HORMONE THERAPY IN REHAB. AGAIN. Yet more studies have shown that hormone therapy begun soon after menopause is a pretty safe way to relieve pesky symptoms like hot flashes — and may even reduce the risk of chronic disease. The evidence is now quite convincing that most of the increases in late-life health risks that led the National Institutes of Health to shut down its massive study of hormone replacement a decade ago were related to timing of the meds.
NIH's Women's Health Initiative was not studying conventional use of HT to relieve menopause symptoms. WHI was studying whether the most-used conventional hormone replacement combination of estrogen and progestins could prevent late-life chronic disease. Subjects in the WHI study began hormones at the average age of 63, many years beyond menopause.
But the data were interpreted to apply to women of all ages — with the result that women (to say nothing of their docs and the docs' insurance companies) were afraid to use hormone therapy at all. Prescriptions plummeted.
I suspect there will medical fallout more consequential than just discomfort. To take just one example, more osteoporosis; estrogen therapy strengthens bones reliably and cheaply. So we will probably be seeing more papers reporting increases in fractures, more old ladies permanently bedridden with broken hips, and more deaths. And see below for hints about other bad news to come because millions of women who would have liked to use HT were frightened off.
HERE'S THE NEWEST HORMONE THERAPY DATA. A 4-year study of 772 perimenopausal women, funded by NIH and the Kronos Longevity Research Institute, evaluated estrogen pills and patches. It was too small and short to show possible late-life chronic health risks. But, in addition to banishing menopause symptoms, the study showed that the pills lowered cholesterol and improved mood, while the patch reduced diabetes risk. At the Daily Dose, the Boston Globe's Deborah Kotz details the findings and interviews JoAnn Manson, lead investigator of both the new research and the WHI.
Even more reassuring was the open-label study, just published in the British Medical Journal, that was a bit larger (1026 perimenopausal women) and substantially longer (10 years). The hormone therapy group suffered fewer deaths, myocardial infarction, and heart failure. Perhaps even more important, the rate of breast cancer and stroke was not increased among these women. Breast cancer and stroke are two conditions widely believed to be increased by hormone therapy at any age. Larry Husten discusses the study at CardioBriefs and there's also a summary and brief comment at Journal Watch.
At her blog, Eve Harris writes as if there is something new about the idea that beginning hormone therapy around menopause is much safer than beginning it later. But it's not new at all.
Since soon after NIH shut down the WHI in 2002, experts have been pointing out that WHI subjects were much older than the usual candidates for hormone therapy, and the results might not apply to younger women. I have written a lot about this hormone therapy contrarianism. The first time was in 2003, less than a year after the shutdown, when I covered a meeting of the Endocrine Society. I've written about it here, too.
So, not new. Not new at all. Just ignored.
OH, BTW, IT'S NOBEL PRIZE WEEK. Here's a disciplinary blogging sample.
CHEMISTRY: The 2012 Nobel Prize in Chemistry went to Robert J. Lefkowitz of the Howard Hughes Medical Institute and Duke University Medical Center and Brian K. Kobilka of the Stanford University School of Medicine for studies on G protein-coupled receptors. David Bradley summed it up succinctly at Sciencebase, "It’s bio but with huge pharma implications." At the Curious Wavefunction, Ashutosh Jogalekar provides a lot more details on why GPCRs got the Prize.
This is the most controversial of the Prizes this year because the Chemistry Prize went, once again, to biologists. And not only to biologists, but to docs. And not only to docs, but to cardiologists. Chemist Jogalekar regards the controversy as tiresome. He grumbles
I thought chemists were supposed to rub their hands with glee at the reduction of biology to chemistry while biologists fret and fume. But I see the opposite, biologists being quite sanguine about proteins being awarded medicine Nobels while chemistry continue to complain about proteins (chemicals!) being awarded chemistry Nobels.
Bloggers at Chemical & Engineering News's CENtral Science network had much to say, of course. Glen Ernst, Just Another Electron Pusher, also defended the Prize award to biologists — although he pointed out that, if all biology is chemistry, and all chemistry is physics, maybe this work should get the Physics Prize.
At Terra Sigillata, David Kroll was so happy he posted twice. First he defended GPCRs as worthy of the Chemistry Prize, although he conceded that it might fit with Physiology or Medicine too. In another post Kroll focused on Lefkowitz and the local celebration honoring him.
PHYSIOLOGY OR MEDICINE: The 2012 Prize was awarded jointly to Sir John B. Gurdon of the (eponymous, I presume) Gurdon Institute at Cambridge and Shinya Yamanaka of Kyoto University and the Gladstone Institutes in San Francisco. They got their Prize for stem-cell pioneering, showing that mature specialized cells can be reprogrammed back to an unspecialized state that can then develop in a different direction.
We think of work on pluripotent stem cells as pretty new, and Yamanaka did indeed do his in 2006. But Gurdon's work, showing that a nucleus from a mature frog cell placed in a frog egg could trigger development of a normal tadpole, dates from 1962. In 1949, when Gurdon was still in high school, his biology teacher gave him terrible grades. The report card said
... several times he has been in trouble, because he will not listen, but will insist on doing his work in his own way. I believe he has ideas about becoming a Scientist; on his present showing this is quite ridiculous.
Apparently he kept right on not listening and insisting on doing his work in his own way. In 1962, the idea that a cell could be reprogrammed to create a new organism, that a frog could be cloned, was certainly outside mainstream biology. See the report card for yourself in a post by Robert Gonzalez at io9.
Knight Science Journalism Tracker Paul Raeburn critiqued media coverage of the prize for stem cell reprogramming, puzzled that some science writers left "stem cells" out of the lede. He notes, and I agree, that it's a scientific term with some public recognition, and that would help keep readers reading.
PHYSICS: The 2012 Physics Prize went to Serge Haroche of the Collège de France and Ecole Normale Supérieure in Paris and David J. Wineland of the National Institute of Standards and Technology and the University of Colorado, Boulder. They got the prize for developing ways to measure and manipulate individual particles while preserving their quantum-mechanical nature, something once thought impossible — and still thought impossible to explain to mere mortals. Chad Orzel makes a noble Nobel attempt at Uncertain Principles. Did he get it right? How would I know? It was at least intelligible, and that's an accomplishment not to be scorned.
At Cosmic Variance, Sean Carroll bows out of explaining the prize himself and cross-posts a piece by quantum physicist John Preskill of CalTech who recalls a few personal encounters with the winners.
A COUPLE OF NOBEL SIDELIGHTS. There was some grumbling that the Physics Prize should have gone to discovery and confirmation of the Higgs boson, undeniably the Physics Event of the Year. At Cosmic Log, Alan Boyle explains why that wasn't going to happen, but why the Higgs may eventually force changes in the way Nobels are awarded.
Maybe next year. The clock, Boyle points out, is ticking. Nobels are awarded to living scientists only, and Peter Higgs is 83.
In other Nobel news, the rock-solid New England Journal of Medicine, arguably the best in the business, has just published a paper showing that chocolate causes Nobel laureates. Of course. Obvious. At Evolving Thoughts, John Wilkins explains.
But see also Larry Husten at CardioBriefs and the quoted comment explaining why the chocopaper is really a subtle dig at overinterpretation of medical observational studies. Did you get that? Me either. Subtle is hardly the word.
