Return to Transcripts main page

American Morning

Government to Hold Forum on Hormone Replacement Therapy

Aired August 14, 2002 - 08:31   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

PAULA ZAHN, CNN ANCHOR: On to some medical news this morning. The FDA has announced it is going to reevaluate the risk and benefits of all combination hormone products that contain estrogen used by post-menopausal women. This comes after some startling news last month that combination hormone drugs could have serious side effects. Among them, cancer.
CNN Medical Correspondent Dr. Sanjay Gupta is here to help us sort this out, and explain what this may mean for the millions of Americans out there that are knocking themselves on their head, saying, what am I supposed to believe?

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Right.

ZAHN: You can't believe the number of e-mails we've gotten about this subject. Women are really angry about this.

GUPTA: I think this effects everybody, women and men alike, because they really have to make this decision about hormone replacement therapy, and it was an easy decision in the past. You just took it during menopause, because it took care of the symptoms of hot flashes and things like that, and doctors also thought that maybe it would take care of heart disease, osteoporosis, things like that. What they are finding now is the reason that it is getting so much attention, is that the biggest study ever done on this, 16,000 women, actually found that not only did it not prevent symptoms of heart disease, it actually probably increased it. We knew for a while that it probably increased the signs of breast cancer, the likelihood of breast cancer.

For that reason, the FDA, along with HHS, Health and Human Services out of the federal government, is actually going to host a series of public forums. This is not an unusual step. They've done this for things in the past. Basically, what this mean is they are going to get together with citizens, drug companies, doctors, people like that to actually sit down and come up with some comprehensive guidelines, some clear guidelines, for what women should do. Should they not be taking it at all, should they take it just for a little while, or is it still OK in some situations? That's the guidelines we are hoping to get.

ZAHN: Oh, that is great. So we have to sit around and wait for another six months to a year to find out what women in America are supposed to do?

GUPTA: Well, I think for now, still, what doctors are telling us is that probably hormone replacement therapy was oversold. It's not something that all women should be taking all the time. For profound symptoms of hot flashes, profound symptoms of menopause, for a couple of years, it may be OK, but it is not something that people should stay on for their entire lives. I think that's probably what they are going to come up with. But also, regarding certain medications like Prempro (ph), or hormone replacement therapy, they may actually say, you know what, you shouldn't call yourself a hormone replacement therapy, and just say this is a medication to treat symptoms of menopause. Changing the labelling, things like that may make it more clear years down the line.

ZAHN: I will tell you, doctors feel just as conflicted as parents, because I've talked with a number of folks that specialize in this area, and they're not satisfied with the research either. So it's very difficult for them to dispense advice in black and white, which I know is almost impossible in medicine.

GUPTA: That's right, and I think this was surprising for everybody. I think people really believed that hormone replacement therapy was going to provide more benefits for women, and they're just not seeing that.

ZAHN: All right. Now on to another subject near and dear to my heart. Earlier this morning, we heard that women doctors actually spend more time with patients then male physicians. So let's talk about people skills in general. Is that something you were taught in medical school?

GUPTA: It was not something I was taught in medical school, but there is a new organization, a new board, that believes that you cannot only teach interpersonal skills, bedside manner, but you can also test it. Let's have a look.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Taking tests are not unusual for those studying to be doctors. But before Dr. Pete Conteri (ph) could start his residency, he had to take a somewhat unusual test. He demonstrated it for us.

UNIDENTIFIED MALE: What brings you to the office today?

GUPTA: It's called the Clinical Skills Assessment Exam.

DR. PETER SCOLES, NATIONAL BOARD OF MEDICAL EXAMINERS: It's a measure of a person's ability to gather information through a patient, process it, and give information back to a patient in a manner that makes the person comfortable.

GUPTA: Most people know it simply as bedside manner.

UNIDENTIFIED MALE: Anything else going on?

GUPTA: During the exam, each student sees ten patients for 15 minutes each, but they are not real patients, they are part of the test, trained and standardized for their particular ailment. At the end, they evaluate the student. MATT SAUNDERS, STANDARDIZED PATIENT: There is an itemized checklist that I know, like the back of my hand, that while I'm portraying the case, I have to, you know, keep in my head, you know, OK, why is he asking me this, is he asking me that?

GUPTA: And just as important as medical knowledge is the evaluation of interpersonal skills.

DR. GERALD WHELAN, ECFMG: If you know lots of medicine, but you don't have the ability to communicate, to talk and listen to patients, then you won't pass the examination, and conversely, if you are very glib and very smooth with the patients, but you don't really have the medical knowledge that you need, you also won't pass the examination.

GUPTA: This is already a requirement for internationally trained medical students who want to practice medicine in the United States. And now, there are plans to add this exam as a requirement for all doctors to get their medical license.

SCOLES: It's surprising to think that this isn't a routine part of the medical evaluation curriculum.

GUPTA: But apparently, good bedside manner doesn't come cheap. The American Medical Association is against the test, saying there is no proven benefit to justify the cost of $950 for each student. The group that oversees licensing of doctors says the public would benefit.

SCOLES: The first time that a potential physician who completely lacks clinical skills, who completely lacks bedside manner is barred from practice. That's a payoff for the public. Expensive, perhaps, for that physician, but much less expensive in the cost of errors or mistakes that physician might make later on.

(END VIDEOTAPE)

GUPTA: As we know, good bedside manner and profound medical knowledge don't always go hand-in-hand. We certainly know of "great doctors" -- quote-unquote -- who have really poor bedside manner. This board wants to see the future doctors have both.

ZAHN: Best score comes from patients who don't come back if they don't feel...

GUPTA: That's right. Economics...

(CROSSTALK)

ZAHN: ... treatment they deserve. Absolutely. Thank you, doctor. A practicing doctor, I might add, whose patients love him, we are told.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com