Made-to-order medicine

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story never quantified any of the benefit claims made by the physicians pushing bioidentical hormones. Instead, anecdote is used instead of any hard data.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

It isn’t until the final third of the story that any risks associated with bioidentical hormones are mentioned, and here they are only mentioned in a he said/she said way that does not serve the reader. The story says, “Bazzan insists that bioidentical hormones, compounded by qualified pharmacists based on his customized prescription for each patient, are safer than the synthetic ones churned out by drug firms. But the American Medical Association and the U.S. Food and Drug Administration have said there is no evidence of the increased effectiveness or lower risk of bioidentical hormones.” The story has presented long anecdotes from patients claiming sweeping health improvements and two doctors claiming the same. Then, making matters worse, the story dismisses the best evidence we have on the safety of hormone therapy — the Women’s Health Initiative — by saying, “Despite the kerfuffle about the safety of hormone therapy, which Judith Volkar, a physician in the women’s health division at the Cleveland Clinic, feels has been overblown, both she and Schiff use it selectively, as does Bazzan, only with patients who show a deficiency, and always informing them about the risk/benefit ratio.” Kerfuffle? The Women’s Health Iniatitive has studied more than 160,000 women over 15 years in randomized, controlled clinical trials and observational studies. The entire basis for this story, by contrast, is the opinion of two doctors and the experience of two patients. In addition, the potential harm of testosterone was addressed only very briefly by noting the potential for rising PSA level. In fact, testosterone should be given only with clear indications and monitored carefully.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

There is no attempt to evaluate any of the evidence behind any of the dozens of health claims made in this story or what “extensive testing” means for patients at the Great Life center. In one sentence alone, the story makes seven different health claims: “Everyone on the program is asked to take supplements of Vitamin D, aiming for a 50 ng/ml blood level, which Bazzan believes protects against myriad conditions including diabetes, non-Hodgkin’s lymphoma, and breast, ovarian, and colon cancer; probiotics for a healthy immune system; and omega-3 fatty acids, which he calls ‘life-giving’ fat.” None of these or any of the other claims in the story are either backed up with data or with independent analysis. We have seen few stories of this length that spend so little time analyzing the evidence.

Does the story commit disease-mongering?

Not Satisfactory

Clear examples of disease mongering. The story conflates serious, life threatening conditions, such as diabetes, non-Hodgkin’s lymphoma and various cancers with lesser health issues, such as insomnia and low libido. All of them are mentioned in this story as reasons to start this bioidentical hormone program, and all of them are presented as problems that can be overcome with the program. The lead anecdote about a patient says that a woman who has had bioidentical hormones injected into her buttocks for four years “feels energized and less stressed, and experiences none of the agonizing symptoms of menopause that troubled her in the pre-pellet days.” That patient’s husband claims that bioidentical hormones rescued him from “debilitating fatigue following critical spinal surgery and grueling rehabilitation.” Note how everything these patients were experiencing before is “agonizing,” “debilitating” or “grueling,” while the hormones give them “a dramatically enhanced quality and quantity of life.”

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

This story is chock full of people opining about the supposedly miraculous benefits and allegedly negligible risks of this program’s “personalized integrative regimen based on genetics.”  But fewer than 10 percent of the word count is devoted to any independent perspectives offering healthy skepticism. The imbalance in the sourcing leads us to grade this unsatisfactory.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

There is no comparison in this story to alternatives to bioidentical hormone therapy. Instead, through the anecdotes, other modes of therapy are dismissed. For example, one patient says he started the biodentical hormone regimen described in the story because he wanted to “to get off my blood-pressure and cholesterol medicines and get in better shape.” We are never told, though, whether bioidentical hormones or the diet described can successful replace cholesterol lowering drugs. As research has shown, dieting and exercise alone are not adequate to reduce cholesterol levels in some people with heart disease and a predisposition to high cholesterol. This is just one area in a story full of broad statements like this that could be misleading and, frankly, dangerous for patients currently following established, effective treatment plans who choose to abandon them for uNPRoven therapies. Programs aimed at exercise and appropriate diet may yield similar benefits in terms of reducing obesity related illnesses.

Again, Arnold Relman’s skepticism was appreciated – “Relman insists integrative medicine is “all nonsense.” “I believe it’s a whole collection of things said to be effective that have never been proven or tested. When patients who are tired or depressed or have no energy say they feel better” after trying integrated medicine, “it is only a placebo effect. They’d be better off going to church or joining an exercise program. Medicine is for people who are sick, not for people who are unhappy. This is just a waste of money.” – But it’s overwhelmed by the unverified, non-evidence-based claims for the Great Life Program.

Does the story establish the true novelty of the approach?

Not Satisfactory

The story never establishes the novelty of bioidentical hormones but, instead, presents anecdotal evidence as proof of their superiority. It’s not hard to find practitioners who offer the same type of “extensive testing” highlighted in this story. For example, patients may be asked for urine, hair, nail clippings and the like. They may be given, as this story describes, “tailored dietary supplements and advice.” What makes this Great Life program different?