After L’Affaire Economist, (parts 1, 2, 3) HolfordWatch really wanted to be able to commend Jerome Burne for something. We have noticed that although his last few articles in the Daily Mail haven’t actually carried links to the research upon which he relies, he has provided enough detail to allow the careful reader to identify the papers. It would, of course, be good if we did not have to resort to a treasure hunt to identify the primary sources but that is probably a confluence of out-moded thinking by both journalists and newspaper.
Today, Burne gave generous amounts of detail as to one of the major sources for his claims in his article: Should middle-aged women be taking natural HRT?. HolfordWatch was poised to congratulate Burne for semi-identifying this work up until we actually read the paper that he describes as a “major review”: Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?. Leaving aside the lack of appropriate rigour in the paper, we noticed that, despite his usual exquisite sensitivity in such matters, Burne seems to be overlooking the “review” author’s failure to declare what might appear, to others, as a substantial conflict of interest.
Dr Kent Holtorf is the author of this “major review”. He is part of the Holtorf Medical Group: Center for Hormone Imbalance, Hypothyroidism and Fatigue that specialises in…hormones and longevity, including HRT and bio-identical hormone replacement. Forgive me for quoting this at length but, according to the section on bio-identical hormones:
Dr. Holtorf and the doctors at the Holtorf Medical Group, Inc have been using and preaching the superiority and safety of natural hormones verses [sic] synthetic for many years (long before the Women’s Health Initiative Study). There are many doctors that now claim to specialize in natural hormones but our expert knowledge and experience can make the difference between feeling great and so so.
Get Off Premarin, Provera, Prempro and other Synthetic Hormones
And get on to the safe and natural pharmaceutical hormones.
The doctors at the Holtorf Medical Group, Inc can help you actually obtain the health benefits you have been striving for without compromising your health with the side effects of the synthetic hormones you have heard about on the news. [Emphasis added.]
This is relevant because, at the end of this “major review”, we read:
Conflict of Interest Statement
Kent Holtorf, MD discloses no conflicts of interest.
Holtorf offers seminars on bio-identical hormone therapy and physician training. We’re just highlighting this because Burne is sensitive to conflicts of interest (see Economist links above) and it seems a little unusual for him not to have brought Holtorf’s financial interest in bio-identical hormones to his readers’ attention.
Before we go any further, we should state that nobody at HolfordWatch has a position on hormone replacement therapy (HRT), nor do we have a direct or indirect financial or other association with it. We object to the medicalisation of women’s health and are also concerned by what Chris McDonald characterises as the “alternativization of women’s health”:
“Alternativization” is the tendency to understand normal events (for example, menstruation, pregnancy, childbirth, menopause) as pathological states requiring intervention by practitioners of alternative therapies. Alternativization gives practitioners of various art-forms — sometimes poorly understood art-forms — control over women’s health, and authority to “solve” therapeutically what might otherwise have been seen as political, personal, or social issues. Not all alternative therapies will be equally subject to this worry.
Big Herba is not necessarily a lesser perceived evil than Big Pharma just because in this example, its hormones are derived from friendly-natural-sounding, yams and soy rather than horse urine. As Scott of Science-Based Pharmacy puts it in his discussion of bio-identical hormones:
Bioidentical is often used synonymously with the term “natural”, inferring that bioidentical, compounded hormones are natural, effective, and therefore good, while pharmaceutical-company manufactured hormones (bioidentical or not) are unnatural, ineffective and dangerous.
“Natural” is a meaningless term with respect to BHT. All bioidentical hormones are manufactured using wild yams or soy as the starting ingredient, and all undergo chemical conversion in a laboratory to be synthesized to the final ingredient.   There are no bioidentical hormones that do no undergo some sort of laboratory manipulation. Consequently there are no truly “natural” bioidentical hormones.
We shall continue a discussion of Burne’s article in Part 2 when we assess the technical aspects and quality of Holtorf’s review.