Complementary and alternative medicine Medicine

From the ridiculous to the sublime: A journalist takes down Suzanne Somers over “bio-identicals”

Suzanne Somers annoys me.

She annoys me because, despite the fact that her statements and activities over the last 25 years reveal her to be probably no more intelligent than the character that she played on Three’s Company, she still feels the need to spread misinformation about diet and medicine in several books that she has written. Indeed, my annoyance at her was manifested very early in the history of this blog, when I mentioned her in the context of testimonials for alternative medicine treatments for breast cancer. The reason? In 2001, Somers was diagnosed with breast cancer. She underwent standard lumpectomy and radiation therapy but made a great show of eschewing chemotherapy (it is unclear if she underwent axillary lymph node sampling or dissection), opting instead for Iscador, an extract of mistletoe, which is touted by alties to “boost the immune system,” a standard vague, unmeasured (and probably unmeasurable) claim common to many alternative medicine therapies. In any case, blissfully for me, not much has been heard from her for a while.

Until now.

Yes, she has a new book out, if you can call it that, and it seems to be no better in the quality of its medical information than a Kevin Trudeau screed. Most unusually, in contrast to the credulity demonstrated by the Chicago Tribune over alternative cancer therapy, a major news magazine has taken Somers to task for pushing dubious claims and even more dubious medicine. Pat Wingert and Barbara Kantrowitz have written a lovely takedown of Somers’ woo published online in Newsweek as an article entitled A Blowup Over “Bioidenticals.” I had been aware of Somers’ pushing of bogus pseudoscience with respect to her choosing Mistletoe extract over chemotherapy as an adjuvant treatment of her breast cancer. Indeed, I used her as an example of how breast cancer testimonials are usually meaningless because most of these patients have had lumpectomies and surgery alone cures most cancers. (Chemotherapy is the “icing on the cake” that decreases the rate of recurrence below an already rather low number.) I further pointed out that most patients who opt for alternative medicines over adjuvant chemotherapy, like Somers, usually end up crediting their alternative medicine rather than good old fashioned surgical steel with their cure. However, I must confess to you, my readers, that I was totally (and quite happily) unaware of Somers’ book from a couple years ago, The Sexy Years, in which she promoted so-called “bioidentical hormones” as “natural” alternatives to hormone replacement therapy and a veritable fountain of youth that would forestall the ravages of the aging process. Nor was I aware of Somers’ latest incursion into the world of woo, Ageless, which sounds like more of the same. I almost wish that Wingert and Kantrowitz hadn’t informed me:

Oct. 31, 2006 – We have to admire Suzanne Somers’s persistence. She doesn’t give up–even when virtually the entire medical community is lined up against her. Three years ago, Somers wrote a best-selling book called “The Sexy Years” in which she promoted so-called bioidentical hormones as a more natural alternative to hormones produced by drug companies for menopausal women. Somers, now 60, claimed that these individually prepared doses of estrogen and other hormones, sold via the Internet or by compounding pharmacies, made her look and feel half her age. As the popularity of bioidenticals soared, major medical organizations like the American College of Obstetricians and Gynecologists grew so alarmed that they mounted publicity campaigns to convince Somers’s readers that these alternative treatments, which are usually custom made for each patient, haven’t been proven safe or more effective than traditional hormone therapy for symptoms like hot flashes.

Heh. It’s not quite a Respectful Insolence™-level takedown, but it’s probably about as pointed as we can expect from a major news magazine. After all, this is a blog, and I can pretty much say whatever I want without editing. Columnists for major news magazines aren’t allowed the leeway that I am. (If I ever wrote anything or a popular journal, you can expect that my commentary would be more–shall we say?–“measured” in my commentary, too.) Particularly amusing is the way that Somers has managed to piss off even some advocates of so-called “bioidenticals”:

Inside, she calls bioidenticals “the juice of youth” and also promotes the questionable dosage advice of a former actress and “independent researcher” named T.S. Wiley (whose academic credentials are limited to a bachelor’s degree in anthropology) who thinks menopausal women should have as much estrogen in their bodies as 20-year-olds. Now, even some of the pro-bioidentical doctors Somers quotes in her books are screaming foul. “Many of the claims throughout the book are scientifically unproven and dangerous,” three of these doctors assert in a letter sent a few weeks ago to Somers’s publisher, Crown. “By mixing quotes from qualified physicians … with those of a person with no medical or scientific background, this book will further confuse women and we believe, may potentially put their health at risk.”

No kidding.

It’s utterly ridiculous to think that menopausal women “should have as much estrogen as 20-year olds.” If that were the case, then there probably wouldn’t be such a thing as menopause. In fact, all of this is no different than Ponce de Leon looking for the fountain of youth, because Somers seems to believe that taking these “bioidentical” hormones will keep her young indefinitely. As another irony, it never ceases to amaze me how people who castigate conventional medicine for going “against nature” are more than willing to ingest lots of one type of synthetic hormone that is synthesized to be identical to what their body produces, just as their bodies are naturally decreasing the levels of that hormone. Don’t get me wrong; I realize that menopause symptoms can be quite debilitating in some women. I see them artificially induced in my breast cancer patients on Tamoxifen therapy. Indeed, early in my career, one of the first breast cancer patients that I took care of as a newly minted attending had to stop her Tamoxifen because she just couldn’t stand the menopausal side effects. There’s no doubt at all that estrogenic hormones, whether “bioidentical” or modified or synthetic estrogen analogs, can greatly alleviate the symptoms of menopause. Unfortunately, the other benefits claimed for HRT (cardiovascular protection, for example) were cast in grave doubt in 2002 when the Women’s Health Initiative showed more heart attacks and more clots in women on a commonly used form of HRT, leading to medical science quite righty backing off from advocating HRT for almost every menopausal woman. There is at present no data to suggest that “bioidentical” hormone therapy in any way avoids the problems associated with the combination tested in the Women’s Health Initiative. Unfortunately, this example of medical science showing that what we previously thought about HRT was probably wrong had unintended consequences:

Much of the demand can be traced to continuing confusion over the troubling conclusions of the federally funded Women’s Health Initiative. In 2002 one arm of the study was halted early because researchers found that women taking the estrogen and progesterone in a widely used form of hormone therapy had more heart attacks, strokes, blood clots and breast cancer than women on a placebo. This was the opposite of what most doctors expected to hear. For decades, they had been recommending hormones to prevent future heart, bone and memory troubles. Their patients were equally stunned and many lost faith in their physicians and Big Pharma. Sales of FDA-approved hormones plummeted, inadvertently opening the door to bioidenticals.

One problem is that the whole term “bioidentical” is pretty meaningless in biological terms. All it means is that the hormones are synthesized to be “identical” to the natural hormones made by the body. That’s it. Of course, it is the natural estrogen that women’s own bodies make that can stimulate breast epithelial cells to grow and cause breast cancer, and it does it just as well as any synthetic hormone–better, in fact, because it’s always there before menopause. Indeed, one risk factor for breast cancer is prolonged unopposed estrogen exposure unbroken by pregnancy. Thus, if a woman starts menstruating early and stops late, and never has a child, she will be at increased risk, and it’s long been known that increased exposure to estrogens results in an increased risk of breast cancer later in life. Also, some of these drugs have been around for a long time and are FDA-approved, which makes me wonder about the whole “natural” part of Somers’ claims. In Suzanne Somers’ world, though, more than anything else, what “bioidentical” really seems to mean is that it’s not something made by big pharma or that it’s “personalized” for each patient. (Never mind that many “bioidentical” hormones are made by the same pharmaceutical companies that make other hormones used in HRT.) Moreover, Suzanne Somers advocates an approach in which made-to-order treatments are made by pharmacies with dosages determined by the results of blood tests. Sounds nice and neat, right? “Tailored” and “personalized” doses, who could argue with that? The problem is, there really isn’t much science to support this, nor is it known if there is a “safe” dose of estrogen for use over the many years that Somers recommends taking this “personalized” HRT, nor is this method recommended by the majority of doctors who treat women’s menopausal symptoms. Certainly using saliva tests to “measure” her hormone levels is very unreliable.

Of course, none of the criticism from her former admirers phases Somers in the least:

Somers adamantly defends her book and bioidenticals. “From a woman’s standpoint, this is the first time we’ve gotten some relief in a non-drug way,” she says in an interview with NEWSWEEK. And the criticism from major medical groups? “Doctors are embarrassed that they don’t know about this,” Somers says. “When doctors don’t have an answer, they like to pooh-pooh it.” As for the letter to her publishers, she accuses those doctors of trying to get publicity for themselves. “Women at this point trust me more than someone they don’t know,” she says. She urges all doctors to study up on bioidenticals. “Learn more, go deeper,” she says. “If I can learn it, they can learn it.”

Apparently Somers is stupid enough to trot out the old “doctors-don’t-know” ploy, as if she knows more about HRT from reading on the Internet than doctors and scientists who have spent years studying it and who actually prescribe it. Then, as is the tendency of woos to do when attacked, she questions the motivations of those criticizing her, rather than substantively addressing their criticisms.

From the point of view of being a cancer surgeon, though, what really irritates me about this is that Somers reportedly had an estrogen receptor-positive breast cancer, yet she’s taking a lot of estrogen and advocating the same for postmenopausal women. Whether they are “bioidentical” or not, taking large amounts of estrogens after having been treated for an ER(+) breast cancer without the input of a medical oncologist is a very bad idea. A prior history of breast cancer is almost an absolute contraindication to HRT. Indeed, HRT is only used in menopausal women with breast cancer for the most severe and debilitating menopausal symptoms, only after all non-estrogen treatments have failed, and only then with a great deal of angst and trepidation on the part of the physicians prescribing it. Fortunately for Somers, assuming she had stage I breast cancer, without her chemotherapy she could expect a 90% chance of survival from surgery and radiation alone, as Dr. Moran and I have pointed out for breast cancer testimonials in general. Even if taking her “bioidentical” estrogen were to increase her chance of cancer recurrence by, say, 25%, it would still leave a nearly 2/3 chance that her cancer won’t recur. Somers has very likely increased the odds of her breast cancer recurring, but it is still more likely than not that it won’t. However, her hormone advocacy is nonetheless not without its price; Somers has had to undergo a hysterectomy for postmenopausal uterine bleeding, which was likely to have been a consequence of her prolonged ingestion of large doses of estrogens. My concern is that other women with breast cancer who may read Somers’ book and follow her lead in taking “bioidentical” estrogen to “rejuvenate” themselves may not be so lucky in avoiding cancer recurrence.

Another thing that irritates me about Somers is the thing that irritates me about many alties: Namely, the claim that their favorite woo is not a “drug” or is somehow accomplished “without drugs.” In the case of bioidentical hormones, this is a load of bovine feces, as Kantrowitz and Wingert explain:

Somers says these custom-made treatments are natural and not really drugs. That’s just not true. Bioidenticals may start out as wild yams or soybeans, but by the time this plant matter has been converted into hormone therapy, it is in fact a drug. All of these products–whether or not they’re approved by the FDA–are chemicals synthesized in a lab. Another thing you should know: there are only a few labs in the world that synthesize these hormones. Everyone–from small compounding pharmacies to big pharmaceutical companies–gets their ingredients from the same places.

Another thing that’s rather ironic is that the same women who are so concerned with “natural” ways and who view the “old” way of HRT of being another example of the medicalization of a normal condition, a turning of a natural bodily process into a “disease” that needs to be “treated” are the same ones who will flock to “bioidentical” hormones, even though they are drugs made by pharmaceutical companies. Let me be very clear: If a compound, whether “bioidentical,” whether it comes from an herb, or whether made by a pharmaceutical company, has a measurable physiological or biological effect when introduced into the human body by ingestion, injection, inhalation, or through the skin, it is a drug. Period. If an herb causes a measurable physiologic effect, it is a drug. If herbal remedies weren’t drugs, Abel Pharmboy would have to find another subject to do his research on.

Satisfyingly (to me, anyway), the article finishes with what has been in essence the theme of this blog since the very beginning:

Since the health initiative, women have become much more skeptical about claims from pharmaceutical companies–and that’s a good thing. Now we should apply that same skepticism to claims for alternative therapies.

As I’ve said time and time again, if there is one principle I hope to impart on this blog, it is that the claims of conventional medicine and alternative medicine should be evaluated in the same way and that they should be held to the same standard of scientific and clinical evidence. I do not differentiate between the two when considering evidence, nor should you. Indeed, if you ever see it argued or implied that “alternative medicine” should be held to a different standard of evidence, you should wonder why the treatment in question shouldn’t be held to the same standard of evidence as any other medicine or treatment. (Better yet, ask the person making the claim; put them on the spot.) If someone like Suzanne Somers (or anyone else, for that matter) claims that her version of “bioidentical” hormones are an “elixir of youth” and are “safe,” I expect to see the same level of evidence backing up those claims that I would expect of a pharmaceutical company claiming that its latest cancer drug is major improvement in the treatment of cancer. Instead, what I get from Somers is pseudoscience, anecdotes, and woo.

I just hope her advice hasn’t led to any women with breast cancer recurring and dying.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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