Who shall guard the guardians? Dr Malcolm Kendrick

A quick skim through this entry taken, with permission, from the blog of Dr Malcolm Kendrick, gives frightening insight into the bias and financial conflicts of interest often at play when various committees draw up the various “guidelines” we are all supposed to stick to in our health programmes. Yet if doctors do not stick rigidly to these guidelines, even though they feel that doing so is not in the best interest of their patient, they are in danger of having their practice licences revoked as has happened here in Singapore. The double standards working here are such a travesty of justice!

http://drmalcolmkendrick.org/2013/08/02/who-shall-guard-the-guardians/

Who shall guard the guardians?

(Quis custodiet ipsos custodes?)

Mainstream medicine increasingly relies on Guidelines. Well, they are called guidelines, but increasingly they carry the force of law. In many countries if you try to practice outside the wise and infallible guidelines you may lose your license to practice medicine. In the US, you may well be dragged into court, and if you have not been following the guidelines, you will be sued. You can even be gaoled (or jailed, as we say in the UK).

In short, guidelines are very serious and important things indeed, and they now rule medicine with a rod of steel. In the UK up to 50% of general practice time is spend ensuring that all patients are constantly monitored to ensure that various guidelines are rigorously followed. Is the BP low enough, the cholesterol low enough, have you checked blood sugar levels etc.

But where do guidelines come from – exactly? Who gives people the right to sit on guideline committees? What are the entrance requirements? Who shall guard the guideliners?

The answer is, perhaps shockingly, that there are almost no rules to this. If a group, such as the National Institutes for Health in the US, decides to set up a committee to decide on, for example, what is the healthy level for cholesterol lowering, what happens? They ask a number of Key Opinion Leaders to join the committee. In this case the NCEP (National Cholesterol Education Programme – which is a committee, not a programme).

In 2004 this committee decided that cholesterol levels should be lowered far more aggressively than in the past. Based on, as far as I could see, very flimsy evidence.  Could it be that that committee was, in some way, biased in favour of cholesterol lowering companies?  A number of people, including me, demanded to see if any of the eight invited members of this hugely important committee had financial conflicts.

With much reluctance, the conflicts were revealed (I have highlighted, in bold, the companies who marketed cholesterol lowering agents at the time.) See below

ATP III Update 2004:  Financial Disclosure of NCEP members

Dr. Cleeman: (Chairman) has no financial relationships to disclose.

Dr. Grundy: has received honoraria from Merck, Pfizer, Sankyo, Bayer, Merck/Schering-Plough, Kos, Abbott, Bristol-Myers Squibb, and AstraZeneca; he has received research grants from Merck, Abbott, and Glaxo Smith Kline.

Dr. Bairey Merz: has received lecture honoraria from Pfizer, Merck, and Kos; she has served as a consultant for Pfizer, Bayer, and EHC (Merck); she has received unrestricted institutional grants for Continuing Medical Education from Pfizer, Procter & Gamble, Novartis, Wyeth, AstraZeneca, and Bristol-Myers Squibb Medical Imaging; she has received a research grant from Merck; she has stock in Boston Scientific, IVAX, Eli Lilly, Medtronic, Johnson & Johnson, SCIPIE Insurance, ATS Medical, and Biosite.

Dr. Brewer: has received honoraria from AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Esperion, and Novartis; he has served as a consultant for AstraZeneca, Pfizer, Lipid Sciences, Merck, Merck/Schering-Plough, Fournier, Tularik, Sankyo, and Novartis.

Dr. Clark: has received honoraria for educational presentations from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer; he has received grant/research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Merck, and Pfizer.

Dr. Hunninghake: has received honoraria for consulting and speakers bureau from AstraZeneca, Merck, Merck/Schering-Plough, and Pfizer, and for consulting from Kos; he has received research grants from AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, and Pfizer.

Dr. Pasternak: has served as a speaker for Pfizer, Merck, Merck/Schering-Plough, Takeda, Kos, BMS-Sanofi, and Novartis; he has served as a consultant for Merck, Merck/Schering-Plough, Sanofi, Pfizer Health Solutions, Johnson & Johnson-Merck, and AstraZeneca.

Dr. Smith: has received institutional research support from Merck; he has stock in Medtronic and Johnson & Johnson.

Dr. Stone: has received honoraria for educational lectures from Abbott, AstraZeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Novartis, Pfizer, Reliant, and Sankyo; he has served as a consultant for Abbott, Merck, Merck/Schering-Plough, Pfizer, and Reliant.

http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3upd04_disclose.htm

Of course, as people have stated to me, the mere fact that there were seventy two financial conflicts of interest does not mean that the guidelines themselves were biased. But you know what, I don’t believe it. Imagine if eight Supreme Court judges, ruling on any issue, had seventy two direct financial conflicts of interest to do with that issue…..Well, the outcry would never end.

Yet doctors, it seems, are beyond any suspicion – of any sort. There is not the slightest possibility that any doctor would ever do anything wrong….We are, after all, superior beings. ‘But, what’s that you say skippy…. hold on.’

‘Despite a 2-year-old scandal discrediting key evidence, current guidelines relying on this evidence have not been revised. As a result of physicians following these guidelines, some researchers say, it is possible that thousands of patients may have died each year in the UK alone. It is unlikely that a true understanding of the damage will ever be known…..

The guidelines, which were published in 2009, were based on analyses of the available trials. The strongest evidence came from the DECREASE family of trials, which appeared to strongly support perioperative beta-blockade, and one other large trial, POISE, which raised concerns that beta-blockers might lead to an increase in deaths

In 2011, however, faith in the reliability of the DECREASE trials was shattered as a result of a scientific misconduct scandal centering on the principal investigator of the studies, the now disgraced Dutch researcher Don Poldermans. The issue was further complicated because, in addition to his key role in the trials, Poldermans was the chairman of the committee that drafted the guidelines.’ http://cardiobrief.org/2013/07/31/european-heart-guidelines-based-on-disgraced-research-may-have-caused-thousands-of-deaths/

Oh well, maybe not.

The fact is that, wherever you look, guidelines are being developed by doctors who have widespread conflicts of interest. And if you go a step further back to review the studies that the guidelines are based on, they are run by, and written up by, doctors who have enormous conflicts of interest. Although sometimes, these conflicts are just…well, forgotten about.

For example, a few opinion leader were ‘named and shamed’ by the Journal of the American Medical Association, when someone pointed out that a number of the authors of the original paper they wrote might just have slipped up in declaring their conflicts:

Unreported Financial Disclosures in: ‘Association of LDL Cholesterol, Non–HDL Cholesterol, and Apolipoprotein B Levels With Risk of Cardiovascular Events Among Patients Treated With Statins: A Meta-analysis.’

….the following disclosures should have been reported: “Dr Mora reports receipt of travel accommodations/meeting expenses from Pfizer; Dr Durrington reports provision of consulting services to Hoffman-La Roche, delivering lectures or serving on the speakers bureau for Pfizer, and receipt of royalties from Hodder Arnold Health Press; Dr Hitman reports receipt of lecture fees and travel expenses from Pfizer, provision of consulting services on advisory panels to GlaxoSmithKline, Merck Sharp & Dohme, Eli Lilly, and Novo Nordisk, receipt of a grant from Eli Lilly, and delivering lectures or serving on the speakers bureau for GlaxoSmithKline, Takeda, and Merck Sharp & Dohme; Dr Welch reports receipt of a grant, consulting fees, travel support, payment for writing or manuscript review, and provision of writing assistance, medicines, equipment, or administrative support from Pfizer, and provision of consultancy services to Edwards, MAP, and NuPathe; Dr Demicco reports having stock/stock options with Pfizer; Dr Clearfield reports provision of consulting services on advisory committees to Merck Sharp & Dohme and AstraZeneca; Dr Tonkin reports provision of consulting services to Pfizer, delivering lectures or serving on the speakers bureau for Novartis and Roche, and having stock/stock options with CSL and Sonic Health Care; and Dr Ridker reports board membership with Merck Sharp & Dohme and receipt of a grant or pending grant to his institution from Amgen. http://jama.ama-assn.org/content/307/16/1694.3.full?etoc

Not a bad little list. As you can see, Dr Ridker had board membership with Merck Sharp and Dohme…… a company that has made billions from selling statins. Now, here is he is authoring a paper on the benefit of statins (which will be used to develop guidelines on cholesterol lowering), and he simply forgot about this conflict of interest. As for the others, well, they’re also busy people; things must have just slipped their minds, such as thirty three separate financial conflicts.

For this terrible crime against the integrity of medical science, none of them can ever again do medical research, or author a medical paper, or sit on guideline committees. Cue, mad cackling laughter. As you may expect, absolutely nothing happened at all, apart from the publication of that statement you in the Journal in the American Medical Journal (JAMA).

I am sorry, but the system of developing guidelines is, frankly, bust. It has been for many years, but it is a very big and dangerous looking nettle to grasp, and no-one, currently has the will to do it.

Someone, somewhere, needs to ensure that guidelines, and the evidence they are based on, and the interpretation of that evidence, is of the highest quality – and free from potential bias, and financial conflicts of interest. We are about as far from this happy state of affairs as I am from being invited onto any guideline committee, ever, anywhere.

And that, my friend, is a very, very long way away indeed. You would need to Hubble telescope to see across distances as vast as that.

 

Note from HCS:

Dr Kendrick’s latest book, “Doctoring Data”, to be officially launched this year, is available at http://doctoringdata.co.uk/

After reading this book you will know what to believe and what to ignore. You’ll have a much better understanding of the world of medical research. A world in crisis.

 

Is medical research now beyond redemption? Dr Malcolm Kendrick

The following entry is taken, with permission, from the blog of Dr Malcolm Kendrick, a GP in Macclesfield, UK, an original member of the Centre for Evidence Based Medicine in Oxford and of The International Network of Cholesterol Sceptics (THINCS). He describes his blog thus:

This blog is my best effort at providing some balance to the increasingly strident healthcare lobby that seems intent on scaring everyone about almost everything. Is there a foodstuff that is safe to eat anymore? Is there any activity that does not cause cancer or heart disease?

http://drmalcolmkendrick.org/about/

 

Is medical research now beyond redemption?

(Bolding by HCS)

51 Replies

Below, I have copied an entire article from the BMJ, written by Dr Des Spence, who is a fellow Scottish GP. We communicate from time to time, and share a general view that medicine is heading in a very unfortunate direction with overdiagnosis and over-treatment/polypharmacy becoming a massive problem.

This is driven, in the main part, by the pharmaceutical industry. An industry that would like to see the entire population of the world taking medication every day….. forever. To achieve this they have, effectively, grabbed hold of medical research and twisted it to their own ends.

Anyway, please read this article. It encapsulates much of what I feel, and I believe it needs a wider audience [I have added a few comments into the text to ensure that I am not breaching copyright]

Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fuelling overdiagnosis and overtreatment.

[This is now a major problem for GPs who are increasingly measured and monitored, and funded, according to how accurately we follow guidelines mk comment] [And in some cases in Singapore, barred from running their practices. HCS]

You see, without so called “evidence” there is no seat at the guideline table. This is the fundamental “commissioning bias,” the elephant in the room, because the drug industry controls and funds most research. So the drug industry and EBM have set about legitimising illegitimate diagnoses and then widening drug indications, and now doctors can prescribe a pill for every ill.

[As you can imagine, this makes it difficult not to prescribe statins mk comment]

The billion prescriptions a year in England in 2012, up 66% in one decade, do not reflect a true increased burden of illness nor an ageing population, just polypharmacy supposedly based on evidence. The drug industry’s corporate mission is to make us all sick however well we feel. [Absolutely true mk comment] As for EBM screening programmes, these are the combine harvester of wellbeing, producing bails of overdiagnosis and misery.

Corruption in clinical research is sponsored by billion dollar marketing razzmatazz and promotion passed off as postgraduate education. By contrast, the disorganised protesters have but placards and a couple of felt tip pens to promote their message, and no one wants to listen to tiresome naysayers anyway.

[Speaking as a tiresome naysayer, I could not agree more mk comment]

How many people care that the research pond is polluted, with fraud, sham diagnosis, short term data, poor regulation, surrogate ends, questionnaires that can’t be validated, and statistically significant but clinically irrelevant outcomes? Medical experts who should be providing oversight are on the take. Even the National Institute for Health and Care Excellence and the Cochrane Collaboration do not exclude authors with conflicts of interest, who therefore have predetermined agendas. The current incarnation of EBM is corrupted, let down by academics and regulators alike.

[If anyone has any suggestion how to improve regulation, please let me know mk comment]

What do we do? We must first recognise that we have a problem. Research should focus on what we don’t know. We should study the natural history of disease, research non-drug based interventions, question diagnostic criteria, tighten the definition of competing interests, and research the actual long term benefits of drugs while promoting intellectual scepticism. If we don’t tackle the flaws of EBM there will be a disaster, but I fear it will take a disaster before anyone will listen.

[There have already been many disasters, but nobody has yet listened mk comment]

Original article can be found here

Sorry about the intrusive comments, but I don’t want the BMJ jumping up and down on me – especially as they are the only major journal that seems keen to criticize the industry.

What Des Spence is saying, is what I have been saying for some time now. Evidence Based Medicine (EBM) could have been a great thing – so long as it was not enforced too rigidly. But the evidence has been manipulated and corrupted all the way along the line. EBM is now almost completely broken as a tool to help treat patients.

Some years ago I stated that I no longer believe in many research papers that I read. All I tend to do is look at the authors, look at the conflicts of interest, look at the companies who sponsored the study, and I know exactly what the research is going to say – before I have even read the paper.

I have also virtually given up on references. What is the point, when you can find a reference to support any point of view that you want to promote? Frankly, I do not know where the truth resides any more. I wish to use evidence, and the results of clinical studies, but I always fear that I am standing on quicksand when I do so.

We are at a crisis point. Medical research today (in areas where there is money to be made) is almost beyond redemption. If I had my way I would close down pubmed, burn all the journals, and start again, building up a solid database of facts that we can actually rely on – free from commercial bias. But this is never, ever, going to happen.

 

Note from HCS:

Dr Kendrick’s latest book, “Doctoring Data”, to be officially launched this year, is available at http://doctoringdata.co.uk/

After reading this book you will know what to believe and what to ignore. You’ll have a much better understanding of the world of medical research. A world in crisis.

 

Previous Editor of the British Medical Journal Makes an Admission

Richard Smith, the previous editor of the British Medical Journal, recently published an article in that journal entitled Are some diets ‘mass murder’? (British Medical Journal, 15 December 2014.) While the article was related to diet (he was explaining that, after reading Nina Teicholz’s book The Big Fat Surprise,  he now feels that the dietary advice given by western medicine about saturated fat for the last fifty years or so is complete nonsense), the sentiments expressed relate to many areas of general medical wisdom handed out to the public by the FDA and various health authorities.

He states that, ”…the forensic demolition of the hypothesis that saturated fat is the cause of cardiovascular disease is impressive. Indeed, the book is deeply disturbing in showing how overenthusiastic scientists, massive conflicts of interest, and politically driven policy makers can make deeply damaging mistakes. Over 40 years I’ve come to recognise which I might have known from the beginning – that science is a human activity with the error, self-deception, grandiosity, bias, self-interest, cruelty, fraud, and theft that is inherent in all human activities (together with some saintliness), but this book shook me.”

(Bolding by HCS)

The Confusion Continues

Unfortunately, in the year since this Hormone Choice Singapore (HCS) website was started, the confusion about bioidentical hormone replacement therapy in Singapore has continued, creating a great deal of stress for patients who suddenly find their hormone treatment (including desiccated thyroid) no longer available or difficult to find and for doctors who are unsure whether they are    going to be penalised if they continue to give the healthcare they know is of such great benefit to their patients.

In March 2015 the Ministry of Health (MoH) sent two new circulars  to Licensees/Managers of Clinics.

Testosterone For Hormone Replacement – eLis – Ministry 

MoH Letter 2

Moh Letter 3

There was some confusion in the first circular in that none of the doctors consulted by HCS had heard of intravenous thyroid therapy being used for the conditions listed. The second circular containing a clarification of the first seemed to underline MoH’s own confusion. It is also not clear whether this guideline refers to synthetic or bioidentical testosterone hormone replacement.

In the second circular the second sentence in the second bullet is particularly interesting: “If there is laboratory confirmation of testosterone deficiency, then the use of testosterone would not be considered as non-evidence based”.  In the opinion of both the doctors and patients HCS has spoken to, if this definition is followed, none of the bioidentical hormone replacement therapy used in

Singapore is non-evidence based, since all doctors who use it only do so with the guidance of regular laboratory blood tests. Indeed this is the joy of it, in that doses can be individually adjusted to reflect the tiniest change shown up in a blood test. This exact matching of the treatment to the individual patient is something that synthetic drugs cannot accommodate.

The circulars continue to call for “evidence based medicine”. One of the reference sources (Duke University, Introduction to Evidence-Based Medicine)  on the MoH website gives us this definition from David Sackett, the founding father of the concept of evidence-based medicine (bolding by HCS):

Evidence Based Practice (EBP) is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology.

(Sackett, D. (2002) Evidence-based Medicine: How to Practice and Teach EBM, 2nd edn. London: Churchill Livingstone.)

The Duke University website goes on (bolding by HCS):

The evidence, by itself, does not make the decision, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, and/or the etiology of disorders.

(The analysis below is taken from Evidence Based Practice, McGraw-Hill Education: https://www.mheducation.co.uk/openup/chapters/9780335244737.pdf  )

Sackett acknowledges and values the different types of knowledge held by the clinician, for example, knowledge acquired through cultural and personal experiences, logical and critical knowledge gained through curriculum and the extra insight that can only be acquired through cumulative clinical expertise. He values the patient as an empowered decision maker and highlights that not all research is transferable into practice due to flaws in either design or reason.

Note that Sackett states that the best evidence is usually  found in what the MoH would call “relevant research”. However, when the evidence found in laboratory tests is responded to with finely adjusted bioidentical hormone replacement (including desiccated thyroid) there is ample evidence available provided by well respected doctors worldwide (some of it on this site) that patients are receiving the care they need and, further, the care that addresses “the patient’s unique concerns, expectations, and values”.

Since bioidentical hormone therapy is derived from a plant source that cannot be patented, little money is likely to be made available  for expensive studies to match those funded by drug companies who stand to make mega-bucks from any drug produced as a result. Nevertheless, those patients who continue to use the hormones all over the world constitute a huge body of “evidence” of their value, while well-run studies continue to point out the flaws, clinical and ethical, in synthetic hormone replacement therapy.

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

Inside Health – Conflicted Medicine – BBC Radio 4

BBC Radio 4 recently ran a series of three broadcasts entitled Inside Health, each 28 minutes long, which may be of relevance in Singapore.

  • Programme One, first broadcast 12 August 2014 – Conflicted Medicine: Pharmaceuticals 

Are conflicts of interest in medicine out of control and undermining public trust, or an over-hyped concern? Dr Mark Porter investigates the hidden influences affecting your health.

http://www.bbc.co.uk/programmes/b04d4n8q

  • Programme Two, first broadcast 19 August 2014 – Conflicted Medicine: Specialists & GPs

Dr Mark Porter examines the hidden conflicts of interest that may affect how your GP or specialist treats you. He discovers that the advice patient groups give you is also not immune to the influences of organisations such as pharmaceutical companies.

http://www.bbc.co.uk/programmes/b04dmbws

  • Programme Three, first broadcast  26 August 2014 – Conflicted Medicine: Public Health Campaigns

Dr Mark Porter examines how powerful lobbying groups like the food and alcohol industries steer public health policy in the direction that suits them most.

http://www.bbc.co.uk/programmes/b04f9rdw

 

Letters to the press: Let consumers make the choice

Let consumers make the choice, 8 May 2014,  Catherine Cook

http://www.straitstimes.com/premium/forum-letters/story/bioidentical-hormones-let-consumers-make-the-choice-20140508

This letter again discusses the enormous benefits experienced by a patient using bioidentical and natural desiccated thyroid hormones. The letter was edited before publication, removing the references to the failure of osteoporosis drugs and the description of the writer’s integrative practitioner in Singapore. The writer has allowed us to post the original below.

Please give us back our bio-identical hormones

Dear Editor

Like many others, I am extremely upset that I can no longer receive my bio-identical thyroid and other hormone treatment in Singapore.

I have been hypothyroid for 20 years. I took synthetic thyroxine initially but never felt well. I was thus delighted to find, in Singapore, as in other developed countries, a Western medical doctor practicing integrative, functional medicine, to prescribe desiccated thyroid and do the necessary regular tests and resultant dosage adjustments. This treatment provides not only the T4 hormone that synthetic drugs provide, but also all other compounds produced by the thyroid, which some people cannot produce from T4. It was the only treatment some years ago, and is still frequently used in the USA, UK, Europe and Australia.

To alleviate menopause symptoms I took synthetic estrogen but suffered more. I am particularly concerned about osteoporosis but, wary of side effects, I refused to take drugs for osteoporosis. My “intuition” proved correct. US drug companies have recently had to make huge payouts to compensate for some serious consequences of these. After much research, I decided to take natural progesterone, getting my supplies from overseas without medical supervision but feeling much better. When the first compounding pharmacy opened in Singapore I benefitted immensely from being medically supervised with a prescription finely tuned for my body, and adapted for my body at different times, if circumstances changed. As I understand it, unlike synthetic hormones, bio-identical hormones have exactly the same composition as those produced by the body and are a perfect fit for cell receptors. This treatment has been wonderful. My health, and consequently my quality of life, has been excellent with no side effects.

The argument is that “there is no scientific evidence” for bio-identical hormones. Obviously, since they are natural and cannot be patented, money will not be spent on research, while drug companies try to suppress this increasingly widely used treatment. There was “science” behind the much touted drugs for osteoporosis but taking them has proved disastrous for many. Can we not look instead at the results of treatment, at the way patients feel?

Yes, bio-identical hormones carry some risks but so does every single drug. Please let me choose which risks to take. I will now have to get my treatment overseas, at huge inconvenience and cost.

I beg the MoH to give us back our treatment of choice.

Regards

Catherine Cook (Ms)

 

 

 

 

Letters to the press: Consider the merits of anti-aging medicine

Consider the merits of anti-aging medicine, 3 May 2014, Jaap Huigan

http://www.straitstimes.com/premium/forum-letters/story/consider-merits-anti-ageing-medicine-20140503

This writer points out that:

There is a growing community of medical practitioners around the world that has departed from allopathy, which seeks all or most remedies for medical conditions in drugs, and now practises anti-ageing medicine.

This branch of medicine takes a holistic approach to health and supports balancing one’s hormones via bioidentical hormones and the administration of carefully selected supplements

He also argues that such approaches could cut healthcare costs for the elderly compared to drug treatment.

Letters to the press: Hold dialogue on issues

Hold Dialogue on Issues, 3 May 2014, Madam Julia Morgan

http://www.straitstimes.com/premium/forum-letters/story/hold-dialogue-issues-20140503

This letter asks for clarification from the MOH and the Health Sciences Authority as to what the letter from MOH to the practices actually means. The writer calls for:

a dialogue between all parties involved – the ministry, HSA, doctors, gynaecologists, endocrinologists and members of the public who use bioidentical hormones – so that all can understand the concerns and move forward based on scientific fact and reason, and not emotion?

As noted earlier, there was no response from MOH.

Letters to the press: Fund studies on bioidentical hormones

Fund studies on bioidentical hormones, 29 April 2014, Ms Elaine Wong

http://www.straitstimes.com/premium/forum-letters/story/fund-studies-bioidentical-hormones-20140429

Some more very strong evidence of the benefits, witnessed when the writer’s mother was given bioidentical hormones and a plea for research into, rather than a ban on, such treatment.

I have mentioned the treatment to her other doctors, but most seemed clueless. However, they saw a significant improvement and suggested continuing the treatment, with regular check-ups