Dr. Peter Attia

Now, people who listen to this podcast are well aware of how critical I am of epidemiology, and it's certainly very easy to make the case that in the 1980s, women who were taking hormones had a healthy user bias.

Now, people who listen to this podcast are well aware of how critical I am of epidemiology, and it's certainly very easy to make the case that in the 1980s, women who were taking hormones had a healthy user bias.

These are women that probably had better access to healthcare, they were probably more health conscious, and as a result, they were probably doing many more things to improve the quality of their health. The NIH did something that I think made a lot of sense. It was the right thing to do, which was they said, look, we can't rely on this epidemiology. We need to do a randomized control trial.

These are women that probably had better access to healthcare, they were probably more health conscious, and as a result, they were probably doing many more things to improve the quality of their health. The NIH did something that I think made a lot of sense. It was the right thing to do, which was they said, look, we can't rely on this epidemiology. We need to do a randomized control trial.

And they did it through something called the Women's Health Initiative, which had two components, a nutritional component that was asking a question about low-fat diets, and then a component that was looking at the HRT.

And they did it through something called the Women's Health Initiative, which had two components, a nutritional component that was asking a question about low-fat diets, and then a component that was looking at the HRT.

Would you like to pick up the story as to how the study was designed, maybe talk about some of the potential pitfalls of it, and ultimately how the results of that have been misunderstood and misinterpreted for so long?

Would you like to pick up the story as to how the study was designed, maybe talk about some of the potential pitfalls of it, and ultimately how the results of that have been misunderstood and misinterpreted for so long?

So, Rachel, I don't know how good you are at sensing a person's blood pressure from across the room, but if you were able to sort of project your vision into my carotid artery... I see it bulging. Yeah, you'd notice that my blood pressure is up. I'm probably at 180 over 120 right now. First off, I think that was a remarkable, succinct summation of the WHI.

So, Rachel, I don't know how good you are at sensing a person's blood pressure from across the room, but if you were able to sort of project your vision into my carotid artery... I see it bulging. Yeah, you'd notice that my blood pressure is up. I'm probably at 180 over 120 right now. First off, I think that was a remarkable, succinct summation of the WHI.

I'm only going to repeat a few things, not because I didn't think you did a great job. You did. But because sometimes hearing it twice highlights the egregiousness of this study.

I'm only going to repeat a few things, not because I didn't think you did a great job. You did. But because sometimes hearing it twice highlights the egregiousness of this study.

Truthfully, I have friends, female friends, and I have patients who to this day are paranoid about hormones, and I just want to offer yet another opportunity for them to sort of understand what's going on. So this was a study that had two parallel arms, one where women without a uterus were just randomized to either this synthetic or equine-based estrogen or

Truthfully, I have friends, female friends, and I have patients who to this day are paranoid about hormones, and I just want to offer yet another opportunity for them to sort of understand what's going on. So this was a study that had two parallel arms, one where women without a uterus were just randomized to either this synthetic or equine-based estrogen or

versus a placebo, and then one where if you had a uterus, you got MPA, a synthetic progesterone, and the estrogen. As you pointed out, the elephant in the room here, the one finding that got all of the attention was that in the women with uterus group, If you got the synthetic progestin and estrogen, you had an increase in your incidence of breast cancer.

versus a placebo, and then one where if you had a uterus, you got MPA, a synthetic progesterone, and the estrogen. As you pointed out, the elephant in the room here, the one finding that got all of the attention was that in the women with uterus group, If you got the synthetic progestin and estrogen, you had an increase in your incidence of breast cancer.

It turned out it didn't actually lead to any change in mortality from breast cancer, but there was an increase in the incidence. The number is really scary if it's given in relative terms. It was a 24% increase in the incidence. Incidence, for the listener, meaning getting breast cancer. You had a 24% higher chance of getting breast cancer if you took the two hormones.

It turned out it didn't actually lead to any change in mortality from breast cancer, but there was an increase in the incidence. The number is really scary if it's given in relative terms. It was a 24% increase in the incidence. Incidence, for the listener, meaning getting breast cancer. You had a 24% higher chance of getting breast cancer if you took the two hormones.

On the surface, that sounds devastating, but again, as people who listen to this podcast know, we always need to think in terms of absolute risk. And relative risk doesn't mean that much if you don't understand absolute risk.

On the surface, that sounds devastating, but again, as people who listen to this podcast know, we always need to think in terms of absolute risk. And relative risk doesn't mean that much if you don't understand absolute risk.