Whither Hormone Therapy?

Will it go the way of therapeutic bleeding?

(Editor's Note: Yo' has been quite busy this week, and therefore unable to undertake production of his usual hard-hitting column. As a substitute, knowing that there is NO absolute substitute for Yo'Doc, we present some thoughts on a couple of topics of current interest.)

First, the women's hormone study had its unexpected outcome of increased heart attacks, strokes and phlebitis. This bombshell of negative information tipped the medical community on its collective ear. (The ear is an appropriate analogy - the gynecologists' and family doctors' phones have been ringing off their hooks with calls from anxious patients.) What are we to do with the millions of women currently taking hormone replacement therapy (HRT)?

Some of the answers: 1. Do nothing, since this is just a single study and needs to be confirmed. (Bad response. Go to the foot of the class.) 2. Stop all use of combination HRT (Estrogen alone can relieve menopausal symptoms, prevent osteoporosis and possibly reduce incidence of senile dementia.) 3. DON'T use estrogen alone, since it increases breast and uterine cancer risk (the latter is preventable by using the now-discredited combination HRT). Of course, many women will then be obliged to suffer the consequences of hormone deprivation.

4. Switch all estrogen-deficient women to something "natural", like soybean or yam products. Maybe OK, but the safety and effectiveness of these substances have never been carefully tested. (Please note: Premarin as used in this study is perfectly "natural", too. It comes from the urine of pregnant mares.) 5. Why not use lower doses of agents known to be effective? (The Prempro used in the study was .625 /2.5 mgm, not an unusually large dose, but smaller amounts might not cause the same problems.)

There are going to be lots of phone calls and office visits before this subject is laid to rest.

Second, a major trauma center in Las Vegas, Nevada had to shut down because all of its orthopedists quit. They did so because their malpractice insurance premiums went from a staggering $90,000 per year to an unbelievable $200,000! They came back to work after they were all temporarily "hired" by the county which runs the facility, and whose employees' malpractice award limit is set at $50,000.

Nevada is one of several states (Arizona is another) in which there are no limits on attorneys' fees or amounts awarded in malpractice cases. Both states have experienced significant losses in physician coverage in high-risk specialties like obstetrics and trauma. California and some others have placed limits on awards for "pain and suffering" and on attorneys' fees, and malpractice insurance there is still affordable.

Whenever the issue comes up, trial lawyers associations use the false argument that the limits are the result of "those greedy insurance companies" not wanting to compensate victims adequately. Why doesn't someone "victimized" by the closed trauma center in Las Vegas sue the greedy trial lawyers for about a billion dollars?

Yo'Doc will be pleased to note that at the end of this page is a link to one of his previous pieces, in which he deals appropriately with a malpractice threat.