Re-Printed from COAST Magazine, January/February 1996 issue*
For many years Dr. John Lee has held a minority view in the controversy over estrogen replacement therapy (ERT) for menopausal women. Even as we go to press a new study touting the benefits of ERT appears on the front page of Santa Rosa’s Press Democrat. In a chapter of Dr. Lee’s most recent book, What Your Doctor May Not Tell You About Menopause (Time-Life Publishing), which will be available in bookstores this March (Note: is available now), he explains that such reports are influenced by the pharmaceutical companies which make the drugs under study. Further, he illustrates how for decades most medical school training has been provided or subsidized by pharmaceutical companies. And pharmaceutical companies continue to influence doctors in their private practice with free samples, invitations to “training seminars,” and parties. Over the past few decades, skepticism towards medications has increased, and doctor-recommended products have lost the credibility they once had.
The general public begun doubting whether doctor knows best, and members of their own profession are questioning and challenging contemporary medical practice. In her book, Women’s Bodies, Women’s Wisdom, Christiane Northrup, MD, talks about how little time doctors spend understanding their patients. Rather than listening to the patient to discover what other issues may impact their health, doctors dispense medication because it is the easiest response. In Menopause Naturally, Sadja Greenwood, MD, says, “Helping a patient clarify such problems...takes much more time than the average doctor can spare, so prescriptions are often written as an alternative.”
Dr. John Lee of Sebastopol, a retired Mill Valley family practice doctor for 30 years, is the author of several books. His most recent is a re-write of Natural Progesterone: the Multiple Roles of a Remarkable Hormone. The original was written to help doctors understand menopause and alternative forms of treatment. When publishers discovered that more lay people were reading it than doctors, they decided to have Dr. Lee re-write his book for the layperson. The “medical-industrial complex,” the intimate relationship between the medical community, the pharmaceutical companies, and the Food and Drug Administration (FDA), and how this relationship impacts the consumer is one of the concerns he examines.
In an interview with Dr. Lee, we explored some of the issues facing doctors and patients today.
“As Medical students at the University of Minnesota Medical School in the early 50’s, we looked forward to receiving gifts everyday from the pharmaceutical companies. They helped us survive the year. We were married and had children, so they sent us cereals and we had breakfast to eat. We would stock pile the gifts thinking that we were above being swayed by this form of marketing. It was a way of matching wits with some of the pharmaceutical agents, the people who called on doctors. We thought it was fun, but we didn’t realize how clever they really are at influencing what we do.
“In order to remain a member of the Family Practice Group of Doctors, there is a requirement that we had to accumulate 50 hours of accredited post-graduate learning. It may not seem like much, but you’d have to have five or six 8-hour days to make up the hours. It means being away from home and practice, and most of the time you had to pay money for the courses.
“But the pharmaceutical companies provided free seminars. You know, trips to San Diego, staying at the Coronado Hotel, reduced rates, travel paid for, bring the family, spend a three-day weekend. Of course, if you had a choice between going to some meeting where you had to pay $300 per day and be away from your family, or taking your family along to an essentially free conference, you would choose the latter. Assistant or Associate Professors of various medical schools who were doing research that was funded by the pharmaceutical companies provided all of the teaching for these courses. They’d research things like hypertension agents, or stomach ulcer agents. And of course there was nothing in any of these lectures to indicate that there was another way to treat or correct the problem.
“It was fairly clear that the pharmaceutical companies had co-opted the young professors who were doing the research and were dependent on the grant research money from the drug companies. Of course the grant-giver is the one who decides whether you ever publish or not. You could do a marvelous study, but if your results show that the drug you were studying didn’t really work very well, it is very unlikely that you would be published. That biased the work.
“Some of my favorite professors were involved in this. They’d recommend several similar products at the same time. For example, they’d work on antacids, compare Mylanta with Maalox, and several others, then write six different papers each one showing that one particular antacid was slightly better than the others in a certain way and get paid by six different companies. It has a very corrupt influence, not only on the practicing doctors, but also on the teaching that goes on. This has become even truer since the money crunch hit the medical schools.
“Medical schools used to have huge clinics. They received county funds to treat welfare patients. When I was in Medical School as a student, we would be the practicing doctors, almost like interns or residents, at clinics for pediatrics, for obstetrics, for public health, for general medical, and the people on welfare would come to the county hospital.
“The county hospital was the place where all the real education took place. If some little kid had a bellyache, he would be sure to have appendicitis, so the surgeons could get some practice doing an appendectomy. The attitude was how can that patient complain, he’s not paying anything? The county’s paying, so the county hospital and teaching hospitals received all this money from the county. But when the welfare system changed, everybody got a card and went to their own doctor.
“While at Minnesota General Hospital during my rotating internship, I was one of 3 interns performing about 150 deliveries per month. When I went back some years later, the typical intern was only performing 3 deliveries on his whole tour. Most of the time the poor intern would be holding the patient’s hand. The quantity and quality of medical instruction went way down. Of course that created a niche for a pharmaceutical to move in. They could provide grants for teaching and for research so the young residents would have something to do and get paid for. Of course, the pharmaceutical companies picked up the tab.
“Doctors my age are probably the last ones to experience relatively uncontaminated medical training. Since then the course of medicine was permanently altered, and the pharmaceutical companies took over. They were the people with the money. More and more the medical profession has been co-opted by these companies.
“Once in their own practice, doctors are given samples of drugs. For example, a new antibiotic would come out or a new arthritis medicine and you’d receive all these free samples. If you had a patient who had a hard time affording a prescription, you’d say, ‘Here’s a new drug’ — it made you look like you were on the forefront of medicine while really you were relying on the drug company to give you a safe product. You seemed like a hero.
“Once you’ve been in practice long enough, you see that a lot of these medicines are recalled because some toxic side effects show up that haven’t been anticipated. Then you realize that it didn’t really work as well as anything else. Or perhaps you ran out of samples that the patient wanted to continue using, but now they have to pay even more for the new ones, and they aren’t really any better.
“The pharmaceutical companies are a major influence on doctors and the decisions they make in their practices. To survive, the companies have to make a profit. They know very little about how to treat real illnesses in a preventive way, helping the body heal rather than simply overcoming symptoms.
“In the FDA, it’s just as bad. They need people with experience to run the FDA, and the testing of medicines. Who can they go to? The people who were already well experienced and had their names on papers, were in the literature, and well known. These were the same people who were under the thumb of the pharmaceutical companies for whom they worked. Of course there would be close cooperation between the one doing the research for the FDA and the drug company.”
Menopause and osteoporosis are specialties of Dr. Lee. He explained the tendency of doctors to automatically assume that if a woman is approaching menopause, she needs estrogen. Dr. Lee became very animated as he explained:
“When I give talks to doctor groups, I’ll say, ‘How many here have actually looked up primary references on the level of estrogen production five years before menopause and five years after menopause? How many here even know what it is?’ Not a hand goes up. I spent two hours in the library looking it up one day. It turns out that there are people who have measured estrogen production before and after menopause. The estrogen production only falls by about 40%. Yet doctors believe it has fallen to 0. Then I say, ‘What happens to progesterone production when the ovaries quit ovulating?’ No one answers, so I say, ‘It goes essentially to 0.’ The fact is that prior to menopause, progesterone was a 1000 times greater than estrogen. It is the dominant hormone! And when progesterone falls down to 0, estrogen becomes the dominant hormone. Just like that. It’s a totally different ball game for the body.
“Then I ask these doctors, how many have done serum progesterone levels to find out if their patients are still ovulating? Why do they assume that symptoms that occur a week before a menstrual cycle are due to excess progesterone unless they’ve measured it? Maybe the symptoms occur because there’s no progesterone. It should be there at that time, but it isn’t.
“Then I’ll ask how many have looked in the PDR (Physician’s Desk Reference) to see what the dose is in the estrogen patch versus the same company’s estrogen pill? None of them have. So I explain that it’s the same estrogen, estradiol; they put some in the patch and some in the pill. If you count up 7 days worth of pills and compare it to a week’s supply of the patch, the difference in the dosage is 70 to 1. The oral pill has to be 70 times greater than the skin patch. 70 to 1! And what is the fate of the oral pill? The ovary never put its hormones into anybody’s stomach. How do you know what happens to it? It turns out; it’s been studied. And what happens is that it’s absorbed into the liver and the liver sets to work to metabolize it, break it down. But the rate at which the liver can do that varies from person to person. Who knows how much of it stays in the liver, how much gets in the blood stream? Putting it into someone’s stomach is obviously a very iffy prospect.
“It is well-known that with cream, the absorption is into the blood stream, and you can measure it with the oral saliva test. It’s been done by the World Health Organization for the last 5 years to monitor hormone levels. You could have a patient put on a little progesterone cream, three hours later measure the saliva. You can see; it’s all there.
“I don’t understand the question doctors have about how to dose. There’s 480 milligrams in an ounce. If a person uses up that ounce over 24 days, that’s 480 divided by 24, that’s 20 milligrams per day. That’s the normal physiological dose the ovaries are supposed to be making. Once you establish that the ovaries aren’t making it any more, why not prescribe it? If you find someone who’s low on thyroid, you give them thyroid. If you find someone who is low on insulin, you give them insulin. If you find someone who’s low on cortisone, you give them cortisone. If someone is low on progesterone, why wouldn’t you give them progesterone? Medicine made the mistake in the 40’s and 50’s when they opted for estrogen as the only hormone to replace.
“It demolishes the doctors. They say, ‘Well, it isn’t in any of our books!’ I tell them, yes, I know, that’s why I wrote my book. If it was already in our books, do you think I would have bothered to write a book about it?
“For the doctors who don’t know any better, they say, ‘How do you know that it is absorbed by the skin? I can’t show any change in the progesterone level of the blood.’ But you see in my book, I describe that when the ovary makes it, progesterone is available in the watery part of the blood, the serum plasma. When the doctor says he does a blood test, he skims it down to get just the plasma. When you absorb it through the skin, the blood picks it up and it rides on the red bloods cells. We know the progesterone is available, because we have saliva tests. In 2-5 hours, you get a peak of progesterone and it shows very well. So this doctor who did the plasma test said, ‘Well, I checked their blood and it isn’t there!’ But he’s checking the wrong part of the blood.”
Dr. Lee emphasized his points by describing a recent study released in October 1995.
“Several French doctors in Taiwan conducted a study, which demonstrates that progesterone protects the breast against cancer. They had 40 patients ready for breast surgery for benign conditions, young, pre-menopausal women. The doctors selected the timing of the surgery to be 10 days after the first part of the cycle when there is no real progesterone made, but there is quite a bit of estrogen. In those 10 days, they gave 1/4 of the women progesterone cream, 1/4 received an estrogen cream, another 1/4 got a combination cream, and the last 1/4 got a placebo. It was double blind, the patients didn’t know which was which and the doctors didn’t know. It was randomized; it was placebo controlled.
“After 10 days, the doctors took a little breast tissue in the process of doing whatever they were doing in the surgery of the breast. They examined it for the level of the hormone. They found that the level of progesterone had risen 100 times by using a little progesterone cream, proving it’s well absorbed and gets to the target tissue. They found that those that used the estrogen also had an increase of estrogen, so the estrogen was well absorbed. They found that the combination was well absorbed. The women who used the placebo were the control group to measure what the normal level was.
“They did 2 tests looking at the rate at which these milk duct cells were multiplying. One was to actually count the multiplying cells seen under the microscope. They found that estrogen increased the rate of replication by 250%, 2.5 times the control group, very rapid. They found that progesterone lowered it to 15% of the control group, slowing it way down. So the message of estrogen is to make more, proliferate. The message of progesterone is calm down; don’t multiply; slow down; don’t proliferate.
“The one that really interested me was the combination cream, the estrogen and progesterone cream. It kept the milk ducts from multiplying just as well as if the estrogen wasn’t there. So the progesterone really helps, because the woman is going to be making her own estrogen.
“The doctors conducted tests 2 different ways and found the same results. The other way was to measure something called PCNA, proliferating cell nuclear antigen. That is even more accurate than just counting cells. But in both cases, the results were the same. Also checked were the levels of hormones in the plasma – there was none. Just like I said, it rides on the red blood cells. They didn’t find it in the plasma. It got to the breast. It slowed down the replication. It countered the effect of estrogen.
“Women will call me and say, ‘I had my breast operation and they found it had receptor sites for estrogen and progesterone, oh dear, how can I take progesterone?’ And I say, ‘No, you’re one of the lucky ones. It has receptor sites – that means the progesterone has a chance to work. Hormones work by combining with the receptors.’
“If there’s no receptor there, the hormone just glides right out through the other side of the cell and is gone. She’s the lucky one. She has a progesterone receptor. But her doctor told her that she has estrogen receptors and therefore cannot take estrogen. And I say, ‘Yes you can, because the message of estrogen is multiply, proliferate. If your cancer cells have that same receptor, that’s what they’re going to do!’ So the woman says, ‘OK.’
“She calls back the next day and says, ‘My doctor says I can’t take progesterone because I have progesterone receptors.’ I explain to her, ‘Your doctor doesn’t understand. You try explaining it to him again. The message of progesterone is slow down, normalize, become what you’re suppose to be, don’t multiply. And that’s the message you want.’”
During this two and a half hour interview, Dr. Lee received three calls from women with medical questions about progesterone – one call was from England – and several calls requesting him to present to medical groups. Lee has a wealth of stories about women’s experiences with doctors. One of the more powerful stories he shared occurred at his own family reunion.
“Last summer I attended my 40th medical school reunion. My sister arranged a family gathering of people I hadn’t seen in about 40 years. All these young families came – and it was a lot of fun. I talked to some of my female relatives who were in their 40s and 50s. There were 5 of them there and every one of them had already had a hysterectomy. They all told the same story.
“As they approached menopause, they had some changes in their periods, they were either longer or shorter. They noticed that they were getting fatter around the middle; they noticed that they were losing interest in sex; they had less energy, and they saw their doctors to see what they could do about it. Their doctors all said, ‘Well, my dear, you’re approaching menopause, your estrogen is dropping, let’s give you some estrogen.’ So they took the estrogen and, of course, it all got worse. They became fatter, more run down, developed fibrocystic breasts, clotting, bleeding. So the doctors raised the dose. And that made it even worse. With the irregular periods, they were told they’d better have a D&C.
“By this time, the doctor had created endometrial hyperplasia – the cells being stimulated by unopposed estrogen multiplying at a faster rate. Then the doctor said, ‘Well, hyperplasia is a marker that you’re on the road to getting cancer of the uterus. You might s well have your hysterectomy.’ So they all went and had their uterus removed. And now they all are on Premarin with no progesterone. The doctors all said that you don’t have to take progesterone, you don’t have a uterus. Dumb thinking! Since they don’t know the benefits of progesterone, they have no idea that progesterone is important. They don’t know that they’ve been giving away too much estrogen and that they are going to increase the chance of the women getting breast cancer on down the line.
“But then you realize – his mistakes are making him money! He’s being rewarded for this! He has no reason to discover that there is a better way. When the woman first came in, he could measure her progesterone level and know that she is not ovulating and that she’s estrogen dominant. He could give her natural progesterone; she could be fine. She could pass through menopause without further symptoms. She would not be at risk for cancer of the uterus; she would not be at risk for breast cancer later on. He would probably never see that woman again!
“But everything the doctor does guarantees that he’s going to have more problems in her to treat. He’s going to end up, not only with a hysterectomy, but he’s going to have to do hormone controls, give diuretics, measure potassium levels. He’s going to do breast surgery later on. Then he’s going to give her Tamoxifen and chemotherapy, maybe radiation, and then he’ll have to follow all this up. He’s got a gold mine! He has very little reason to learn any different. When I come along and say, “Hey, a quarter’s worth of progesterone a day would change all of this, and she could do it herself” he has very little incentive to change. Imagine. There goes the Cadillac; there goes the sailboat; there goes the alimony payments.
“And not all doctors have this attitude. Most really want to do what is right for their patient. What keeps these doctors from doing the research? Training has a lot to do with it. Doctors adopted a work ethic in medical school – regurgitate what the professor tells them.
“When you get into private practice, you’re seeing 50-60 patients per day. A woman comes in saying she has to urinate more often, it stings and hurts a little bit, you collect the specimen and find that there is a lot of puss in it. You say, ‘Well, ma’am, you have cystitis’ – and you write out a prescription because it’s faster. Then you go to the next patient. You don’t have time to wonder: why did this woman get this? Why did she get it the last time? What’s really going on here? Is it something she’s eating? Is it a sex partner who’s giving it to her? You get the same amount of money to write a prescription and go on to the next patient.”
According to Dr. Lee and a growing number of medical professionals, for an individual to receive quality health care, they have to take responsibility for themselves. They can’t just wait or hope that the doctor will figure it out. Medical training does not provide them the skill to know how to help an individual heal. Their training is geared toward relieving symptoms with pharmaceuticals. Dr. Lee wrote his book, Natural Progesterone, the Multiple Roles of a Remarkable Hormone, for doctors but he’s learning that it is the patient who is reading it and educating their doctor.
Dr. Lee continues, “For modern medicine to create hormones, they can grow the wild yams, extract the fat, convert fat into progesterone. That process has bee in existence since at least 1938, almost 60 years. But doctors say, ‘You can’t absorb hormones through the skin with wild yam creams.’ These are the same doctors who have patients on the hormone patch. Instead of opening their mouths about something they know nothing about, they should say, ‘I’ll look into this.’ That would be the intelligent response.
Approaching this problem – the lack of knowledge and training on the part of the physician and co-opting by the drug companies – is very difficult for the consumer.
John Lee, M.D. urges: “Unfortunately the medical doctor is not educated in nutrition or alternative approaches. His education has been confined to the use of pharmaceuticals. The patient has to be his or her own best advocate. If they don’t feel up to that, they have to find someone to help them evaluate what the medical doctor is telling them.”
Note: This is a good thing. It makes us, as individuals, caretakers of our own health. It forces us to pay attention to eating healthier, exercising, noticing how different foods affect how we feel. You and I are the custodians for the quality of our own lives. And that’s a good thing.
*While this article was published in 1996, it applies just as much now, perhaps more so, than it did then – perhaps we are more prepared and less stunned to hear it.