Thursday, September 14, 2017

Wow!  This is the end of the scares about hormone replacement therapy

Because it is so helpful to many women, HRT had to come under attack from the superior souls in the medical community.  If you like it, it is bad for you seems, in fact, to be a majority view among health commentators.

But the evidence that HRT is bad for you was always flimsy and the latest finding could not be clearer.  HRT does you no harm at all.  Women who find it helpful should not hesitate to use it.  It doesn't give you cancer, it doesn't give you heart attacks and it doesn't make you die sooner.  How's that?

Study abstract below:

Menopausal Hormone Therapy and Long-term All-Cause and Cause-Specific Mortality: The Women’s Health Initiative Randomized Trials

JoAnn E. Manson et al.


Importance:  Health outcomes from the Women’s Health Initiative Estrogen Plus Progestin and Estrogen-Alone Trials have been reported, but previous publications have generally not focused on all-cause and cause-specific mortality.

Objective:  To examine total and cause-specific cumulative mortality, including during the intervention and extended postintervention follow-up, of the 2 Women’s Health Initiative hormone therapy trials.

Design, Setting, and Participants:  Observational follow-up of US multiethnic postmenopausal women aged 50 to 79 years enrolled in 2 randomized clinical trials between 1993 and 1998 and followed up through December 31, 2014.

Interventions:  Conjugated equine estrogens (CEE, 0.625 mg/d) plus medroxyprogesterone acetate (MPA, 2.5 mg/d) (n = 8506) vs placebo (n = 8102) for 5.6 years (median) or CEE alone (n = 5310) vs placebo (n = 5429) for 7.2 years (median).

Main Outcomes and Measures:  All-cause mortality (primary outcome) and cause-specific mortality (cardiovascular disease mortality, cancer mortality, and other major causes of mortality) in the 2 trials pooled and in each trial individually, with prespecified analyses by 10-year age group based on age at time of randomization.

Results:  Among 27 347 women who were randomized (baseline mean [SD] age, 63.4 [7.2] years; 80.6% white), mortality follow-up was available for more than 98%. During the cumulative 18-year follow-up, 7489 deaths occurred (1088 deaths during the intervention phase and 6401 deaths during postintervention follow-up). All-cause mortality was 27.1% in the hormone therapy group vs 27.6% in the placebo group (hazard ratio [HR], 0.99 [95% CI, 0.94-1.03]) in the overall pooled cohort; with CEE plus MPA, the HR was 1.02 (95% CI, 0.96-1.08); and with CEE alone, the HR was 0.94 (95% CI, 0.88-1.01). In the pooled cohort for cardiovascular mortality, the HR was 1.00 (95% CI, 0.92-1.08 [8.9 % with hormone therapy vs 9.0% with placebo]); for total cancer mortality, the HR was 1.03 (95% CI, 0.95-1.12 [8.2 % with hormone therapy vs 8.0% with placebo]); and for other causes, the HR was 0.95 (95% CI, 0.88-1.02 [10.0% with hormone therapy vs 10.7% with placebo]), and results did not differ significantly between trials. When examined by 10-year age groups comparing younger women (aged 50-59 years) to older women (aged 70-79 years) in the pooled cohort, the ratio of nominal HRs for all-cause mortality was 0.61 (95% CI, 0.43-0.87) during the intervention phase and the ratio was 0.87 (95% CI, 0.76-1.00) during cumulative 18-year follow-up, without significant heterogeneity between trials.

Conclusions and Relevance:  Among postmenopausal women, hormone therapy with CEE plus MPA for a median of 5.6 years or with CEE alone for a median of 7.2 years was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years.

JAMA. 2017;318(10):927-938. doi:10.1001/jama.2017.11217


Trump as a lone hero battling hostile forces on all sides

Dramatic events that signify the turning points of history usually come when they are least expected. The election of Donald Trump was one of those events, the depth and historical importance of which are not being fully understood. History was made twice in a single day. The defeat of the well-organized and well-funded Democratic machine by a political upstart epitomized the most stunning election upset in American history. But even more important history was made by the defeat of socialism in the United States. This watershed moment may serve as a catalyzing event of American renewal: Never before has the incumbent socialist government been repudiated at the ballot box.

Ironically, winning the elections and defeating socialists may not be Donald Trump's greatest accomplishment. Standing against a congressional bipartisanship determined to bring him down may prove the President's ultimate triumph.

The spiteful Democrats hate him for their defeat in 2016; the vindictive Republicans cannot forgive him for their victory.

Inebriated by the defeat and lacking any plausible explanation for their loss, since it could not possibly be the Democratic Party's socialist policies, the only politically acceptable alibi was an outside influence. A perilous blend of hostility, anger and disbelief drove the Democratic Party to embrace a strategy of fanatical resistance and ferocious investigations. Democrats are no longer acting as a political party-they are an egalitarian cause.

In contrast, Republicans had gotten comfortable being in opposition. For the previous eight years they had been making grand pronouncements on the academic theories of conservatism, secure in the knowledge that they were not in power to implement them. Many of Republicans hoped that day would never come.

Stunned by unexpected victory, Republicans were not in a position to offer superior rationality. They found themselves woefully unprepared to face the scope of challenges arrayed against them and live up to their election promises. Furthermore, their duplicity was going to be exposed by a new president who cared less about the theoretical aspects of conservative ideology and more about the practical implementation of his agenda.

This unforeseen political reality forced the leadership of the Republican Party to take extraordinary measures to alleviate the impending disaster.

Acting on the political instinct of self-preservation, Republicans have joined with Democrats to undermine the President. In a concerted effort to paralyze executive authority, they blatantly subvert almost every program on the President's agenda and actively support a collective mania for ever more sweeping investigations of dubious claims, rumors, unsubstantiated allegations and innuendos that has descended over the President, his family and his associates. No president has ever been vilified and attacked in such a systematic and vicious manner by his own party.

While the President continues to advance his agenda, a troubling coalescence is emerging across a political Grand Divide. As stated earlier, the Democratic Party has become a cause, and cause leads to intolerance and intolerance to violence.

To be sure, in order to preserve socialist gains the Democrats prior to the 2018 elections will mobilize hordes of disturbed souls looking for a motive to unleash their anger, creating riots accompanied by vandalism and confrontations with police on a scale not seen since the 1960s. The upheaval will be led by professional provocateurs such as AntiFa, left-wing domestic terrorists, and aimed to create a virtuous dynamic leading to the President's impeachment. Whether the ongoing revolts are in the name of anti-racism, anti-capitalism, anti-police, anti-Confederate statues or anti-anything else doesn't really matter. As mass staged protests grow in number and calls for impeachment become louder, congressional Republicans indifferent to the common principles of constitutional legitimacy, will be tempted to go along with any shady enterprise designed by the socialists to remove Trump from office.

In this environment Paul Ryan may not be able to resist the temptation to become vice president, and the Republican Party establishment, which never supported Trump in the first place and had prepared itself for a comfortable co-existence with President Hillary Clinton, would not be terribly disappointed with a President Pence.

But nothing is going to degrade the President's fortitude as he stands alone against a legion of enemies united by common danger. This is the characteristic that makes him dear to millions of Americans. Trump understands the mood of the people better than almost any other politician of our time and is poised to have the candidates supporting his agenda to win in the 2018 elections, transforming the conservative-in-the-name-only Republican Party and writing "Donald J. Trump" on the ruins of Obama's Social-Democratic Party.



Supreme Court restores Trump's travel ban: Justices say administration CAN bar thousands of refugees from entering the country

The Supreme Court is allowing the Trump administration to maintain its restrictive policy on refugees.

The justices on Tuesday agreed to an administration request to block a lower court ruling that would have eased the refugee ban and allowed up to 24,000 refugees to enter the country before the end of October.

The order was not the court's last word on the travel policy that President Donald Trump first rolled out in January.

In a statement, the justices said: 'The application for stay of mandate presented to Justice Kennedy and by him referred to the Court is granted, and the issuance of the mandate of the United States Court of Appeals for the Ninth Circuit in case No. 17-16426 is stayed with respect to refugees covered by a formal assurance, pending further order of this Court.'

The justices are scheduled to hear arguments on October 10 on the legality of the bans on travelers from six mostly Muslim countries and refugees anywhere in the world.

It's unclear, though, what will be left for the court to decide. The 90-day travel ban lapses in late September and the 120-day refugee ban will expire a month later.

The administration has yet to say whether it will seek to renew the bans, make them permanent or expand the travel ban to other countries.

Lower courts have ruled that the bans violate the Constitution and federal immigration law. The high court has agreed to review those rulings. Its intervention so far has been to evaluate what parts of the policy can take effect in the meantime.

The justices said in June that the administration could not enforce the bans against people who have a 'bona fide' relationship with people or entities in the United States. The justices declined to define the required relationships more precisely.

 The appeals court also upheld another part of the judge's ruling that applies to the ban on visitors from Iran, Libya, Somalia, Sudan, Syria and Yemen

A panel of the San Francisco-based 9th U.S. Circuit Court of Appeals upheld a district judge's order that would have allowed refugees to enter the United States if a resettlement agency in the U.S. had agreed to take them in.

The administration objected, saying the relationship between refugees and resettlement agencies shouldn't count. The high court's unsigned, one-sentence order agreed with the administration, at least for now.

The appeals court also upheld another part of the judge's ruling that applies to the ban on visitors from Iran, Libya, Somalia, Sudan, Syria and Yemen.

Grandparents and cousins of people already in the U.S. can't be excluded from the country under the travel ban, as the Trump administration had wanted. The administration did not ask the Supreme Court to block that part of the ruling.



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