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lec22_green - BE.104 April 28, 2005 Human health risk...

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BE.104 April 28, 2005 Human health risk assessment (and human health benefit assessment): Collecting and weighing evidence Laura Green
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Outline of lecture: 1. Jerry Avorn (2004) 2. From London, 1952 to today: evidence and beliefs about PM (and other pollutants) and mortality. 3. With what might ambient air PM (or other pollutants) co- vary? (That is, by what might associations between PM and mortality be confounded?)
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Excerpt from Powerful Medicines , by Jerry Avorn, M.D. (Knoph, 2004) “In a former British colony, most healers believed the conventional wisdom that a distillation of fluids extracted from the urine of horses, if dried to a powder and fed to aging women, could act as a general tonic, preserve youth, and ward off a variety of diseases. The preparation became enormously popular throughout the culture, and was used widely by older women in all strata of society. Many years later modern scientific studies revealed that long-term ingestion of the horse- urine extract was useless for most of its intended purposes, and that it caused tumors, blood clots, heart disease, and perhaps brain damage.”
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Excerpt from Powerful Medicines , by Jerry Avorn, M.D. (Knoph, 2004) “The former colony is the United States; the time is now; the drug is the family of hormone replacement products that include Prempro and Premarin (manufactured from pregnant mares' urine, hence its name). For decades, estrogen replacement in postmenopausal women was widely believed to have ‘cardio-protective’ properties; other papers in respected medical journals reported that the drugs could treat depression and incontinence, as well as prevent Alzheimer's disease. The first large, well-conducted, controlled clinical trial of this treatment in women was not published until 1998; it found that estrogen replacement actually increased the rate of heart attacks in the patients studied. Another clinical trial published in 2002 presented further evidence that these products increased the risk of heart disease, stroke, and cancer. Further reports a year later found that rather than preventing Alzheimer's disease, the drugs appeared to double the risk of becoming senile. The studies resulted in a reduction, but not an end, to the long-term use of these products.” H ow did this “shared delusion” about long-term use of hormones in postmenopausal women start, why did it persist, and how did it end?
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Initial Observations : Young women (typically) menstruate and tend to be healthy. Old women do not menstruate, and (typically) tend to be unhealthy. Menopause is due to decrease in estrogen production in vivo . Perhaps exogenous estrogen can keep women young and healthy longer. Pregnant mares secrete lots of estrogen in their urine: let’s use that as a drug. Actions
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lec22_green - BE.104 April 28, 2005 Human health risk...

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