Why Did Doctors Keep Prescribing Cancer?

We’ve known about the role of estrogen in breast cancer going back to the 1800s, when surgical removal of the ovaries seemed to help in some cases. Ovaries were said to send out “mysterious” influences to the rest of the body, which were identified as estrogen in 1923. The medical profession jumped on this discovery and started injecting menopausal women by the thousands, and it was said that “[t]he ‘shot’ gives a ‘respectable’ hook on which to hang the visit to the doctor…” Soon, there were pills and patches, and medical journals like the Journal of the American Medical Association regaled doctors with ads I feature in my video How Did Doctors Not Know About the Risks of Hormone Therapy? on how they can “help the women to happiness by simply prescribing estrogen” and, “[w]hen women outlive their ovaries…,” there is Premarin.

As far back as the 1940s, concerns were raised that this practice might cause breast cancer, noting it would have been nice to figure this out before we started dosing women en masse. But breast cancer risk didn’t seem to matter as much, because heart disease was the number-one killer of women, reviews concluded, and because women taking hormones appeared to have lower heart attack rates, which would outweigh any additional breast cancer. However, women taking estrogen tended to be of a higher socioeconomic class, exercised more, and engaged in other healthy lifestyle changes like consuming more dietary fiber and getting their cholesterol checked. So, maybe that’s why women taking estrogen appeared to be protected from heart disease. Perhaps it had nothing to do with the drugs themselves. Despite the medical profession’s “enthusiasm for estrogen replacement therapy,” only a randomized clinical trial could really resolve this question. We would need to divide women into two groups, with half getting the hormones and half getting a placebo, and follow them out for a few years. There was no such study…until the 1990s, when the Women’s Health Initiative study was designed.

Wait a second. Why did it take the bulk of a century to decide to definitively study the safety of something prescribed to millions of women? Perhaps because there had never been a female director of the National Institutes of Health until then. “Just three weeks after being named NIH Director in 1991, [Bernadine Healy] went before Congress to announce, ‘We need a moon walk for women.’ That ‘moon walk’ took the form of the Women’s Health Initiative, the most definitive, far-reaching clinical trial of women’s health ever undertaken in the United States.”

The bombshell landed in summer 2002. There was so much more invasive breast cancer in the hormone users that they were forced to stop the study prematurely. What about heart disease? Wasn’t that supposed to balance things out? The women didn’t just have more breast cancer—they had more heart attacks, more strokes, and more blood clots to their lungs.

The news that women treated with hormone replacement therapy “experienced higher rates of breast cancer, cardiovascular disease, and overall harm has rocked women and physicians across the country.” Estrogen started out as the most prescribed drug in America before the study, but, after, the number of prescriptions dropped immediately and, within a year, so did the incidence of breast cancer in the United States.

The most important question about this story is why were we all so surprised? There had been “decades of repeated warnings” about the risks of cancer. In fact, the reason breast cancer patients had so much trouble suing the pharmaceutical company was that “the drugs have contained warning labels for decades.” And, with that disclosure, surely any reasonable physician would have included it in their risk and benefit discussions with their patients, right? It’s like the warning labels on packs of cigarettes. If you get lung cancer now, you should have known better. And, so, if you were on hormone replacement therapy and got breast cancer, don’t blame the drug company. They warned you about the risks, right there in the fine print.

Why didn’t more doctors warn their patients? Even after the study came out, millions of prescriptions continued to be dispensed. That’s a lot of cancer in our patients we caused, wrote one doctor. “How long will it take us to discard the financial gains, to admit that we are harming many of our patients, and to start changing our prescription habits?”

“Why did this practice continue in the face of mounting evidence of harm?” Well, it is a multibillion-dollar industry. “Despite an overwhelming amount of evidence to the contrary, many physicians still believe that estrogenic hormones have overall health benefits,” a “non-evidence-based perception [that] may be the result of decades of carefully orchestrated corporate influence on medical literature.” Indeed, “[d]ozens of ghostwritten reviews and commentaries published in medical journals and supplements were used to promote unproven benefits and downplay harms of menopausal hormone therapy…” PR companies were paid to write the articles that were then passed off as having been written by some expert.

What now? “Gynecologists must switch allegiance from eminence-based to evidence-based medicine.” In other words, they must consider what the science says and not just what some so-called expert says. It’s been said that the “current culture of gynecology encourages the dissemination of health advice based on advertising rather than science.”

“Women were placed in the way of harm by their physicians, who acted as unsuspecting patsies for the pharmaceutical companies.” If we really wanted to prevent heart attacks in women, simple lifestyle behaviors can eliminate more than 90 percent of heart attack risk. So, instead of being Big Pharma’s pawns, “recommending a healthful diet, increased exercise, and smoking cessation would truly benefit women’s health.”


The whole Premarin debacle speaks to the importance of putting purported therapies to the test (see, for example, Do Vitamin D Supplements Help with Diabetes, Weight Loss, and Blood Pressure?), as well as to the power of Big Pharma (Eliminating Conflicts of Interest in Medical Research), medical community collusion (American Medical Association Complicity with Big Tobacco), and my most series on mammograms.

What about Plant-Based Bioidentical Hormones and Soy Phytoestrogens for Menopause Hot Flashes? Check out the videos to find out.

In general, patients (and doctors) tend to wildly overestimate the efficacy of pills and procedures. See Why Prevention Is Worth a Ton of Cure and The Actual Benefit of Diet vs. Drugs.

Medical care, in general, may be the third leading cause of death in the United States. See How Doctors Responded to Being Named a Leading Killer.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Dishonest Doctors

One of the critical questions to ask whenever reading a medical journal article is, “Who funded the study?” In most journals, researchers are required to identify their sources of funding, so what’s the problem? Well, researchers can obscure the true origin of financial support: They can hide it, disguise it, or even launder the money through a front group. A case in point is a study downplaying the risks of lung cancer that was funded in part by the Foundation for Lung Cancer: Early Detection, Prevention, and Treatment. That doesn’t sound so bad until you realize it was underwritten by millions of dollars from a tobacco company. There’s no obligation to “disclose a funding source’s source of funding,” which allows “companies to evade financial disclosure requirements” and makes it harder to “follow the money trail.”

As I discuss in my video Disclosing Conflicts of Interest in Medical Research, why does the funding source matter? Every single one of eight reviews covering over a thousand studies found that research funded by industry is more likely to make conclusions that are favorable to industry. For example, why do some review articles on the health effects of secondhand smoke reach different conclusions than others? The only factor found was whether an author was affiliated with the tobacco industry. “This is a disturbing finding. It suggests that, far from conflict of interest being unimportant in the objective and pure world of science…it is the main factor determining the result of studies.”

Not that we’d even know, because 77 percent of authors failed to disclose the sources of funding. And that’s another problem: The responsibility to disclose funding sources is left entirely up to the authors. So, how many researchers divulge the truth? Evidently, a law was passed in Denmark requiring physicians to register any time they worked with industry, which allowed researchers to cross-reference the studies physicians published to see how honest they were. Forty-eight percent of the time, the conflicts of interest were not disclosed, “reinforc[ing] the perception that physicians simply don’t take conflict of interest seriously” (or at least Danish physicians don’t).

What about the United States? Historically, there had been “no means of confirmation or verification” when an American doctor said they had no conflict of interest. Then in 2007, hip and knee replacement companies were forced to pay hundreds of millions of dollars in fines for giving orthopedic surgeons illegal kickbacks. “[M]any orthopedic surgeons in [the] country made decisions predicated on how much money they could make—choosing which device to implant by going to the highest bidder….[W]e expect doctors to make decisions based on what is in the best interests of their patients,” said the Department of Justice’s U.S. Attorney of the District of New Jersey, “not the best interests of their bank accounts.” Part of the settlement was that the companies would have to make public all the payments they made to physicians. The release of those records offered a rare opportunity to see if physicians were telling the truth on disclosure forms. And, lo and behold, more than half of payments were not disclosed, totalling millions of dollars.

That was for surgeons and medical device companies. What about doctors and drug companies? The same thing happened: Drug companies were forced to disclose who they were paying off. In looking at the publications of the doctors who got the most money—at least $100,000—the study found that they were worse than the surgeons. In 69 percent of the cases, they failed to disclose their industry ties. The problem is that we just assume researchers are going to be honest and tell the truth, but these “findings suggest that the accuracy and completeness of [conflict-of-interest] disclosures cannot be assumed.” So, even when a paper says no conflict of interest, who knows if it’s really true.

A long-time editor-in-chief of the New England Journal of Medicine wrote a scathing piece on drug companies and doctors who failed to disclose hundreds of thousands of dollars from drug companies like GlaxoSmithKline, which has been fined literally billions of dollars for activities such as bribing and suppressing data. When GSK got results that were “commercially unacceptable,” the company just buried them. Billions of dollars in fines get assessed, but for drug companies, that may just be the cost of doing business. “As reprehensible as many [drug] industry practices are…much of the medical profession is even more culpable.” We can expect drug companies to prioritize the bottom line, but maybe we should expect more from the healing profession.


What else might your doctor not be telling you? See:

Good examples of conflicts of interest include:

Instead of just disclosing conflicts of interest, how about getting rid of them? That’s the subject of my video Eliminating Conflicts of Interest in Medical Research.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Dialing Down the Grim Reaper Gene

Only about 1 in 10,000 people live to be a 100 years old. What’s their secret? I discuss this in my video Animal Protein Compared to Cigarette Smoking.

In 1993, a major breakthrough in longevity research was published about a single genetic mutation that doubled the lifespan of a tiny roundworm. Instead of all worms being dead by 30 days, the mutants lived 60 days or longer. This lifespan extension was “the largest yet reported in any organism.” This methuselah worm, a “medical marvel,” is “the equivalent of a healthy 200-year-old human.” All because of a single mutation? That shouldn’t happen. Presumably, aging is caused by multiple processes, affected by many genes. How could knocking out a single gene double lifespan?

What is this aging gene—a gene that so speeds up aging that if it’s knocked out, the animals live twice as long? It’s been called the Grim Reaper gene and is the worm equivalent of the human insulin-like growth factor 1 (IGF-1) receptor. Mutations of that same receptor in humans may help explain why some people live to be a hundred and other people don’t.

So, is it just the luck of the draw whether we got good genes or bad ones? No, we can turn on and off the expression of these genes, depending on what we eat. Years ago I profiled a remarkable series of experiments about IGF-1, a cancer-promoting growth hormone released in excess amounts by our liver when we eat animal protein. Men and women who don’t eat meat, egg white, or dairy proteins have significantly lower levels of IGF-1 circulating within their bodies, and switching people to a plant-based diet can significantly lower IGF-1 levels within just 11 days, markedly improving the ability of women’s bloodstreams to suppress breast cancer cell growth and then kill off breast cancer cells.

Similarly, the blood serum of men on a plant-based diet suppresses prostate cancer cell growth about eight times better than before they changed their diet. However, this dramatic improvement in cancer defenses is abolished if just the amount of IGF-1 banished from their systems as a result of eating and living healthier is added back. This is one way to explain the low rates of cancer among plant-based populations: The drop in animal protein intake leads to a drop in IGF-1, which in turn leads to a drop in cancer growth. The effect is so powerful that Dr. Dean Ornish and colleagues appeared to be able to reverse the progression of early-stage prostate cancer without chemotherapy, surgery, or radiation—just a plant-based diet and lifestyle program.

When we’re kids, we need growth hormones to grow. There’s a rare genetic defect that causes severe IGF-1 deficiency, leading to a type of dwarfism. It also apparently makes you effectively cancer-proof. A study reported not a single death from cancer in about 100 individuals with IGF-1 deficiency. What about 200 individuals? None developed cancer. Most malignant tumors are covered in IGF-1 receptors, but if there’s no IGF-1 around, they may not be able to grow and spread.

This may help explain why lives appear to be cut short by eating low-carb diets. It’s not just any low-carb diet, though. Specifically, low-carb diets based on animal sources appear to be the problem, whereas vegetable-based low-carb diets were associated with a lower risk of death. But low-carb diets are high in animal fat as well as animal protein, so how do we know the saturated animal fat wasn’t killing off people and it had nothing to do with the protein? What we need is a study that follows a few thousand people and their protein intakes for 20 years or so, and sees who lives longest, who gets cancer, and who doesn’t. But, there had never been a study like that…until now.

Six thousand men and women over age 50 from across the United States were followed for 18 years, and those under age 65 with high protein intakes had a 75 percent increase in overall mortality and a fourfold increase in the risk of dying from cancer. Does it matter what type of protein? Yes. “These associations were either abolished or attenuated if the proteins were plant derived,” which makes sense given the higher IGF-1 levels in those eating excess protein.

The sponsoring university sent out a press release with a memorable opening line: “That chicken wing you’re eating could be as deadly as a cigarette.” It explained that “eating a diet rich in animal proteins during middle age makes you four times more likely to die of cancer than someone with a low-protein diet—a mortality risk factor comparable to smoking.” And when they say “low-protein diet,” what they actually mean is getting the recommended amount of protein.

“Almost everyone is going to have a cancer cell or pre-cancer cell in them at some point. The question is: Does it progress?” said one of the lead researchers. That may depend on what we eat.

“[T]he question is not whether a certain diet allows you to do well for three days,” a researcher noted, “but can it help you survive to be 100?” Excessive protein consumption isn’t only “linked to a dramatic rise in cancer mortality, but middle-aged people who eat lots of proteins from animal sources…are also more susceptible to early death in general.” Crucially, the same didn’t apply to plant proteins like beans, and it wasn’t the fat; the animal protein appeared to be the culprit.

What was the response to the revelation that diets high in meat, eggs, and dairy could be as harmful to health as smoking? One nutrition scientist replied that it was potentially dangerous because it could “damage the effectiveness of important public health messages.” Why? Because a smoker might think “why bother quitting smoking if my cheese and ham sandwich is just as bad for me?”

This reminds me of a famous Philip Morris cigarette ad that tried to downplay the risks of smoking by saying that if we think second-hand smoke is bad, increasing the risk of lung cancer 19 percent, drinking one or two glasses of milk every day may be three times as bad with a 62 percent higher risk of lung cancer. What’s more, doubling the risk is frequently cooking with oil, tripling our risk of heart disease is eating non-vegetarian, and multiplying our risk six-fold is eating lots of meat and dairy. So, they conclude, “Let’s keep a sense of perspective.” The ad goes on to say that the risk of cancer from second-hand smoke may be “well below the risk reported…for many everyday items and activities.” So, breathe deep!

That’s like saying we shouldn’t worry about getting stabbed because getting shot is so much worse. Or, if we don’t wear seatbelts, we might as well have unprotected sex. If we go bungee jumping, we might as well disconnect our smoke alarms at home. Two risks don’t make a right.

Of course, you’ll note Philip Morris stopped throwing dairy under the bus once they purchased Kraft Foods.


The IGF-1 story is so pivotal that it’s one of the first video series I ever produced for NutritionFacts.org. I’m so glad I was able to release this long-awaited update. If you want a blast from the past, watch the original series starting with Engineering a Cure.

For more parallels between the tobacco industry and the food industry, see:

What about the mobile phone industry? Does Cell Phone Radiation Cause Cancer?

For more on healthy aging and longevity, see:

It’s important to note the so-called low protein intake is actually the recommended protein intake, which is associated with a major reduction in cancer and overall mortality in middle age, under age 65. But did you notice that it says not among older individuals? All of this is covered in my video Increasing Protein Intake After Age 65.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: