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.

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)

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 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.

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)