When Dr. Lauren Streicher, an assistant professor of obstetrics and gynecology at Northwestern University's medical school in Chicago, got a call from "The Oprah Winfrey Show" inviting her to discuss menopausal hormones with actress Suzanne Somers, she figured she'd better read Somers's best-selling books on the subject. As Streicher worked her way through the first chapter, she started underlining every sentence she felt was inaccurate. "But pretty soon, I had to stop," Streicher says, "because I was underlining almost everything."The taping of the show, which aired Jan. 29, proved equally disconcerting. Somers, a self-styled hormone and anti-aging expert whose controversial books promise midlife women that they will feel young and sexy if they take unregulated hormone therapy (HT) in much higher doses and for much longer time periods than most experts recommend, was literally given center stage. She was seated next to Winfrey, the newly proclaimed convert to the so-called bio-identical hormones promoted by the 62-year-old Somers. (Bio-identical generally refers to products that are chemically identical to hormones produced by a woman's body.) While Winfrey, 55, encouraged "every woman" to read Somers's book, the guests with actual medical degrees were relegated to seats in the audience, where they had to sit quietly unless called upon. Interspersed were taped segments of Somers smearing her arms with hormone cream, standing on her head and lining up the 40 dietary supplements she takes with her morning smoothie. The whole setup seemed to give the drugs that Somers uses the same enthusiastic endorsement that turns everything Winfrey promotes into a blockbuster. (Article continued below...)
The resulting spectacle disappointed many doctors who thought Winfrey had higher standards for the quality of medical information she dispersed—or, at least, more of a commitment to balance. Some said they were particularly upset because doctors had complained to Winfrey's production company about what they saw as misinformation disseminated during the show she did on hormone therapy two weeks before that featured Dr. Phil McGraw's wife, Robin.
Some experts are far more than disappointed: "I found the program to be quite shocking, and full of audacious claims, not substantiated by evidence," says Dr. Wulf Utian, a gynecologist and consultant at the Cleveland Clinic and founder of the North American Menopause Society, who has also worked as a consultant to the pharmaceutical industry. "Oprah is the most influential woman in the world, and I don't think she comprehends the amount of damage she has done to women's health. I came away feeling like Oprah really didn't understand the issue. Personally, I feel like she has set us back 100 years."
Somers puts partial blame for the hailstorm of criticism she gets from doctors on the fact that some medical experts, like Utian, have connections to the pharmaceutical industry. While many bio-identicals are produced by drug companies (which has become a highly profitable business for pharmacies and those who prescribe the hormones) and regulated by the FDA, the ones that Somers promotes are made in compounding pharmacies that are not required to be tested for quality or safety. Many other doctors, Somers says, simply don't understand bio-identical hormones as well as she does, because they "don't learn about them in medical school" or go to the alternative-medicine conferences she attends.
But it's not just clinicians who take issue with her recommendations that women follow a long-term high-dose hormone-replacement regime; the bulk of scientific research on the subject suggests that prolonged use of these hormones is associated with an increased risk of serious health conditions including cancer and heart disease.
Somers concedes she's not a scientist, but she is "a lay person passionately interested in preserving the quality of life and appalled by the lack of knowledge about this." She is particularly annoyed with the criticism of male doctors, saying they've never experienced menopause. But even though Somers reminds people she's just a layperson, she wasn't presented that way on the Winfrey program. And that's a problem, say experts. "My concern is with someone like Somers, whose only medical expertise is a personal one, giving medical advice to other people," explains Dr. Isaac Schiff, professor of obstetrics and gynecology at Harvard Medical School. "When people see this on TV, they may be encouraged to try hormones, without fully understanding the benefits and risks. They should have had a physician, who is trained and experienced, sitting on the stage at the same level and presenting another point of view."
When NEWSWEEK contacted Winfrey for comment about the criticism from medical experts, her production company, Harpo, issued this statement: "Through two recent episodes of 'The Oprah Winfrey Show,' we began our national conversation about hormone therapy (HT) with the hope that women would take responsibility for their individual health and educate themselves on what options are available. We informed our audience about the differences between synthetic and 'bioidentical' hormones and the risks/controversy surrounding HT. Experts with varying viewpoints from the medical community helped us explain this confusing subject to our viewers. As was clearly stated in both shows, without endorsing any particular regimen, any decision to proceed with HT should be made in consultation with a physician based on an individual's health and history."
That's all sensible advice, but by putting Somers and her controversial ideas center stage , doctors feared that wasn't the message viewers would take home from the show. How exactly did Winfrey let her audience down? Let us count the ways:
1. Downplaying the Risks of HT
Although Winfrey read the FDA warning about the controversial and unregulated "bio-identical" hormones Somers promotes, the doctors got relatively little air time to detail the risks. Although everyone agrees that HT is the most effective way to alleviate menopausal symptoms like hot flashes and night sweats, solid research indicates that prolonged use of hormones can increase a woman's risk of developing breast cancer, endometrial cancer, stroke, heart disease and blood clots. There's also the research that indicates that breast cancer rates have been falling since HT became less popular in recent years. Generally, major medical organizations, like the National Institutes of Health, the FDA, the American College of Obstetricians and Gynecologists, the Endocrine Society and the North American Menopause Society now recommend taking the lowest effective dose for no more than a few years.
2. Big C Omissions
Menopause experts, including board-certified endocrinologists, have publicly criticized Somers's hormone theories calling them naive, misguided, and potentially dangerous. Winfrey, who has been known to ask some tough questions, didn't ask Somers about her public and hugely controversial insistence that breast cancer doesn't feed on estrogen, as most cancer researchers believe. (Somers tends to focus only on the minor studies that agree with her, rather than conclusions drawn after reviewing the bulk of the highest-quality studies.)
Nor did Winfrey ask Somers about her own history of breast cancer—Somers was diagnosed with the disease after she started taking her estrogen supplements—or more recent precancerous changes in Somer's uterus that led to her hysterectomy. (Privacy wasn't an issue; Somers has written extensively about both incidents in her books.) Winfrey also didn't question Somers about her decision to continue hormone supplementation after the cancer diagnoses or her latest cancer-fighting theory: that older women should "restore" their hormones to the levels they had in their 30s and start having periods again, because then they'd be more like younger women who get less cancer. That upside-down logic puts Somers at odds with just about every oncologist in the country.
Meanwhile, her decision to take supplemental progesterone despite her hysterectomy baffles mainstream doctors. "There is no medical reason to use progesterone after a hysterectomy," says Dr. Nanette Santoro, a board-certified reproductive endocrinologist and professor at Albert Einstein College of Medicine, who added that prolonged supplementation with estrogen and progesterone could further increase the risk of a breast cancer recurrence.
3. A False Fountain of Youth
Somers's idea that most midlife women need to "replace" their hormones to stay attractive, sharp and healthy is an outdated concept, long abandoned by most experts. Researchers say menopause is no longer viewed as a "hormone deficiency disease," to be "cured" or "treated" by hormones or anything else, but a natural transition. Still, part of the lure of hormones has always been about trying to look and feel younger, not about science. Somers's hormone books, for example, all feature glamorous cover portraits in which she looks decades younger. But even if a woman in her 60s takes enough hormones to start getting her period again, that doesn't mean she can make time stand still. That was one thing Winfrey's show made clear. When the TV cameras zoomed in on Somers for her close-up, she simply looked like a very attractive 62-year-old who takes good care of herself.
4. A One-Treatment-Fits-All Philosophy
While Winfrey and Somers were busy comparing notes about their severe symptoms ("I went two years and didn't sleep," said Winfrey), they never bothered to mention that their experiences aren't typical. . But the fact is that most women are more annoyed by menopausal symptoms than disabled by them. Almost everyone gets hot flashes, and many experience periodic night sweats, sleeplessness, moodiness and a loss of libido. (It's not surprising that these things often occur together.) But some women barely notice a thing, and most women manage to get through the transition without needing or wanting hormonal assistance. Even those who decide to take hormones are typically off them within two years. Very, very few take large doses for more than 10 years as Somers does.
That said, just because those who have a particularly hard time during menopause are a minority, that doesn't mean the medical community should be dismissive of their pain and frustration. They deserve to be taken seriously, and Winfrey and Somers are right to encourage them to find doctors who will work with them to find solutions. They should have suggested that a consult with a specialist like a board-certified reproductive endocrinologist or gynecologist at a menopause clinic can make a big difference.
5. Blaming Menopause for Everything.
The show promoted the idea that menopause is behind most typical midlife problems. While it's true that hot flashes and night sweats are almost always due to menopause, there are many reasons other than menopause that a woman in her late 30s, 40s and 50s might experience depression, crankiness, sleeplessness, forgetfulness and a droopy libido. They could be caused by a totally different physical ailment, or something happening in your life (marital problems, pressures at work, and the stress of dealing with elderly parents or teenage children). Streicher said she was particularly upset when Somers, answering audience members' questions after the show, advised specific women to try bio-identical hormones. Streicher said Somers even told one woman to ignore her doctor's diagnosis and try hormones instead. Speaking to NEWSWEEK, Somers insists Streicher misunderstood her: "I just said, 'It sounds like hormones to me.' That's not advice."
6. Lack of Clarity
If Winfrey hoped her TV shows would help quell the confusion over the various kinds of hormones out there for women, she failed. Somers and Winfrey both say they take bio-identical hormones. But they brushed over the fact that "bio-identical" is simply a marketing term, not a scientific one. It is used to sell plant-based drugs approved by the FDA as well as unregulated drugs prepared in compounding pharmacies. Like all supplemental hormones, both types are synthetics, even though the name implies that they are more natural. (Not surprisingly, many women prefer the idea of taking these to those older varieties derived from mare's urine.)
What particularly upset doctors about the broadcast was Winfrey's decision not to clarify whether she's chosen one of the dozens of FDA-approved versions of the hormones, most of which are low dose and covered by insurance, or the more controversial unregulated drug regime advocated by Somers. The unregulated drugs are more expensive because they're not covered by insurance, and neither are the frequent blood tests and office visits these practitioners insist are needed to adjust the dosage. Somers says extensive blood testing allows doctors to tailor the dosage precisely to a woman's needs, but most mainstream doctors see it as a scam that's profit-driven. Because of a government loophole, unregulated bio-identicals can legally be dispensed without drug inserts that specify known risks, and some advocates use that to assert that these drugs are more natural or safe. Recently, the FDA has been clamping down on such claims. If you want a much more balanced and accurate view of hormone therapy, check out the February issue of … O, The Oprah Magazine. The risks and benefits are clearly spelled out. Which raises the question: does Oprah read her own magazine?