Speaker 1: Bloomberg Audio Studios, Podcasts, radio News. You're listening to Bloomberg
Speaker 1: Business Week with Carol Masser and tim Stenoveek on Bloomberg Radio.
Speaker 2: We want to get to our weekly segment, BusinessWeek Women's
Speaker 2: Health segment, where we focus on key issues in developing
Speaker 2: technologies impacting the present and future of women's health around
Speaker 2: the world. And a lot of times it's women's health,
Speaker 2: but also even more generally a look at major health issues.
Speaker 2: And this week, though definitely pertains to women, we're talking
Speaker 2: about hormone replacement therapies used to treat menopause symptoms no
Speaker 2: longer needing to carry strict warnings about some potential side effects,
Speaker 2: including cancer and heart disease, that came from the US
Speaker 2: Food and Drug Administration earlier in the week, actually on
Speaker 2: Monday it came. So we wanted to get to a
Speaker 2: voice that we've talked to before, and it's great to
Speaker 2: have her back with us.
Speaker 1: Doctor Fanny Lawi is Associate Professor of Neurology and neuroscience
Speaker 1: at the Icon School of Medicine at Mount Science and
Speaker 1: now she joins US from New York City. As Carol mentioned,
Speaker 1: this week, the FDA said it would remove the black
Speaker 1: box warnings from HRT products. The last time you're on
Speaker 1: the show with us, you said HRT may actually help
Speaker 1: diminish women's risk of dementia. What are your views on
Speaker 1: just the warning or the changing warnings coming from the
Speaker 1: federal government on this net a good thing.
Speaker 3: So I want to qualify that statement by I hope
Speaker 3: that it will diminish the risk of dementia. I am
Speaker 3: delighted by the fact that this warning that I and
Speaker 3: many others think was never warranted, was finally lifted. It's
Speaker 3: sad that we lost two decades, and during this time
Speaker 3: many women did not get the chance to go on
Speaker 3: hormone replacement therapy due to the fear of the side
Speaker 3: effects that were not indicated.
Speaker 4: But I think now we need to make.
Speaker 3: Up for the lost time and advance the science to
Speaker 3: the point where we are more precise with our predictions.
Speaker 1: Were those statements there in the first place? If we
Speaker 1: go back in history, you said we lost it's unfortunate
Speaker 1: that we lost twenty years of treatment here, Why do
Speaker 1: those come around in healthcare in the US?
Speaker 3: In the first place, it was unfortunately a flawed design.
Speaker 3: Hormone replacement therapy was started for women who had gone
Speaker 3: through metopause in their fifties, and it wasn't until mid
Speaker 3: sixties that hormone replacement therapy was started.
Speaker 4: By then, it's too late.
Speaker 3: The physiology has drastically changed, A decade has gone by,
Speaker 3: and the impact of hormones may no longer. The hormones
Speaker 3: may no longer have the impact on the health span
Speaker 3: that we need them to have, and then you just
Speaker 3: deal with the side effects.
Speaker 2: Wait, so I'm confused. So you're saying not as dangerous. So,
Speaker 2: and what a shame that women weren't allowed to use
Speaker 2: them earlier because there were these concerns and warnings on it.
Speaker 3: Right, So, what I'm saying is that the timing of
Speaker 3: the hormone replacement therapy that was tested in the w HI,
Speaker 3: the Women's Health Initiative study, was wrong. Timing of treatment
Speaker 3: is really critical. This is not just for hormones. For
Speaker 3: any kind of treatment, you cannot wait years when disease
Speaker 3: has truly evolved, where the physiological state is different, and
Speaker 3: then test the impact of your intervention. It's like having
Speaker 3: a treatment for Alzheimer's disease for the early.
Speaker 4: You know, most.
Speaker 3: Maybe even pre clinical stage of disease, but waiting until
Speaker 3: full blown dementia to test it. This is no different
Speaker 3: so doctor replacement.
Speaker 1: Yeah yeah, well so doctor Lowie. When should women start
Speaker 1: talking to their primary care physicians about hormone replacement therapy.
Speaker 3: Right around menopause? It's it's really really important, and this
Speaker 3: is really a point that I hope people here and
Speaker 3: start doing. When people are thinking that there may be
Speaker 3: perimenopausal that's when the conversation starts, or even before, as
Speaker 3: you're preparing to approach the age of which you may
Speaker 3: go through menopause or early post menopause.
Speaker 4: We don't actually know how many.
Speaker 3: Years can go by before you start hormone replacement therapy.
Speaker 3: We definitely know a decade is too much, and I
Speaker 3: would say as early as possible is probably the smartest move.
Speaker 2: Wait, so let me go back to because I do
Speaker 2: think it's safe to say, you know, as a woman
Speaker 2: like there has been that fear when it comes to
Speaker 2: hormone replacement therapy. So the concerns about cancer, heart disease,
Speaker 2: that's just not a reality.
Speaker 3: There is one kind of cancer that can the risk
Speaker 3: for which can increase.
Speaker 4: That's utter in cancer.
Speaker 3: If people are taking only estrogen, this is an important point.
Speaker 3: If women are considering to take only estrogen, they need
Speaker 3: to be aware that they need to get very close
Speaker 3: monitoring if they still have their uterus. But most hormon
Speaker 3: replacement therapy are of combination pills. The risk of heart disease.
Speaker 3: That was just because these were older women and the
Speaker 3: formulation that was used.
Speaker 4: The route would also matter.
Speaker 3: Oral estrogen therapy can increase the risk of coagulation and
Speaker 3: perhaps other things. So route of administration matters, Timing of
Speaker 3: administration really matters, and I would say that we are
Speaker 3: actually still in the dark with regards to the duration
Speaker 3: of the administration. That's a really important question remaining to
Speaker 3: be answered.
Speaker 2: So what should most women be asking themselves right now
Speaker 2: in regards to hormone replacement therapy.
Speaker 3: They need to be having the conversations with their providers
Speaker 3: and think about each The provider would need to be
Speaker 3: thinking about each woman on an individual level, their pros
Speaker 3: and cons to every treatment, and hormone replacement therapy in
Speaker 3: general no longer are considered risky and in fact, we
Speaker 3: think could be really beneficial.
Speaker 4: In the right clinical setting.
Speaker 3: If someone has a really high risk for various kinds
Speaker 3: of cancers, that would need to be taken into account,
Speaker 3: and the kind of hormone replacement therapy that is being
Speaker 3: administered would need to be investigated very closely. Women in
Speaker 3: general are at higher risk for various kinds of cancers,
Speaker 3: so the routine screening and care does not change the
Speaker 3: fact that getting hormone replacement therapy after menopause increases, independent
Speaker 3: of any other risk factors, your risk for breast cancer
Speaker 3: is no longer true.
Speaker 2: Interesting. I know we're not supposed to do this, but
Speaker 2: will you be my doctor?
Speaker 4: No, it's'll just be delighted.
Speaker 2: Okay, but I'm.
Speaker 4: A brain specialist. I will take care of your brain. Okay,
Speaker 4: really help with that.
Speaker 1: We only have about thirty seconds left. But I do
Speaker 1: want to know why you think hormone replacement therapy is
Speaker 1: having a moment right now after so many years of
Speaker 1: it being questioned by medical professionals.
Speaker 3: I'm really delighted because I think we believe that in an
Speaker 3: era of precision medicine, and this is one of the
Speaker 3: many changes that I hope to see implemented in healthcare
Speaker 3: where we design.
Speaker 4: The studies really well.
Speaker 3: But I hope that in the future we don't make
Speaker 3: conclusions on group levels anymore either, and that we have
Speaker 3: biomarker strategies. This is what my LIBE is really focused on,
Speaker 3: to make treatment precise for that given individuals, to decrease
Speaker 3: their risk and to maximize their benefit.
Speaker 2: Will you be all of art doctors so appreciate it.
Speaker 2: I already looking forward to next time. Doctor Fanny Alahi.
Speaker 2: She is Associate Professor of Neurology and your Science at
Speaker 2: the Icon School of Medicine at Mount Sinai, joining us
Speaker 2: right here in New York City.
Speaker 1: You got to make sure she accepts your insurance. I
Speaker 1: know you didn't check.
Speaker 2: This might be one you pay out a pocket for.
Speaker 2: I'm just saying, all right, this is Boomberg