Not long ago on her TV show, Oprah Winfrey sat beside actress and self-proclaimed women's health guru Suzanne Somers and told millions of viewers to read Somers' 2007 book, "Ageless: The Naked Truth About Bioidentical Hormones." Somers was singing the benefits of bioidentical hormone replacement therapy for postmenopausal women.
Hormone replacement therapy is one of medicine's most controversial subjects. In 2002, after a period of prescribing HRT routinely to women to improve their energy, sex drive, heart health and bone strength, and to reduce the risk of certain cancers, doctors were forced to do an abrupt about-face. A study known as the Women's Health Initiative, which followed more than 150,000 postmenopausal women starting in 1991, concluded that prolonged HRT (more than two years) increased the risk of heart attacks, strokes and breast cancer. It wasn't what doctors or their patients had hoped for, but it was the scientific truth. Doctors have therefore been recommending that hormone replacement therapy be taken for short periods of time to mitigate those risks.
But what Somers was advocating was radically different from standards of medical care. She admitted to using mega-doses of bioidenticals continuously and aggressively. She started her regimen, she told Winfrey, by rubbing bioidentical estrogen and progesterone creams on her arms, injecting another hormone, estriol, vaginally every day, and topping herself off with 60 different oral supplements. Physicians who may have been watching the show surely winced, but Winfrey was not concerned. "Many people write Suzanne off as a quackadoo," she declared. "But she just might be a pioneer."
It's not the first time Winfrey's advice on health issues has raised concern. In the past, the media mogul has been criticized for promoting cosmetic therapies that were untested and later deemed dangerous. Her recent development deal with Jenny McCarthy, who now blogs on Oprah.com and has a television show in the works, drew criticism from children's advocates, as McCarthy and her autism advocacy group, Generation Rescue, have been leading an ideological, unscientific crusade against childhood vaccines. Add in Winfrey's endorsement of the snake-oil self-help book, "The Secret," and Dr. Phil, and you might be tempted to sue her for malpractice.
"Bioidentical" is supposed to refer to drugs that mimic a woman's endogenous hormones. Somers argues that these hormones are more natural, more effective and safer than what doctors prescribe. In reality, however, there are no good medical studies to back up those claims.
The word "bioidentical" has no medical meaning. All hormones, whether they're prescribed or not, are derivatives of plant or animal hormones and manipulated in a lab to get the finished product. Many bioidentical hormones (including the ones Somers uses) come from non-FDA regulated compound pharmacies, where drugs are not subject to the same quality standards as those made by pharmaceutical companies. An FDA survey demonstrated a 40 percent failure rate for compounded bioidentical hormone products when those drugs were tested for purity and potency.
And what about Somer's host? This particular episode was Oprah's second in less than a month on this topic, part of a "great debate" on hormone therapy. But Winfrey didn't pose any tough James Frey-like questions to Somers. She didn't ask about whether her super-hormone regimen could have contributed to Somers' history of breast cancer. She didn't ask Somers about her hysterectomy, the result of pre-cancerous changes in her uterus from her use of HRT. And she didn't ask about the validity of Somer's book's sources, many of whom are neither experts in women's health or endocrinology, nor board-certified physicians, nor experienced researchers.
No doubt Winfrey has scored good ratings with her health episodes. But in doing so, she seems to have thrown therapeutic caution to the wind. Take another example, cosmetic surgery. Periodically, Winfrey will tout a procedure that promises great results, but without discussing its potential problems. On one show several years ago, Winfrey featured a medication called Restylane, which doctors could inject into the eyelid to eliminate wrinkles. What wasn't discussed, however, were the risks of doing that, which include severe eye swelling and blood clots that could lead to blindness. In another instance, she showcased a technique called the facial thread lift, where doctors insert sutures under the skin to tighten lax tissue, referring to it as "a cutting-edge procedure with no cutting edges." After that episode aired, doctors became aware of serious problems with it, including indentations, bunching, dimpling, broken threads and facial asymmetry.
Another major medical topic Winfrey has attempted to address is thyroid disease, a subject that's pitted the mainstream scientific community against alternative medicine for years. In 2007, Winfrey revealed in her magazine that she had a thyroid condition. But she wasn't specific, instead offering that "my body was turning on me." At the time, Winfrey hosted a show called the "The Big Wakeup Call" with her guest, Dr. Christiane Northrup. Winfrey referred to Northrup as "just the best doctor when it comes to women's health issues because she not only has the information, the medical information, but when I called her to talk about the whole thyroid issue, she always connects the mind, the body and the spirit."
On her Web site, Northrup seems more than a bit fuzzy on thyroid disease. She writes: "In many women, thyroid dysfunction develops because of an energy blockage in the throat region, the result of a lifetime of 'swallowing' words one is aching to say. In the name of preserving harmony, or because these women have learned to live as relatively helpless members of their families or social groups, they have learned to stifle their self-expression. These women may, in fact, have struggled to have their say, only to discover that it doesn't make any difference -- because in their closest relationships they have been defined as insignificant."
Northrup told me in an interview that she attributes her comments to her extensive background in alternative and complementary medicine. She said she relies on Ayurvedic and other Eastern approaches to health to treat thyroid disease and other disorders. Yet there's no medical evidence at all to support her view that thyroid disease is the result of a woman's inability to assert herself.
Northrup, who appeared on both hormone episodes, said Somers provided a good opportunity to get out the good news about bioidentical hormones, which Northrup has been trying to spread for more than 20 years. She did, however, call Somers' HRT regimen "far to the extreme of anything I would recommend." And she was blunt in her assessment of TV doctoring. She referred to Somers as "TV cute" with the kind of celebrity cachet that grabs an audience.
I have to wonder about Oprah's socioeconomic perspective on healthcare. After being diagnosed with her thyroid condition, she wrote in her magazine about how she went away to Hawaii for month, where she rested in seclusion and ate food prepared by her chef. Further, the first bioidentical hormone episode featured another regular medical guest, Dr. Mehmet Oz, touring compound pharmacies and the offices of Dr. Prudence Hall in Santa Monica. Hall runs what could be called a medical day spa, where "The Female Medical Visit" consultation with hormone analysis, thryoflex, nutrition consultation, pelvic ultrasound and pap smear (blood work not included) costs $850. Expensive, yes. And don't expect your insurer to pay.
None of these options are exactly prescriptions for the health of the masses. Given that Winfrey's fan base (based on demographics for her magazine) is 90 percent female, has an average age of 45, and has a median individual income of about $36,000 and a family income of about $70,000 per year, perhaps she could provide some more practical medical advice. While standard medical advice isn't as sexy as the stuff of Somers and Northrup's mantra of empowerment, women potentially in need of real help deserve real balance and consideration of their safety. (I would have liked to ask Winfrey and Somers about their level of consideration, but my calls to their offices went unreturned.)
It's not that Winfrey doesn't try to maintain medical credibility in her shows. But her efforts seem subpar. She did include physicians in the Somers episode. But they appeared in taped segments, expressing concern and caution like stern parents. The only "outside" physician in the studio was the obstetrician and gynecologist Dr. Lauren Streicher, but she was placed in the audience and given very little time to rebut Somers' claims. Streicher told me in an email that some of her rebuttals were edited out of the show, including her telling the audience that Somers relied on "experts" without medical degrees or clinical experience.
Streicher stressed that doctors should shoulder the responsibility and accountability of being better guides for the health of women. "There are a lot of profit-motivated physicians out there that take advantage of desperate women who are just trying to feel better," she said. "Quite frankly, policing our own is a much bigger problem than ill-informed actresses dispensing advice. At the end of the day, Somers can say what she wants ... The onus is on us to ensure that our patients are given the correct recommendations and receive appropriate medical care."
It's an admirable point: Doctors should hold each other accountable. But Winfrey is an economy of scale onto herself. Her weekday show reaches millions of people, while each doctor can reach only one patient at a time. That could easily be corrected by Winfrey providing more thought and balance in her medical advice.