Talk:Medroxyprogesterone

message: Evidence shows that Wyeth knew the dangers of Medroxyprogesterone Acetate (the "Pro" in Prempro) but marketed it in reckless disregard for the risks to the women who received it.  
Another Loss for Pfizer in Drug Suits  
http://www.nytimes.com/2009/11/24/business/24wyeth.html?fta=y
By DUFF WILSON
Published: November 23, 2009 
:"... On Monday a jury in Philadelphia Common Pleas Court awarded $28 million in punitive damages to Donna Kendall of Decatur, Ill., whose breast cancer was found after she had taken hormone drugs for 11 years. The jury had already given her $6.3 million in compensatory damages.
:Punitive damages in Pennsylvania require a finding of “wanton and reckless” conduct. The jurors heard testimony that Wyeth paid consultants and ghostwriters of medical journal articles to play down concerns about breast cancer, as well as testimony that Pharmacia did not study known risks. The punitive award was split $16 million for Wyeth and $12 million for Pharmacia.
:After that ruling was made public, Sandra M. Moss, the judge who leads the complex litigation program at the Philadelphia court, unsealed a $75 million punitive damage award from last month in a case brought against Wyeth by Connie Barton of Peoria, Ill. She was also awarded $3.7 million in compensatory damages previously made public." 
 
:"... Esther E. Berezofsky, a lawyer for one of the women who won the awards in Philadelphia said Monday, 'This is just the tip of the iceberg.'
:She said that in cases that had reached jury judgments, women with breast cancer had won damages in 10 of the 12 hormone drug cases, although many are on appeal. Ms. Berezofsky also said a federal appeals court decision in St. Louis this month had significantly improved plaintiffs’ chances of receiving punitive damages and winning appeals.
:In that decision, a three-judge panel of the United States Court of Appeals for the Eighth Circuit overturned an award of $27 million for an Arkansas woman, citing improper testimony by an expert witness. But the court ordered a new trial on punitive damages. The judges’ ruling said 'there was sufficient evidence upon which a jury could conclude that Wyeth acted with reckless disregard to the risk of injury.'"  —Preceding unsigned comment added by 66.167.61.214 (talk) 17:15, 18 April 2010 (UTC)
thread_title:  Wyeth acted with reckless disregard to the risk of injury to women in marketing dangerous PremPro  

message: Bioidentical progesterone shown to be more efficacious than synthetic MPA medroxy progesterone in peer reviewed clinical study in mainstream literature.
"The effect of progesterone compared with MPA included a 30% reduction in sleep problems, a 50% reduction in anxiety, a 60% reduction in depression, a 30% reduction in somatic symptoms, a 25% reduction in menstrual bleeding, a 40% reduction in cognitive difficulties, and a 30% improvement in sexual function. Overall, 65% of women felt that HRT combined with progesterone was better than the HRT combined with MPA." Quoted from Holtorf
Reference: Fitzpatrick LA, Pace C, Witta B. Comparison of regimens containing oral micronized progesterone of medroxyprogesterone acetate on quality of life in postmenopausal women: a cross-sectional survey. J Womens Health Gend Based Med. 2000;9(4):381–387. UGAcodon (talk) 23:58, 1 July 2010 (UTC)
replies: text: Wikipedia prefers secondary sources.  This, being the reporting of a single experimental trial, is considered a primary source.  See WP:MEDRS.  WLU (t) (c) Wikipedia's rules:simple/complex 18:46, 2 July 2010 (UTC)
replies: text: In that case the secondary source, as you know, is the Holtorf review article. http://www.postgradmed.com/index.php?article=1949 Postgraduate Medicine: Volume 121: No.1 January 2009. The Bioidentical Hormone Debate:Are Bioidentical Hormones (Estradiol, Estriol, and Progesterone) Safer or More Efficacious than Commonly Used Synthetic Versions in Hormone Replacement Therapy?Kent Holtorf, MD Conclusion: Physiological data and clinical outcomes demonstrate that bioidentical hormones are associated with lower risks, including the risk of breast cancer and cardiovascular disease, and are more efficacious than their synthetic and animalderived counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT. Further randomized controlled trials are needed to delineate these differences more clearly.  I assume you would have no problem with this as a reference, since it has been accepted on the Bioidentical Hormone Page. UGAcodon (talk) 22:58, 2 July 2010 (UTC)

text: Assuming there are no objections I will go ahead with the edit.UGAcodon (talk) 22:18, 2 July 2010 (UTC)
replies: text: Please stop creating new headings unnecessarily.  That should probably be attributed to Holtorf, since he's writing in defence of a principle rather than a neutral summary of the literature.  I looked for a recent review article on progesterone and couldn't find one on pubmed, the newest one was from 1999 and that wouldn't incorporate the WHI results.  I'd also like to review the article itself, a quick look seemed to conflate MP and MPA.  But still, it is a secondary source about progesterone and medroxyprogesterone.  Be sure to differentiate medroxyprgesterone and medroxyprogesterone acetate.  WLU (t) (c) Wikipedia's rules:simple/complex 23:19, 2 July 2010 (UTC)
replies: text: OK, Will go ahead since we all have agreement.UGAcodon (talk) 23:47, 2 July 2010 (UTC)

text: The full article can be found here and I would agree that caution is warranted given the source.  WLU (t) (c) Wikipedia's rules:simple/complex 13:47, 3 July 2010 (UTC)
replies: text: Also, given Cirigliano's statements about MPA versus progesterone, "more efficacious" is, if not wrong, then certainly misleading.  MPA is more absorbable, has a longer half-life, and leads to more stable blood levels.  The statement would have to be clearer about what "more efficacious" means.  And the word "bioidentical" shouldn't appear, it should simply say progesterone, assuming a coherent statement about specifically how it is better than MPA can be found.  WLU (t) (c) Wikipedia's rules:simple/complex 10:28, 5 July 2010 (UTC)
replies: text:  There is a huge undue weight problem here,  - slow down, stop edit warring, and try to summarize the literature as a whole, please. - 2/0 (cont.) 07:06, 6 July 2010 (UTC)
thread_title:  Bioidentical progesterone shown to be more efficacious than synthetic MPA  

message: The difference between MP and MPA is apparently equivocal.  See here.  Someone mentioned merging the two, I'm not sure yet, but if not then clarifying the difference would be helpful.  WLU (t) (c) Wikipedia's rules:simple/complex 13:47, 3 July 2010 (UTC)
thread_title: MPA

message: I am requesting mediation and dispute resolution on Medroxyprogesterone regarding WLU placing statements without a valid reference. See the changes regarding section Comparison with progesterone.  UGAcodon (talk) 01:23, 6 July 2010 (UTC)
replies: text: There have now been four editors saying your recent changes have been problematic, for the same reasons I have - the sources are inadequate to support the weight given to a single opinion.  Mediation is not needed.  What is needed is for you to accept consensus is that it is undue weight to give the "progesterone is inherently better" opinion anything but a limited, attributed context.  The molecules have not been adequately tested head-to-head, and there is an appropriately contextualized, properly weighted statement saying progesterone might have health advantages, but that's the limit that should be explored.  This is not the progesterone, or hormone replacement therapy page.  It should not discuss progesterone at length, and no page should give excessive weight to progesterone being better unless that is the appropriate, majority opinion.  Right now it's not there.  No-one, no-one has supported your version and you have been cautioned several times about problematic edits.  Stop it.  WLU (t) (c) Wikipedia's rules:simple/complex 00:56, 9 July 2010 (UTC)
thread_title:  Requesting Mediation 

message: Two secondary reviews state, " When combined estrogen/progestin therapy is used, the risk of breast cancer is consistently higher than that of estrogen alone use." see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1974841/ 
Review - Progestins and progesterone in hormone replacement therapy and the risk of breast cancer by Carlo Campagnolia
Also see second review: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670363/
Expert Opin Pharmacother. 2006 December; 7(18): 2455–2463. 
Current breast cancer risks of hormone replacement therapy in postmenopausal women by Nirav R Shah
These two reviews indicate the weight of the medical evidence supports the claim that progestins added to HRT increase breast cancer risk in women.  This increased breast cancer risk was also demonstrated in the women's health initiative study which used medroxyprogesterone added to premarin.  The study was halted early due to increased breast cancer in the drug group compared to placebo. see http://jama.ama-assn.org/cgi/content/full/288/3/321 UGAcodon (talk) 11:27, 12 July 2010 (UTC)
replies: text: And that's noted in the adverse effects section.  WLU (t) (c) Wikipedia's rules:simple/complex 12:52, 12 July 2010 (UTC)
replies: text: Regarding the inclusion of extra sources for breast cancer being a risk.  Yes, it is known.  It is in fact noted in the article, and I was the one who placed it there. Breast cancer is one risk of several faced by women taking medroxyprogesterone.  By placing extra references on that single point, and particularly by including quotations (utterly unnecessary quotations by the way - the statement isn't controversial and the quotations are bare statements of fact without nuance; no-one is arguing that breast cancer is not a risk of HRT) the reader's attention is drawn to that fact in such a way as to give undue weight to it.  First, there are multiple side effects to MP supplementation, so why highlight just one?  Second, the WHI used estrogen plus medroxyprogesterone acetate, not MP making it technically incorrect.  Third, they just aren't necessary and interrupt the citation - to be truly clear about the attribution of text to sources, it would require Russouw to be cited at least five times rather than once, due to Shah/Campagnoli interrupting the citation making the paragraph less clear and considerably uglier.  Citations interrupt reading.  Fourth, Shah & Wong only mentions medroxyprogesterone once, and it is in reference to medroxyprogesterone acetate making this arguably the wrong article to use it in - in addition to the risk being greatest for MPA plus estrogens.  There is too much emphasis being placed on a single finding, to no end.  MPA + CEE has been demonstrated to increase breast cancer.  It's in the article, there's no need to add emphasis.  I frankly don't see the value.  The single WHI source verifies all risks, while the two extra sources place undue weight on the risk of breast cancer, without regard for context or relative risk for other possible conditions, and focus solely on breast cancer relative to many different combinations of progestins. The problem isn't that the sources aren't neutral (sources must be reliable, neutrality is generally not a concern and specifically not a concern in this case).  The issue is that the number of sources focussing on one page is undue weight.   WLU (t) (c) Wikipedia's rules:simple/complex 14:32, 14 July 2010 (UTC)
thread_title:  Progestins and the Risk of Breast Cancer  

message: Per Talk:Medroxyprogesterone 17-acetate#Difference between Medroxyprogesterone acetate and Medroxyprogesterone, the compounds appear to be discussed substantially as if they were identical.  Are there sufficiently few differences between the two that unique aspects of MPA can't be dealt with in the body text of medroxyprogesterone acetate?  WLU (t) (c) Wikipedia's rules:simple/complex 16:40, 12 July 2010 (UTC)
replies: text: Unless someone can find an unambiguous source where medroxyprogesterone (MP) and not medroxyprogesterone acetate (MPA) is used clinically, I support the merger.  However since it appears that only MPA has been used clinically, I think the direction of the merger should be reversed (i.e., merge MP into MPA).  Boghog (talk) 20:27, 12 July 2010 (UTC)
replies: text: Agree with BogHog.--Literaturegeek | T@1k? 01:02, 13 July 2010 (UTC)
replies: text: Agreed also, corrected direction of merge on this and other pages.  WLU (t) (c) Wikipedia's rules:simple/complex 03:56, 13 July 2010 (UTC)
thread_title:  Merge 
from
 to MPA