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- [00:04]
A
Welcome to the youe Are Not Broken podcast. I'm your host, Dr. Kelly Casperson, a board certified urologist, thought leader and conversation starter on midlife living, hormones and sexuality. Enjoy the show.
- [00:18]
B
Hey everybody. Welcome back to the youe're Not Broken podcast. Very excited, fangirling excited to have Dr. Carol Tavris on. An American social psychologist and feminist who has been doing this work for over four decades, changing people's lives, criticizing psychobabble. And her writings have dealt with critical thinking, cognitive dissonance, anger, gender, and many other topics in psychology. She most recently is well known for the second edition that has just come out of estrogen matters with Dr. Avram blooming. Thank you so much for joining me today.
- [00:49]
C
A pleasure to be with you, Kelly.
- [00:51]
B
Can we get one definition out of the way just for everybody? Because I think we have to keep redefining it. What is feminism?
- [00:59]
C
Oh, good luck. Oh, good luck. You're gonna start right off with that one, please. No, no, sorry. That's like saying, what's a Democrat, what's a republic? You know what, you know, it's many, many things. My mother, bless her Hart, who got her law degree in 1927 when she was 21 years old, she was a born feminist, but for her, what was feminism? Just treating women the way you would treat men, with the same opportunities and the same, the same, the same anyway. And she loved quoting the suffragist Alice Stewart Miller, who said, mother, what's a feminist? A feminist, my daughter is any woman now who dares to think about her own affairs as men don't think she ought to. So, you know, that's how old this is. What is feminism? You know, one of the first books I wrote, the Mismeasure of Woman, which was a title in homage to Stephen Jay Gould about who studied bias in the study of intelligence. And mine was about bias in the study of gender and how it is that when one sex is the normal sex, any comparisons to that norm mean you are by definition abnormal. And so, of course, for hundreds of years, many years, women were seen as the lesser sex, the inferior sex, the stupid sex, the incompetent sex, and so forth. Well, as women entered the modern era, Starting in the 70s and 80s, feminism came to be a way of a corrective on the bias in science and every other field, history, ornithology, name the field. As women went into it, they created a feminist corrective to the way women had been excluded from research, mislabeled, misdiagnosed through the biased perceptions of the male researchers. When I was starting out as a social psychologist in the 70s, it was a heavenly time to be a feminist because it was the best way to correct the misogynist masculinist biases in so many fields. Now then, what happened was. This is a long way around your question of what's feminism?
- [03:11]
B
That's what I want. A short answer would be concerning.
- [03:14]
C
Right, well, thank you. It's your fault. You asked a complicated question right off the bat. But, but what was of interest to me before very long, because I am a feminist and a scientist, what cognitive dissonance means is. Cognitive dissonance is the uncomfortable feeling we have when something we believe, something we care about, some notion about ourselves, meets disconfirming information that we don't want to have. It's really an unpleasant feeling. So I watched as a feminist, as my feminism became not a corrective to science, but a resistor of science. That is, with any ideology. When the data dispute what your ideological commitment or belief is, we tend to say, oh, the hell with the evidence. And so my book, the Mismeasure of Women, not only was about how women are seen as inferior to men, but what happened when women decided, no, actually we're superior to men. We're better, kinder, sweeter, cuter, better friends, better lovers, better everything things. Well, you know, the data don't necessarily support that either. So my job, as I have seen it, is to bring the best of science to bear on what I regard as the bottom line feminist question. What is best for women's health, well being, psychology, life, relationships? What's the best information that we need? Men and women? Not that one sex is better or worse, but what is it that impedes women from success and progress? What is it that that keeps us from doing what we need to do? Well, in medicine, medicine was the classic example of the male norm. The male body is studied in medicine and the female body is lesser. And every premise based on a study of men does not necessarily extrapolate to women or to old people, you know, or to different ethnic groups. So what is feminism? Feminism? Feminism is moving the cause of women forward toward a more just and equal world for both sexes.
- [05:34]
B
Not to the exclusion or to try to put other people, genders in their place is to say we all deserve to have a seat at the table. And staying curious as to why that isn't so. Maybe what I kept hearing in your answer was staying curious. Keep asking the questions.
- [05:50]
C
Curious, flexible, willing to give up premise or an idea that turns out not to be the right direction. Or the best solution to a problem. We jump to a solution or a belief in our idea and stick with it long past its shelf life when it's time to give it up. One interesting thing, for example, I've noticed historically people have been writing about this is that when women noticed in the 70s and 80s the discrimination that women in schools, well, from childhood through college and graduate school, were experiencing at the hands of teachers, girls raised their hands and they weren't called on, and girls were having trouble in classrooms and they had all kinds of sexism to deal with and so forth. Well, the world changed. And what did we see? The problems now arising for males dropping out of school, schools not attending to their issues and needs, schools thinking of boys as being little sexists in training. And the exclusion of males not paying attention to males has led to a horrific social problem of males dropping out. I consider that a feminist issue. But, you know, as long as women continue to think that the problem in education is discrimination against women, we're not paying attention to discrimination against males. To the loss of both.
- [07:06]
B
Absolutely. I feel like all the work that you've done, I mean, the Mismeasure of Women. I'm gonna read the whole title because the subtitle's as excellent. So the book is called the Mismeasure of why Women Are not the Better Sex, the Inferior Sex, or the opposite sex. March 1992. That and then the book Mistakes Were Made, But Not By Me, which is also a fantastic title. Set you up. I really want the story of how you met Dr. Blooming, how you collaborated on this book. I'm like, you're the perfect person to point out why we're in the pickle with hormones and treating women with menopause. Tell us that kind of evolutionary story to this book.
- [07:44]
C
It's a funny story. One of the things I'm fond of saying is that we are the perfect collaboration. Because what I know about medicine is what he knows about social psychology, which is not very much and let alone feminism. He's so adorable. He'll call up and say, carol, I've just learned this horrible thing about how women are treated in medicine. Exaggerating. But, you know, he's. He's such a decent, compassionate, phenomenal physician. I've never really known anybody like him as a doctor and as a scientist. And when we first met, we realized he was doing in medicine what I was doing in psychology, which was identifying and trying to narrow the gap between the people who do research in medicine or psychology and the people who practice it clinically in psychology, we've spoken of the therapist scientist gap, the number of psychotherapists running around doing psychotherapy without any of the scientific background of how memory works, how child development works. You know, they come up with a theory of fad therapy and off they go because the word psychotherapist isn't licensed. Now, it's not the same in medicine, of course, but what is the same is that the people practicing medicine are not usually the ones doing research on a particular area in that of concern. So doctors have to rely on the guidelines of their specialty or what they learned in medical school, and they do not have the time and interest to keep up with changing research needs and so forth. So Onram and I, we share a love of science and following it where it leads, even when it leads into findings we didn't really want to know and so forth. So we met professionally, but mostly personally to begin with, because I knew his name since he had saved my sister in law's life. She had taken a medication that caused aplastic anemia. He looked up the six cases in the world of this devastating side effect of her medication and he found one doctor who had treated it successfully and he saved her life. So I knew his name. And the next thing I knew is I'd gone to dinner at Friends and they had this couple here, Abram and Martha Blooming. Best thing that's ever happened to you, financially. Go easy.
- [09:56]
D
Sold by car on Carvana. Amazing offer, really.
- [09:59]
C
I hit 200 on the scratcher.
- [10:01]
D
Did the scratcher come to your house and hand you a check? No. How many scratchers did you hit to get that? I hit a button on Carvana.com once.
- [10:09]
C
Okay, that's fair.
- [10:10]
D
It's like the lottery, except you always win.
- [10:13]
C
Not like the lottery at all, actually.
- [10:15]
D
Exactly. Inexplicably good offers worth bragging about. Sell your car today on Carvana. Pick up. Fees may apply.
- [10:23]
B
I said, I know you, I know
- [10:24]
C
you, I know you. And so we met through friends, really. And then we just never stopped talking, you know, because we had so much we shared about medicine and psychology. And when the Women's Health Initiative exploded upon the land in 2002, he called me up in a froth because first of all, the JAMA article wasn't even available to read. He said, this is outrageous. This is not anything that we know. This completely turns on its head everything we've known about estrogen for 50 years. What is this? So ever since he and I have been, you know, got out our lances, got up on our horses, off he went to the windmills. You know, we've knocked a few windmills over, I'm happy to say. It's just been a long and very happy collaboration with him.
- [11:10]
B
That's amazing. I mean your work with cognitive dissonance and maybe we should define that for people who don't. You know, you and I talk about it because we know what it is, but really the brain's hardware is wired to resist new information that collides or goes against or challenges information the brain is already holding in there. Can you define that in a better way?
- [11:34]
C
No. That was very good.
- [11:36]
A
Thank you.
- [11:37]
B
I was a neuroscience, I was a neuroscience undergrad. So like, like for me to like segue into urology and then come back to the brain is actually very, very fun for me.
- [11:46]
C
I'm sure. I'm sure. Well, so the, one of the brains most characteristic biases we call the confirmation bias. This is the bias to see, remember, notice everything that confirms what we believe and to minimize and ignore.
- [12:01]
B
When you're shopping for a Toyota, you see all the Toyotas on the road.
- [12:05]
C
No. When you're shopping for a new car, you'll consider everything you want to know about the Toyota and everything you want to know about the, whatever else, the BMW. You'll weigh the benefits of each. That is when you will be your most open minded. Before you make a decision. Before you decide, should I wear a mask or not? Before you decide, should I marry this person or not? While you're deciding, that's when you will be at your most open minded.
- [12:29]
B
Should you take hormones or not?
- [12:30]
C
Should you take hormones or not? Absolutely. The minute a person makes a decision, they will be in a state of dissonance needing to justify the decision or choice they made. And to do that you have to ignore, overlook any disconfirming evidence that the car you chose really was a lemon, or that the decision you made really wasn't the right one, or even that
- [12:57]
B
the Toyota still has some benefits even though you went with the BMW.
- [13:01]
C
Exactly. You want to be in a state of consonance between what you believe and what you think the evidence shows to support that belief. It's very uncomfortable when someone we know and admire does something unethical, immoral, illegal fattening and something that we really don't approve of that will put us in dissonance too. Where people will have to decide, do I want to end this friendship or minimize the seriousness of the mistake or the crime or the harm my friend caused. It's just uncomfortable to Live that way. Sarah Silverman did a beautiful video of the dissonance she felt when her good friend Louis CK Was outed for his inappropriate sexual behavior with young women comedians. And she said, here's the thing. He's my friend. I've known him 25 years. I love him. And what he did was wrong. And what he did was wrong. What do most people do? They end the friendship or they minimize the actions of the friend. That's why it's hard to live with dissonance. So in the case of hormone therapy, how do the researchers associated with the Women's Health Initiative who came out with a scary press conference in 2002, and Avram and I have been watching them over the years. They have never called a national press conference to say, we were wrong. You know, we were actually wrong that hormones don't help menopausal symptoms. We were wrong about. We were wrong. We were wrong about everything. We're actually even wrong about breast cancer risk. But we're not quite prepared to tell you that yet. Has there been such a press conference? No. And so women go to their doctors who tell them what they learned in medical school, because now a generation of young doctors have gotten this Women's Health Initiative bullshit. They do not know that the Women's Health Initiative itself has walked back virtually all of those scare stories now. So think of it. You are a researcher with the Women's Health Initiative. You've achieved many publications and fame and glory and success and a life career and established academic credentials and the publication list as long as two arms. And now how are you going to say, gee, you know that analysis we did back in 2006 on breast cancer? We really made a bad mistake there? Are you going to do that? Are you going to just double down and say, we've saved so many lives by scaring women off hormones, they continue, in other words, to justify their original claims, rather than, nobody says we were wrong. What they say is science marches on. And now we know.
- [15:44]
B
We've known all along because that feels better. A lot of this is ego protection, right? Of, like, it's very uncomfortable to have your ego identity threatened on many levels.
- [15:54]
C
Excuse me, but that is exactly why we are so motivated to reduce cognitive dissonance, to protect the feeling that we are the competent, smart, kind, good people. And now you're telling me I did something that wasn't smart and kind, then the hell with you.
- [16:10]
B
So, yeah, yeah, absolutely. When Abram calls you and it's 2002 and he says, the bomb just dropped on the media, but I don't have the data yet. As an expert in cognitive dissonance, were you, like, here we are, they might be right and we need to hold space for that, and they might be wrong and we'd have to hold space for that. Like, when you were in the moment, what were you thinking? Because they could have been right.
- [16:33]
C
Yes. Well, okay.
- [16:35]
B
In the.
- [16:35]
C
Well, first of all, in the space was 10 days. And then the minute. I mean, Avram said, first of all, it was completely inappropriate for the Women's Health Initiative to do a publication by press conference. Many critics of what was happening in science had been warning about this bypassing peer review and the usual scientific procedures. You don't publish a finding by press conference unless you have a finding that's going to save 5,000 lives a day. I mean, really significant importance. Stop the presses. So of did what a scientist would do. He waited to see what the article in JAMA actually said. So he looks at the actual article in JAMA and he says, they have six findings here, six on the risks of hormones, not one of them achieving statistical significance. Now, for people who know what that means, what that means is the convention under which we regard a finding as acceptable solid. We don't even use statistical significance on its own anymore. We want to know, is this finding significant? But trivial, is it. You know, what are the absolute numbers we're talking about here? If a risk is doubled, does it mean it went from 1 to 2 or 200 to 400? So there's a lot of slimy reporting in much of scientific and medical research scaring you. Your risk will double if you. Okay, well, again, what are the numbers? So Om goes and looks at the Gemma article and he calls and he says, none of these findings were significant. They weren't significant statistically or clinically. Why have they done this? The biostatistician, head of the Women's Health Initiative, said, oh, well, we set the bar low because we know how women worried women are about breast cancer. We set the bar low so that if we found anything of a hint of worry, we would report that. A biostatistician, right?
- [18:41]
B
Yeah, exactly. That's what their PhD is in. I want to go back to the beginning where we're talking about feminism and women being at the table. What I've been saying with this whole breast cancer scare, even though there's no data to support it, is the best way to control a woman is to keep her afraid.
- [18:58]
C
I agree with you completely.
- [18:59]
B
Do you see it every day?
- [19:02]
C
Of course. The best way to control a country is to keep the country afraid and
- [19:06]
B
to keep the country fighting with itself.
- [19:08]
C
Fighting with itself. And fears, fears always of foreigners, fears of change, fears of people who are different from us. Fear is the big motivator for all human beings. Fear and uncertainty. In the case of women, the misogyny that persists in medicine, and I have to say, as practiced by women as well as by men, women are not immune to this. Let's not say if you go to a woman doctor, you're going to get a different set of reactions than if you go to a male doctor. My male gynecologists were completely pooh, poohed the Women's Health Initiative from the beginning because they went and read the data. On the other hand, there are still so many assumptions about women's behavior and women's irrationality and how women can't really make judgments. And there's still that pat on the head. There, there, dear. Don't bring me this book that you think is important. You know, what, what do you know? If you've been to medical school, you know, there, there, little girl. I mean that there's still a whole lot of that.
- [20:08]
B
There was just this article on NBC.com this week and it said women are being influenced by influencers to ask their doctors about testosterone. And it was all about. And then it was a couple of gynecologists who were like, I'm paraphrasing, but they were basically like, this is so bad, it's so awful, blah, blah, blah, blah. And I'm like, the headline of this article could have been more women are going to their doctors asking for their sexual health needs to be taken care of.
- [20:38]
C
We didn't do that, did we?
- [20:39]
B
It's as if women have no independent thought or control over themselves whatsoever. And like, you know, I speak on stages now and I'm like, you should have body autonomy over what you want to do with your body. And I get like a fricking standing ovation for like the most obvious thing in the entire world.
- [20:59]
C
These are, well, I say these are difficult times for women and difficult times for everybody. But, but medically, oh, our poor, poor medical system, right? You know, menopause, not being taught in, in most medical schools, or if it is, it's taught for 20 minutes. And then much of that isn't the correct thing either. And so, so women are understandably at a loss for where to go to get the best information on this. I'm extremely sympathetic. So the business of fear mongering or influencers and so forth. Women have to navigate several streams of influence that are not harmonious and can be helped. So one stream is the monetization of menopause. These are people who want to sell women every potion, lotion, and so forth. I don't object to potions and lotions. Potions are one of the good things, but they're not substitutes for estrogen for menopausal symptoms. Okay, but still, there's the how can we take advantage of all these women who are now in perimenopause men, Then we have a feminist strand that I've opposed for a long time now, although I was once a part of it. The feminist strand is women and men are encouraged to medicalize normal problems in life. So if you have a sexual problem with your partner, a pill is what you want. Forget talking, you know, forget having a naughty weekend. You know, just a pill is a lot easier than talking. And so let's find a sex pill. So as part of that feminist idea that medicalization is a bad thing for women has been in opposition to hormone therapy in menopause. It's not necessary, it's harmful, it's unfeminist. And I myself held that view for a long time when I was young and arrogant and didn't know better. And when I went through menopause and really didn't have any serious symptoms. So it's easy for me to please. You know, just suck it up. It'll go away. I didn't know. So here you are, you know, you're a woman nowadays and getting all kinds of messages about whether hormones are good for you or bad for you. You've got your friends that you're listening to and what their experiences are. Somebody has an anecdote. I don't know. I took hormones and my foot fell off. I mean, everybody's got a story. It's very hard to navigate in a sea of conflicting messages. And, you know, it's why, for Avram and for me, what we wanted is to present the clearest evidence that would be readable by doctors as well as by women reading the book, and to set the whole issue in the context of the history of women taking hormones. It's a lot to ask an individual woman to say, how do I know what's best for me? We're not doctors. I get to call Avram and say, hey, what about this? But that's denied to a lot of women. So I appreciate the difficulty in becoming informed.
- [23:57]
B
What advice do you have for women? So they come to See a hormone expert who knows all of this, meaning they know the current data on the safety of hormones, so they know that. But then they go and they read the boxed warning on their vaginal estrogen that says probable dementia. That's the government telling them incorrect information, but they don't know that's incorrect. And then they go home and their neighbor's sister comes and says, you know, oh, well, your, your sister had breast cancer and that's a reason. Blah, blah. What advice do you have for women? Because you can't get away from cognitive dissonance on this topic. This topic is cognitive dissonance. What advice do you have for them
- [24:36]
C
apart from read our book?
- [24:38]
B
Definitely read their book.
- [24:39]
C
I'm sorry, that sounds self serving and self justifying nevertheless.
- [24:43]
B
Well, I tell them to read your book all the time so they'll hear that from me.
- [24:46]
C
Well, thank you. But we have launched and many women are signing on to a national effort to get the FDA to remove that black box form. It's just out of date. It's wrong. Of course. We got a letter, the sweetest letter from a couple saying, well, we wanted to improve our sex life and so we got some vaginal estrogen. We were so excited. Then we read the black box warning and my husband said, honey, I'd rather do without sex than have you die. Yeah.
- [25:13]
B
When given two options.
- [25:15]
C
Given two options.
- [25:15]
B
Sex or death.
- [25:16]
C
Sex or death. I'm going to choose. I might, I might choose. Not everybody would make the same decision. Yeah, exactly. Right, exactly. I mean, this is outrageous. It's just outrageous. Of course, you know, it's. And what's also interesting is that everybody looks at the, if you look at the warnings on any drug, you know, you will find all kinds of black box warnings, mostly that don't take this on Thursdays or something, but, but that people do or don't pay attention to depending on what their doctors prescribe. But the question, so the question is whether the doctor in prescribing the vaginal estrogen says, and by the way, ignore the stupid black box warning. The doctors have to know that to say that. What advice would I say is ignore the black box warning. If it's on it, it's on every estrogen product. Forget about it, as New Yorkers would say.
- [26:06]
B
The problem is, which I found out literally yesterday, this small pharmacy called Amazon.
- [26:11]
C
Oh yeah.
- [26:11]
B
Is now putting stickers on estrogen patches saying hazardous medication. I'll send you the picture. And so we dug into it and we talked to the Amazon pharmacist and we said, what justifies this label? Two reasons justify this label. Number one, the boxed warning on estrogen that says dementia, breast cancer and heart disease, things that have been walked back, but the label's still on. And number two, these are both important reasons that it is category X for fetal harm, which the person who's taking the estrogen patch, by definition can't get pregnant because they're menopausal. So neither one of those are accurate. And this small pharmacy called Amazon is putting hazardous medication stickers on estrogen patches. I saw it this week.
- [26:57]
C
What do we do about this? There is a person making this decision, a committee. Who is the committee?
- [27:04]
B
It's pharmacists saying, we've made the decision to put this label on because we have the power to make that decision and we believe that it's going on. But I'm like, until we remove black box warnings and explain to people postmenopausal women by definition can't get pregnant, you're putting, again, it's the fear and control of women. The doctor said it was safe. They read your book, which said it was safe. And now in the mail, they're getting something that says hazardous medication on it with no explanation. We had to dig to find out the reasons why, both of which aren't good.
- [27:38]
C
All right, you need to publicize the contact information for those pharmacists or how a regular human can write to them or reach them. And we need to get organized on getting that done, starting with that pharmacy. I mean, if the pharmacy, for whatever legal reasons, feels it has to follow these guideline things. So many doctors say this, I can't prescribe hormones to my breast cancer survivor because da, da, da, da. And Avram says, you know what? Here, let me provide for you the informed consent form for your patient which says everything that you would want to say. And the person says, I'm sorry, I want to take. I'm in terrible symptoms and I want hormones. So we need to reach that.
- [28:17]
B
What would you say to the women? Because I'm heavily involved in unboxing menopause campaign and it bloom and me and my friends have a lot of followers on social media. Even when we ask women give them the link, they're not doing it. What do you think that's about? And how do we combat that?
- [28:33]
C
I don't know. We've done this too with getting people to write to the fda, starting there, starting at the top, to get that black box warning done. And Sharon Malone and others with government connections, you know, to Congress are Likewise trying to work that direction. This is a level of high politics. Getting the FDA to change its mind about anything is. That's really high politics. Because consider that the FDA would have to say we made a mistake and paying attention to the Women's Health Initiative all those years ago. And. But what we found is many organizations have asked their membership. I don't know myself personally. I've lost count of how many individual women ended up. We provide, provided the letter, the address, send it here. I don't have any idea how many, what the numbers are.
- [29:18]
B
It was shockingly low with how big the push was. What I want to address is the women who say, my voice doesn't matter, nothing ever changes. I want to address that apathy. What do you think from your knowledge of how women have been socialized? What's that about?
- [29:36]
C
Okay, well, first of all, it depends what the it is, is. Okay, Think of how many petitions people have been asked to sign. Think about how many marches we've had to march in.
- [29:46]
B
So maybe they're tired.
- [29:47]
C
Well, tired. But also, how effective is this way of protesting, for example, with the fda? The FDA is used to getting lots and lots and lots of letters from consumers. You know the case of sex drugs for women, you know the quote pink vagrants over many women wrote in, I need this drug, Please approve it. Now, if you're the fda, you shouldn't be paying attention to a consumer movement to approve or not approve a drug. You should be doing this based on the scientific evidence, the medical evidence. So the letters that we write, the letters that come from doctors and scientists and researchers and women citing the medical evidence are going to have more of an impact pact than just, you know, hey, I want to take estrogen. And you know, I'm writing to urge you to overthrow the black box. That's not going to count for the fda. Numbers won't even count because the numbers of people, as a social scientist, you know, done survey research and knowing how survey research works, the numbers are not necessarily representative of an interest group. The people who have an interest, of course, who do the writing. So it's not that I would discourage women from, from writing, they absolutely should. But it has to really be with an organized focus. And in the case of the fda, I really think it has to be top down.
- [31:08]
B
I agree with you. But to me, I'm like, the FDA works for the people. This is government. They work for the people. They don't work for pharma, at least in my purity mindset.
- [31:16]
C
Oh, how sweet you are.
- [31:17]
B
I know and to me, I'm like, listen, you know, testosterone got approved with six months of data. Viagra got approved with not much more than six months of data. We've got years of safety data for testosterone and other drugs that aren't getting approved for women. So to me, I'm like, there's. I think hearing from women is the right thing.
- [31:36]
C
I don't want to say don't write. I mean, I think as many letters as we ever can get going to the FDA is crucial. I don't know enough about the politics of the FDA to know how. What the process would be. Would they have to convene another committee? And then they would have to get people. What they do is they get people on both sides of an issue. Then they have general consumers who get to come and testify at a hearing. This is why I think this drug is important for not important and so forth. So the first step. The first step is through Congress, I think congressional pressure, possibly from the new, you know, bill that's given so much money for women's health that the Bidens organized. We're hoping to get a. A foot in the door that way.
- [32:19]
B
I love it. I think all. All angles to get the job done is, don't say women.
- [32:23]
C
Don't protest. Women are noisy protesters when it's an issue near and dear to their hearts.
- [32:29]
B
Get loud. Women. We.
- [32:30]
C
We get loud.
- [32:31]
B
Get loud. Yeah, that's what I told them at. You know, I was on stage the other day, and I get loud. Don't wait for the next generation to have to deal with this. I want to tell. I want to shift to another cognitive bias.
- [32:41]
C
What's a. What's a feminist?
- [32:42]
B
Kelly, you have me on your podcast. I'll think long and hard about that answer. I mean, I think I know what it means to me, but. Well, this is what I see all the time, especially with hormones. And it is a thought error that brains do. And I want you to address this one, too. The correlation doesn't equal causation. I started on hormones, and then my. Then I got a ringing. Then I got constipated, which sometimes it does cause. But, like, we can get plenty constipated without hormones. But it's like, once you start that hormone and this is a medication that you're. It's going to be with you if you want it to work. It's going to be with you for the rest of your life. Right. The brain cannot identify because the brains just want to correlate all the time. That's what brains do. Right. And people can't see. I see that cognitive bias all the time. That correlation doesn't equal causation. And I think physicians understand that. Scientists understand that. But the average brain who hasn't been taught to look for it, everything gets tied into it. I twisted my ankle. Is it because of this? Like, we want to know a why. And I see that a lot with breast cancer. Breast cancer is incredibly complicated, but people want a why. And the best breast cancer doctors will be like, we don't know a lot of the time. And if we did know, it wasn't one thing, it was multiple things.
- [33:58]
C
Especially with something as complicated as cancer. Avram is the first to say he's been studying cancer his whole life. He's been studying cancer since before there was the field of oncology. He said, and I still don't know what cancer is. It's a mysterious kind of.
- [34:10]
B
People can't handle that.
- [34:12]
C
No, no, no. Exactly. So it's the sequential fallacy too. If A comes before B, A caused B. I had an interesting conversation with a woman who illustrated this. She said, well, you know, she said, I had been taking hormones and I got breast and it was mild DCIS form of cancer, it was completely treatable and so forth. And I said, well, I have good news for you in the sense that it is most likely that being on hormones was not the cause of your breast cancer. Thinking she'd been beating herself up because she'd been on hormones, and now look what happened to her. And I thought, oh, I can remove the rock from her shoulder, right? And she said, don't you get it? She said how aware she was. She said, I want to believe that hormones caused my breast cancer because now I can control the chance of recurrence by not taking hormones anymore. I want to believe this because now I have something to control my risk of recurrence. And then she paused and said, of course, every woman waiting with me in my oncologist's office had had coffee that morning, too.
- [35:20]
B
This is a smart woman, very self aware.
- [35:24]
C
Nobody is thinking coffee is what caused my breast cancer. See? And so the feeling of being in control about recurrence is of course very powerful for anybody who's experienced breast cancer and had to deal with it. Minimizing the risk of recurrence is of course a major thing. I mean, you know, it's why Avram's story of his wife who had breast cancer and then was, you know, begged him for HRT so she could read again and remember what she was reading. And he Said, you know, I'm not gonna cause a recurrence, you know, decades later. And she was spared the dementia and osteoporosis that her mother suffered. Causal. Helpful. You know, who can say? We have to live with uncertainty whether her being on hormones really protected her in the way it did not protect her mother. But seems from supporting data that indeed it did. But you know, it's, it's hard on an individual human level. We are our own anecdote.
- [36:23]
B
Yes. And our N of 1 is very important.
- [36:27]
C
Exactly.
- [36:28]
B
That's a thought error sandwich. Right. Because it's like correlation doesn't equal causation. Then when you try to explain that the hormones didn't cause that it wasn't correlated, now you're going against what they already believe. So there's your cognitive dissonance.
- [36:40]
C
There you are. Well, you know, your correlation and causation is such an important thing because I mean, for example, this was how the whole vaccines cause autism began, which is that autism was in those days, earlier days diagnosed at about the same time that little kids get their first round of vaccines. It's simultaneous, but it seemed to be causal to too many people. And then once they decided that vaccines cause autism, there was no dislodging that belief double down.
- [37:12]
B
So what you're. Is it possible, Dr. Tavris, that this push and pull about hormones and safety and breast cancer and is it good and blah. Are you saying this could go on for quite some time?
- [37:25]
C
Is it possible that it could go on? Yes. Is it likely? Yes. But this is what's fascinating. See, Amram and I used to joke about this. This is how it works in medicine. Your idea is completely stupid, wrong headed and idiotic and you're just a crank. Pause. Okay, well there's two or three people who agree with you, so you're just a little menacing conspiracy of cranks. Then you have a few more people agreeing with you and it's oh, this is kind of an interesting idea, followed by we knew it all along, there's a critical mass at which point we knew it all along is a way of forgetting for the sake of consonants that we ever thought otherwise. This is how paradigms change when enough evidence finally topples this entrenched belief, in this case that estrogen is carcinogenic. My dear colleague Carol Way, we wrote an introductory psychology textbook for many years and she had what I thought was exactly the right metaphor. She said, science is a matter of getting a sheet of evidence to fit the mattress of theory. When the sheet, when you are trying to Get a double sheet on a queen size bed. You need a new sheet or a new mattress. Such a domestic image, but it's exactly right. We are at the point where we need a new mattress. About hormones. But they've been trying and trying to get the sheet that estrogen is carcinogenic to fit their paradigm, their theory, and it doesn't fit. And Avram's indefatigable accumulation of evidence, all the ways in which he looked at, well, you know, if estrogen was carcinogenic, then a pregnant woman who gets breast cancer should have an immediate abortion. All of those logical consequences of the belief not being supported. So where I think we are now is there's enough of an upswelling of interest by women and activism by women and activism by doctors, your own self included, may I say, fighting against that tired, dated paradigm that estrogen is carcinogenic. With enough support from doctors and from women demanding better answers and attention from their doctors, I think we will see a return so ironic to the pre 2000 era when HRT was the normal thing you gave women in hormones.
- [40:00]
B
That's what's so like the Twilight Zone about all of this is like, guys, guys, guys. We actually did this before. In the 1990s, 40% of women were on hormones. It was the fifth top selling medication in America. It was common. And like the fact that that's actually existed in my lifetime before I feel like I'm in the twilight Zone. You are like, I just want to get back to how it was because like that was going well. This interview with you right now, honestly is coming at a very beautiful time for me personally. I'm in the M Factor documentary and literally this morning experienced some pretty serious backlash questioning what's said in that documentary. The data to say that the documentary is wrong is quoting whi. I always do just like the Amazon pharmacy saying this is an unsafe medicine. It's always going back to that. And so to hear you speak today and to talk to you and to feel your energy, like it's so needed for me because I feel like I'm literally in the trenches with this right now. And so I guess my question is like, you've been doing this for 40 years. You know, 1992 is when the women book was published by you. How do you keep going? What advice do you have for me? Because we want to keep helping and we want to keep. I see all the suffering women, but like, it's hard. Nobody ever said activism was easy. I get it. Cry me a river. But like, what Advice do you have for Gen X?
- [41:33]
C
What is it they say the worst vice is? Advice.
- [41:36]
A
I mean,
- [41:39]
C
the one question avermen I get all the time is why? Why, why, why? Why did the Women's Health Initiative lie? Why were they only reporting scary findings and not their good findings? Why were they manipulating their data? Their study was never based on an effort to find out anything about menopausal women anyway. They were looking at women the average age, in their 60s, smokers, overweight, they were looking at heart disease. How did this even come about? As you know, the lead investigator, Jacques Rosseau, a cardiologist. I don't know if correlation is causation, but let's just say cardiology is a field that believes that statins are the treatment of choice for preventing a heart attack. Even though they do not prevent a first heart attack in women, which has long been known, they are nonetheless prescribed widely for women considered at risk of heart disease. Okay. Statins were the best selling drug at the turn of the century. And in 1995 or 6, Rousseau published an article, published an article in a medical journal saying it's time to stop the bandwagon of hormone replacement therapy been rolling along. It's getting too much attention, it's too popular, the risks are not reported along with the benefits, and it's time to stop the bandwagon of hrt. And this impartial guy is the head researcher of the Women's Health Initiative. Something disgraceful there. I have no idea why or how. I don't want to say I don't know, I don't know. But this study was so clearly biased from the get go and I am waiting patiently. I've been trying for years to persuade an investigative journalist to get into the story of how that study was done and why it found what it didn't find. One of the things we know about how dissonance operates is that there are some people whose minds we will never change. They've invested too much time, effort, energy, reputation, status in holding a position and we will not change their minds. So the people whose minds we have to change are those whose minds are changeable. Those in medical school, those who are coming up, those who are open minded enough to listen at a conference to get new information, who do not themselves have a vested interest in a policy of no hormones. But keep this in mind too. Speaking of dissonance, you're a doctor, you're an oncologist, and you believe that estrogen has maybe caused your patient's breast cancer or certainly could increase the Risk of a recurrence. So you have denied hormones to the dozens and dozens of women who have come to you asking for hormones or asking for relief from menopausal symptoms. You've invested a lot in your belief. How likely are you to be to say, boy, I was wrong? Because now I have to admit, all of the harms I did to the patients in my past. It's the same as the doctors who were doing radical mastectomies long after it was known that lumpectomies were just as effective and safe for women. To admit I was wrong. You're telling me I am an incompetent doctor. I haven't kept up with the research. I have harmed my patients. Well, piss off. So what it takes is to reach a significant number of physicians with open minds. Avram's going to be speaking at Harvard in the spring and at other professional organizations. That's really where this has got to go. Every little fire that you can try to put out. I mean, he certainly is. I need to get him a fireman's hat.
- [45:26]
B
Oh, that would be awesome. What I'm hearing, the advice that I'm taking away from this is focus on the people you can help.
- [45:34]
C
Yes.
- [45:35]
B
It's very hard to change minds that are concrete. It's very easy to have discussions with people who are open. Focus on the open people.
- [45:44]
C
Yes, I would say. And, you know, we must keep in mind, too, so many young doctors getting out of medical school now who don't know. And to know the history of this big study that has influenced so many people. You know, it's not like it was the greatest study in the world. And we're saying, hey, wait, it wasn't. It was a terrible study from the get go. We describe it as a medical mystery story. Not just who done it, but why they done it. And it's such a fascinating puzzle to everyone about why they distorted their findings as they did. For doctors to understand that story makes them feel not quite so foolish for believing the results. These were prestigious people. These were big name people. And, you know, and then. Okay, now I'm going to. Let me tell you this story courtesy of Robert Langer, one of the investigators who let the world know that only three of the 40 physicians involved even saw the paper that was sent to jama. There were so many shenanigans about it at the beginning, meaning you were right originally to believe the whi, because look how impressive they were. But now, look, isn't this interesting? And what they were doing, and it turns out not to be so you can. It might work.
- [46:59]
B
The word maybe we haven't used yet is humility of like in medicine, we've made more mistakes than we've been right. That's just how medicine moves forward. Trial and error. So by definition, we've made more mistakes than we've been right. And is it quite possible that we can keep making mistakes and be right? Sometimes, because that's the way the world moves forward. But when we know better, we can do better.
- [47:29]
C
You have exactly put your finger on it. No one needs to beat themselves up for believing something that they believed with the best evidence at the time. That's how medicine operates. That's how science operates. Here's the best information we have now. And the goal is not to give up beliefs or to think they're all baloney or they're all nonsense. No, we must have beliefs that we live by and practice our lives by. We must have feminist goals that motivate us. We must have beliefs about how the world should work, that guide us, that give us meaning in a spinning society. But the goal is to hold them lightly enough so that if better evidence comes along, that allows us to be better citizens, better scientists, better doctors, we're able to let the old go for the change to the new. That's the challenge. That's what's hard. But it's doable all the time.
- [48:22]
B
This is an absolutely beautiful conversation. I feel better already. Thanks for the personal therapy session.
- [48:30]
C
Thank you, Kelly.
- [48:31]
B
It's been an absolute pleasure to have you on and thank you for your time.
- [48:34]
C
Thank you, Kelly. It's been a pleasure for me too.
- [48:37]
A
Thank you for listening to this week's episode of youf Are Not Broken. If you want to dig deeper with me, sign up for my Adult Sex Education Masterclass where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content. More time with yours truly. A private podcast, coaching and educational empowerment and you can watch my interviews live and get them immediately without advertising. Head over to www.kellycaspersonmd.com for the membership and Adult Sex ed Masterclass members get the master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests, including on this podcast, are not giving individual medical advice or practicing medicine. See it in consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms is at your own risk. Until next time, remember, you are not broken.