Singapore’s Medical Tourism Fatally Threatened

This article from the November 2014 edition of Singapore Business Review explains how Singapore’s medical tourism is under threat from competition from neighbouring countries. Many people come to Singapore from neighbouring countries to obtain their bioidentical hormone treatment under the care of well-qualified western medicine doctors here. If these hormones are no longer available in Singapore, these medical tourists too will go elsewhere.

[See also   http://www.straitstimes.com/premium/forum-letters/story/why-disallow-hormone-treatment-20140425]

Medical Tourism

Bioidentical Hormones – What you need to know

This very informative article is on the website of Dr Christiane Northrup, M.D. It deals with issues regarding the various “labels” used in the field of hormone replacement.

There seems to be a lot of confusion around the definition of “natural” versus “bioidentical” versus “synthetic” hormones. One thing to remember when making this distinction is that “bioidentical” refers to the shape of the molecule itself rather than the source of the hormone. By this, I mean that hormones can be marketed as “natural” or “plant-based,” yet not come near to being “bioidentical” to native human female hormones or performing as such in the body. Examples of this are the numerous proprietary HRT options being marketed as “plant-based” and “natural,” as well as purely yam-based creams.

http://www.drnorthrup.com/bioidentical-hormones/

 

Diet and Lifestyle Factors for Hormone Health

This article is posted with permission from Easy Health Options. (Bolding by HCS)

http://easyhealthoptions.com/healthy-habits-help-hormone-therapy/#

Diet & Lifestyle Factors for Hormone Health

Dr Isaac Eliaz

August 12, 2014

More and more people are using bio-identical hormone therapy. Though this therapy conveys a wide range of benefits, it can also pose the risk of undesirable side effects. But you can make this therapy safer and more effective with an individualized approach: Understand how your body metabolizes hormones and boost their benefits with the right diet, lifestyle and supplements.

Hormonal Help

As you age, your hormonal profile changes. For instance, menopause depletes the essential female hormones estrogen, progesterone and testosterone. Research in Europe has demonstrated a good safety record for using bio-identical hormones in these circumstances, especially if you apply them transdermally (on your skin) instead of taking them as pills.

The use of bio-identical hormone therapy is becoming more popular with the increasing awareness of its potential benefits for a range of age and hormone related conditions. At the same time, people have been searching for ways to make this therapy as safe as possible. A promising approach is to look closely at how hormones are metabolized in each person, using advanced urine analysis. Once we obtain an accurate view of an individual’s hormone metabolism, we can help to optimize hormone therapies with appropriate food choices as well as lifestyle habits and supplementation.

Test Your Body’s Hormone Metabolism

We can increase the safety of hormone use by supporting healthy hormone breakdown. A relatively new 24-hour urine hormone test being offered by several laboratories has made it possible to look at how hormones are being processed by the body. This is an important strategic tool for evaluating hormone usage in both men and women, and provides insight into possible risk factors for breast, prostate and other hormone related cancers.

This information has value for anyone who wants to be proactive in healthy aging and cancer prevention, those who are taking hormones or those who have hormone-dependent cancers. The information can help guide treatment strategies and determine individual supplement and dietary guidelines. Some of the intermediate compounds produced as the body breaks down hormones can promote the growth of cancer and cause damage to DNA. But each person’s metabolism differs. By using this test, we can tell if an individual is having problems with hormone breakdown and provide more support for these important processes. This can greatly improve the safety of taking hormone preparations for both men and women.

Recommendations For Healthy Hormone Breakdown

A number of nutrients, foods and lifestyle interventions can support healthy hormone metabolism and breakdown. Beneficial supplements include:

  • Activated forms of B vitamins such as methylcobalamin (B12), 5 methyltetrahydrofolate (folic acid), pyridoxyl-5-phosphate (B6),
  • Trimethylglycine (TMG)
  • Sulfur donors (SAM-E, whey protein, MSM)
  • DIM
  • Zinc
  • Flax lignans
  • Cruciferous vegetables
  • Medicinal mushrooms
  • Compounds such as quercetin and curcumin
  • Integrative formulas for women that include herbs, flavonoids, reishi, and astragalus
  • Integrative formulas for men that include minerals and medicinal mushrooms

Healthy lifestyle habits can also have a positive impact in helping to balance and breakdown hormones. Minimizing alcohol intake, eating an organic unprocessed diet, getting enough sleep, reducing stress, increasing regular exercise and improving the omega-3 to omega-6 ratio in the body with balanced omega or essential fatty acid supplements also help to promote normal hormone balance.

By taking a deeper and broader approach to using bio-identical hormones, we can improve the safety of this popular and valuable therapy. If you are taking hormones or are considering this area of treatment, ask your doctor about urine hormone testing to help evaluate and guide your hormone treatment plan.

Cancer linked to menopause drug in new report – thestar.com

Cancer linked to menopause drug in new report

Leading epidemiologist points finger at Premplus, but manufacturer denies claim.

By: Mary Ormsby Feature reporter, Published on Mon Aug 11 2014

Popular menopause drugs made in part from estrogen found in the urine of pregnant horses have caused breast cancer in thousands of Canadian women, according to allegations in a new report by the Canadian Cancer Society’s top epidemiologist.

“The body of evidence to date overwhelmingly points to a causal connection between the use of Premplus and the development of invasive breast cancer in women,” the society’s Prithwish De wrote in a report to be filed in a Canadian class-action lawsuit against drug manufacturer Wyeth Canada, now owned by Pfizer.

The drug manufacturer states that its products are “safe and effective when used as directed” and they do not cause breast cancer. A trial date is set for October in a Vancouver court.

MORE ON THESTAR.COM:

Hormone replacement debate heats up again

Ghostwriting is bad medicine, say critics

Hormone therapy firmly tied to breast cancer: U.S. study

According to the report, hormone replacement therapy was the main risk factor in an estimated 12,000 new Canadian breast cancer cases detected between 1994 and 2006 at a time when Wyeth’s products, Premarin and Premplus, dominated the market. The drugs remain on the market, but in more recent years they have contained strong warnings and are also prescribed in lower doses.

In the lawsuit against Wyeth, women like Hamilton’s Rose Scarff, 70, say they were not properly warned of breast cancer risk when the drugs — prescribed to relieve menopausal symptoms such as hot flashes, night sweats and vaginal dryness — were packaged by the drug firm and prescribed by doctors.

“I never suspected there was anything wrong with taking it,” said Scarff, who developed an aggressive form of breast cancer after taking combined hormone replacement therapy continuously for 10 years.

Like millions of other women in North America, Scarff said she wanted to recapture a youthful zest extolled in health literature — “you’d feel like a younger woman,” Scarff recalled of articles about menopause relief treatments — as she entered menopause at age 49.

American courts have dealt with these allegations for years. Pfizer, which in 2009 acquired Wyeth, has paid $1.7 billion to settle nearly all of the 10,000 hormone replacement therapy claims against the drug manufacturer. Pfizer said it makes no admission of liability in the American settlements.

Since 2004 Health Canada has revised the product safety information for the drugs to list potential side effects including coronary heart disease, gynecologic cancers, breast cancer and dementia.

Two medications, Premarin and Premplus, are at the core of both De’s study and a Canadian class action suit for which he was hired as a hormone replacement therapy expert. The estrogen in the drugs comes from the urine of pregnant mares, mostly produced by a Pfizer plant in Manitoba.

Pharmaceutical giant Pfizer responded for comment on the civil suit with an email to the Star stating that “the court has made no ruling on the merits of any class member’s claim.”

In pleadings filed in response to the class action claims, Wyeth Canada (now a division of Pfizer) states that “Premarin and Premplus do not cause breast cancer.”

“The cause of breast cancer is not known. The vast majority of women who take hormone therapies such as Premarin and Premplus do not develop breast cancer,” according to the pleadings filed by Wyeth Canada in a British Columbia court.

The Wyeth documents also note Premarin and Premplus “are proven treatment options for menopausal symptoms and postmenopausal osteoporosis.”

Premarin is a very old drug that went on the market in Canada and the United States about 70 years ago. Premarin contains the equine estrogen hormone extracted from pregnant mare urine. Its name has long been considered a play on its plentiful natural source — PREgnant MARe urINe — but Pfizer staff could not confirm that is true.

Premplus is a combination product containing the equine estrogen and another hormone called progestin in a single medication. Premplus was approved for sale in Canada in 2000. Premarin and progestin can also be prescribed for use as separate tablets.

There are about 2,000 horses stabled at 20 Pregnant Mare Urine (PMU) ranches in Manitoba and Saskatchewan. Back in the 1990s, at the height of the drugs’ popularity, Wyeth had approximately 25,000 to 30,000 mares producing urine, according to a finding of fact in a U.S. patent lawsuit where Wyeth successfully sued to protect a trade secret.

Pfizer contracts ranchers to collect the urine for initial processing at its plant in Brandon, Man. To amass the urine, mares are kept in stalls with flexible pouches hanging between their hind legs to capture every drop.

Foals are removed from the mother when they are young. Some horse welfare advocates claim the PMU offspring often end up in a slaughterhouse. In response to slaughter claims, the ranching association stated its members “are contractually obligated to sell their horses to productive markets” in which horses can be competitive, ridden for pleasure or used to work on farms.

The ranching association website reports 50 per cent of foals are sold privately, 30 per cent go to auction and 20 per cent are purchased by breeders.

Women responded enthusiastically when Premarin came to market, making it the top-selling menopause drug in North America.

Gross sales of Premarin in the United States grew from over $500 million to in excess of $2 billion during the period of 1992 to 2001, according to Wyeth’s 2002 patent lawsuit submissions in a Minnesota court. The Star was unable to find Canadian sales information.

The Canadian class action suit follows years of litigation (thousands of cases with similar breast cancer claims) launched against Pfizer in the United States. Pfizer has won some of those suits, lost others and settled many.

Pfizer paid victims $1.7 billion (U.S.) to settle nearly all 10,000 hormone replacement therapy claims against it as of Dec. 31, 2013, according to the pharmaceutical manufacturer’s most recent annual financial report. The settlements included breast cancer, ovarian cancer, stroke and heart disease claims.

The Canadian class action was filed in 2004 by Dianna Stanway, a 68-year-old woman from Sechelt, B.C., and is only now coming to court.

Stanway, the lawsuit’s leading claimant, alleges she developed breast cancer after using Premarin in combination with the hormone progestin for about eight years. She, on behalf of 209 plaintiffs and others who can still join, are suing Wyeth Canada for general and punitive damages, costs and other relief as the court sees fit. No dollar amount is listed in the suit.

Stanway’s allegations include: Wyeth suppressed study results that indicated “significant health risks” associated with Premarin and Premplus use; Wyeth failed to conduct proper drug safety testing; the company oversold the drugs’ effectiveness; long-term use was promoted when the drug maker knew that serious risks outweighed their “limited benefits” and that Wyeth “deliberately chose to value their own profits over public safety” by its conduct.

In its response to the allegations, Wyeth states in its pleadings that “for the vast majority of women, the potential risks associated (with Premarin and Premplus) are outweighed by the benefits of treatment.” Wyeth provided information on risks to doctors and “acted appropriately” at all times when testing, manufacturing and marketing the drugs, the pleadings state.

The allegations have not been tested in a Canadian court. Similar claims about Pfizer’s family of hormone replacement therapy drugs have been tried in American courts.

For example, in 2007 a Philadelphia jury found Prempro — a Pfizer product — caused breast cancer in an Arkansas woman who took the medication from 1999 to 2001 and awarded her $1.7 million in compensation. In 2010, another Philadelphia jury rejected a claim that Prempro caused breast cancer in two Pennsylvania women.

A written statement from Pfizer to the Star said the American settlements are confidential “but they do not contain admissions of liability.”

“The company believes it has strong defences to the claims in this litigation and has prevailed in a substantial number of the cases that have gone to trial. Any previous settlements are a desire by the company to focus on the needs of patients and prescribers,” the statement said.

As part of the Canadian lawsuit, Prithwish De was hired by the plaintiff’s law firm, Klein Lyons, to produce a report. In addition to De’s role with the Canadian Cancer Society, he is an associate professor of epidemiology at the Dalla Lana School of Public Health at the University of Toronto.

De reviewed national and international studies of women using the Wyeth products named in the legal claim in his 25-page report for the lawsuit.

Hormone replacement therapy, used in combination prescriptions like the Wyeth products, was the major risk factor in new breast cancer cases among Canadian women from 1994 until 2002, De writes, referring to research from a 2010 Canadian study he reviewed for his report.

By the 1990s, red flags were popping up regarding health concerns related to Wyeth’s menopause medications, according to information filed by lawyers in the class action.

The world’s first extensive, long-term randomized controlled trial study was commissioned by the U.S. National Institutes of Health in 1991. De describes randomized controlled trials as the gold standard of clinical drug testing.

The Women’s Health Initiative study involved 16,000 healthy post-menopausal women aged 50 to70 who had not had a hysterectomy. Half the women took combined hormone replacement therapy drugs, the other half had placebos. The study was halted prematurely in 2002; researchers feared there were more risks (such as breast cancer, blood clots, strokes) than benefits among the group using the hormone replacement therapy drugs. The women’s study also reported the medications’ beneficial effects, such as reduced risk of colorectal cancer and fewer fractures.

De notes the dramatic decline of combined hormone replacement therapy use began in 2002 after the Women’s Health Initiative published findings from its long-term study about the medications’ serious side effects (including breast cancer).

Scarff said she believes her breast cancer was tied to hormone replacement therapy. “I’m positive that was the cause of it,” she said.

Mary Ormsby can be reached at mormsby@thestar.ca or 416-869-4373

This article from thestar.com is posted with permission from the author

http://www.thestar.com/news/canada/2014/08/11/cancer_linked_to_menopause_drug_in_new_report.html

 

2010 Study on Progesterone Cream

Abstract

Stephenson, Kenna, Price Carol, Kurdowska Anna et al , “Topical Progesterone Cream Does Not Increase Thrombotic and Inflammatory Factors in Postmenopausal Women,” Blood , Volume 104, issue 11, November 16, 2004 .

Postmenopausal women have an increased risk of cardiovascular disease, and heart disease is the leading cause of death in postmenopausal American women. Conventional hormone replacement therapy has been shown to result in an increase in thrombotic events in large prospective clinical trials including HERS I, and the recently halted Women’s Health Initiative.

One possible mechanism for this observed increase is the unfavorable net effects of conjugated equine estrogens and medroxyprogesterone acetate on the hemostatic balance and inflammatory factors. An estimated 50 million American women are peri or postmenopausal and clinical therapies for menopausal symptoms remain a significant challenge in light of the known thrombotic risks.

In this prospective blinded study, we examined the short-term effect of topical progesterone cream on menopausal symptom relief in 30 healthy postmenopausal women. Potential adverse effects of topical progesterone on hemostatic and inflammatory factors and cortisol levels were also examined. Subjects were randomized to first receive either 20 mg of topical progesterone cream or placebo cream for 4 weeks.

Following a subsequent 4-week washout period, subjects were crossed over to either placebo cream or active drug for an additional 4-week period. In each case, progesterone and cortisol levels were monitored by salivary sampling. Baseline values, 4-week follow-up values and end-of-study values were also obtained for the Greene Climacteric Scale, total factor VII:C, factor VIIa, factor V, fibrinogen, antithrombin, PAI-1, CRP, TNFá, and IL-6.

For subjects receiving 20 mg of topical progesterone cream for 4 weeks, Greene Climacteric Scale scores were consistently and significantly improved (decreased) over baseline, demonstrating significant relief from menopausal symptoms.

In addition, in a subpopulation of hypercortisolemic women, topical progesterone was associated with a favorable decrease in nocturnal cortisol. Surprisingly, and in sharp contrast to earlier studies with conventional hormone replacement therapy, topical progesterone had no effect on any of the hemostatic components examined: total factor VII:C, factor VIIa, factor V, fibrinogen, antithrombin, and PAI-1 levels were all unchanged. Levels of CRP, TNFá and IL-6 also remained unchanged.

From this study we conclude that administration of topical progesterone cream at a daily dose of 20 mg significantly relieves menopausal symptoms in postmenopausal women without adversely altering prothrombotic potential. Since the thrombotic complications that are typically observed with conventional hormone replacement therapy do not seem to occur with topical progesterone, this treatment should be seriously considered as an effective and safe alternative clinical therapy for women suffering from menopausal symptoms.

http://www.naturone.com/articles/post-title-click-and-type-to-edit1

American College for Advancement in Medicine – International Educational Symposium on Complementary, Alternative and Integrative Medicine (CAIM) 2005, ‘Menopause, Andropause: Power in Transition’

The American College for Advancement in Medicine’s (ACAM) 63rd International Educational Symposium on Complementary, Alternative and Integrative Medicine (CAIM) was held on May 18–22, 2005 at Disney’s Coronado Springs Resort in Orlando, FL, USA. ACAM’s scientific symposium brought together physicians and scientists from 13 countries for a comprehensive educational program on the evaluation and treatment of age-associated hormone deficiency with special attention to the use of bioidentical hormones in andropause and menopause.

ACAM’s Spring 2005 convocation, entitled ‘Menopause, Andropause: Power in Transition’, addressed a multitude of topics relevant for physicians and scientists interested in improving their understanding of safe and effective hormone replacement therapy, nutritional intervention and the lifestyle modifications needed in order to ensure healthier and longer lives as our population transitions into middle age. The scientific presentations focused upon the use of bioidentical hormone supplementation for the treatment of aging and a wide variety of illnesses. Keynote presentations highlighted the adverse consequences of endocrine disrupting chemicals on human health along with recent advances in predictive genomics testing for evaluating both risks and benefits of hormone replacement therapy. Evidence-based protocols were presented for the use of bioidentical hormones in the treatment of disorders of the endocrine, reproductive and cardiovascular systems.

As a growing body of research has demonstrated a significant increase in disease risk in menopausal women taking conventional non-bioidentical hormone replacement therapy (1,2), the conference served as a testament to the overwhelming professional interest in the use of bioidentical hormones and CAIM therapies for treating disorders of hormonal senescence.

References

1. Cauley JA, Robbins J, Chen Z, et al. Effects of estrogen plus progestin on risk of fracture and bone mineral density: the Women’s Health Initiative randomized trial. J Am Med Assoc. 2003;290:1729–38. [PubMed]

2. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women’s Health Initiative randomized controlled trial. J Am Med Assoc. 2000;288:321–33. [PubMed]

For a summary of the proceedings go to: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1193553/#!po=97.6190

Malaysia set to become a destination of excellence in preventative medicine

Dr Duncan Carmichael MBChB (SA) MRCGP(UK) is one of the foremost experts  in various facets of aesthetic and anti-aging medicine.

In this blog he describes his visit to University College Sedaya International (UCSI) in Kuala Lumpur. He believes Malaysia is set develop ahead of other countries  in the field of preventative medicine.

I was most fortunate to be invited to UCSI University in Kuala Lumpur, Malaysia as their guest international speaker for 3 days last week. UCSI is South East Asia’s biggest Anti-aging university program and the only university in the world that I have come across that offers a post graduate degree in aesthetic medicine, anti-aging hormone medicine and regenerative stem cell medicine. These are the 3 growing fields in Anti-aging medicine, but to receive advanced tuition on all 3 in the same program is unique.

Unlike much of the rest of the world, Malaysia does not seem to have been affected by recession and on the back of tourism and oil money, the economy and property market is continuing to boom. There is a cosmopolitan society of Malaysians, Chinese, Indians, Iranians, and Europeans. The country is mainly Muslim but the other religions of Hindu and Christianity are progressively accepted and everyone seems to live harmoniously together despite recent election disgruntlements.
Beggars are rare as the government rehouses them and the only downside of a prosperous nation is a growing obesity rate and a delicious selection of international restaurants.

I was asked to give 3 days of lectures on topics ranging from the theories of aging, to adrenal fatigue and bio-identical hormones. We went through the theory and plenty of case studies and the class of 40 post graduate doctors easily picked up the concepts of healthy hormone balancing over the 3 days.

They have other growing programs of cardiac stem cell research, drinking-water toxin assessments and genetic testing programs that are all developing fast. Where other countries are putting barriers in the way of this important preventative medical field, Malaysia is embracing it under academic guidelines. My prediction is that Malaysia is set to become a destination of excellence in this growing field of health medicine.

http://www.taac.co.za/blog/duncan-does-malaysia/