-18. {{cite web}}: Cite has empty unknown parameter: |1= (help)

• "There's a lot of interest in bioidentical — or so-called "natural" — hormone therapy for menopause symptoms. However, there's no evidence that bioidentical hormones are safer or more effective than standard hormone replacement therapy...Bioidentical hormones are custom-mixed formulas containing various hormones that are chemically identical to those naturally made by your body. These prescription and over-the-counter products are marketed as being tailored to a woman's individual hormone needs, typically determined through saliva hormone testing."

Mayo Clinic (2007-08-21). "Bioidentical hormones: Are they safer?". Retrieved 2007-08-27.

• This reference doesn't define bioidenticals, but does come down quite strongly against them, calling them expensive, unproven and the prescribers dishonest.

Davis, SR (2008-08-14). "2003 November 29 - Bioidentical hormones (troches) advice for doctors". Australian Menopause Society. Retrieved 2009-08-25. {{cite web}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

• "In contrast to this, compounding chemists can “hand make” pharmaceuticals in novel delivery systems. Currently, these compounds are not directly regulated by the Therapeutic Goods Administration. Thus, little is known about the quality control, pharmacokinetics, safety and efficacy of these treatments. Compounded hormone replacement therapy is often termed “bioidentical” HRT. Typically, bioidentical HRT contains three oestrogens (oestrone, oestradiol and oestriol), progesterone, and androgens such as testosterone and DHEA, and is usually given either as cream rubbed onto the skin or as troches. Often, bioidentical HRT is monitored using blood or salivary levels of sex hormones."

Eden, JA (2007). "Three cases of endometrial cancer associated with "bioidentical" hormone replacement therapy" (pdf). Medical Journal of Australia. 187 (4): 244–5. PMID 17708728. Retrieved 2009-08-25. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

• "In response to safety concerns promoted in the lay press, women have turned increasingly to phytoestrogens and other “natural” products as safer alternatives to pharmaceutical dosage forms of estrogens and/or progestogens. In addition, conventional hormonal substances prepared in unique, individualized dosage forms (eg, gels, sublingual tablets, suppositories) are promoted by some prescribers in conjunction with compounding pharmacies. These practitioners are touting “natural” (sometimes referred to as bioidentical) hormone therapy (NHT) as a safer and more effective alternative to conventional HT...The steroid hormones most commonly compounded include dehydroepiandrosterone (DHEA), pregnenolone, testosterone, progesterone, estrone (E1), estradiol (E2), and estriol (E3). To individualize the composition of the final product, women first submit a saliva or blood sample for determination of hormone levels. Based on the results, the prescriber will then select the individual agent or agents to be incorporated and the amounts of each. Proponents claim that NHT is better tolerated than manufactured products or synthetic preparations."

Boothby, LA (2004). "Bioidentical hormone therapy: a review". Menopause: The Journal of The North American Menopause Society. 11 (3): 356–67. doi:10.1097/01.GME.0000094356.92081.EF. PMID 15167316. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

• "They are looking for something safe which will ameliorate their symptoms, but will not have any associated risks. Does this magic cure exist? Unfortunately, no. Nothing is all good and without any associated risk. However, women have a misperception that there exists some risk free panacea due to advertisements, marketing strategies etc., that may be feeding into the symptomatic woman’s fears and claiming that they have this magic potion, the “Bioidentical Hormone,” which they claim is safer than standard, prescribed hormone therapy. What exactly does the term Bioidentical Hormone mean? This is a somewhat nebulous term used to describe medications which are plant derived...and modified to be structurally identical to endogenous human hormones."

Chervenak, J (2009). "Bioidentical hormones for maturing women". Maturitas. doi:10.1016/j.maturitas.2009.08.002. PMID 19766414.

There's probably others too. There are several themes - molecularly identical, claims of "natural", unproven efficacy against a variety of conditions, salivary testing, compounding, and a substantial amount of criticism. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:05, 2 October 2009 (UTC)

I've now expanded these quotes to include any mention of the safety concerns, use of the term "natural", the relationship to compounding and salivary testing. Now, nearly every single one of them contains mention of all of these ideas. I can not understand how it is not due weight to briefly mention what the "technical" definition of bioidentical is, then not focus on these issues since that is what the articles do. I think there is a point here. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:22, 8 October 2009 (UTC)

I've got three more references from peer-reviewed journals that cite the same issues - unsupported, exaggerated claims, salivary testing, compounding, mis-use of "natural". I'll try to post them tomorrow. This takes time away from actually editing the article, but I hope it demonstrates where the weight should go in the article. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:33, 9 October 2009 (UTC)

Table, derived from Boothby

A variety of specific claims have been made for the effectiveness of bioidentical hormones and BHRT, with varying evidence to support or contradict them:

Claim	Status	Evidence
Bioidentical hormones fit precisely in receptors while conventional HRT fit 'cockeyed'; this mismatch causes serious side effects	True, but misleading	Synthetic and endogenous progestins have different binding affinities for different receptors depending on the model and animal used; the differing pharmacodynamics have not been associated with specific side effects
The body is unable to metabolize synthetic hormones	False	The biological half-life for synthetic hormones is between five minutes and two days
Lack of progesterone causes 'estrogen dominance', resulting in irregular or painful, heavy menses	False	Oral progesterone is no more effective than placebo at alleviating symptoms of premenstrual syndrome
Progesterone can counter-act stress, increases metabolism and decreases abdominal fat	False	There is no evidence to support weight loss due to progesterone; progestin has only been associated with weight gain in patients with cancer-related anorexia
'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
Progesterone therapy can prevent cardiovascular disease, atherosclerosis and raise good cholesterol	False	The Women's Health Initiative found hormone therapy had no effect on cardiovascular disease but was associated with a greater risk of thromboembolism, strokes and pulmonary embolism; though BHRT proponents claim these events are due to the synthetic nature of the hormones used, "certain progestins are associated with increased cardiovascular risk, whereas pregnane derivatives and micronized progesterone neither increase nor decrease cardiovascular risk in the doses studied"

FDA information

According to the FDA

COMPOUNDED BIO-IDENTICAL HORMONE REPLACEMENT THERAPY PRODUCTS

FDA is aware that an increasing number of pharmacists compound hormone products for use by postmenopausal women. These pharmacies often promote their products as “bio-identical” to the hormones produced by a woman’s body, and the phrase “bio-identical hormone replacement therapy” (BHRT) has been used to describe these products. Compounded BHRT products typically contain various forms of estrogen and progesterone and, in some cases, testosterone and dehydroepiandrosterone. BHRT drugs are compounded for oral, topical, transdermal, suppository, and other routes of administration.

FDA’s regulatory approach toward compounded BHRT products is framed by its general approach to compounded drugs: FDA recognizes the legitimacy of traditional pharmacy compounding of BHRT products, i.e., when a pharmacist compounds a BHRT product in response to a licensed practitioner’s decision that a patient’s specific medical need cannot be met by an FDA-approved drug. FDA will generally continue to defer to state regulators regarding this practice. Claims Regarding Compounded BHRT Products

FDA is concerned, however, that a number of pharmacies make claims about compounded BHRT products that are false and that may mislead patients and practitioners as they decide whether these products are appropriate. Drugs that make false and misleading claims are misbranded under the FDC Act.

FDA believes that some promotional materials for compounded BHRT products contain inaccurate information and do not adequately advise patients and practitioners of the risks associated with compounded hormone products (risks that appear to be the same as the hazards related to FDA-approved hormone products). These promotional materials may also contain unsubstantiated claims about the safety and efficacy of compounded BHRT products.

Moreover, some compounding pharmacists claim that their BHRT products are a “natural” alternative to FDA-approved drugs, because the compounded hormones are identical to the hormones produced in the body. These pharmacists may further claim that their “natural” compounded BHRT products are a safe alternative to FDA-approved drugs because they lack the risks and side effects associated with those drugs. FDA is unaware of any credible scientific evidence supporting the assertions that these bio-identical compounded products are a safe or effective alternative to FDA-approved drugs containing hormones. Equally concerning are claims by compounding pharmacists that compounded BHRT products can be used to prevent serious illnesses, including breast and colon cancers, cardiovascular disease, and Alzheimer’s disease. These claims are not substantiated by scientific evidence for these compounded BHRT products, and they risk misleading consumers into using compounded BHRT products to prevent these illnesses in the absence of any evidence supporting there effectiveness.

FDA is also not aware of sound evidence showing the superiority of compounded BHRT products over FDA-approved drugs. Likewise, FDA has no information indicating that the side effects and risks of compounded BHRT products are dissimilar to those of FDA‑approved drugs. Thus, claims regarding the safety, efficacy, and superiority of compounded BHRT products have not been substantiated by FDA and may mislead patients and practitioners. -end quote- (restored 10/6/09, no copyright on FDA material)

The FDA's approach appears to me to be unbiased. The article as it currently stands does not appear to share this lack of bias.

Having no background exposure to this topic, I do not share the view that bioidentical automatically refers to compounded, and I was dismayed to find that it is used interchangeably in this article. As the Wikipedia should be an encyclopedic reference, I believe that these terms need to be de-linked here, as the FDA seems to have done inasmuch as it consistently refers to "compounded BHRT". Riverpa (talk) 14:59, 6 October 2009 (UTC)

Fortunately that's not what the article says. The article says it is frequently associated with compounding - among other things like dubious, unscientific claims, saliva testing, intense marketing and unacknowledged risks that are expected to be essentially identical to conventional hormone replacement therapy. Also fortunately, I've got sources to back up every statement in the article. I've removed the POV tag and added the sources to the lead. Since I have considerably more background in the topic (having read most of the sources used on the page), I'm content with the current presentation. Also note that this page is about bioidentical hormone replacement therapy - bioidentical itself is a bit of accurate, if misleading fluff used by advocates to make some money off of people scared by the WHI findings. The whole package of bioidentical hormone replacement therapy includes salivary testing, compounding and wild claims. Not that it can't be improved, but the sources I've read and included above seem to clearly place much of their weight on the idea that BHRT is less science, more greed. About the only positive piece on it in a peer-reviewed journal is that 2008 bit published by "Dr Erika" in Prim Care Clin Office Pract, which it is a bit early to claim it has revolutionized HRT. The FDA is certainly one authoritative source, but not the only source, on BHRT. WLU (t) (c) Wikipedia's rules:^simple/_complex 17:16, 6 October 2009 (UTC)

Your citations did not accurately reflect what you wrote in the text. I changed the quotes to more accurately reflect the content of the articles. I have no doubt that Compounding Bioidentical Hormone Therapy is a controversial topic. Perhaps the discussion of the compounding aspect and the popular marketing of it should be removed to a separate section and addressed separately. I accessed this article to get information and references about Bioidentical Hormone therapies which are manufactured and marketed through conventional channels. The introduction to this article barely acknowledges that this is a valid option in the pharmaceutical industry today, and does disservice to those of us who wish for this information. Riverpa (talk) 17:40, 6 October 2009 (UTC)

Please space your postings per WP:TALK. I have no problem with your content changes. As far as I know there is no such thing as Compounding Bioidentical Hormone Therapy, but BHRT and compounding are so closely intertwined (as evidenced by the many sources discussing this) that the two are considered essentially interchangeable. We are both editing the lead section, which should summarize the body - it shouldn't be moved elsewhere, it should be expanded upon based on reliable sources. There is lots of information and plenty of references to be accessed, and more on the talk page in the #Definitions section. Those definitions agree - there's not much science there, and a couple are explicit that bioidentical hormones have been an option for decades. The advocates for BHRT and bioidenticals in general are bringing nothing new to the table - no new research, no new information, no new studies, no new compounds, no new techniques for creating them. They are bringing a lot of hype, and the sources are again clear and given due weight - most doctors and researchers don't think the hype is justified. I'm sorry if this doesn't account with what you believe to be true about bioidentical hormones, but that is the majority opinion and that is what we are obliged to report. The FDA quote (which may be a copyright violation so I've removed it) pretty much restates this rather clearly. User:Hillinpa shared similar views about bioidentical not equalling compounding and being horribly besmirched by the association. I would suggest reviewing previous discussions on the matter from this talk page. However, several sources clearly equate bioidentical hormones with compounding, and the idea that there are no substantial benefits beyond conventional hormone replacement therapy and no evidence to support a unique magic to their functioning. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:00, 6 October 2009 (UTC)

I have tried to clarify the differences between compounded and manufactured bioidenticals in several places. I understand that some sources equate compounding and bio-identical, that is why I copied the FDA source which clearly differentiates between the two as it always qualifies BHRT with compounded if that is what it wants to say. I don't believe that we need to propagate an error if we can be more accurate. I extracted the FDA quote here as you have extracted the Boothby table above. I don't really see much difference and wonder why your extract is ok but not mine. As far as the POV tag, I understood that there should be consensus before it is removed. You did not attempt to reach any consensus, you just removed the tag, both times, even though I reduced the scope of the second tag. I still have some issues with the statement beginning "Other features associated with compounded bioidentical hormones". It may have cites, but I cannot find anything in the citations that directly reflect this statement. I would appreciate some clarification.Riverpa (talk) 18:37, 7 October 2009 (UTC)

Nope, you've misrepresented the sources. NAMS is explicit about it being "most often" used to refer to compounded bioidenticals, as are numerous other sources (McBane, Rosenthal, Boothby, Kalvaitis, ACOG, Mayo and Eden are explicit, others are probably implicit). You seem to think that you can provide the truth about bioidentical hormones and correct what you see as misconceptions about them. In fact, we only discuss what can be verified in reliable sources. Until science catches up with the presumed benefits of bioidentical hormones, we stick with what the sources say. Again, I've been over this - please review the talk page and base your arguments on sources, not your own research. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:59, 7 October 2009 (UTC)

I can't figure out what your answer "Nope" is in response to. So, I guess the easiest thing to do is start clean, and ask for an answer to my question regarding my issues with the statement in the first paragraph beginning "Other features associated with". You added the cites, but I cannot find anything in the citations that directly reflect this statement. —Preceding unsigned comment added by Riverpa (talk • contribs) 03:08, 8 October 2009 (UTC)

Undent. Try the Definitions section on this talk page. The FDA is one source. I've identified seven above that clearly associate the two (as demonstrated in the quotes from each article in the definition section ). As for the "other features", the references speak for themselves, and I'm not sure what difficulty you are having. Try reading the second paragraph of the Mayo clinic article, the Boothby definition above, and Eden article. All three are quite clear, and I am frankly confused how they could not be seen as verifying the text they are appended to.

I removed the FDA statement as a WP:COPYVIO because it was essentially the whole page from the FDA. My understanding is that brief exerpts are acceptable for reproduction, but whole pages are not (and completely unnecessary since the link takes you there immediately). My adaptation of Boothby above isn't a series of lengthy quotes, it's paraphrasing the information from the source. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:54, 8 October 2009 (UTC)

The excerpt I copied is approximately 20% of the page it was excerpted from. Here is the FDA policy on copyright: Linking To or Copying Information On the FDA Website: Unless otherwise noted, the contents of the FDA Web site (www.fda.gov)--both text and graphics--are not copyrighted. They are in the public domain and may be republished, reprinted and otherwise used freely by anyone without the need to obtain permission from FDA. Credit to the U.S. Food and Drug Administration as the source is appreciated but not required. -end quote-

Your adaptation from Boothby does not differentiate between the use of compounded BHRT and conventionally manufactured BHRT, which is the basis for this discussion.

Your Definitions section clearly shows a split on the terminology issue, several sources clearly state Compounded BHRT when they want to refer to the treatment, and further qualify that terminology as being used "often", not always. Since they are all excerpts of larger articles it is hard to say what context for the term BHRT has been established elsewhere in other articles. Riverpa (talk) 17:07, 8 October 2009 (UTC)

I've amended the definitions to include the points in the articles where there is mention of the lack of support for its claims, safety concerns, compounding, saliva testing and misuse of the term "natural". It seems to me that WP:NPOV requires that the page focus therefore in these issues, not on the much less discussed idea that bioidenticals happen to be molecularly identical. The story of bioidenticals is the story of its flaws, not of its totally unsupported, claimed triumphs. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:24, 8 October 2009 (UTC)

Seeking Consensus on Definitions

Please do not cut my quote here, your quotes have been allowed to stand above. This is quoted from [26]

The FDA says:

What does the term “bio-identical” mean?

The term “bio-identical” has no defined meaning in any medical or conventional dictionary, and FDA does not recognize the term. Even different medical groups define the term differently. The Endocrine Society, for example, defines “bio-identical” hormones as “compounds that have the exact same chemical and molecular structure as hormones that are produced in the human body,” while the American College of Obstetricians and Gynecologists (ACOG) defines “bio-identical” hormones as “plant-derived hormones that are biochemically similar or identical to those produced by the ovary or body.”

Many compounding pharmacies use “Bio-identical” as a marketing term to imply that drugs are natural, or have effects identical to those from hormones made by the body. FDA is not aware of credible scientific evidence to support these claims. Compounded products that have identical chemical structures to synthetic hormones can be expected to have the same benefits—and risks— associated with FDA-approved hormone therapy.

While you wish to conform to the NAMS definition of bio-identical, even the FDA acknowledges that there is no one definition. I think that qualifying the term BHRT with 'compounded', as the FDA does, eliminates any confusion, as do several of the other editors, as they have indicated in the preceding sections. While the meaning you espouse is perfectly valid, and we are not trying to negate it, the "non-marketing" meaning is also valid, and should be considered when writing this article. It may be used by a minority, but it is used by expert professional organizations such as the Endocrine Society and ACOG, and should therefore be considered significant. Riverpa (talk) 03:29, 8 October 2009 (UTC)

I can click on a hyperlink and read, so the whole quote is unnecessary. Your shorter quote is probably acceptable, but still unnecessary.

The first sentence of the lead of the article clearly states the definition of bioidentical hormones as molecularly identical. The second sentence equally clearly states that bioidentical hormones are mostly associated with compounding. The third equally clearly states other associations - salivary testing and the meaningless term "natural". All are sourced. The majority of the sources I have read portray bioidentical hormones as a sham used to sell expensive compounding processes while making claims about benefits that are wildly out of character with the actual benefits (that are expected to be about the same as conventional hormone replacement therapy). Accordingly, I have given due weight to this coherent set of ideas expressed within the appropriate expert body, the mainstream medical community. People agree that bioidentical hormones, as a technical definition of "identical to molecules produced by the human body", do exist. But the scientists just don't think the claims made are supported by evidence. There's far more to "bioidentical hormones" to just chemical mimicry, and that's what the page should represent. "Bioidentical hormones" as molecules exist and are used, but "bioidentical hormones" as a set of unsupported claims, unnecessary compounding, unclear testing and an unethical marketing concept is what people are pissed off about and what most of the publications are about.

Bioidentical is both a technical definition of molecules identical to those produced by the human body, and a set of unsupported claims made about their effects. The latter is what most people have written about and object to. It's due weight to discuss these ideas in the most depth while more-or-less ignoring the actual effects of bioidentical hormones - which have been used for years and are not expected on the basis of current research to have effects and side effects substantially different from conventional hormone replacement therapy. The NAMS statement doesn't spend large amounts of time discussing molecularly identical hormones; it briefly mentions then, and goes on to talk about compounding, saliva testing, lack of scientific support, safety concerns and expense. For us to wax eloquent on "bioidentical hormones" as a set of molecules is inappropriate original research. Most sources talk about the problems and illegitimacy of the concept that is marketed to women. They don't talk about how great individual molecules are, or the effectiveness of these molecules that have been used for years. That's because individual molecules have individual effects for individual women, and different tissues thereof - each molecule is treated separately and not as if it were a magic group because they happen to be structurally the same as those in the body. The reason they use estrogen-blocking drugs on women with breast cancer (or at risk of it) is because these molecules can be, in certain cases, cancer-promoting even though they are produced endogenously.

But all of this is just meaningless talk - WP:NPOV clearly states we represent the views as we find them in the literature, and WP:OR equally clearly states we don't write about what we think is important.

Incidentally, who is "we"? Are you a representative of an authoritative body? WLU (t) (c) Wikipedia's rules:^simple/_complex 15:11, 8 October 2009 (UTC)

please see WP:IDHT - Riverpa (talk) 19:51, 8 October 2009 (UTC)

The sources explicitly support my points. You have your own opinion and have yet to provide any evidence to support your assertions. You do not appear to understand WP:RS, WP:V, WP:OR and WP:NPOV, or you are deliberately ignoring them. I get your opinion, I got Hillipna's opinion, I got QB's opinion, but none are supported by sources so I don't see any reason to take them seriously. Since I'm the only one of the three that seemed to have actually read the sources, and has used them to substantiate my points, repeatedly, using many, many sources, all from peer-reviewed journals, all converging on single points, I don't know what I'm supposed to listen to. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:01, 9 October 2009 (UTC)

undent

Allmost every one of the citations that you provide attempts to clearly differentiate between the fad treatment use of the term "BHRT" and the use of the term bioidentical to differentiate these estrogens from CE estrogens.

The Cirigliano, M (2007). "Bioidentical hormone therapy: a review of the evidence" text directly supports my contention that the term "Biodentical" is used in two different ways.

Moskowitz, D (2006). "A comprehensive review of the safety and efficacy of bioidentical hormones for the management of menopause and related health risks". Alternative Medicine Review 11 (3): 208-23. PMID 17217322. http://www.thorne.com/altmedrev/.fulltext/11/3/208.pdf.

which abstract you excerpted very briefly, also includes this text which clearly refers to the use of bioidentical hormones for replacement therapy while not referring to the fad treatment plan:

"Research indicates these synthetic hormones vary clinically in safety and efficacy. As such, women and their physicians have, in increasing numbers, been opting for the use of bioidentical hormones; i.e., those that match the structure and function of hormones produced in the body. With greater utilization and research surrounding bioidentical hormones, the differences can now begin to be fully assessed and appreciated. This article reviews the disparities between synthetic and bioidentical estrogens and progestins/progesterone with respect to safety and efficacy; special attention is devoted to clinical outcomes in the breast, endometrium, bone, cardiovascular system, and brain. The studies reviewed suggest bioidentical progesterone does not have a negative effect on blood lipids or vasculature as do many synthetic progestins, and may carry less risk with respect to breast cancer incidence. Studies of both bioidentical estrogens and progesterone suggest a reduced risk of blood clots compared to non-bioidentical preparations. Bioidentical hormone preparations have demonstrated effectiveness in addressing menopausal symptoms. The author advocates for continued research on bioidentical hormones and concludes there is currently sufficient evidence to support their preferred use over that of their synthetic cousins."

Also look at your extract of Holtorf K (January 2009). "The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?". Postgrad Med 121 (1): 73–85. doi:10.3810/pgm.2009.01.1949. PMID 19179815. http://www.holtorfmed.com/wp-content/pdfs/BHRT-PGM-2009.pdf. While Holtorf muddies the water by discussing the term 'natural', he has a clear definition of bioidentical HRT as in opposition to the use of synthetic homones, rather than using it as the fad definition.

The excerpt you provided from the FDA Statement cut this sentence which indicates that the concern the FDA has is primarily directed at compounded drugs:

"Compounded drugs are not reviewed by the FDA for safety and effectiveness, and FDA encourages patients to use FDA-approved drugs whenever possible. The warning letters state that the pharmacy operations violate federal law by making false and misleading claims about their hormone therapy drugs."

The excerpt that you provided from the Endocrine Society Postion Statement has this statement cut out if it by you:

"As women seek safer treatments, they often request “bioidentical hormones” from their physicians."

"The Endocrine Society- Position Statement: Bioidentical Hormones" (pdf). The Endocrine Society. 2006-10-01. http://www.endo-society.org/advocacy/policy/upload/BH_Position_Statement_final_10_25_06_w_Header.pdf. Retrieved 2009-02-29.

There is considerable controversy over the use of compounded BHRT. There does not appear to be a great deal of controversy over the actual use of FDA-approved bioidentical hormones as hormone replacement therapy. The FDA may not approve of the term bioidentical as applied to compounded bioidentical pharmaceuticals, but the term appears to already have a consensus meaning as bio-equivalent.

As well, the WP article on [Hormone replacement therapy (menopause)] refers to Bioidentical Hormone Replacement Therapy with no reference at all to the controversial compounding.

As far as due weight goes, if you google "BHRT" you will probably get a ton of references to the fad therapy. But if you google "sex" looking for information, you will probably get a lot of XXX sites. Does that mean we should give due weight to the XXX sex sites on WP? Why, because the commercial interests have over-weighted their influence in popular culture by intensive marketing?

I am trying very hard to WP:AGF. But it is not easy when you write things like "That being said, I think BHRT is a load of crap,... Fortunately, we're still allowed to edit pages we think are a load of crap. " [27]. Then you continue to edit the page to make it reflect your opinion of the fad, rather than attempting to reflect WP:NPOV.

I see you are still making personal attacks. Please stop or point out exactly where the original research is in my contributions. As for reliable sources and verifiability, your sources are my sources, so I fail to see the conflict. Riverpa (talk) 02:49, 10 October 2009 (UTC)

WP:TLDR WLU (t) (c) Wikipedia's rules:^simple/_complex 13:16, 10 October 2009 (UTC)

WP:POT You asked for sources. I provided them. WP:GAME Riverpa (talk) 13:44, 10 October 2009 (UTC)

You are correct, I dismissed your work far too quickly and apologize for that. I still see your analysis as flawed and promoting a version which does not give due weight to the general opinion, but I will get to specifics later on when I have time. WLU (t) (c) Wikipedia's rules:^simple/_complex 13:55, 10 October 2009 (UTC)

I'll try to respond point by point, but the length of your post could make this confusing. I'll do my best.

Citations do differentiate clearly between CHT and BHRT, but also make it clear that BHRT is not simply molecularly identical molecules, it's a series of claims and practices that have nothing to do with the molecular structure. It's claims about safety, about benefits to the cardiovascular system, about a lack of side effects, none of which are proven through any research. It's not simply a matter of stating what bioidentical hormones actually are; it's a matter of explaining how the term is used. Do most of the articles say just "bioidentical hormones are molecularly identical to those produced in the body" then stop? Or do they go on to say more? I'm trying to get at the "more" part, which is generally not good. The WP:NPOV nutshell states "Articles must be written from a neutral point of view, representing all significant views fairly, proportionately, and without bias." It's the proportionately part that results in the emphasis on criticisms - most articles are mostly critical. Emphasizing and rewriting the page based primarily on a small number of articles places undue weight on those articles. Since most of the articles are critical, and most of the position statements made by official bodies are also critical, the page should be mostly critical as well. A small number of articles taking a different position doesn't mean rewriting the article, that's undue weight. Determining appropriate weight is difficult, which is why I excerpted the large number of definitions above to show that due weight requires emphasis on the compounding, saliva testing and "natural" claims, as well as the criticisms of these claims.

We can't decide what is a "fad" or "appropriate" definition. We can only write what we can cite and we have to write and cite in proportion to what the sources say. I can't speak to the contents of other wikipedia pages, if I ever get the time I may try to correct them.

Please see WP:GHITS and again NPOV - we represent significant views as published in reliable sources. Those commercial sites are not reliable sources, the appropriate sources are medical ones. No websites, no popular books, no talk show postings, just medical literature. I do my best to avoid polluting the page with opinion, primarily by using large amounts of references. As for personal attacks, where have I made them? I have gotten frustrated before because of editors who kept pushing truth that runs in the face of sources. It's not sufficient to cherry-pick sources, they must be represented, as best possible, en masse. That is NPOV, and it's something I've tried to work towards during my three years and 40,000 edits on wikipedia. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:53, 12 October 2009 (UTC)

I would actually prefer that you do respond point by point, since you seem to not take notice of details very well. For example, the first detail that you have missed, and the underlying fallacy in your argument is that "Citations do differentiate clearly between CHT and BHRT". They do not differentiate between CHT and BHRT, they differentiate between CHT and Compounded BHRT, almost 100%, because they treat some BHRT as a sub-set of CHT. That is clearly indicated in almost every article by using the phrase "compounded BHRT" to indicate the type of BHRT which is not a subset of CHRT, which is controversial, and all the tempest is about. When you look at the small amount of primary research that is being done in the field, it is being done about FDA-approved BHRT - the type that you don't want to acknowledge exists.

Yes, we all understand that you are the expert editor and must let everyone know. And because, of course, you are not pushing truth, and everyone else here must have a hidden agenda, because you have decided that you are the absolute arbiter of NPOV where this article is concerned.

As far as NPOV goes, you should re-visit the table you inserted and re-consider, that if a claim has not been proven, it does not make it false. It makes it "unproven". Is that not NPOV? Is that not how FDA and other expert sources refer to unfounded claims about this therapy? They answer "Unproven", you translate that to "False". There is a difference.

That type of transformation occurs with great frequency in your writing on this page, which is why I would like compounded BHRT treated separately from the FDA-approved BHRT, which you do not acknowledge as a notable subject, though millions of women use it.Riverpa (talk) 23:45, 12 October 2009 (UTC)

A page about real and fake BHRT will turn out pretty much the same. The "real" BHRT page will be extremely short, and say that bioidentical hormones exist and have for a long time and are FDA-approved. It would then be a list of bioidentical hormones, and a link to the "fake" page. The "fake" page would look pretty much like this one - it would list all the unsubstantiated claims about bioidentical hormones, call them refuted or unproven, criticize bioidentical hormones for being associated with dangerous, expensive and unnecessary compounding, salivary testing and "natural" public relations crap, list the many agencies that criticize bioidentical hormones, and talk about celebrity testimonials. Focusing on details and individual publications means losing sight of the overall thrust and coherence of the sources on a set of points of general agreements. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:11, 13 October 2009 (UTC)

Per Riverpa's comment I've removed the "status" column from the table and allowed the claim and evidence colulumns to stand on their own. The table still needs further expansion based on Boothby & Doering. WLU (t) (c) Wikipedia's rules:^simple/_complex 18:14, 13 October 2009 (UTC)

Seeking input on terminology

The term Bioidentical Hormone in this sense is used in two discrete ways, one: as a scientific term to indicate the identical nature of two hormones, and 2: as part of the term Bioidentical Hormone Replacement Therapy, popularized by Suzanne Somers and others (primarily compounding pharmacists and some naturopathic physicians) as an unproven therapeutic approach for menopause symptom relief. I would like this distinction emphasized, particularly in the opening paragraphs, and the emphasis maintained throughout, by consistently qualifying the therapeutic approach as "compounded BHRT", as the FDA and many other citations currently do. The word "compounded", and the quotes around the term "bioidentical", tend to get lost between the cited articles and the WP article. Riverpa (talk) 16:02, 8 October 2009 (UTC)

This ignores the numerous citations that not only directly treat the two as identical, but also qualify the the relationship - bioidentical hormones are molecularly identical, and are often associated with compounding. See the verbatim quotes from the above #Definitions section. This is already emphasized, quite clearly in the lead. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:29, 8 October 2009 (UTC)

"Bioidentical Hormones: Ethics and Misinformed Consent"

Focusing specifically on ethical considerations: [28] Debv (talk) 01:08, 9 October 2009 (UTC)

Unless that was published in a peer-reviewed journal somewhere, I wouldn't use it. There's lots of sources from the scientific literature, so there's not much reason to use web pages that aren't from notable agencies or mission statements from authoritative bodies. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:14, 9 October 2009 (UTC)

I'm not familiar with the publication myself but it appears to be peer-reviewed. See for instance About Us and Author Guidelines. And this indicates it is a printed and circulated publication. Debv (talk) 01:29, 9 October 2009 (UTC)

Just to add, this article obviously doesn't serve to supplement or supplant existing sources for the medicine and science of BHRT. It focuses on BHRT in terms of medical ethics.

It does raise an interesting scientific point in passing: "Wright used 'bioidentical' to communicate his still unsubstantiated claim that plant-derived hormones are 'identical' in molecular structure to human hormones. The necessary structural crystallographic data demonstrating this do not exist, which is why the term bioidentical remains misleading." It seems there are reliable sources asserting that bioidentical hormones are actually chemically identical, but on what basis? Are there primary sources validating this? I wouldn't argue for a change in the article on this reference alone, but it does raise an interesting question. I think it would be worthwhile to look for any primary sources that actually prove that they are identical. Debv (talk) 04:07, 9 October 2009 (UTC)

Pubmed won't let me link to it, but a search indicates it's not indexed, which is a vague minimum standard for being a WP:MEDRS. There's already lots of sources, including one by Rosenthal that focusses on the ethics of BHRT. There's a lot of other, more basic issues to be addressed as well and I'd rather focus on them.

As for primary sources asserting they are molecularly identical, there are plenty to justify this but again the molecularly identical assertion is only one rather minor part of the whole story of BHRT; without a solid source stating they are in fact not identical, I don't think it's worth exploring. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:31, 9 October 2009 (UTC)

If you don't personsonally want to use the source, I'm certainly not saying that you must. I'm simply offering it for consideration, should anyone choose to expand on the medical ethics aspect of BHRT. If you're arguing that it's not an acceptable source, I don't find anything compelling in your argument. WP:MEDRS does not require that sources be indexed in PubMed nor in any way suggest that PubMed indexing should be used as substitute for judgment in evaluating sources. In fact it makes clear that PubMed's scope is limited and suggests other search engines. Debv (talk) 17:18, 9 October 2009 (UTC)

The question of whether bioidentical hormones are in fact chemically identical to endogenous hormones is not a minor point. It's central to the argument offered by proponents of BHRT -- that the difference between the hormones tested in the WHI study and the hormones they're selling is that the former are chemically different, hence the deleterious results published by the WHI, and that the latter are safe, truly identical, "bioidentical", to endogenous hormones.

Yes, there are reliable sources, in WP terms, that accept the identicality of bioidentical hormones. Rosenthal here questions this premise and says it remains unproven. The question this raises -- are there any primary sources that actually validate this claim? -- hardly seems to me unworthy of consideration. Whether this question will turn up anything that warrants a change in the article's language, I don't know and I'm not at this point arguing for it. Debv (talk) 06:46, 10 October 2009 (UTC)

Regarding Safety vs Regulation

WLU, please read a little more closely here. The FDA is not making a statement about safety in this quote. They are warning the compounding pharmacies not to make safety claims. This is very different from the FDA making a statement about safety, because they have no opinion about safety in this area because they have no research about it - Here is their statement: "The FDA does not have evidence that “bioidentical hormones” are safer or more effective than other hormone products. FDA believes that the benefits and risks are likely to be the same." If you want a quote on safety from the FDA, that would be the better one to use in that section.

Please read things a bit more closely for context. Just because the word "safety" appears in the quote does not mean it is a statement regarding relative safety of the product.Riverpa (talk) 03:03, 12 October 2009 (UTC)

PS - I didn't see the added text you had made about estriol until after I reverted. (since you did not mention making additional changes, I did not look for any.) While it looks like a perfectly respectable sourced statement, it doesn't really seem to belong to the Wiley Protocol section since that section has no mention of estriol, and there seems to be no linkage between the two. (Estriol and Wiley) Plus, why did you delete my quote regarding the FDA's statement on estriol? Please discuss things like that first. You had no justification to delete it and it should have been left in place since it was properly cited and from a reliable, verifiable source. Riverpa (talk) 03:25, 12 October 2009 (UTC)

The FDA statement belongs in the safety section - the issue is the lack of evidence about claims of safety made by manufacturers and proponents. They have an opinion - claims about safety are unwarranted because there's no evidence to support it. This is the same idea as the other statements made about safety by many other sources. I've replaced the estriol quote with my earlier statement, in the appropriate section; I also did mention it in my edit summary - "integrated statement with citation template". See HELP:DIFF for how the diff-by-diff comparison shows changes. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:51, 12 October 2009 (UTC)

Please do not use my Talk page

Hid tangent and reply

If you wish to address me use this Talk Page.

You message to me :Nuvola apps important.svg You currently appear to be engaged in an edit war according to the reverts you have made on bioidentical hormone replacement therapy. Note that the three-revert rule prohibits making more than three reversions on a single page within a 24 hour period. Additionally, users who perform several reversions in content disputes may be blocked for edit warring even if they do not technically violate the three-revert rule. When in dispute with another editor you should first try to discuss controversial changes to work towards wording and content that gains a consensus among editors. Should that prove unsuccessful, you are encouraged to seek dispute resolution, and in some cases it may be appropriate to request page protection. Please stop the disruption, otherwise you may be blocked from editing.

WLU (t) (c) Wikipedia's rules:simple/complex 12:27, 16 October 2009 (UTC) -end quote-

should go here, as well as any other communication you wish to have with me.

This is a tangent and a failure to appreciate the use of talk pages on wikipedia. Article talk pages should be used only to discuss the article. User talk pages are for discussions of specific issues with editors. The 3RR warning, which is standard, should not be used on this page. If you want to edit wikipedia, you'll have to accept people posting on your talk page, even if you don't like them. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:06, 16 October 2009 (UTC)

I fail to see the conflict in my reversion. You seem to think that reverting is an acceptable way to edit the page, as you have reverted several of my properly cited and written edits, and have deleted content that I have inserted in order to improve the article. You have reverted the same material several times, though it meets WP standards for citation and relevance. When you could not revert again because you would trigger the 3R rule, you re-wrote the affected sections.

I'll be interspersing comments. I don't like doing it, but it'll let me get at specifics. I revert when I see an edit which demonstrably worsens the page. I rewrite sections when there's something of merit in the contribution, not to avoid the 3RR (note that a revert can mean rewording as well as simply changing back). I'm also not the only one reverting, so any comment you make about reverting applies to yourself as well. I've also given reasons for my changes each time. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:06, 16 October 2009 (UTC)

I have deleted statements because your cited sources do not support them. [29]

Placing multiple citation sources on a single statement is almost certainly synthesis, especially since you had a single cite on the statement until I found that the cite did not support the statement. [30]

I, and others, have tried to engage you to collaborate on this page, yet you continue to "own" the article and block any attempt to introduce any material that you do not find meets the standard of your POV. You make citations, but do not read for the actual content, choosing instead to only absorb the parts of the articles that match your views. You drop words that change the intent of articles,[31] you change words to more support what you want to support. [32]

You will not discuss anything that is counter to your POV, or tolerate any entries in the article that may conflict with it. You response is always "No" to anyone's attempt to arrive at any decision that does not mirror your own POV in this matter.

Do not address me on my talk page. Keep you comments, accusations, and threats on this page. Riverpa (talk) 14:02, 16 October 2009 (UTC)