Useful links from Jeffrey Dach MD

Useful links to message boards:

http://www.lowcarbfriends.com/bbs/thyroid/659019-dr-jeffrey-dach-hollywood-florida-any-feedback.html
Dr. Jeffrey Dach Hollywood Florida….Any feedback?

http://www.lowcarbfriends.com/bbs/thyroid/717366-need-amazing-top-thyroid-bio-hormones-doctor.html
I don’t think you can go wrong with Dr. Dach. I’m pleased with my current doctor(s) but I would love to find someone like him here in Texas. He’s a perfect combination of western and eastern medicine. At this point I’m seeing my DO, a Naturopath and Acupuncturist.
The fact that Dr Dach looks at the whole body is gold. With your concerns that is what you need. So many Drs will RX the symptoms without looking at the big picture. And believe me, there’s a big picture.

 http://www.lowcarbfriends.com/bbs/thyroid/687790-pam-any-preference-between-these-2-docs.html
Pam, any preference between these 2 docs?

http://www.lowcarbfriends.com/bbs/thyroid/717121-dr-dach-selenium-iodine.html  Dr. Dach -Selenium/Iodine

http://www.health-forums.com/alt-support-cancer-breast/bone-scan-v-pet-scan-18715.html#post150479

Re: bone scan v. PET scan

http://www.health-forums.com/alt-support-cancer-breast/bone-scan-v-pet-scan-18715.html#post151685

http://www.health-forums.com/misc-fitness-weights/jarvik-heart-lipitor-jeffrey-dach-6671.html

 Jarvik Heart and Lipitor by jeffrey dach

http://www.health-forums.com/alt-support-diet/lipitor-ad-campaign-jarvik-heart-jeffrey-dach-6668.html

 Lipitor Ad Campaign with Jarvik Heart by jeffrey dach

 http://www.health-forums.com/alt-support-anxiety-panic/depression-anxiety-panic-attacks-6317.html

 Depression, Anxiety and Panic Attacks

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http://www.health-forums.com/alt-support-arthritis/new-book-natural-medicine-101-jeffrey-dach-172684.html

 Natural Medicine 101 the book by jeffrey dach md

http://www.health-forums.com/alt-support-arthritis/jeffrey-dach-book-announcment-natural-medicine-101-a-161586.html

 Natural Medicine 101 the book by jeffrey dach md

A new book Natural Medicine 101

http://www.health-forums.com/arthritis/jeffrey-dach-book-announcement-natural-medicine-101-a-162168.html

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http://www.health-forums.com/alt-support-cancer-breast/bone-scan-v-pet-scan-18715.html#post150479
Re: bone scan v. PET scan

http://www.health-forums.com/alt-support-cancer-breast/bone-scan-v-pet-scan-18715.html#post151685

http://www.health-forums.com/misc-fitness-weights/jarvik-heart-lipitor-jeffrey-dach-6671.html
Jarvik Heart and Lipitor by jeffrey dach

http://www.health-forums.com/alt-support-diet/lipitor-ad-campaign-jarvik-heart-jeffrey-dach-6668.html
Lipitor Ad Campaign with Jarvik Heart by jeffrey dach

http://www.health-forums.com/alt-support-anxiety-panic/depression-anxiety-panic-attacks-6317.html
Depression, Anxiety and Panic Attacks

http://www.health-forums.com/alt-support-arthritis/new-book-natural-medicine-101-jeffrey-dach-172684.html

Natural Medicine 101 the book by jeffrey dach md

http://www.health-forums.com/alt-support-arthritis/jeffrey-dach-book-announcment-natural-medicine-101-a-161586.html

Natural Medicine 101 the book by jeffrey dach md
 

 

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Useful links from Jeffrey Dach MD
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http://www.medkb.com/Uwe/Forum.aspx/arthritis-forum/19105/Cordyceps-the-Energy-Superfood-by-Jeffrey-Dach-M-D
Cordyceps, the Energy Superfood by Jeffrey Dach M.D.

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http://www.health-forums.com/arthritis/jeffrey-dach-book-announcement-natural-medicine-101-a-162168.html
A New Book Natural Medicine 101 by Jeffrey Dach

http://newsgroups.derkeiler.com/Archive/Alt/alt.support.arthritis/2011-06/msg00003.html
A New Book Natural Medicine 101 by Jeffrey Dach

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http://sci.tech-archive.net/Archive/sci.med.nutrition/2011-01/msg00003.html
Jeffrey Dach Book Announcment, Natural Medicine 101
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http://sci.tech-archive.net/Archive/sci.chem/2011-01/msg00022.html
Announcing a New Book, Natural Medicine 101 by Jeffrey Dach
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http://sci.tech-archive.net/Archive/sci.med/2007-01/msg00104.html
Hypertension by Jeffrey Dach, M.D.
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Nutritional Supplementation: Back to the Basics
http://sci.tech-archive.net/Archive/sci.med/2006-12/msg00147.html
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http://newsgroups.derkeiler.com/Archive/Alt/alt.support.arthritis/2010-12/msg00085.html
Jeffrey Dach Book Announcment, Natural Medicine 101
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Jeffrey Dach MD
7450 Griffin Road
Davie, Fl 33314
954-983-1443
http://www.jeffreydach.com
http://www.drdach.com
http://www.naturalmedicine101.com

http://disc.yourwebapps.com/Indices/244124.html
http://disc.yourwebapps.com/Indices/244066.html
http://disc.yourwebapps.com/Indices/244067.html
http://disc.yourwebapps.com/Indices/244161.html
http://disc.yourwebapps.com/Indices/244163.html
http://www.bioidenticalhormones101.com

Useful links from Jeffrey Dach MD

 Useful links to message boards:

Useful links from Jeffrey Dach MD

http://www.health-forums.com/alt-support-cancer-breast/bone-scan-v-pet-scan-18715.html#post150479
Re: bone scan v. PET scan

http://www.health-forums.com/alt-support-cancer-breast/bone-scan-v-pet-scan-18715.html#post151685

http://www.health-forums.com/misc-fitness-weights/jarvik-heart-lipitor-jeffrey-dach-6671.html
Jarvik Heart and Lipitor by jeffrey dach

http://www.health-forums.com/alt-support-diet/lipitor-ad-campaign-jarvik-heart-jeffrey-dach-6668.html
Lipitor Ad Campaign with Jarvik Heart by jeffrey dach

http://www.health-forums.com/alt-support-anxiety-panic/depression-anxiety-panic-attacks-6317.html
Depression, Anxiety and Panic Attacks

—————————————————————

http://www.health-forums.com/alt-support-arthritis/new-book-natural-medicine-101-jeffrey-dach-172684.html
Natural Medicine 101 the book by jeffrey dach md

http://www.health-forums.com/alt-support-arthritis/jeffrey-dach-book-announcment-natural-medicine-101-a-161586.html
Natural Medicine 101 the book by jeffrey dach md

 

http://www.medkb.com/Uwe/Forum.aspx/arthritis-forum/19105/Cordyceps-the-Energy-Superfood-by-Jeffrey-Dach-M-D
Cordyceps, the Energy Superfood by Jeffrey Dach M.D.

http://newsgroups.derkeiler.com/Archive/Alt/alt.support.arthritis/2011-06/msg00003.html
A New Book Natural Medicine 101 by Jeffrey Dach

http://sci.tech-archive.net/Archive/sci.med.nutrition/2011-01/msg00003.html
Jeffrey Dach Book Announcment, Natural Medicine 101
——————————————————————————–
http://sci.tech-archive.net/Archive/sci.chem/2011-01/msg00022.html
Announcing a New Book, Natural Medicine 101 by Jeffrey Dach
——————————————————————————–
http://sci.tech-archive.net/Archive/sci.med/2007-01/msg00104.html
Hypertension by Jeffrey Dach, M.D.
——————————————————————————–
Nutritional Supplementation: Back to the Basics
http://sci.tech-archive.net/Archive/sci.med/2006-12/msg00147.html
——————————————————————————–

http://newsgroups.derkeiler.com/Archive/Alt/alt.support.arthritis/2010-12/msg00085.html
Jeffrey Dach Book Announcment, Natural Medicine 101
——————————————————————————–

Jeffrey Dach MD
7450 Griffin Road
Davie, Fl 33314
954-983-1443
http://www.jeffreydach.com
http://www.drdach.com
http://www.naturalmedicine101.com

http://www.bioidenticalhormones101.com

http://disc.yourwebapps.com/Indices/244124.html
http://disc.yourwebapps.com/Indices/244066.html
http://disc.yourwebapps.com/Indices/244067.html
http://disc.yourwebapps.com/Indices/244161.html
http://disc.yourwebapps.com/Indices/244163.html

 

10 Ten Bioidentical Hormone Fallacies of Staness Jonekos

A recent article on hormones for menopause caught my attention. I was puzzled by the fact that the author, Staness Jonekos, has no medical credentials, training or even a rudimentary knowledge of biological science. Rather, she is an actress with a theater arts degree from UCLA. She chronicled her menopause experience with a book and blog entitled Menopause Makover. To make up for her lack of medical knowledge, Staness joined up with Wendy Klein MD , an academic physician who advocates synthetic, chemically altered hormones (progestins), and SSRI antidepressants for menopausal symptoms.  The latest article by the two women, "10 Hormone Therapy Facts ", is a compilation of nonsense, falsehoods, and half truths, with a hidden agenda  promoting the synthetic hormone industry by maligning natural bioidentical hormones.

Above left image: Bioidentical Hormones represented by Natural Redhead  courtesy of wikimedia commons.

10 Ten Hormone Facts should be renamed 10 Ten Hormone Fallacies

Firstly, the Jonekos article maligns bioidentical hormones as unregulated, non-FDA approved and not supported by science. These claims against bioidentical hormones are  false, and are a smokescreen to hide the really scary fact that synthetic hormones are monsters that cause cancer and heart disease, as shown in the Women’s Health Initiative study.

Secondly, the article tries to confuse the difference between bioidentical hormones and synthetic, chemically altered hormones made by the pharmaceutical industry. Do not be confused, they are very different. Synthetic hormones are chemically altered monsters that cause cancer and heart disease. Bioidentical hormones are identical to hormones found naturally in the human body, the safe and effective choice.
 
Left Image: Synthetic Hormones are Monster Creations.  Boris Karlof  in The Bride of Frankenstein 1935, Courtesy of Wikimedia Commons

Thirdly the article contradicts itself in number 7, stating that blood testing is not needed, while the author earlier reported that blood testing revealed a high estrogen level. Obviously, blood testing was needed.

Fourth, the article quotes the Menopause and Endocrine Societies as authorities without revealing their financial ties to the synthetic hormone makers such as Wyeth.

Fifth, the author says that bioidentical hormones did not work for her. Quite to the contrary, millions of women use bioidentical hormones every day for relief of menopausal symptoms and quality of life. Bioidentical hormones work quite well.

Sixth, After ranting that bioidentical hormones don’t work, the author reports they DO work, and she uses estradiol, a bioidentical hormone.  Estrogen alone without progesterone causes increased risk of endometrial cancer. This important information is omitted from the article, possibly harming women readers who accept Staness as a medical authority, incorrectly concluding that estrogen without progesterone is acceptable.  It is not acceptable, and is a disservice to women.

Let’s go through the article in detail. Note: the Jonekos article text is in italics:

Bioidentical hormone treatment made my menopausal symptoms worse.

"I splurged for Somers’ expensive Beverly Hills doctor recommendation, assuming he must have the answers. He confirmed I was menopausal and gave me tubes of compounded triple estrogen gel and compounded 10 percent micronized progesterone gel, with orders to apply them regularly. After a few months of visiting this overpriced Beverly Hills doctor, my menopause symptoms were exaggerated and my moodiness turned into depression. "

My comment: This bioidentical hormone program of estrogen gel and progesterone is the correct one, used by millions of women daily. It is safe and effective. However, close patient monitoring is required, and the patient should be alerted to watch out for signs of  hormonal excess.

Blood Test revealed my estrogen levels were 7 times higher than normal

A blood test revealed that my estrogen levels were seven times higher than normal, my increased weight now placed me into the overweight BMI category, and my severe crankiness made it impossible to work. There is no need for testing of hormone levels, either in saliva or blood. The science has shown that there is no predictable correlation between hormone levels in saliva or in blood and severity of symptoms. “

My comment: Apparently Jonekos visited a bioidentical hormone doctor in Beverly Hills. Uzzi Reiss MD  is well known in Beverly Hills and prominently mentioned in Suzanne Somer’s book.  Jonekos obviously did not read Reiss’s books on bio-identical hormones which explain the symptoms of estrogen excess. These are fluid retention, bloating, breast enlargement and tenderness.  Once these estrogen excess symptoms are identified, the estrogen dosage is held until symptoms are gone. Educating the patient about estrogen excess symptoms, and when to hold hormone dosage is the key to successful treatment program.

An omission Jonekos revealed in a blog posting elsewhere is the story of birth control pills for many years. Birth control pills are synthetic hormones, and when these are abruptly stopped, this causes onset of menopausal symptoms. This complicates the story considerably. Birth control pills are a form of chemical castration, halting ovulation. Birth control pills cause artificial cycles without ovulation. Once the pills are stopped, there is usually a delay of months before normal ovarian function and normal cycling resumes. Until ovarian function returns, there is no hormone production and patients experience typical menopausal symptoms with low hormone levels.

Let’s assume such as a scenario took place.  When such a patient begins a bioidentical hormone program, hormone levels will go up with relief of menopausal symptoms. The patient feels better.  However, a few months later, there is resumption of ovarian function which pumps new hormones into the patient’s body, added to the levels produced by her hormone creams.  This causes hormonal excess with all the usual symptoms of bloating, breast enlargement and mood disorder. This is not a failure of the bioidentical hormone medication. Hormonal excess means the hormones are working too well, raising estrogen levels too much. This is not a failure of the medication, rather it is a failure of patient monitoring and failure to alert the patient to these symptoms. Blood testing is useful here to show elevated estrogen levels.

Unregulated Hormones Not Supported by Science

"What went wrong? I trusted a resource not supported by science. I was taking unregulated hormones. It was eye-opening to learn that natural compounded bioidentical hormones were unregulated by the FDA. There was no standardization for producing the product, and no tests on the formulations. There are NO real natural hormone products available."

My comment: Jonekos clearly has a bad experience with this first doctor, and then incorrectly concludes there is something wrong with the bioidentical hormones, saying that biodientical hormones are not supported by science, unregulated, non-standard, and untested. Of course, this is all nonsense. Bioidentical hormones are heavily regulated, tested and supported by science. The statement , “There are NO real natural hormone products available” is more nonsense. Quite to the contrary, millions of women are using them every day.

Science DOES support the use of bioidentical hormones for menopausal symptoms. Go to Medline and do a search for estrogen or progesterone (link ) and 90,000 articles will come up. Dr Holtorf’s article in PostGraduate Medicine , The Bioidentical Debate , cites 196 articles supporting that bioidentical hormones are safer and more effective than synthetic chemically altered hormones.

Bioidentical hormones are heavily regulated as both FDA approved products at the corner drug store and as compounded preparations. Compounding does not fall under the jurisdiction of the FDA, so FDA regulation is not needed or even desired. Instead, Compounding pharmacies have a separate system of regulation at the state and local level which is rigorous and recognized by the AMA. Look for a compounding pharmacy with PCAB accreditation .

1 ) Natural: The word "natural" is a marketing term. There is no scientific evidence that custom-compounded bioidenticals are safer or more effective or more "natural" than standard pharmaceutical bioidentical prescriptions. The only "natural" hormones are the hormones being made by your body.

My Comment: The word “natural” is not only a marketing term. Natural means anything found in the natural world that cannot be patented.  This next comment is a tautology as bioidentical is still bioidentical whether found in FDA approved prescriptions or in compounded preparations.  We know from the Women’s Health Initiative study JAMA 2002 , that synthetic hormones are monsters that cause cancer and heart disease. Bioidentical hormones are safe and do not increase risk of cancer or heart disease as shown in the French Cohort study .

2) Bioidenticals: Laboratories create formulations that are either identical (bioidentical) or not (non-bioidentical) to those in your body. There are FDA approved prescription estradiol products that are bioidentical that are not "compounded."

My Comment: This is correct.

3) Compounded hormones: Made in a pharmacy by combining, mixing or altering ingredients to create a customized hormone for an individual patient. Compounding pharmacies must be licensed and regulated by the State Pharmacy boards. However, they do not have to demonstrate the safety, effectiveness and quality control, based on large, scientific studies that the FDA requires of pharmaceutical manufacturers. Compounding pharmacies use chemically synthesized hormones made from plants —
the same government-approved ingredients that are used in a manufacturer’s laboratory. "Compounded" formulations are neither safer nor more "natural."

My Comment: Compounded Pharmacies are not under FDA jurisdiction, and that is why they are not regulated by the FDA. Instead, they are regulated by the state and local government. To expect and insist on FDA regulation for compounding pharmacies is like saying your state driver’s license is invalid because it was not issued by the federal government.

What Does FDA Approval Mean?

The author creates confusion about the meaning and significance of FDA Approval
Food and Drug Administration approval does not confirm that the drug is the most effective or the safest drug for you.  FDA approval means the drug is more effective than placebo for its indicated use and benefits outweigh risks.  Drug Manufacturers spend 500 to 800 million doing clinical studies submitted for FDA approval, because of the future prospects for greater profit.  The chemical structure of a bioidentical hormone, like other natural substances, cannot be patented, so there is very little financial incentive for a drug company to spend all that money on clinical studies when profits cannot be assured. 

Non-FDA aproved indications

Drugs are FDA approved for certain medical indications.  About 20% of the time, doctors  prescribe drugs for non-FDA approved indications. For example, Dr Wendy Klein advocates the use of SSRI antidepressants as a non-hormonal treatment for hot flashes. This is a non-FDA approved use of the drug. At the same time, Dr Klein criticizes doctors who prescribe compounded bioidentical hormones as non-FDA approved.  This is hypocrisy.

Chemically Synthesized Hormones

By using the phrase, “Compounding pharmacies use chemically synthesized hormones” , the author is again confusing the reader with the difference between synthetic hormones and bioidentical hormones. They are quite different.  Synthetic hormones are chemically altered monsters.  On the other hand, Bioidentical hormones have the same chemical structure as those found in the human body.  How the hormone was made or manufactured is not important as long as the chemical structure is identical to the human hormone.

The North American Menopause Society (NAMS), a non-profit organization of expert scientists and clinicians, "does not recommend custom-compounded products over well-tested, government-approved products for the majority of women." The Endocrine Society has stated that, "Post-market surveys of such (compounded) hormone preparations have uncovered inconsistencies in dose and quality."

My comment: The author omits that both NAMS and Endocrine Society have publicly acknowledged financial ties to the drug industry.   In addition, both organizations advocate the use of synthetic “monster” hormones, and as such, represent the financial interests of the synthetic hormone industry (such as Wyeth and Abbott ), rather than the health of the public.  Half of the board of trustees of NAMS receive money from Wyeth in the form of consulting fees or research support.  Wyeth makes Prempro and Pristiq.  These Financial Disclosures are listed page 10 of the NAMS 2007 position statement on Hormones for Menopause.

4) All hormones, whether made in compounding pharmacies or in manufacturer’s laboratories, are synthetic in the sense that they are made by a chemical process.

My Comment: This is another attempt to confuse the difference between synthetic chemically altered “monster” hormones and bioidentical hormones. Again, they are quite different. Make no mistake, Bioidentical hormones are NOT synthetic hormones. The word synthetic is intended to mean a chemical structure which is different from the human hormone, allowing the drug maker to obtain a patent for the altered structure.

5) To determine whether hormone therapy is appropriate and safe, one’s risk factors must be assessed based on personal and family medical history, as well as personal preference. There is no "one size fits all."

My Comment: Personal and family medical history is always part of any medical evaluation. However, the above statement is nonsensical. The important fact to remember is that Bioidentical hormone therapy is safe and effective while synthetic “monster” hormones cause cancer and heart disease.

6 Low dose hormone therapy, used judiciously, still remains the most effective way to treat the troubling symptoms of menopause for those who need it and who can use it safely.

My Comment: Since mainstream physicians know that synthetic “monster” hormones are dangerous, causing cancer and heart disease, they shrug their shoulders and accept “low dose” synthetic hormone therapy as more desirable than higher standard dosage. Less of the harmful monster hormone is given to the patient.  Synthetic chemically altered hormones are “Monsters” at any dosage. Stay away.

7) There is no need for testing of hormone levels, either in saliva or blood. The science has shown that there is no predictable correlation between hormone levels in saliva or in blood and severity of symptoms. Unless there are unusual complications, it is the standard of care to treat symptoms if needed and adjust medications according to response, not saliva levels.

My Comment: There are no blood tests for synthetic hormones, so proponents of synthetic hormones pretend that lab testing is not needed. The reality is that very useful blood, urine and saliva testing is available for the entire range of bioidentical hormones. If your doctor doesn’t do some sort of testing, you need a new doctor.

8 ) Standard prescription hormone therapy is the safest form available. It has been tested by the FDA and manufactured in a highly regulated manner. Doses are consistent.

My Comment:“Standard Prescription hormone therapy” is coded language for chemically altered synthetic “monster” hormones shown to cause cancer and heart disease in the Women’s Health initiative study. That’s not so safe. “Tested by the FDA” is a misnomer and error. The FDA doesn’t do any testing. The drug company pays for testing and then submits the results on paper to the FDA for approval. The testing has to show drug efficacy over placebo. That’s all. Sometimes the testing is fudged. Ten percent of FDA approved drugs are later banned . Another 10% receive a black box warning.

9 ) There are also FDA approved non-hormonal therapies available to treat menopause symptoms for those who cannot take hormones.

My Comment: The above statement a reference to the use of SSRI antidepressants for menopausal symptoms. These drugs were recently shown to be no better than placebo for depression (Newsweek ) (Jama Jan 5, 2010 ) Regarding efficacy for hot flashes, drug company funded studies done by academic physician like Dr Klein showed efficacy over placebo was marginal. Synthetic altered hormones are bad enough, they cause cancer and heart disease. Effexor and Pristiq are even worse, they are chemically addictive with horrendous withdrawal effects. The use of SSRI antidepressants for menopausal symptoms is not about health, its about money, and is a grotesque caricature of what real medical care should be.

10 ) Whether hormone therapy is needed depends on severity of symptoms, including hot flashes, night sweats, vaginal dryness and irritability. Hormone therapy should be individualized, which may mean trying different doses and schedules, as well as different routes of administration.

My Comment: Many mainstream doctors will ask patients to “live with it” if they deem the menopausal symptoms not severe enough to warrant treatment. Millions of smart women have rejected synthetic hormones, and SSRI antidepressants, and are finding success with bioidentical hormone programs.

Unregulated formulas and inconsistent compounded dosing can be dangerous and has jeopardized the health of many women, including myself. I wished I had known the dangers involved with compounded-hormones. After my menopause symptoms were stabilized with a standard prescription of bioidentical estradiol, I found a new way of eating, lost 30 pounds and updated my beauty regime without cosmetic surgery or alterations. I have never been healthier.

My Comment: The author clearly blames inconsistency in her compounded formula for an episode of hormonal excess. I would disagree, and suggest the hormonal excess was due to her body’s resumption of hormonal production after stopping birth control pills. A resumption of hormone production in addition to using the estrogen cream results in hormone excess.

To avoid hormonal excess, we monitor patients closely, and alert them to watch for signs of hormonal excess. At the earliest sign of hormonal excess, the patient stops using the estrogen cream. This type of program very safe. In my experience prescribing compounded hormone preparations and monitoring patients, the formulas have been very consistent and standardized, and patients have been happy with the results.

In the end, the author confesses she returned to bioidentical hormones, namely Estradiol. Yet the author omits the historical information that Estrogen alone (Premarin) causes endometrial hyperplasia and cancer. That is why progesterone must be given with the estrogen to prevent endometrial hyperplasia.  Omitting this information is a disservice to women and potentially harmful for readers.

In Conclusion

This "10 Facts" article is a mixture of nonsense, falsehood and half truth. The quality of information reflects the authors credentials, which are none, other than briefly visiting a few doctors for symptoms of hormonal imbalance. The medical information appearing in the article comes from Dr Wendy Klein, regurgitated drug company propaganda advocating synthetic chemically altered “monster” hormones and SSRI antidepressants for menopause, performing a disservice to women.  A safer, more effective alternative is bioidentical hormone therapy.

A Plea to Staness Jonekos

Rather than rely on biased advice from Wendy Klein, who advocates synthetic hormones and SSRI antidepressants for menopause, I suggest you find a more balanced viewpoint by interviewing well known medical experts such as David Brownstein, Kent Holtorf,  Bruice KentonSangeeta PatiC. W. Randolf, Erika Schwartz, and Jonathan Wright . Read their books, web sites and call them.

A plea to Dr Wendy Klein and all other supplicants to the drug companies:  Join with Marcia Angell in her crusade to free medical academia from the drug company money which has corrupted medical eduication and research.  Read Marcia Angell’s talk given at Harvard University on December 10, 2009, outlining the way forward.  I call on you to renounce synthetic hormones and antidepressants for menopause as a disservice to women.  Join with thousands of your colleagues who have embraced bioidentical hormones. 

A plea to all others: The history of modern medicine is replete with the medical victimization of women.  A few discarded examples are: radical mastectomy, excessive hysterectomies, and bone marrow transplant for breast cancer.  Synthetic hormones belong on that list. The latest medical hoax is SSRI antidepressants for hot flashes.  Take back control of your bodies. Do not allow yourselves to be victims of synthetic hormones and antidepressants for menopausal symptoms.  The proper treatment is bioidentical hormone therapy. To find a bioidentical hormone doctor in your area, click here for the doctor’s directory, AHMA , ACAM , A4M .  

Articles with Related Content:

The Safety of Biodientical Hormones

Bioidentical Hormones According to Chris Woolston LA Times

BioIdentical Hormones Trashed by Marilynn Marchione AP News

More Articles with Related Content:

The Importance of Bioidentical Hormones

The Safety Of Bio-Identical Hormones by Jeffrey Dach MD

The Battle for BioIdentical Hormones by Jeffrey Dach MD

Breast Cancer Prevention and Iodine Supplementation by Jeffrey Dach MD

Links and References:

10 Hormone Therapy Facts Every Woman Should Know by Staness Jonekos
http://www.huffingtonpost.com/staness-jonekos/10-hormone-therapy-facts_b_615199.html

http://www.ncbi.nlm.nih.gov/pubmed/19179815/
http://www.iacprx.org/site/DocServer/HoltorfStudy_Jan09_PostgraduateMedicine.pdf?docID=5841

Postgrad Med. 2009 Jan;121(1):73-85. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?
Holtorf K. Holtorf Medical Group, Inc., Torrance, CA 90505, USA

http://bostonreview.net/BR35.3/angell.php

MAY/JUNE 2010 Big Pharma, Bad Medicine-
How corporate dollars corrupt research and education by Marcia Angell

The boundaries between academic medicine—medical schools, teaching hospitals, and their faculty—and the pharmaceutical industry have been dissolving since the 1980s, and the important differences between their missions are becoming blurred. Medical research, education, and clinical practice have suffered as a result.

To a remarkable extent, then, medical centers have become supplicants to the drug companies, deferring to them in ways that would have been unthinkable even twenty years ago. In addition to grant support, academic researchers may now have a variety of other financial ties to the companies that sponsor their work. They serve as consultants to the same companies whose products they evaluate, join corporate advisory boards and speakers bureaus, enter into patent and royalty arrangements, agree to be the listed authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposia, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in sponsoring companies.

Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
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Disclaimer click here: www.drdach.com/wst_page20.html

The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician. Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship. Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur.

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Copyright (c) 2010,11 Jeffrey Dach MD All Rights Reserved. This article may be reproduced on the internet without permission, provided there is a link to this page and proper credit is given.

FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of issues of significance. We believe this constitutes a ‘fair use’ of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.

 

10 Ten Bioidentical Hormone Fallacies of Staness Jonekos

A recent article on hormones for menopause caught my attention. I was puzzled by the fact that the author, Staness Jonekos, has no medical credentials, training or even a rudimentary knowledge of biological science. Rather, she is an actress with a theater arts degree from UCLA. She chronicled her menopause experience with a book and blog entitled Menopause Makover. To make up for her lack of medical knowledge, Staness joined up with Wendy Klein MD , an academic physician who advocates synthetic, chemically altered hormones (progestins), and SSRI antidepressants for menopausal symptoms.  The latest article by the two women, "10 Hormone Therapy Facts ", is a compilation of nonsense, falsehoods, and half truths, with a hidden agenda  promoting the synthetic hormone industry by maligning natural bioidentical hormones.

Above left image: Bioidentical Hormones represented by Natural Redhead  courtesy of wikimedia commons.

10 Ten Hormone Facts should be renamed 10 Ten Hormone Fallacies

Firstly, the Jonekos article maligns bioidentical hormones as unregulated, non-FDA approved and not supported by science. These claims against bioidentical hormones are  false, and are a smokescreen to hide the really scary fact that synthetic hormones are monsters that cause cancer and heart disease, as shown in the Women’s Health Initiative study.

Secondly, the article tries to confuse the difference between bioidentical hormones and synthetic, chemically altered hormones made by the pharmaceutical industry. Do not be confused, they are very different. Synthetic hormones are chemically altered monsters that cause cancer and heart disease. Bioidentical hormones are identical to hormones found naturally in the human body, the safe and effective choice.
 
Left Image: Synthetic Hormones are Monster Creations.  Boris Karlof  in The Bride of Frankenstein 1935, Courtesy of Wikimedia Commons

Thirdly the article contradicts itself in number 7, stating that blood testing is not needed, while the author earlier reported that blood testing revealed a high estrogen level. Obviously, blood testing was needed.

Fourth, the article quotes the Menopause and Endocrine Societies as authorities without revealing their financial ties to the synthetic hormone makers such as Wyeth.

Fifth, the author says that bioidentical hormones did not work for her. Quite to the contrary, millions of women use bioidentical hormones every day for relief of menopausal symptoms and quality of life. Bioidentical hormones work quite well.

Sixth, After ranting that bioidentical hormones don’t work, the author reports they DO work, and she uses estradiol, a bioidentical hormone.  Estrogen alone without progesterone causes increased risk of endometrial cancer. This important information is omitted from the article, possibly harming women readers who accept Staness as a medical authority, incorrectly concluding that estrogen without progesterone is acceptable.  It is not acceptable, and is a disservice to women.

Let’s go through the article in detail. Note: the Jonekos article text is in italics:

Bioidentical hormone treatment made my menopausal symptoms worse.

"I splurged for Somers’ expensive Beverly Hills doctor recommendation, assuming he must have the answers. He confirmed I was menopausal and gave me tubes of compounded triple estrogen gel and compounded 10 percent micronized progesterone gel, with orders to apply them regularly. After a few months of visiting this overpriced Beverly Hills doctor, my menopause symptoms were exaggerated and my moodiness turned into depression. "

My comment: This bioidentical hormone program of estrogen gel and progesterone is the correct one, used by millions of women daily. It is safe and effective. However, close patient monitoring is required, and the patient should be alerted to watch out for signs of  hormonal excess.

Blood Test revealed my estrogen levels were 7 times higher than normal

A blood test revealed that my estrogen levels were seven times higher than normal, my increased weight now placed me into the overweight BMI category, and my severe crankiness made it impossible to work. There is no need for testing of hormone levels, either in saliva or blood. The science has shown that there is no predictable correlation between hormone levels in saliva or in blood and severity of symptoms. “

My comment: Apparently Jonekos visited a bioidentical hormone doctor in Beverly Hills. Uzzi Reiss MD  is well known in Beverly Hills and prominently mentioned in Suzanne Somer’s book.  Jonekos obviously did not read Reiss’s books on bio-identical hormones which explain the symptoms of estrogen excess. These are fluid retention, bloating, breast enlargement and tenderness.  Once these estrogen excess symptoms are identified, the estrogen dosage is held until symptoms are gone. Educating the patient about estrogen excess symptoms, and when to hold hormone dosage is the key to successful treatment program.

An omission Jonekos revealed in a blog posting elsewhere is the story of birth control pills for many years. Birth control pills are synthetic hormones, and when these are abruptly stopped, this causes onset of menopausal symptoms. This complicates the story considerably. Birth control pills are a form of chemical castration, halting ovulation. Birth control pills cause artificial cycles without ovulation. Once the pills are stopped, there is usually a delay of months before normal ovarian function and normal cycling resumes. Until ovarian function returns, there is no hormone production and patients experience typical menopausal symptoms with low hormone levels.

Let’s assume such as a scenario took place.  When such a patient begins a bioidentical hormone program, hormone levels will go up with relief of menopausal symptoms. The patient feels better.  However, a few months later, there is resumption of ovarian function which pumps new hormones into the patient’s body, added to the levels produced by her hormone creams.  This causes hormonal excess with all the usual symptoms of bloating, breast enlargement and mood disorder. This is not a failure of the bioidentical hormone medication. Hormonal excess means the hormones are working too well, raising estrogen levels too much. This is not a failure of the medication, rather it is a failure of patient monitoring and failure to alert the patient to these symptoms. Blood testing is useful here to show elevated estrogen levels.

Unregulated Hormones Not Supported by Science

"What went wrong? I trusted a resource not supported by science. I was taking unregulated hormones. It was eye-opening to learn that natural compounded bioidentical hormones were unregulated by the FDA. There was no standardization for producing the product, and no tests on the formulations. There are NO real natural hormone products available."

My comment: Jonekos clearly has a bad experience with this first doctor, and then incorrectly concludes there is something wrong with the bioidentical hormones, saying that biodientical hormones are not supported by science, unregulated, non-standard, and untested. Of course, this is all nonsense. Bioidentical hormones are heavily regulated, tested and supported by science. The statement , “There are NO real natural hormone products available” is more nonsense. Quite to the contrary, millions of women are using them every day.

Science DOES support the use of bioidentical hormones for menopausal symptoms. Go to Medline and do a search for estrogen or progesterone (link ) and 90,000 articles will come up. Dr Holtorf’s article in PostGraduate Medicine , The Bioidentical Debate , cites 196 articles supporting that bioidentical hormones are safer and more effective than synthetic chemically altered hormones.

Bioidentical hormones are heavily regulated as both FDA approved products at the corner drug store and as compounded preparations. Compounding does not fall under the jurisdiction of the FDA, so FDA regulation is not needed or even desired. Instead, Compounding pharmacies have a separate system of regulation at the state and local level which is rigorous and recognized by the AMA. Look for a compounding pharmacy with PCAB accreditation .

1 ) Natural: The word "natural" is a marketing term. There is no scientific evidence that custom-compounded bioidenticals are safer or more effective or more "natural" than standard pharmaceutical bioidentical prescriptions. The only "natural" hormones are the hormones being made by your body.

My Comment: The word “natural” is not only a marketing term. Natural means anything found in the natural world that cannot be patented.  This next comment is a tautology as bioidentical is still bioidentical whether found in FDA approved prescriptions or in compounded preparations.  We know from the Women’s Health Initiative study JAMA 2002 , that synthetic hormones are monsters that cause cancer and heart disease. Bioidentical hormones are safe and do not increase risk of cancer or heart disease as shown in the French Cohort study .

2) Bioidenticals: Laboratories create formulations that are either identical (bioidentical) or not (non-bioidentical) to those in your body. There are FDA approved prescription estradiol products that are bioidentical that are not "compounded."

My Comment: This is correct.

3) Compounded hormones: Made in a pharmacy by combining, mixing or altering ingredients to create a customized hormone for an individual patient. Compounding pharmacies must be licensed and regulated by the State Pharmacy boards. However, they do not have to demonstrate the safety, effectiveness and quality control, based on large, scientific studies that the FDA requires of pharmaceutical manufacturers. Compounding pharmacies use chemically synthesized hormones made from plants —
the same government-approved ingredients that are used in a manufacturer’s laboratory. "Compounded" formulations are neither safer nor more "natural."

My Comment: Compounded Pharmacies are not under FDA jurisdiction, and that is why they are not regulated by the FDA. Instead, they are regulated by the state and local government. To expect and insist on FDA regulation for compounding pharmacies is like saying your state driver’s license is invalid because it was not issued by the federal government.

What Does FDA Approval Mean?

The author creates confusion about the meaning and significance of FDA Approval
Food and Drug Administration approval does not confirm that the drug is the most effective or the safest drug for you.  FDA approval means the drug is more effective than placebo for its indicated use and benefits outweigh risks.  Drug Manufacturers spend 500 to 800 million doing clinical studies submitted for FDA approval, because of the future prospects for greater profit.  The chemical structure of a bioidentical hormone, like other natural substances, cannot be patented, so there is very little financial incentive for a drug company to spend all that money on clinical studies when profits cannot be assured. 

Non-FDA aproved indications

Drugs are FDA approved for certain medical indications.  About 20% of the time, doctors  prescribe drugs for non-FDA approved indications. For example, Dr Wendy Klein advocates the use of SSRI antidepressants as a non-hormonal treatment for hot flashes. This is a non-FDA approved use of the drug. At the same time, Dr Klein criticizes doctors who prescribe compounded bioidentical hormones as non-FDA approved.  This is hypocrisy.

Chemically Synthesized Hormones

By using the phrase, “Compounding pharmacies use chemically synthesized hormones” , the author is again confusing the reader with the difference between synthetic hormones and bioidentical hormones. They are quite different.  Synthetic hormones are chemically altered monsters.  On the other hand, Bioidentical hormones have the same chemical structure as those found in the human body.  How the hormone was made or manufactured is not important as long as the chemical structure is identical to the human hormone.

The North American Menopause Society (NAMS), a non-profit organization of expert scientists and clinicians, "does not recommend custom-compounded products over well-tested, government-approved products for the majority of women." The Endocrine Society has stated that, "Post-market surveys of such (compounded) hormone preparations have uncovered inconsistencies in dose and quality."

My comment: The author omits that both NAMS and Endocrine Society have publicly acknowledged financial ties to the drug industry.   In addition, both organizations advocate the use of synthetic “monster” hormones, and as such, represent the financial interests of the synthetic hormone industry (such as Wyeth and Abbott ), rather than the health of the public.  Half of the board of trustees of NAMS receive money from Wyeth in the form of consulting fees or research support.  Wyeth makes Prempro and Pristiq.  These Financial Disclosures are listed page 10 of the NAMS 2007 position statement on Hormones for Menopause.

4) All hormones, whether made in compounding pharmacies or in manufacturer’s laboratories, are synthetic in the sense that they are made by a chemical process.

My Comment: This is another attempt to confuse the difference between synthetic chemically altered “monster” hormones and bioidentical hormones. Again, they are quite different. Make no mistake, Bioidentical hormones are NOT synthetic hormones. The word synthetic is intended to mean a chemical structure which is different from the human hormone, allowing the drug maker to obtain a patent for the altered structure.

5) To determine whether hormone therapy is appropriate and safe, one’s risk factors must be assessed based on personal and family medical history, as well as personal preference. There is no "one size fits all."

My Comment: Personal and family medical history is always part of any medical evaluation. However, the above statement is nonsensical. The important fact to remember is that Bioidentical hormone therapy is safe and effective while synthetic “monster” hormones cause cancer and heart disease.

6 Low dose hormone therapy, used judiciously, still remains the most effective way to treat the troubling symptoms of menopause for those who need it and who can use it safely.

My Comment: Since mainstream physicians know that synthetic “monster” hormones are dangerous, causing cancer and heart disease, they shrug their shoulders and accept “low dose” synthetic hormone therapy as more desirable than higher standard dosage. Less of the harmful monster hormone is given to the patient.  Synthetic chemically altered hormones are “Monsters” at any dosage. Stay away.

7) There is no need for testing of hormone levels, either in saliva or blood. The science has shown that there is no predictable correlation between hormone levels in saliva or in blood and severity of symptoms. Unless there are unusual complications, it is the standard of care to treat symptoms if needed and adjust medications according to response, not saliva levels.

My Comment: There are no blood tests for synthetic hormones, so proponents of synthetic hormones pretend that lab testing is not needed. The reality is that very useful blood, urine and saliva testing is available for the entire range of bioidentical hormones. If your doctor doesn’t do some sort of testing, you need a new doctor.

8 ) Standard prescription hormone therapy is the safest form available. It has been tested by the FDA and manufactured in a highly regulated manner. Doses are consistent.

My Comment:“Standard Prescription hormone therapy” is coded language for chemically altered synthetic “monster” hormones shown to cause cancer and heart disease in the Women’s Health initiative study. That’s not so safe. “Tested by the FDA” is a misnomer and error. The FDA doesn’t do any testing. The drug company pays for testing and then submits the results on paper to the FDA for approval. The testing has to show drug efficacy over placebo. That’s all. Sometimes the testing is fudged. Ten percent of FDA approved drugs are later banned . Another 10% receive a black box warning.

9 ) There are also FDA approved non-hormonal therapies available to treat menopause symptoms for those who cannot take hormones.

My Comment: The above statement a reference to the use of SSRI antidepressants for menopausal symptoms. These drugs were recently shown to be no better than placebo for depression (Newsweek ) (Jama Jan 5, 2010 ) Regarding efficacy for hot flashes, drug company funded studies done by academic physician like Dr Klein showed efficacy over placebo was marginal. Synthetic altered hormones are bad enough, they cause cancer and heart disease. Effexor and Pristiq are even worse, they are chemically addictive with horrendous withdrawal effects. The use of SSRI antidepressants for menopausal symptoms is not about health, its about money, and is a grotesque caricature of what real medical care should be.

10 ) Whether hormone therapy is needed depends on severity of symptoms, including hot flashes, night sweats, vaginal dryness and irritability. Hormone therapy should be individualized, which may mean trying different doses and schedules, as well as different routes of administration.

My Comment: Many mainstream doctors will ask patients to “live with it” if they deem the menopausal symptoms not severe enough to warrant treatment. Millions of smart women have rejected synthetic hormones, and SSRI antidepressants, and are finding success with bioidentical hormone programs.

Unregulated formulas and inconsistent compounded dosing can be dangerous and has jeopardized the health of many women, including myself. I wished I had known the dangers involved with compounded-hormones. After my menopause symptoms were stabilized with a standard prescription of bioidentical estradiol, I found a new way of eating, lost 30 pounds and updated my beauty regime without cosmetic surgery or alterations. I have never been healthier.

My Comment: The author clearly blames inconsistency in her compounded formula for an episode of hormonal excess. I would disagree, and suggest the hormonal excess was due to her body’s resumption of hormonal production after stopping birth control pills. A resumption of hormone production in addition to using the estrogen cream results in hormone excess.

To avoid hormonal excess, we monitor patients closely, and alert them to watch for signs of hormonal excess. At the earliest sign of hormonal excess, the patient stops using the estrogen cream. This type of program very safe. In my experience prescribing compounded hormone preparations and monitoring patients, the formulas have been very consistent and standardized, and patients have been happy with the results.

In the end, the author confesses she returned to bioidentical hormones, namely Estradiol. Yet the author omits the historical information that Estrogen alone (Premarin) causes endometrial hyperplasia and cancer. That is why progesterone must be given with the estrogen to prevent endometrial hyperplasia.  Omitting this information is a disservice to women and potentially harmful for readers.

In Conclusion

This "10 Facts" article is a mixture of nonsense, falsehood and half truth. The quality of information reflects the authors credentials, which are none, other than briefly visiting a few doctors for symptoms of hormonal imbalance. The medical information appearing in the article comes from Dr Wendy Klein, regurgitated drug company propaganda advocating synthetic chemically altered “monster” hormones and SSRI antidepressants for menopause, performing a disservice to women.  A safer, more effective alternative is bioidentical hormone therapy.

A Plea to Staness Jonekos

Rather than rely on biased advice from Wendy Klein, who advocates synthetic hormones and SSRI antidepressants for menopause, I suggest you find a more balanced viewpoint by interviewing well known medical experts such as David Brownstein, Kent Holtorf,  Bruice KentonSangeeta PatiC. W. Randolf, Erika Schwartz, and Jonathan Wright . Read their books, web sites and call them.

A plea to Dr Wendy Klein and all other supplicants to the drug companies:  Join with Marcia Angell in her crusade to free medical academia from the drug company money which has corrupted medical eduication and research.  Read Marcia Angell’s talk given at Harvard University on December 10, 2009, outlining the way forward.  I call on you to renounce synthetic hormones and antidepressants for menopause as a disservice to women.  Join with thousands of your colleagues who have embraced bioidentical hormones. 

A plea to all others: The history of modern medicine is replete with the medical victimization of women.  A few discarded examples are: radical mastectomy, excessive hysterectomies, and bone marrow transplant for breast cancer.  Synthetic hormones belong on that list. The latest medical hoax is SSRI antidepressants for hot flashes.  Take back control of your bodies. Do not allow yourselves to be victims of synthetic hormones and antidepressants for menopausal symptoms.  The proper treatment is bioidentical hormone therapy. To find a bioidentical hormone doctor in your area, click here for the doctor’s directory, AHMA , ACAM , A4M .  

Articles with Related Content:

The Safety of Biodientical Hormones

Bioidentical Hormones According to Chris Woolston LA Times

BioIdentical Hormones Trashed by Marilynn Marchione AP News

More Articles with Related Content:

The Importance of Bioidentical Hormones

The Safety Of Bio-Identical Hormones by Jeffrey Dach MD

The Battle for BioIdentical Hormones by Jeffrey Dach MD

Breast Cancer Prevention and Iodine Supplementation by Jeffrey Dach MD

Links and References:

10 Hormone Therapy Facts Every Woman Should Know by Staness Jonekos
http://www.huffingtonpost.com/staness-jonekos/10-hormone-therapy-facts_b_615199.html

http://www.ncbi.nlm.nih.gov/pubmed/19179815/
http://www.iacprx.org/site/DocServer/HoltorfStudy_Jan09_PostgraduateMedicine.pdf?docID=5841

Postgrad Med. 2009 Jan;121(1):73-85. The bioidentical hormone debate: are bioidentical hormones (estradiol, estriol, and progesterone) safer or more efficacious than commonly used synthetic versions in hormone replacement therapy?
Holtorf K. Holtorf Medical Group, Inc., Torrance, CA 90505, USA

http://bostonreview.net/BR35.3/angell.php

MAY/JUNE 2010 Big Pharma, Bad Medicine-
How corporate dollars corrupt research and education by Marcia Angell

The boundaries between academic medicine—medical schools, teaching hospitals, and their faculty—and the pharmaceutical industry have been dissolving since the 1980s, and the important differences between their missions are becoming blurred. Medical research, education, and clinical practice have suffered as a result.

To a remarkable extent, then, medical centers have become supplicants to the drug companies, deferring to them in ways that would have been unthinkable even twenty years ago. In addition to grant support, academic researchers may now have a variety of other financial ties to the companies that sponsor their work. They serve as consultants to the same companies whose products they evaluate, join corporate advisory boards and speakers bureaus, enter into patent and royalty arrangements, agree to be the listed authors of articles ghostwritten by interested companies, promote drugs and devices at company-sponsored symposia, and allow themselves to be plied with expensive gifts and trips to luxurious settings. Many also have equity interest in sponsoring companies.

Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
954-983-1443
www.jeffreydach.com
www.drdach.com
www.naturalmedicine101.com
www.truemedmd.com

Disclaimer click here: www.drdach.com/wst_page20.html

The reader is advised to discuss the comments on these pages with his/her personal physicians and to only act upon the advice of his/her personal physician. Also note that concerning an answer which appears as an electronically posted question, I am NOT creating a physician — patient relationship. Although identities will remain confidential as much as possible, as I can not control the media, I can not take responsibility for any breaches of confidentiality that may occur.

Link to this article:
http://jeffreydach.com/2010/06/27/10-ten-bioidentical-hormone-fallacies-of-staness-jonekos.aspx

Copyright (c) 2010,11 Jeffrey Dach MD All Rights Reserved. This article may be reproduced on the internet without permission, provided there is a link to this page and proper credit is given.

FAIR USE NOTICE: This site contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available in our efforts to advance understanding of issues of significance. We believe this constitutes a ‘fair use’ of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material on this site is distributed without profit to those who have expressed a prior interest in receiving the included information for research and educational purposes.

  

The Eight Hundred Pound Gorilla in the Health Insurance Industry
 
 
What do you do with an eight hundred pound Gorilla that misbehaves and denies coverage for your medical bills? Patsy Bates found out this week when a California court awarded her 9 million dollars for damages arising from Health Net cancelling her insurance coverage just when she needed treatment for breast cancer. (41) (AP News Story here)  How did her lawyer William Shernoff win against the eight hundred pound Gorilla, Health Net? It’s all in his book, "Fight Back and Win: How to Get HMOs and Health Insurance to Pay Up", by William Shernoff. (37)(40)
 

Rocky Delgadillo, LA
City Attorney, Modern Hero 

Files Suit Against Health Net for Cancelling Due to Pre-Existing Condition
Also this week, Los Angeles City Attorney, Rocky Delgadillo filed suit and criminal charges against the same company, Health Net, claiming it unfairly cancelled policies when patients needed expensive medical treatment. This is also known as cancelling for a Pre-Existing Condition.

Health Net Inc. saved about $35 million by illegally canceling the coverage of at least 1,600 patients over four years, the city attorney alleges in the lawsuit filed Wednesday. 

The Pre-Existing Condition Gimmick

A typical ploy the insurance company uses to cancell insurance coverage is the "pre-existing condition".  Los Angelos City Attorney Rocky Delgadillo said, "This is an industry with a history of putting profits before people.  Their practices are not only illegal, they are immoral and we are going to hold them accountable." In November, state regulators fined the company $1 million for lying about its incentive program for reaching cancellation targets. Delgadillo’s office is pursuing a criminal investigation against individual employees who received bonuses based in part on canceling policies of people who have submitted substantial medical claims. (1)(2)  A California State legislature introduced a new law last week that would prevent this abusive cancellation for pre-existing  condition.

    

Nebraska is not happy with United HealthCare
Jan 9, 2007, UnitedHealthCare Group violated 18 insurance laws hundreds of times during a review period, state insurance regulators say. Nebraska Insurance Department attorney Ann Frohman said that numerous complaints prompted a review og United HealthCare which revealed decision delays, wrong decisions about coverage and bad information given to consumers. (3)

UnitedHealthcare Settles Complaint and Pays $600,000 Fine.

In what could be the largest penalty ever imposed by the state against a health insurer, UnitedHealthcare of Wisconsin and two affiliates will pay $600,000 for not adequately responding to consumer complaints and grievances, not paying for certain benefits, and other violations of state insurance regulations. The forfeiture was part of a settlement reached with the Office of the Commissioner of Insurance in November and announced on Friday. It stemmed from investigations done in 2003 and 2004. (4) By Guy Boulton, The Milwaukee Journal Sentinel Jul. 15, 2006.

Read the comsumer complaints here. (5)

 
New York Attorney General Andrew Cuomo, Modern Hero,  Goes After United HealthCare 

February 13, 2008: New York Attorney General Andrew Cuomo Announces Industry Wide Investigation into Health Insurer’s Fraudulent Re-Imbursement Scheme for Out-of-Network Doctor Visits. This scheme involves out-of network doctor visits which are billed by the doctor directly to the patient.  The patient sends the a reimbursment form with the bill into the insurance company.  If the out of network provision was purchased and part of the policy, the insurance company will pay 80% of reasonable and customary fees.  This is where the fraud comes in.  This reasonable and customary fee is intentionally set low by Ingenix,  a company owned by United Healthcare, an obvious conflict of interest which bilks customers out of millions.  For example if the doctor’s fee is $200, Ingenix says the customary fee is $90, and they pay only 72 dollars instead of $160.

"Health Insurers such as United Healthcare have been systematically cheating patients and doctors of fair reimbursement for medical services through the industry’s arcane procedures for calculating  "reasonable and customary" rates",  according to a New York Times editorial.  (New York Times, 2/18). (6)

United HealthCare Corporate Profits Keep Going Up

Shares of UnitedHealth are up 563% for the five years ending 2004. 
 
These obscene Corporate profits are maximized by rewarding employees for not paying medical claims. (7)
 Like Public Electric Utilities, health insurance companies practices should he regulated by the state. 
Otherwise, we would have $5,000 electric bills every month.

 Stop Corporate Greed, and Take Action


Ask Your Legislature to Regulate Health Insurance like any other Publiuc Utility 

The simple solution is for the states to regulate the health insurance industry same way they regulate the public utilities. Some states are actually starting this process of regulation.  Lawmakers in several states are passing new laws which limit health insurers’ ability to cancel health policies for pre-existing conditions. (45)

Contact Your State Insurance Commissioner and File a Complaint, the State Regulators will start a review.

Do you have a complaint about your insurance company? Call or write to your state insurance commissioner:

Use this handy map to find your insurance commissioner contact information for any state.(8)

Florida Insurance Commissioner:
Kevin M. McCarty
Commissioner of the Office of Insurance Regulation
Office of the Commissioner
200 East Gaines Street
Tallahassee, Florida 32399-0305
850-413-3140
 
Florida State Dept of Insurance Toll-free helpline, 1-877-693-5236, is available 8 a.m. to 5 p.m. M-F 

 
Stop the Shakedowns.  Make Your Insurance Company Pay Your Medical Bills 

Whether your health plan is a traditional insurer, a PPO or an HMO, and whether it dismisses your claim or agrees to pay only part of the bill—here are the steps to take: These instructions are found here. (9)

1. Know Your Rights

When coverage is denied for a treatment or drug, it is up to you to collect information and make the case for coverage. This is true whether you are seeking pre-authorization before you receive a service or are disputing an Explanation Of Benefits form sent to you in response to an unreimbursed claim.

First, check your rights under your health-care plan and under state law. If your employer provides your insurance, call your human-resources department to get a copy of the policy. Read it carefully. The policy will tell you what is covered and what mechanism you can use to challenge your health plan’s decisions. If you don’t understand the provisions, ask someone in human resources for help or call your insurer’s customer-relations number for an explanation.

Health plans are required to follow state and federal law for handling complaints and appeals. Find out your own health plan’s internal review process, then follow it.

2. Contact the Insurer

Get your paperwork together before you call the health-plan insurer. (You’ll find the phone number on the form that was sent to you with denial of your request for reimbursement. It also will be on your policy.) Be prepared to lay out all the evidence to convince your insurer that your position is correct.

Your dispute may be resolved with your first informal call, but that call also may be the start of a lengthy process. Make a file and start keeping accurate records of every contact you make: whom you spoke with, the date of the conversation, what was said and when they said the next step would occur.

3. File a Written Appeal

If you don’t get results from a phone call, file a written appeal with the health plan. To prepare the appeal, request a copy of your entire claim file from the health plan, advises Jennifer C. Jaff, an attorney who is the executive director of Advocacy for Patients With Chronic Illness. The file will include the plan’s specific rationale for rejecting your claim. Tailor your letter to the plan’s criteria for denial or acceptance and attach supporting documents.

If the claim file says the treatment was “unnecessary,” attach your medical records. These should include test results and an explanation of why other treatments have failed as well as a letter from your doctor about why you needed that treatment.

If payment for your treatment is declined as “experimental,” you’ll have to show that the procedure you had is now medically accepted. You can do this by searching on the Internet or at your public library for articles in medical journals that demonstrate the effectiveness of the novel treatment you are trying to get covered.

Make sure you file the appeal within the designated time limit. Some plans, for example, require that you challenge a reimbursement denial within 60 days. The two biggest mistakes patients make in their appeals are not providing enough background material to justify coverage and not meeting deadlines.

4. Get Outside Help

If you have a chronic condition such as diabetes or cancer, or even a rare condition such as Crohn’s disease, the advocacy organization devoted to that disease can help you frame your appeal. For example, the website for the American Diabetes Association, www.diabetes.org, provides information for people who are having trouble getting health-care coverage. Although the website is targeted to people with diabetes, the advice is helpful for all patients.

5. Demand An Independent Review

Starting in 1990, managed-care enrollment in the U.S. increased by 85%. As more patients signed up, more of them also began to complain to their legislatures about denials of coverage by their health plans.

State lawmakers listened: 43 states plus the District of Columbia have enacted some version of a Patient’s Bill of Rights. As a rule, these laws give consumers the right to an independent medical review when a health plan denies coverage for care or access to out-of-network providers.

But few people make use of these mechanisms. In Illinois, where about 1.5 million people are enrolled in HMOs, only one in 225 members a year files a complaint with the HMO. Far fewer—one in 2250—take the appeal to the next level by asking for an independent review of their claim.

That’s a mistake. Although success rates differ from state to state, consumers tend to prevail in these challenges about 50% of the time.

Health-care insurers made profits in the billions last year. Know your rights, so profits will not be taken unfairly from your own benefits.

Jeffrey Dach MD

Jeffrey Dach MD
4700 Sheridan Suite T.
Hollywood Fl, 33021
954-983-1433
www.drdach.com
www.jeffreydach.com
www.naturalmedicine101.com
www.truemedmd.com

References

(1) www.knbc.com/health/15366673/detail.html
CityAttorney Files Lawsuit Against Health Net Inc.February 21, 2008 KNBC TV LA

(2) http://money.cnn.com/news/newsfeeds/articles/apwire/d4202f952209279a7d7a16cc586a24d8.htm
CNN Money: LA Sues Health Net Over Cancellations, Los Angeles City Attorney Sues Insurer Health Net, Alleging Scheme to Cancel Policies. February 21, 2008:

(3) http://wcco.com/business/UnitedHealthCare.Group.broke.2.364251.html
Jan 9, 2007 UnitedHealthCare Accused Of Breaking Insurance Law. WCCO Channel 4 TV

(4) http://www.jsonline.com/story/index.aspx?id=467942&format=print
State fines health insurer $600,000, UnitedHealthcare settles complaint, By GUY BOULTON
July 14, 2006, Milwaukee Journal Sentinel

(5) http://www.unitedhealthcare.topinsurance.org/
A typical complaint found here: <quote>They are the worst company I’ve ever had. They refuse to pay any of the claims, even though they recognize they absolutly have to and should cover those charges. I’v spent hours on the phone with them for almost 3 months. At this point my company is dealing with them through their representative to resolve payments. It would be 10 times cheaper for me to just go to the doctor and pay whatever then pay them and now I have to pay the hospital too for whatever the reason is they can’t explain.. <endquote>

(6) http://www.nytimes.com/glogin?URI=http://www.nytimes.com/2008/02/18/opinion/18mon1.html&OQ=_rQ3D1&OP=c1ade63Q2F.nwS.Q5EJ(ueJJKT.TWWQ3E.WT.@Q3E.JV808J0.@Q3EBJ0@X,KBY
EDITORIAL, A Rip-Off by Health Insurers? February 18, 2008 New York Times

(7) http://earningspower.com/chart.html
Chart showing obscene profits of United Healthcare increasing every year. Shares of UnitedHealth are up 563% for the five years ending 2004, versus a 17% loss for the benchmark S&P 500.

(8) www.naic.org/state_web_map.htm
This is a Link to Your State Insurance Web Site – witn a Handy Map of US, All States.

(9) http://www.parade.com/articles/editions/2008/edition_01-20-2008/Fight_for_Your_Health_Care
TAKE CONTROL OF YOUR HEALTH, Fight for Your Health Care, By Lori Andrews Published: January 20, 2008 Parade

(10) http://www.auanet.org/advocacy/news/cpt/unitedHC.pdf
2002, Michael D. Maves, MD, MBA, Executive Vice President and Chief Executive Officer, AMA, Letter to United HealthCare CEO Dr. William McGuire complaining about miscoding CPT codes, etc.

(11) http://www.usatoday.com/money/industries/health/2006-10-15-unitedhealth-ceo_x.htm
USA Today, UnitedHealth CEO McGuire, retires amid options scandal Updated 10/16/2006 9:13 AM ET

(12) http://hcrenewal.blogspot.com/2007/03/unitedhealth-declares-health-care.html
Tuesday, March 20, 2007 UnitedHealth Declares "The Health Care System Isn’t Healthy" – But Is the Company Part of the Problem?

(13) http://www.theindustryradar.com/Home/?currentHome=/Accounts/IndustryRadar/layouts/Hospital%20Disputes.xml
Disputes with United HealthCare over payments

(14) http://consumerist.com/356233/unitedhealth-group-accused-of-fraud
Uniterd HealthGroup Accused of Fraud

(15) Listing of News Stories on United Health Group

(16) http://www.oag.state.ny.us/press/2008/feb/feb13a_08.html
Press Release by Office of the Attorney General, Andrew Cuono ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS’ FRAUDULENT REIMBURSEMENT SCHEME

(17) http://news.yahoo.com/s/ap/20080213/ap_on_bi_ge/cuomo_healthcare
Andrew Cuomo to sue major health insurers By MICHAEL GORMLEY, Associated Press Writer
Wed Feb 13.

(18) http://www.businessweek.com/magazine/content/08_09/b4073028422999.htm?chan
Business Week, February 21, 2008, Wrangling Over ‘Reasonable’ Fees, It’s a no-holds-barred battle between health insurers and hospitals, with customers caught in the middle. By Chad Terhune, with Brian Grow

(19) http://www.huffingtonpost.com/eve-gittelson/falling-in-love-with-a_b_86758.html
Huffington Post, Falling in Love with Andrew Cuomo by Eve Gittelson Feb 14 2008.

(20) http://www.nytimes.com/2008/02/14/business/14health.html?_r=3&hp=&adxnnlx=1202963413-6MEt1k7Cow4EtTala2dF0Q&pagewanted=all&oref=slogin&oref=slogin
New York Times, Andrew M. Cuomo, New York State attorney general, announced an inquiry into health insurance Wednesday. By REED ABELSON, February 14, 2008

(21) http://www.marketwatch.com/news/story/new-york-state-charges-unitedhealths/story.aspx?guid={A6E79417-6D6C-48EE-9DC0-BB52F816DB09}

UnitedHealth unit charged with fraud New York state says alleged practices left consumers shortchanged By Russ Britt, MarketWatch Feb. 13, 2008

(22) http://www.washingtonpost.com/wp-dyn/content/article/2008/02/13/AR2008021303128.html
Cuomo to Sue Biggest Health Insurer, Others to Receive Subpoenas Over Reimbursements, N.Y. Attorney General Andrew Cuomo says he will sue UnitedHealth over setting artificially low limits on how much patients are reimbursed for medical-care claims. (By Robert Caplin — Bloomberg News) Washington Post

(23) http://labsoftnews.typepad.com/lab_soft_news/2008/02/unitedhealth-dr.html
UnitedHealth Draws Criticism for Its Out-of-Network Reimbursement Policies. I have posted a number of previous notes about UnitedHealth, particularly with regard to its punitive policies toward physicians for out-of-network lab testing.

(24) http://chipsblog.pcc.com/?p=142
Confessions of a Pediatric Practice Consultant, True stories from the land of pediatric practice management.Andrew Cuomo, UnitedHealthCare: Duh. February 14, 2008 . Cuomo’s investigation also found a clear example of the scheme: United insurers knew most simple doctor visits cost $200, but claimed to their members the typical rate was only $77. The insurers then applied the contractual reimbursement rate of 80%, covering only $62 for a $200 bill, and leaving the patient to cover the $138 balance.
 
(25) http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=18974670&m=18974647
NPR Radio story on Andrew Cuomo And United Health

(26) http://www.mydd.com/story/2008/2/22/17219/1258
Health Insurer to Face CRIMINAL CHARGES by California Nurses Shum, Fri Feb 22, 2008 This could be the start of something huge. The sociopaths who run our nation’s health insurance corporations might–just might–begin to face justice for the countless Americans that have suffered at their hands.  Health Net, one of the largest insurers in the nation, is facing multiple civil and criminal charges for retroactive recissions, their habit of kicking people off the insurance rolls as soon as they get sick.This practice is not a coincidence–it’s at the heart of their business plan, in fact of the whole model of for-profit health insurance.  Los Angeles City Attorney Rocky Delgadillo was brave in standing up to the practice,and justified.  We need other activist prosecutors to follow his lead, and help turn the public disgust with insurance corporations into national momentum for replacing them with universal, non-profit guaranteed coverage…also known as single-payer healthcare.

(27) http://www.latimes.com/business/la-fi-insure21feb21,0,5347492.story
L.A. sues insurer over cancellations, The city attorney says Health Net defrauded policyholders by dropping patients who needed costly care. By Lisa Girion, Los Angeles Times Staff Writer,February 21, 2008.

(28) www.protectingtheinsured.org/default.html
File your health insurer complaint with LA City Attorney Delgadillo: "If you believe your health insurer has wrongfully denied or delayed your claim and/or canceled your coverage, we urge you to provide us with a description of your complaint. If you are a health care provider who has had payment withheld, payment delayed or has been retroactively denied payment for services rendered under a health plan or insurance policy."

(29) http://www.guaranteedhealthcare.org/node/add/user-story
California Nurses Association. Submit Your Story Web Site. Are you getting the healthcare you need, when you need it, at a price you can afford? Nearly 48 million Americans have no health insurance at all and nearly 50 million more are under insured with high deductibles and co-pays discouraging them from seeking the care they need in the preventative stages. We’ve created this form to collect your stories, which may be used on our websites, in the news, to educate the public, and/or at legislative hearings.

(30) http://google-sina.com/2008/02/21/ny-attorney-general-investigation-highlights-problems-in-navigating-out-of-network-charges/
N.Y. Attorney General Investigation Highlights Problems In Navigating Out-of-Network Charges

(31) http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/02/14/BUGGV1ML2.DTL
Legislation would crack down on insurers. Victoria Colliver, San Fransisco Chronicle Staff Writer, Thursday, February 14, 2008.  A California lawmaker introduced legislation Wednesday that would require health insurers to get permission from state regulators before retroactively canceling a member’s coverage. The bill, introduced by Assemblyman Hector De La Torre, D-South Gate (Los Angeles County), comes on the heels of news this week that Blue Cross of California had been sending letters to doctors asking them to report pre-existing conditions and discrepancies that could be used to cancel a new member’s policy.

(32) http://www.nyas.org/publications/sciences/pdf/ts_01_94.pdf
Clinton Health Care Proposal called Managed Competition (Jan 1994) starts on page 6 of document.
Under managed competition, all doctors and other caregivers will be under the administrative
thumb of six or eight immense, for-profit insurance companies,which will have gobbled up hundreds of smaller insurers.

(33) http://www.themoneytimes.com/articles/20061016/unitedhealth_shakes_up_over_options-id-101879.html

UnitedHealth shakes up over Options by Shubha Krishnappa – October 16, 2006 The Money Times. McGuire, the longtime chief executive of UnitedHealth Group Inc., who worked hard to turn the Group into a behemoth in its field, was forced yesterday to resign from the company and to give up a portion of the $1.1 billion he holds in severely criticized stock options. The options that McGuire had been granted over the years have led to criminal and civil investigations and public disapproval.

(34) http://www.floir.com/

Florida State Office of Insurance Regulation. The Office serves Floridians through its responsibilities for regulation, compliance and enforcement of statutes related to the business of insurance.

(35) http://www.kff.org/consumerguide/upload/7350ConsumerGuidev4_080805.pdf
A Consumer Guide to Handling Disputes with Your Health Plan or Insurance Carrier – Kaiser

(36) http://www.amazon.com/Making-Them-Pay-Insurance-Managed/dp/0312267606

The Book,  Making Them Pay: How to Get the Most from Health Insurance and Managed Care by Rhonda Orin "It’s time to get down to business-and that means learning the nuts and bolts of health plans…"

(37) http://www.amazon.com/Fight-Back-Win-Health-Insurance/dp/0887231721/ref=pd_sim_b_img_1

The Book, Fight Back and Win: How to Get HMOs and Health Insurance to Pay Up by William Shernoff , Lawyer who won 9 million dollar settlement from Helath Net last week.

(38) http://www.advocacyforpatients.org/health.php
Advocacy for Patients with Chronic Illnesses, Jennifer C. Jaff attorney and founder of Advocacy for Patients with Chronic Illness, Inc., a tax-exempt organization that provides free information, advice and advocacy services to patients with chronic illnesses

(39) http://www.advocacyforpatients.org/healthtalk%20transcript.pdf
Interview with Jennifer Jaff talking about finding and getting health insurance, and then making them pay for your medical bills.

(40) http://www.sbd-law.com/Bio/WilliamShernoff.asp
Law Firm of William Shernoff

(41) http://www.msnbc.msn.com/id/23307983/
Insurer fined $9M for dropping cancer patient. Cancellation had left woman with more than $129,000 in unpaid bills.  Insurance company pays up. Feb. 23: A woman battling breast cancer had her policy cancelled during her treatment. NBC’s Chris Jansing reports that action is costing the insurance company dearly.Associated Press.

LOS ANGELES – A woman who had her medical coverage canceled as she was undergoing treatment for breast cancer has been awarded more than $9 million in a case against one of California’s largest health insurers.  Patsy Bates, 52, a hairdresser from Lakewood, had been left with more than $129,000 in unpaid medical bills when Health Net Inc. canceled her policy in 2004. On Friday, arbitration judge Sam Cianchetti ordered Health Net to repay that amount while providing $8.4 million in punitive damages and $750,000 for emotional distress.

(42) http://www.myfloridacfo.com/Consumers/medical_provider_request/index.htm

Florida State Division of Consumer Services, Medical Provider Informational Memorandum Attention:
Florida Medical Providers Assistance, Complaints, Inquiries, online inquiry form.  The state regulatory agency with file inquiry with the insurance company. 

(43) http://blogs.wsj.com/law/2008/02/14/ny-ag-on-unitedhealth-database-garbage-in-garbage-out/

February 14, 2008, NY AG on UnitedHealth Database: Garbage In, Garbage Out Posted by Dan Slater , New York Times

(44) http://blog.hittransition.com/2008/02/denial-engine-v.html

What is a Denial Engine? That’s the computer software that denies your claim.  Read more here:
Denial Engine Vendor Ingenix Keeps more than Usual and Customary Dollars. In my warnings to providers about denial engines — those sophisticated analytics tools that payers are increasingly using to reduce, deny, or re-collect claims payments — I try to emphasize that they can be used ethically.

(45) http://www.usatoday.com/money/industries/health/2008-02-20-cancel_N.htm#uslPageReturn
States act to protect individual health insurance coverage, By Julie Appleby, USA TODAY 2/21/08

(c) 2008 jeffrey dach md      disclaimer     Original article available here