Challenges facing Bioidentical Hormone Replacement Therapy (HRT)

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There are several forces working against the success of bio-identical hormone replacement for women, which break down into three areas:

  1. The FDA/U.S. Government’s bias toward drugs made by pharmaceutical companies and drugs that benefit men;
  2. MDs, and to a lesser extent DOs, who are not trained to understand bio-identical hormone replacement;
  3. Health care in general does not emphasize the preventive care of menopausal women. Even though we are the primary consumer of medical care and the person who directs the family to specific care, menopausal women rate much lower than young, fertile women, (and all ages of men), in the world of health care.

Lastly, it is a man’s world; men are the CEOs that buy insurance for a company, the majority of lawmakers, the majority of FDA employees, the heads of pharmaceutical companies, and the overseers of Medicare.

First, the FDA is an extremely powerful agency of the U.S. government. Any drug that is not approved by them for a particular use is removed from the options available to Americans. Bio-identical hormones have been under fire by the FDA consistently over the last five years, alleging that there is no research backing their use. Plenty of research on bio-identicals has been conducted, but it is not backed by a pharmaceutical company so the FDA does not recognize the research as legitimate. Without the blessing of the FDA, women will be unable to access bio-identical hormones in the U.S., even if they pay for them outside their health plan.

Secondly, MDs and DOs, as well as Nurse Practitioners and PAs are not trained to use bio-identical hormones. In fact, they are told that because the FDA does not endorse them for HRT (Hormone Replacement Therapy), they are not safe! The negative brain-washing of medical schools causes the majority of doctors to believe that bio-identicals are evil and that doctors who use them are renegades. Those of us who do advocate for both women and for bio-identicals are generally outcasts in the medical community and we have to live under the cloud of suspicion that the FDA, through medical education, has created. We pay a price to advocate for true preventive care for our patients. Our medical malpractice insurance even makes the use of bio-identicals an uncovered problem, therefore in order to do what we believe, we leave ourselves uninsured in these areas.

Thirdly, health care in the form of hospitals generally do not supply bio-identical hormones in their pharmacies. And, insurers save money by denying payment for bio-identicals even if they take place of an FDA approved HRT, making it very difficult and expensive for women to get their necessary prescribed hormones.

Additionally, the men that run these agencies and businesses have a primary priority to keep themselves healthy. This displays itself in overt and covert ways. The overt ways include:

  1. FDA approval of drugs for men with less oversight and roadblocks than the drugs for women.
  2. Hospitals fund Heart and Lung Disease floors and facilities with higher budgets so they are much more comfortable and nicely appointed than the GYN and OBGYN floors and operating rooms.
  3. Insurance coverage for men’s drugs over women’s drugs, and denial of many more medications, (especially bio-identicals), for women. The same bio-identical Testosterone pellets that are not FDA approved, and paid for by insurance, are denied for women!
  4. Medicare even pays less to doctors and hospitals for women’s care than men’s care. Surgery with the same level of difficulty for men is paid at a higher rate to the doctors by Medicare and therefore insurers who follow Medicare rate schedules.

One of the biggest insurers in the country, and a monopoly in my state of Missouri is United Healthcare who has manipulated the GYN doctors by decreasing the reimbursement for a Hysterectomy, (which is a much longer, higher risk and in-patient procedure), over a D & C and Uterine Ablation, (which takes about 20 minutes and is one day surgery), so that we will just stop doing Hysterectomies! For example, at this time, my fee for a Hysterectomy is $3,200 which includes the office visit before and after the surgery, the surgery itself, which is around 2 hours, 2-3 visits in the hospital, and all calls and office visits related to complications during the 6 weeks that follows the procedure. UHC has dropped its fee to around $800, ( 25% of my fee) and last year it paid me $1600 (50% of my fee). My fee for the Ablation and D&C is $2,400 and UHC pays me around $1200 to do this procedure. Let’s see, a one day surgery costs them about 10% of an in-patient surgery, so you can see why they would want me to do fewer in-patient surgeries!

The covert manipulation of doctors is accomplished by insurers under-paying what it costs to do a procedure. Insurers like United Health Care CAN do this, because they own so much of the market share, and doctors would go out of business if we did not accept their fees. Medicare also manipulates the way we practice by under-pricing procedures and prescriptions. If they want us to stop doing a certain procedure or or writing a prescription they just fix a fee that is so low we can’t stay in practice if we continue to do those procedures. For example, they pay radiologists less than $10 a mammogram, when the radiologists fee is over $200. Now you know what pressure your doctor has when suggesting a treatment. If I didn’t have BioBalance as a cash practice, I could not take any insurance for my GYN practice without losing money every day! I have chosen to ignore the low fees and do what my Hippocratic Oath demands, and that is to refer the patient to the best care, independent of the fee we are paid (that is a gross translation of the Oath, but the meaning is proper).

With all the talk about Socialized medicine on the horizon, I think you should know what our government is getting you into. Their covert management is just now beginning in a system like what is being proposed. You may think you can keep your insurance, but businesses will be taxed if they offer private insurance, therefore, they won’t! They say you can have any treatment you want, but what they will do is make the fee very low for procedures, tests and drugs that they don’t want you to have because of their expense and I can promise you American superiority in healthcare will drop off its pedestal like a rock. They say you can keep your doctors and your medications, but expensive care will be discounted so much the best doctors will retire, quit and do something profitable, and intelligent young people will no longer choose to go into medicine. Expensive tests will not be offered because labs and hospitals will not buy MRIs, CT scanners or lab equipment, because the government will discount it. Hospitals’ profit will disappear and medications will have one option for every illness. For example, if you have allergies or trouble taking one medication and have to try several options before you find the right one, you will be out of luck! Emergency rooms will have much longer waits or will just be unavailable. Bio-idenitcals will not be able to compete with Premarin (estrogen from mare’s urine) because it is mass produced and cheap!

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