I had the opportunity to chat with Dr. Erika Schwartz recently about Bio Identical Hormone Therapy, one of the foremost experts in the United States on the subject. She has written 4 best selling books and is also seen on Extra Lifechanger. Dr. Erika trained at Kings County Hospital Center in Brooklyn, NY in Internal Medicine and Critical Care on the front lines and became the Director of Emergency Medicine at Westchester County Medical Center. She also lectured on the topic of bioidentical hormones at Harvard University/Massachusetts General Hospital.
She is also the founder of America’s first physician-led, fully-accredited CME institute dedicated to training physicians in the clinical use of bioidentical hormones for aging, prevention, and wellness, the Bioidentical Hormone Initiative.
The conversation was very enlightening and even motivated me to do some additional research on my own. This subject has been so long misunderstood, and me included with limited knowledge. After our discussion I have a much better idea about not only what the products and treatment processes are, but also read up about the history on how hormone therapy came into existence.
We started out talking about Premarin and all the controversy around the drug over the years with cancer. First off all she explained to me exactly what Premarin is in detail. I knew it was a hormone pill, but other than that I didn’t have much knowledge to speak of.
Premarin she said has been the leading estrogen product for years, and is made from the urine of pregnant mares which is bio-identical if you happen to be a horse. Horse estrogen is foreign to our bodies, where as a molecular derivative created that is like what is naturally found in our bodies would have a better outcome. Our body has to figure out what to do with Premarin and how to metabolize the estrogen from horse since we are human. (Note: Due to some lagging sales, Wyeth has also recently increased the price of Premarin.)
Bio-identical hormones to many, and self included here are a confusing issue as there are both the drugs which are standardized dosages and approved by the FDA, and those that are personally compounded at pharmacies, which means is a custom mix and not out of the box or bottle. When many today seem to think of bio-identical hormones, we automatically believe that they are only drugs compounded by the pharmacy, and that is simply not true. Bioidenticals are synthesized hormones that mimic those produced in women's ovaries, more natural than those produced fromEstradiol and Levonorgestrel here.
Dr. Schwartz named several FDA-approved drugs that are bio identical to include Estrace, Evamist, Vagifem, Estraderm, and Climara for estrogen and Prochieve, Prometrium, and Crinone for progesterone. Well guess what, I had been using an FDA bio identical drug and didn’t even know it, so there again is where my education on hormones began.
Before World War II, about 60 percent of medications in the United States were compounded by pharmacists, until mass production took place in later years, and today compounded drugs are making a comeback with bio identicals in particular. A health-care provider must write a valid prescription and determine that his or her patient needs the drug in a formulation or compound not normally available or approved by the Food and Drug Administration. Compounding has gone on for years with adding a flavor to a cough medicine for a real simple example. Pharmacies that compound are also accredited.
Bioidentical hormones have the same molecular structure as the hormones produced by the body she stated and they can't be patented so this might explain why marketing has not been more aggressive. We see this all the time though with other drugs in other countries too, if there’s not a market, they don’t go there. I asked further about the breast cancer connection and the warnings issued by the FDA years ago, and asked are all hormone replacements pose the same for breast cancer.
She told me the NIH, ACOG, and NAMS recommended doctors take all women off Premarin and other replacement therapies, after the failure of the National Health Initiative, and further stated there are no studies available about bioidentical estrogens of any significance today relative to cancer, even though they have been around since 2002. Where are the studies she asked, and that’ is a very good question indeed. There are many studies from the early 1980s and 1990s and many European studies that prove the safety of bioidenticals, but why have there not been studies conducted with bio identical hormones since the fiasco of WHI (Women’s Health Initiative) in 2002, especially those which are FDA approved and also compare those to the studies conducted with Premarin. I agree with the doctor, we would all like to have some information in that area.
With computer technology data can be collected and tabulated with greater ease and can hopefully start shedding some light. As of today there’s no evidence published that bioidentical estrogens increase the risk of breast cancer or of recurrence. Dr. Schwartz said all we did was end up with lower doses of Premarin on the market instead of teaching women and their doctors of the bioidentical hormones option.
Where are the studies and if they exist, where are they? (Dr. Schwartz quoted from Web MD)
“Erika Schwartz, MD, a New York doctor who prescribes FDA-approved biodentical hormones and compounded bioidentical hormones, says there have been studies that support the safety of bioidentical hormones, compared to other hormone therapy.
Schwartz asks, "If NAMS or ACOG says there are not enough studies, well, why haven't you done the studies if you think you need more? If this had been men's health, would we be having this conversation, or would we have answers?"
Schwartz says she has long wanted to see large, government-sponsored studies compare bioidentical and other hormone therapies head to head.”
We are in the age of personalized medicine and bioidenticals are following this path with personalization without a one size fits all. In medical school, she stated Premarin is still taught as the replacement for hormone therapy.
A short side note of my own here:
(We talk so much about everyone working together and in reference to studies and at least getting some statistics. We have insurance companies that could run some numbers to offer some help along the lines here, as they know what medications patients are taking and which patients have cancer and what kind of cancer. There has been all kinds of talk about working together and supplying the FDA with some of this information in the up and coming Sentinel System that is work in progress; however, do we have to wait until the entire process is ready and available or could one or more of the insurance companies supply some statistics on what they have on file.)
We talked about other drugs that have come to market for hormone treatment. She was very adamant about not using anti depressants for menopause, as many of those drugs have many side effects and are not specifically targeted to treat hot flashes and other menopause symptoms. She stated that either an FDA bio identical hormone or a custom compounded treatment is the better choice, why take an anti depressant if you are not depressed by merely need hormones. Before customizing a solution she stated that she always had a blood test done, so the prescription is precise, and in her practice she preferred this over a swab of saliva, as being more accurate.
A few months ago she was on ExtraTV talking about this exact same subject with reference to Pristiq, which the FDA has given approval to be used for hot flashes, and there are quite a few side effects that come along with that drug such as suicide, as noted on the Wyeth website.
Estrogen metabolism is not simple and has not been well studied. We talked a bit further about new bio identical types of drugs now coming on to the market. Qlaira® being introduced in Europe and Yaz for birth control use approved in the US which contains drospirenone and could increase your potassium. Dr. Schwartz stated that with some of the new drugs and side effects shown, they tend to possibly be “messing with your system” too much with chemically interfering with ovulation, when all that is necessary is a good hormone treatment plan, exercise, a good diet and some supplements or vitamins to keep you on the right path.
The FDA has warned that "BHRT" (Bio Identical Hormone Treatment) is a marketing term they do not recognize and I asked Dr. Erika about why this is such an issue. She stated that the FDA is set up to only regulate the “one size for all” approach for hormones and all other medications and this may not be the right fit for all women, thus enters the customized approach under the direction of a doctor as you need blood tests to get all the facts before starting a treatment program, and the bio identical hormones are molecularly identical to what we have in our system.
She stated recently when lecturing at Harvard, for example, a much warmer welcome and interest rate has appeared in the last couple years with new interest, those wanting additional knowledge on the subject and how it all comes together. A few years ago it was a different story. Dr. Erika is a conventional doctor with the patients health and interest at heart and offers the solutions needed through BHRT therapy to help both women and men feel better.
Next I inquired about celebrities who have recently spoken out about the use of bio identical hormones, Suzanne Somers and Oprah, as both have somewhat taken their own approaches in discussing how they have been helped. Suzanne Somers has her own marketing approach and a book to sell but she did accomplish bringing the focus to the attention of the public. Dr. Erika commented that Oprah has also been outspoken about how her guided process has been of significant help to her overall well being on television and she would perhaps guess that Oprah has a customized compounded formula created for her. Oprah had quite a bit of publicity, good and bad on the subject and Dr. Erika spoke out commending her on the choices she had made.
I inquired, does everyone need a compounded customized formula? Absolutely not, she said and she prescribes both FDA approved bio identical products as well as a customized formula, it all depends on the patient and their needs, which is her foremost concern, and we don’t have to make an issue complicated if it doesn’t need to be; education and studies are needed and it’s time for women to get the treatments they need for hormone replacement. Once again, she reiterated, we would really like to have some studies to help conventional doctors become helpful for the women who should not be suffering from hormone loss. From my point of view I see this as an extension of “personalized medicine” and once we have studies and perhaps some genomic information in the future to add to it, it will grow from there.
To compliment her entire processes and beliefs, there are many products for sale on the website and you can either purchase products online or read one of her books to find out what you might want to find locally as far as vitamin and other supplements. Just recently (press release below) Dr. Erika was appointed Medical Director of Cinergy Health, an organization that is working to make healthcare affordable with solutions outside the normal realm of health insurance to cover normal and preventive visits, help for those who can’t afford and don’t have customary plans, and hopes soon to bring some additional online consultation sessions to the web.
Along with her website, you can also view many of Dr. Erika’s videos at You Tube, which is a combination of both herself and patients talking about their experiences.
The interview was totally enjoyable not to mention educational at the same time, and I thank Dr. Erika for taking time from her busy schedule to talk with me today! The patient is number one in her book, and that’s what we need, doctors who partner with their patients.
Also, we talked about the origins of hormone therapy and I have included a couple links below you might want to explore to see how this all began years ago.
(reminder, double click on any word to get a description or dictionary meaning from any words in the text)
Cinergy Health Appoints Dr. Erika Schwartz as Medical Director
Provider of Affordable Health Care Insurance Will Draw on Physicians' Expertise in Preventative Medicine and Patients' Health Advocacy to Enhance Health Plans
AVENTURA, Fla., June 15 /PRNewswire/ -- Cinergy Health, a nationwide provider of affordable health insurance benefit programs for the consumer market, today announced Erika Schwartz MD, as the company's medical director, a new position. As Cinergy Health's medical director, Dr. Schwartz will provide guidance on health care issues, ranging from the efficacy of emerging medical procedures to so-called non-traditional treatment methods, such as the use of nutriceuticals. In addition, she will engage the public in a dialog on ways they can optimize relationships with their own health care professionals.
"We are excited to have Erika join the Cinergy Health team, especially given her broad and deep experience as a patients' health advocate," said Daniel Touizer, CEO of Cinergy Health. "Her work in both hospital-based and private practice gives her a powerful perspective on the entire health care delivery system and what constitutes a proper and effective level of service - all for the benefit of Cinergy Health Plan members."
Over the past 30 years, Dr. Schwartz has personally taken care of more than 100,000 patients, treated more than 15,000 patients with various formulations of bioidentical hormones and has written four best-selling books published by Warner Books, Putnam and HarperCollins. In December 2008, the Medical Clinics of North America published an entire chapter written by Dr. Schwartz on the use of hormones in wellness and disease prevention, a first in the field of conventional medicine. She was invited by the chair of Obstetrics and Gynecology at Harvard to lecture at Massachusetts General Hospital on the topic of bioidentical hormones in February 2009.
"Cinergy Health is an insurance benefits company that actually puts the individual first. Its affordable health insurance coverage is as innovative as any medical breakthrough I've seen," Schwartz said. "Further, Cinergy Health plans are designed to encourage people to seek care, not delay it such that their condition could worsen. As someone who's been involved in patients' rights for years, I am proud to be associated with this company."
Schwartz received her MD from State University of New York Downstate College of Medicine, graduating cum laude, as a member of the prestigious AOA academic honor society. She served as Director of Emergency Medicine at Westchester County Medical Center (University Hospital of New York Medical College) in Valhalla, NY, a world-renowned trauma center. She has been in private practice, in Internal Medicine, for the last 17 years.
As one of the nation's most widely-recognized experts in the field of bioidentical hormones and an outspoken advocate for patients' rights, Dr. Erika Schwartz has testified before Congress, appeared on CBS News, Larry King Live, The View, The Montel Williams Show, CNN, MSNBC, Oprah Satellite Radio with Dr. Oz and many others. Her affiliations include: Board of Managers at SUNY-Downstate College of Medicine, the American Society for Internal Medicine, National Association of Medical Communicators (AMA), International Coenzyme Q10 Society and the Bioidentical Hormone Initiative.
About Cinergy Health
CINERGY HEALTH, Inc., with headquarters in Florida, is a nationwide provider of innovative and affordable health insurance solutions designed to meet the changing needs of American families. Recognizing the financial challenges for people who cannot afford or qualify for costly major medical insurance plans, Cinergy Health designs and delivers lower cost alternative health plans that facilitate access to quality healthcare services and enable people to maintain better health.
Cinergy Health Preferred Insurance Plans are limited medical benefit plans, which provide first dollar coverage for the predictable medical care people need most frequently. These insurance plans provide coverage starting with a member's very first doctor's visit without a deductible so that s/he doesn't put off important medical care. From doctor visits and diagnostics to maternity and surgery, Cinergy provides essential coverage that's easily within most people's budgets. Further, plan member can choose doctors and hospitals of their choice without being confined to a list.