Article Submission Detail:

Article Title: The Moral Hazard of Hormone Replacement Therapy
Author Name: Dr. Kathleen Ruddy
Contact Email Address: drruddy@...
Word Count: 826
Suggested Category: women's health
Keywords: Dr. Kathleen Ruddy,Oprah Winfrey,hormone replacement
therapy,HRT,breast cancer,breast cancer awareness month,women,
woman,hormones,menopause,hormone replacement,female,estrogen,
progesterone
Description: Breast cancer surgeon, Dr. Kathleen Ruddy, offers
insight into the controversy of hormone replacement therapy
recently discussed on the Oprah Winfrey Show.
Copyright Date: 2009

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The Moral Hazard of Hormone Replacement Therapy

In the midst of the recent tsunami of financial catastrophes the
question of "moral hazard" has been raised to describe how the
banks, which have made very wrong investment decisions, have
been insulated from their harmful consequences by government
bailouts and rescue packages.

Not allowing banks to fail as a consequence of their own idiotic
mistakes insulates them from the negative feedback that might
better correct their behavior in the future.

So how does the moral hazard of rescuing bad banks apply to HRT?
Just this: that the separation between action and consequences,
particularly if the consequences are delayed for years and occur
somewhat randomly, and the "rescue" from consequences are the
hallmarks of moral hazard, and they apply to medicine as well as
banking.

There is no longer any argument among scientists about whether
HRT is associated with an increased risk of cancer: it is. If
HRT contains only estrogen, then there is an increased risk for
uterine cancer. If HRT contains progesterone, then there is an
increased risk for breast cancer.

Furthermore, all types of HRT are associated with an increased
risk for stroke and blood clots. This is not a matter of how
the hormones are made (from natural or synthetic products) but
rather what they do. And what they do to the post-menopausal
female is "unnatural" in the context of an otherwise naturally
aging body.

We know that there is an increased risk of breast cancer in the
group of women who use HRT, but we do not know exactly which of
these women will get the cancer. It is important to understand
that we only know the statistics for the group; we do not know
precisely who will get the disease, and whether or not the
hormones are responsible for it.

The moral and medical hazard associated with HRT is enlarged by
the healthcare system "safety net" - the treatments that are
available once one of the complications of HRT occurs. Today
early treatment of breast cancer produces excellent survival
statistics for most patients, but it is impossible to say
exactly who will live and who will die of breast cancer because
statistics apply to a group, not to an individual patient.

The recent discussion of HRT offered by Oprah Winfrey in her
magazine and on her TV show presents both sides of the argument
about HRT, but does little to settle the question. In the end
women are advised to "talk to their doctor." As a woman, and as
a breast cancer surgeon, I am afraid that millions of women will
come away from Oprah's show with the impression that HRT may not
be so risky after all. I disagree. HRT is risky; the problem
is we cannot say exactly for whom it is risky. Do you want to
take the risk that the bell tolls for you?

You say you cannot sleep at night. How much more sleep do you
think you will lose if you are told you have breast cancer? How
much sleep will you loose worrying about how to pay for all of
your treatments? How much sleep do you think you will loose if
you have to undergo surgery, and possibly loose your breast, as
part of your treatment? How much sleep will you loose thinking
that you might not have gotten breast cancer if you had not
taken the hormones in the first place?

You say you have night sweats and hot flashes. How much more
uncomfortable do you think you will be if you have to have
chemotherapy for four to six months? How much worse are the
side effects of chemotherapy compared to the symptoms of
menopause?

You say you feel emotionally labile. How nerve-racking do you
think it is to be worried about every twinge and pain and change
in your body, dreading that your cancer has returned? How
traumatic do you think it is to loose your hair just as you are
recovering from surgery on your breast, the beacon of female
sexuality? How chronically afraid do you think you might be
wondering if you will live, while you watch so many other women
die?

Menopausal symptoms do not last forever. Certainly they are
challenging, but they can be managed with diet, exercise and
emotional support. And bone loss can be managed with
medications that have a lower risk profile compared with HRT.
You will recover from menopause, and when you do you will no
longer be subjected to the slings and arrows of outrageous
hormones. No statistic can ever tell you if you will be the one
to survive a breast cancer, or whether you will be the one to
die. Think hard about the moral and medical hazards of HRT
before you commit yourself to an uncertain future, one that you
might regret.

(c) 2009, Dr. Kathleen Ruddy. All rights reserved. Reprints
welcomed so long as article and by-line are not edited and all
links are made live.

Dr. Kathleen Ruddy, Founder and President of the Breast Health
and Healing Foundation, is a breast cancer surgeon who is
dedicated to finding the causes of breast cancer and using that
knowledge to prevent the disease. You can find further details
at http://www.BreastHealthandHealing.com