Bioidentical Hormones - U.S. Senate Special Committee on Aging

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RISKS AND BENEFITS OF ESTROGEN PLUS PROGESTIN 167 ment recommnendations for healthy post- Author Coetetbotf ... DrAnderon,. a menopausal -ponopal sity, Chieogn/E.nenton, women It: and with Robedt Wafoace, an Uni- intact iervesgotor of tre Worrrrn Conrdiating Health Initiatnve Center. hudsU Chinscal arenssto versty of the Iowa. datate. I-w the City/Daerrpsl Sian. toquEs Progarr R. Ilssom Of. Nationa f-ear, uterus. Lung, and This trial did not address the stdyand tahesr-ponbdity on thteintegrity of fte short-termi Blond Instf~t.te risks and Clinical C~oodinasrg benefits of Center hor An- dots sod rte accurac of rthe data anlyses Study conept dt Z. LoC.on. and denigo, noon RosIonun E, Pattersn, Anderson, and Ros L. Prentice, fed H.isuctin mones Cance givenfor Reserrh the Cente treasmentrofsneno- Prentan. Data and Safety Muontltorte Based: Janet Wittls pausal nymptoms. On she basis ofHlERS Acquislitio .I of data: Kooperbntg Anderson Preotire, Stnfasrrck, LaCrais, tack-n, tcftelr BeresO.d. Eugtene Howad. 8surood, cry Margaret Cohten. EUleahei Chenern Barrtt-Connr, Hasand other secondary prevention trials, Doid Detoets. Jolhmarn Kotchen, Ocleve. ten Darn. fohanna Dwyer, Robert P. Heantey, Victo the American Heart Association recoin- Analynis and inierpretatn ofdata mended RossuorcAndeaginst iniiating fisimen Vogei, L.eRoy Waiter, oe, Pr-nnor sod toter, IaCr-c4 YVusuf mendedagaint Ropebkeg,tStefanck,lJadnson. snitaltri postteno- Drafting or Pond1eglSatpprt the waecipt Rsoa.Anderse, The Bahonal Blond Heat.t lnstitstn Lung, funds the and WHI program. Wyethpausal hormones for the secondary pre- Prenice t Ayrrt lR-notcs p-ouded tine study mednacn tavcntio cadiovasular ventin ofcrdiovscul, of disase."The dsease. The Critcal inlfertoa reviooo cntent: of the R.sso-, --aonyf for Andersor. inportant in- LaCrnis. tIne and ptocebhuf American Acbr-otdgrreti Hearts Associ.ation The WIl Steeleong made Coireittee no t iKooyedsrtg. Stefani ck. alsn, aerenfonn, Homad, goate~fucknonstedge the dednatd ryfon of firm the recommendation for prsmary pre- Johnson, Koscien. Oskeon. Staiissica WHI penyetise poticiponti Andersn. and Prentice, of key WHI- Coopeincrstget-r staff and venison while awaiting the at results the danicul from rnter berg aind the Clinical Coodinat- mg Center A fat Itoting of the W951 roresgaros ai randomized clinical trials such as WHII, Obtained funding, Ronsoon. Andersn, Prentic,, be fsoond at htrypc/cesw- hi.nrg and stated that contunuauion of she treat- St1fanok, beresfond, Ho.ard, Adnrantrac. Ktother. tcisnial, Ockern or watevel supptn Ron- ___________________ mini should be considered on the ba- snre And-ror, Pretice. L.Criora, loopenberg. REPO~aPCs sss of established noncoronarv benefists Stefanick. iocksn, tiresford, Howad, lohns..n, 1. The corcten, W -nsensHealth Ockene. Initiaftiv Stedy Crony D.- and risks, possibhle coronary beneftss and Studs sopewmion R-ossu, Anderon, loCroin sign of tine Wo-nen Healt Inittonn canica teial and risks, and patient preference. Stefa-icti, Jackso, Oeresfod, Howard, sohnso obeco1 nl tdr1otolCi Results ros9sat from XVrHI indicate that the Ktotcn "Orline. 1. O nf9 MCIl .E~e p-~ combbsned postmsneoopuLhomne .Stefonoc Ictrint. Stanfond Center, for pausal hor fRech in th-rpyiandcnrnay namones eton hseatdoresn. Safod aq-athtuWn nnrit. a- eono CEE, . 0.625 sensnent mg/d, of plus the MPA, rdenpid 2.5 olo mg/d, evidenc Di.- Pre P-enonStanfnlUniiwtC Sled eb 1 a. Gray9,91 een20 Pti47fet63ooon should not be inuiiated orcontinued for i. AMen. Unioerstyofshtcnoin, foodisn: A-snifrs therain te preent di..os and profog life in p05 t the primary . prevenrison of CH D. In ad- B. Assf, B-na Urronityr. Providenc, RI: Tomn meoasa .oeren Ann tneter Med. 1992;1 17: dision, the substanstial risks for cardio- Bi.My A LAhresyforAc owTcfiinsr Cowe ReSN itti7 vascular disease and breaost cancer must serh Center, Henry gOan. RosinPrebyterian-St fAc Rfpin A.t-. vn e SndrAn RfOf f be wesgbed agatinst she benefit for frac- Lokes hfndicol Unesi-dy Cente,. Choago,.I. of Nevda, Seem fitRbert Gregoy BrOn, L. r. Bathe. trerayonseraniphtsandhyioprncerns Wake, untan. 1990;t2:2s9-2os. -Are - Ma4 sure sin selectisng from she available baret Itorcerty Schoof of Medicine, Winston. 5. Adam MR. ogents Ktaplan so prevent Jo. Manisc St. osteoporosis. et al1 lohihi- Deere, NC, Mtle Caun, Kan-rP-intanefewisn sonfso-enoyarterythrruscle-osbys7-ketaer- W of Ilenhni. Oaklnd, Calif; Roma T. Chlebnnmst, trastlo in vanectomend monkeys: fork ot an effert Wrikeg Grap foe the Wnmos.W Reaso eassass.na. Harinu-UCLA Researh nod Educatin Institte, To- of added -etigutprogestron. orn aqun Arteroncleris_ F.RuoM 1990.10. rB MD. N- roe ColA, Dard Curb, 0 Unmeor"a of Hama, Ho- 10s1-to57. It cf.W. nd ore,., Iliosncrra w ---,ttrys- w,.ia~~ Ga-ns iCin~u, L. Audrrs, PhD, Ca,- B. Bas 1. Prentie, PhD. Werss An-. NS. cinn Ore CL, . Ohio. .B fad Jennifer ifH. Wd4ant Hays. AB, Baylor Wahng Collge dm of JR Derneaud risk of fratoMs uf Z. LaCena., PhD, and Ch 'K-lopbekeg, tine PhD. hip and Medokire, lower Houton. Tev, Gerrd Hel~s. Un-osty FIn~dnatdron-Cac-ueeR of Iorroerovn pstnenop..asa sh Cenmer Seattle, -n Wash ofetg-nt Nnstir NFoci Caoia a 1fc ;s Susa Hendro, Mama Wayne L. stfnckk I Med. PhD l9oScasn31195-1198. St-nor Unoeroty Cncl State Snroerdy, School of Medklne/Htaef Honystal CenoterStantntd. 7. Genat Cald, HKc. RreccaD Bylink lavso.unoMD Di. Gallagher )C, hro Ham Detroit. ST, Win,h Borbara V. Ho-cad, State MedStar Unootnty Re- Clinica Steig,,rfPHerbersn. Center. CoabS:htiid ffenr ofestnenesafateonnp-rt- A. neahi lointid, Wonhivofon, DC; ladion Hssa, Georg e rropuosa hone A. los. Be-eford, cusses Cynecol PhD, Fred HaclorN 1990:7k: Carm esarh Woshrgten Lln-fty, Wavyhrgtoo, Cevim, DC, F- Seaftil, dl~er Nb- Wash. Baiboar 579 t5B4. Hoadi. e bt Uwenityrof Star Reveurci Caliloria, Institate, loome ufntnDR Orange KooC. S. Steinihng inhono, on arhker unronstyof taSSitinSi, Tennese, eta. Memphis; Amt-U Hnoard airhyn nthe effert ofestroen MDkso ,M. piacmnntrhrrapy MPH, Uonesl ofToeseMo. add. U.Niersty of Catevorar, Los Aigde,;s sane 510- on Bhe rkobfn ph brass caer. JAMA. n591,2655r9B5. th lasefdodey fKatchenMOMD. duogutl. fy Xitrcnen, Medical Coflege -ono, Miknaake,l.dth of Wucon~n, Mlifoo- OchrhDinut 1990. kt en; Le--n curler, tiN-vrityof Pittsburgh, M.ncactraei Pitts. 9. Gerhordonde Medical atos. VM, Lnndn orese S. BeprIdaciesarbargh, Pa, Oortfrj Lane, State Unicrsdyuof Financf5 NrscYok Dislosr.tor, DInaCnn. eugeno-a in femle oi-vestigafo hnormons and ot Stony cuinrecta Brok: tben D. Langt, UvNurty of Caii- cance by safote Cane on)2 Caunes ossnop-ces Cuntro 19923:3 .stahssparatly forded by Merk freon, Sue Diego. Lasftia/Choia and Ptarr Vita; Dr tacm Norma L-nse, 359-3600 in an inesingutor on I ostn- Lrcorroy nf Medicine and ON~tisfr of New por-ss iersy. stdy funded It, HidIny by Mend S. Grady and D, 1 hormone Basin T. et 01. Ra.nizevad stady N-madi Co.s tina E. Lends~, univrsty of Alabam at Bitun libidninmncen of estrgen PInsfandndtby progesin rntrr for & sernday GamtlrPlu.p-eentiur wnmgtiam Munran Liacher, Unroersty of Flordd. -aeuticak nf cnocray hrartdis.eosin postnenpaasIomv GoneAenuiytobsoes Foe ).A.n Camespod-e Maono,. Begkm lacquer end F. aAMA. R..-.am t99820,605 Macho, i-St13. Wames Hmprtal, Hror Medial Schoblof,Boson. MD, 11. OiMo Godstem of F, W-mns~ Mansoni, Healon Stample Irotiavie, orf. Pustineen- National Ma..: gore &argo. Uninrcrsdof Mnneuto. Hear. Mo- Lang, pos.frirnh and Binod Insttt.W r us and 0705 seconday BRkfdedge pitevnb.o Dr. aiof -epnsis: ldith Ockene. univerity of Musach- nary One ecnnt Rockiedgo in the Nurse Ctr Healon tote 300, Stady MSrl966, dun intern Bethsda setis Medal School, Woceste, MD May Jo 20017 O'SRivtmn, e -ma Med. rsou 2001.t35s-B. .ih~gonf Gamnes i. U.Ninoy ofcaioLMi. eami. Pla; Lor-ence Andero, Philips, PhD , DMssno 12, orAndeig&,P.NesvyLKHnflk.mpAS~e.rti.lin of Pablir ealthr Soenoeve Fred E.ma ry-ior ty, Agantm Ga; Cheryf Ritenbaugh. Hutchin-o Ka- Cancer cation Reseach of hormone Center, replacement f tODO Fii-aer therapy .er after Peoannte ouut Center nI. Health Ace- Reseowi N, MP-1002, Port- nyicndiW PO tnn 19020, infarction Seattle, is assossted WA mite land. woe Ors~uiiohnobmn. cadiac UnreNity of Cateonia, Dau. evnts dutng foow Wino9 up. J2dm 10204e~o Coil Candlot goevetoroin 2001; orgl. Sacannto ORprlnt: Rober WHI Schehenk, Chrnrco University Coordinatung of Tecas Centon., 3B Divc 1-7. Healtitorcr Centor, SandAniteaoyfciaWasnertrdnnon of Pablic '10. Heelth Heckbert Sv~en-e, Son Koplin Fred RC, Hosihinso W~ins NS, Con et - 01~ R~ik tote, of Albert cinstei Coadege of Medicidne. cer Blows, Researc recrrnt Contnc, cornary f tO Pairiem -rol Ace in relui.ton N, teoc and r- MP- NYr: M-mrn rreUno, State Unruersy uf New rek 1002, cnt PO ivihoatino sac 19024. of pnstnenpa...aM Seattlr, WA 9B109-f hurrvne 020. therapy at Baiafl.; Linda Van H.n, BNotinwet-r Uneren. dmint It Med 2001,101:17W9 1173. us2 JAAw.ylal 7i, 2002-SVcl200.14.Sn3(fRyinote 02if02 Aoserics Medical Asnir itun. Asll righf csrevr ed_ DDw loa de d frm. u-s cm nat -- at Notional l steirr c HIh, A on Apri 1 6. 2007
168 RISKS AND BENEFITS OF ESTROGEN PLUS PROGESTIN 14. Grodsten F. Mrtson JE, Colditz GAA Wi/St WC, 25. Grady D. Herrngton D. Bitter V. et a, for the 34. SIhalter C. Luhbn J. Trla R. Sturgeon S. 8ritonW Speneer FE. St.epfer MJ. A prnpectre. obserna- HERS Reesarnfh Group. Cardunaouolur diusW out- L. Homler R. Menopausal estrogen and entgention study of paeerpaosal hano-on thferopy rod cone di6hrti8 yers of hnomniebrorpy- Heat and prosgti.repyetent tepy nd brertu uarcernuk. pim-ry preenter of rardbuasular disease AnnM. Ersroen/progestl Ropiacenent Study Ellow.up JAMA. 2/001023 485.491 ten Med. 2000:133:933-941. (HERS I1) JAMA. 2002.288:49-57. 35. Ross PK. PanhnHi HA, W. PC. Pke MC. Effect 15. The Wrntrg Group forI the PEP TrW Effects of 26. Smon A. Hul. Caleyn A. et a. Po-tmeno- of hr-on pereplarenttherapyor breast cancer k: ho..onerpdacenrent therpy no erndmetra hiStoo- pausal hrn thepy e and i f stke th Heart engeronus estog ph. progeshe. J N&af Cnogy In poetneeopaasal woen: the Pnstrnnso ard EstrogAn -ptogSen Replaceent Study (HERS). rt itL 2000.92:328 332. po.usal Errogen/Pros0n. ntetseno tPEPillTteal. Ciratr 2001.103:638-642. 36. Coldit GA. Hnkison SE, Hter D), et a. The JAMA. 1996;275370-375. 27. V-uor CM, B. LM Keern N, Sorrel PM So- urof etrgens and proge-tor and tre ikofrbrast 16. tNe DG. Fitrpnatk ALt BiMd DE. et at SurMit isea S. Hoenit. Rf. A linroul trial of astrngen. rcr-in postrrreoaamr.EnglJMed. 1995. ostertainmrotntotdinoodscoloresntr -nerefand the replcement therapy after irhenri stroke. N Engf J 332:1589-1593. Cardiosrsculur HealthStudy. An Fridnnco( 1995; Med. 2001345:1243-1249. 37. MgnourotC, Baro M C) ortEN, BergsbomR, 5:275-285. 28. Hodis HN. Mack WJ. Lob.RA, at. B.Estrogen in Admi H-0, Peruron .I1. Breant-cerinskfolfolndg 17. Con DR. RMgmoon Ort-alyss and life tables. J R the pr.eentlon of atherosclroois a randomired, long.-tenr rstrogen and nestrogen-progesttn Slat Stx 1972;34:187 220d d- blnd rorrbolted tetl. Ann tItem Med. 2001; repacement therapy. Itl Cancer 1999-81:339- 18. O rlen PC, Fleeing RT. A mldtple testng pro- 135S39-953. 344. cedre for dinita Mal btiometrice. 1979:35:549- 29. Arngem P. Stot S, Kothry W Smerft P. ron 38 Greendab GA. Rebheorin 8A, Sle A. et ad Effesr 556 Sdurky C. Effed of o.a pmobenn2pisat hormnne of estrogen and estroger-progetin on raror- 19. Feedmrn LS, Andersor G, Kipni V, t d. Ap- repLrent on progresuton of athnrosdoeis: a n. graphk pareechymot delity. AMtn totem Med. 1999: proacfeu to moritoong the reiults of org-term dt- domedzmnveedtrW AlnnnrosfermTh,- iV-SWo, 130:262-269. eaSa pre-erton spat: no.Ptles hom the Womrens 207l1;21:262-26d. 39. Gmdtein F. Nnenmb PA, Stlmpfer Ml. Pot. Heaith lortwuen Control C/n Trils. 1996517:509- 30. Castefsgar ), Petre Gortham S. G-ri. Rod. moenopousil homrn e therapy and tie ik of coIn- 525. ngoa LA. Recent epidriologcd studes of the a- rectal -anuer are-le and me-anolysoi. A. lMed 20. Gail MH. Bnrto- LA. Byat DF. et at. Proeutng snttiohbetrcenn fononnreptcmenmttherapy nd 1999,106.574-582. Heruiduared probebilithesof deeloping bremtstcan reno s nthmoerbhofm a reroec.n Dg Sa.I 1998 40. hi1eS MR. MeadeTh. Wile SC. Hmnre rctor f hitn f-NakIs whore being eaaOned anna- 18:117-123. placemnt therappynda cedo-ascidardoearr. the caus ay Nal Cancer est 1989:91:1879-1886. 31. Grdy D, Weeer NK. HemngtonD et0 a . Post- heorndorred ettoled ha. Cr Found Symp. 21. Pitue 0. Catlun AM. LerJ. IEstrogenre- reropustJ heotone thertpy incasesrisk tare- 1995.191:150-160. ptac ent theriapy: defenonants of persutroce roth roos tnrorboernolkrtd-eera the Heart tnd Esgenl 41. Torgeprn Dl, EI-Seyer SE. Homooe replacetreatment Ooset GYeNyO-. 200t197:97-100. pmgestrr RepaeetSt/udyyAnn In/ter Mee. 2000: ment therapy and pre-eobtn of nonnerteorna harc- 22. WrtgGroup for the PEP Toil Efects of etra- 132:689-696. rre-: a meto-anoysir of raodoroktd thils. lAMA. gen or retorpnlprogestin "m m-s on hetd di..e 32. Col.bativoeGr -ponHmnrca Fartsirres it 2001.285:2891-2897. rrk futorsonpost-qinoaulm.s onrn lAMtA.1995. Cancer reat cancer and hormoe reptucement 42. Writg Group for the PEPI Tnil. Effects of 273 199-200. therapy:colhborat reanarlysIs of data fro 51 epa- honone therapy on bone mineral dueity: results 23. HeerklgtnDM. RebusooDM. r8rarhunKB.etM d ierobgiWoltradiecofS2.7J5 -er o thrbeea t/n- from the Posteenop.uoal Estrogen/Progestin at. Efects of esbogen replacement on the progres- ce rnd 10 .411 roonent with.ut b-rstrarort ta-n Inteesentons (PEPI) Trul. )AMA. t99627S5l36dskn of remoury rteryathr-snlerois. N EnglMed. cet. 1997,3S0.1047-1OS9. 1396 2000:343:522-529. 33. Huelty S, Furberg C. BRaett-Coeno E. et a, for 43. Mnsca L. Cot/ms P, Henhgton DM. et /a Ho- 24. Srhulan SP. Thieman DR. Oyang P. et al. EE- the HERS Rfeearrh Group. Noncardiooaruulr dis- moon replacenst therapy and cidbousracuh disfectt of oa-te hroone therapy on rcurrent isWhe- eas outAones dunng 6.8 year of hnomroe therpy: - ase atent t hr heuhthcae prfesrorut lio the ula in poterenopuasal 0meo wdh -nst.We un- Hearsand Eroenlprobgestt RqaycmrtStudy oF- American Heart As.ution. Crrruturin. 2001,104: gir I Am Coll Cardinl 2002.39:231-237. bw-up (HERS I1). JAWM. 2002;288:58-6. 499-503. 02002 Amiri-r etdi,,al Afrmsiote AU rights roseroed. tReorted) lAMA. July 17. 2002-Vol 2883 No. 3 333 Dotloaded fum cnrj~ba-.rom at Natlonat Iorituct of Hldh. on April 16,2007
Page 1 and 2:
S. HRG. 110-129 Bioidentica
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CONTENTS Page Opening Statement of
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2 The sale of bioidentical hormone
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4 ever, as Dr. Wartofsky points out
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6 with every stage of the disease:
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8 I am pleased to appear before thi
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10 When the trials began, many rese
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Women who began treatment more than
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14 One small trial using oral estra
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16 FDA is aware that a growing numb
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18 DEPARTMENT OF HEALTH & HUMAN SER
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20 safety and efficacy. However, as
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22 adulteration and misbranding pro
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24 The 2002 CPG reflects FDA's curr
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26 Equally concerning are claims by
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28 concerned about the use and mark
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30 Part I: Materials and Partnershi
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32 drugs, when the compounding of t
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34 Our staff identified 34 Web site
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1. Introduction 36 Chairman Kohl, R
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diet and fitness products. 5 For ex
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include "natural" progesterone crea
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42 unique to the computer age, such
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computer users to spam(ftuce.0ov -
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46 accuracy of advertising for heal
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48 Now, you have identified in your
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50 claim." Therefore, since the ter
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52 Such quality control problems ha
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54 Statement Before the U.S. <stron
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in the U.S., whereas WHI participan
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58 between science and hearsay and
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60 How can we determine whether bio
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62 doctors-are not getting the obje
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64 27. Writing Group for the PEPI T
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66 Dr. MANSON. Well, I think that m
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68 Statement of Leonard Wartofsky,
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70 in the WHI. In fact, no study as
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In summary, the Endocrine Society i
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74 The FDA also regulates aspects o
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Statement of Loyd V. Allen, Jr., Ph
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Page 83 and 84:
Page 85 and 86:
82 Senator SMITH. Dr. Allen, as I h
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84 Now, when you are talking about
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86 The only thing the WHI proved wa
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88 Testimony Of T.S. Wiley before t
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Confusion and Media Hype 90 Instead
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92 see a doctor tell a diabetic nea
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94 the only compelling reason to ta
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96 identical hormones synthesized f
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98 The world as we know it, from ba
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100 thereby experienced long period
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102 Bio-identical progesterone repl
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104 had reached optimum theoretical
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106 and the patient can be can reas
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108 Estradiol and Analytical Resear
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110 A controlled systematic pilot c
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112 of set doses. The Wiley Protoco
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114 I'd advocate for either Accredi
Page 119 and 120: 116 D.C., and established a goal to
Page 121 and 122: 118 If this legislation passes, fed
Page 123 and 124: first and second finger on the barr
Page 125 and 126: 122 These products that have been s
Page 127 and 128: 124 Bcl-2, survivin and variant CD4
Page 129 and 130: 126 These are experiments by other
Page 131 and 132: 128 cerebro-cellular inflammation c
Page 133 and 134: 130 Years # women *1>0.5 8 *1+ 9 *2
Page 135 and 136: *Breast cancer 132 -57 y.o. recurre
Page 137 and 138: 134 *Labor intense for patient and
Page 139 and 140: 136 Senator SMITH. Thank you very m
Page 141 and 142: 138 makes these hormones uniquely s
Page 143 and 144: 140 tomize the Wiley Protocol by ra
Page 145 and 146: 142 "natural," because all lead to
Page 147 and 148: 144 maceutical commerce, often with
Page 149 and 150: 146 WHITE PAPER #1 DID YOU KNOW THA
Page 151 and 152: 148 WHITE PAPER #2 Pharmacy Compoun
Page 153 and 154: 150 bleeding of the bowel, locate t
Page 155 and 156: 152 compounding standards can be en
Page 157 and 158: 154 I. The FDA's definition of a "N
Page 159 and 160: 156 ORIIGINAL CONTrMIBTION JANMA-EX
Page 161 and 162: Initially, the design allowed women
Page 163 and 164: ards analyses," stratified by clini
Page 165 and 166: year). These 'drop-in" rates were a
Page 167 and 168: years of prior use, 11 vs 2; HR, 4.
Page 169: trogen plus progestin exposure. Clo
Page 173 and 174: EFFECTS OF POSTMENOPAUSAL ESTIROGEN
Page 175 and 176: EFFECTS OF POSTMENOPAUSAL ESTROGEN
Page 179 and 180: pEyECTS OF POSTMENOPAUSAL ESTROGEN
Page 185 and 186: 10000 isoor i I ea '° a wan 20-24
Page 187 and 188: ~SDt~rpa g~2~Q ~ !~fm~. b~e ~ ng jh
Page 189 and 190: Is associated with an Increased ris
Page 191 and 192: 188 Postmenopausal hormone therapy
Page 193 and 194: group (P= 04001), and In this subgr
Page 195 and 196: Treatmnent recommendations Based on
Page 197 and 198: 21.Grodsteln F. Manson JE, Colditz
Page 199 and 200: _ ORWIGNAL CONTIuBUTION 196 Postmen
Page 201 and 202: showed no striking differences in H
Page 203 and 204: (214 cases; P for trend=.72): howev
Page 205 and 206: 202 HORMONE THERAPY USE AND RISK OF
Page 207 and 208: mal studies, and laboratory studies
Page 213 and 214: 210 ,lmcCII na: CLI I tr: tarty ver
Page 215 and 216: 212 ,mucmai rimi &ronos farty bstro
Page 217 and 218: 214 LntIucwu miau: rronos nary estr
Page 219 and 220: XVI. PNharmacy Licensure Requiremen
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XVI. Pharmacy Licensure Requirement
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220 Roster of Board of Pharmacy Ece
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050. 0l7404405400 Al-h. PeVbU 03283
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Conclusions * Age is a powerful ris
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Women's Health Initiative Trials of
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Hormone Therapy after WHI * Change
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Statement of the American Pharmacis
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232 APhA Statement to the S
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
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240 Written Testimony of Steven F.
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242 STATEMENT OF DAVID G. ADAMS On
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244 Report on State Laws and Regula
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246 Only one state, Utah, requires
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248 5. Compounding Copies of FDA-Ap
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Bioidentical Hormones - U.S. Senate Special Committee on Aging

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