Bad medicine?

In "Unseen Risk: Lifestyle, physical problems may underlie psoriasis link to early mortality" (SN: 12/22&29/07, p. 389), the definition of patients with severe psoriasis as those needing systemic drugs raises the question whether treatment itself may be linked to early mortality. The journal article cited in the story indicates that some systemic treatments may be less toxic than others, but I found nothing to refute the hypothesis that mortality might be due to adverse reactions to the medication.

David Harding
Warrenville, Ill.

The reader is correct that the study did not specifically look at whether the medications, and not the disease, could be responsible. Researchers did find early mortality differences between patients on different medications.—Editors

As I read the article "A Different Side of Estrogen" (SN: 1/5/08, p. 8), I was wondering whether the findings discussed suggest that a woman who has had both a hysterectomy and an oophorectomy should be on estrogen hormone therapy. Does a woman with no uterus or ovaries produce enough estrogen in other organs to benefit from the estrogen receptor beta?

Cathy Gregor
Alexandria, Va.

Almost all estrogen in a premenopausal woman's body is produced by the ovaries. "So after ovariectomy in women who have not gone through menopause, estrogen substitution is recommended," says Jan-Åke Gustaffson of the Karolinska Institute in Stockholm. But in older women, whose ovaries no longer produce very much estrogen, studies have shown risks to estrogen replacement. One of these—an increased incidence of uterine cancer—is obviously not a concern if the woman has no uterus. But others, including an increase in stroke and breast cancer, must be carefully considered by a woman and her doctor. In the future, the development of drugs that bind only to estrogen receptor beta in certain tissues may allow women to reap estrogen's benefits without these risks.—Sarah C. Williams

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