ArticleController :: show
Request
GET Parameters
None
POST Parameters
None
Uploaded Files
None
Request Attributes
| Key | Value |
|---|---|
| _controller | "App\Controller\ArticleController::show" |
| _firewall_context | "security.firewall.map.context.main" |
| _links | Symfony\Component\WebLink\GenericLinkProvider {#3637 -links: [ 3758 => Symfony\Component\WebLink\Link {#3758 -href: "/build/runtime.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3756 => Symfony\Component\WebLink\Link {#3756 -href: "/build/644.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3755 => Symfony\Component\WebLink\Link {#3755 -href: "/build/502.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3754 => Symfony\Component\WebLink\Link {#3754 -href: "/build/app.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3753 => Symfony\Component\WebLink\Link {#3753 -href: "/build/view-more.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3752 => Symfony\Component\WebLink\Link {#3752 -href: "/build/term-condition.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3751 => Symfony\Component\WebLink\Link {#3751 -href: "/build/contact.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3750 => Symfony\Component\WebLink\Link {#3750 -href: "/build/scroll-infinite-article.js" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "script" ] } 3749 => Symfony\Component\WebLink\Link {#3749 -href: "/build/app.css" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "style" ] } 3748 => Symfony\Component\WebLink\Link {#3748 -href: "/build/cookie-style.css" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "style" ] } 3747 => Symfony\Component\WebLink\Link {#3747 -href: "/build/term-condition-css.css" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "style" ] } 3746 => Symfony\Component\WebLink\Link {#3746 -href: "/build/contact-css.css" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "style" ] } 3745 => Symfony\Component\WebLink\Link {#3745 -href: "/build/comment-css.css" -rel: [ "preload" => "preload" ] -attributes: [ "as" => "style" ] } ] } |
| _route | "article_show" |
| _route_params | [ "category" => "science" "slug" => "menopause-hormone-replacement-and-mortality-a-research-reality-check" ] |
| _security_firewall_run | "_security_main" |
| _stopwatch_token | "0dd0be" |
| category | "science" |
| slug | "menopause-hormone-replacement-and-mortality-a-research-reality-check" |
Request Headers
| Header | Value |
|---|---|
| accept | "*/*" |
| accept-encoding | "gzip, br, zstd, deflate" |
| connection | "close" |
| host | "rct.dev.bbntimes.com" |
| user-agent | "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" |
| x-php-ob-level | "1" |
Request Content
Request content not available (it was retrieved as a resource).
Response
Response Headers
| Header | Value |
|---|---|
| cache-control | "no-cache, private" |
| content-type | "text/html; charset=UTF-8" |
| date | "Thu, 17 Apr 2025 19:44:56 GMT" |
| link | "</build/runtime.js>; rel="preload"; as="script",</build/644.js>; rel="preload"; as="script",</build/502.js>; rel="preload"; as="script",</build/app.js>; rel="preload"; as="script",</build/view-more.js>; rel="preload"; as="script",</build/term-condition.js>; rel="preload"; as="script",</build/contact.js>; rel="preload"; as="script",</build/scroll-infinite-article.js>; rel="preload"; as="script",</build/app.css>; rel="preload"; as="style",</build/cookie-style.css>; rel="preload"; as="style",</build/term-condition-css.css>; rel="preload"; as="style",</build/contact-css.css>; rel="preload"; as="style",</build/comment-css.css>; rel="preload"; as="style"" |
| x-debug-token | "5fd197" |
Cookies
Request Cookies
No request cookies
Response Cookies
No response cookies
Session 11
Session Metadata
| Key | Value |
|---|---|
| Created | "Thu, 17 Apr 25 19:44:55 +0000" |
| Last used | "Thu, 17 Apr 25 19:44:55 +0000" |
| Lifetime | 0 |
Session Attributes
| Attribute | Value |
|---|---|
| _csrf/https-comment | "qrXA58tIHnVpWO4JX8mIulz6p6WLJUfKfGDOQTznygk" |
| _csrf/https-cookie_accept | "vXQFMB9jynphqAls98UcOHUAj3_hGjlRSkFhuYLDVrw" |
Session Usage
11
Usages
Stateless check enabled
| Usage |
|---|
Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:76
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:79
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:69
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Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:52
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|
Symfony\Component\Security\Csrf\TokenStorage\SessionTokenStorage:56
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Flashes
Flashes
No flash messages were created.
Server Parameters
Server Parameters
Defined in .env
| Key | Value |
|---|---|
| APP_ENV | "dev" |
| APP_SECRET | "0a988e63f011514eaabfc650b599af4d" |
| CORS_ALLOW_ORIGIN | "*" |
| DATABASE_URL | "mysql://bbndb_rctuser:33F5W25z40or0f7@localhost:3306/rct_bbntimes" |
| GOOGLE_RECAPTCHA_SECRET_KEY | "6LdV5fgpAAAAANxzTG8ZMfIjil1wu-1vrQvnUt-x" |
| GOOGLE_RECAPTCHA_SITE_KEY | "6LdV5fgpAAAAAENKcn73MJAhQrbtQeqgyC4wDLMP" |
| MAILER_DSN | "smtp://no-reply%40rct.dev.bbntimes.com:Bl6%26gLD48%26Of919@rct.dev.bbntimes.com:465" |
| MARIADB_PASSWORD | "i!87pK&!85ezc8" |
Defined as regular env variables
| Key | Value |
|---|---|
| APP_DEBUG | "1" |
| BASE | "/public" |
| CONTEXT_DOCUMENT_ROOT | "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com" |
| CONTEXT_PREFIX | "" |
| DOCUMENT_ROOT | "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com" |
| FCGI_ROLE | "RESPONDER" |
| GATEWAY_INTERFACE | "CGI/1.1" |
| HTTPS | "on" |
| HTTP_ACCEPT | "*/*" |
| HTTP_ACCEPT_ENCODING | "gzip, br, zstd, deflate" |
| HTTP_CONNECTION | "close" |
| HTTP_HOST | "rct.dev.bbntimes.com" |
| HTTP_USER_AGENT | "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" |
| PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY | "0" |
| PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY | "0" |
| PATH | "/usr/local/sbin:/usr/local/bin:/usr/sbin:/usr/bin:/sbin:/bin:/snap/bin" |
| PHP_SELF | "/public/index.php" |
| PP_CUSTOM_PHP_CGI_INDEX | "plesk-php81-fastcgi" |
| PP_CUSTOM_PHP_INI | "/var/www/vhosts/system/rct.dev.bbntimes.com/etc/php.ini" |
| QUERY_STRING | "" |
| REDIRECT_BASE | "/public" |
| REDIRECT_HTTPS | "on" |
| REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY | "0" |
| REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY | "0" |
| REDIRECT_REDIRECT_HTTPS | "on" |
| REDIRECT_REDIRECT_PASSENGER_COMPILE_NATIVE_SUPPORT_BINARY | "0" |
| REDIRECT_REDIRECT_PASSENGER_DOWNLOAD_NATIVE_SUPPORT_BINARY | "0" |
| REDIRECT_REDIRECT_SCRIPT_URI | "https://rct.dev.bbntimes.com/science/menopause-hormone-replacement-and-mortality-a-research-reality-check" |
| REDIRECT_REDIRECT_SCRIPT_URL | "/science/menopause-hormone-replacement-and-mortality-a-research-reality-check" |
| REDIRECT_REDIRECT_SSL_TLS_SNI | "rct.dev.bbntimes.com" |
| REDIRECT_REDIRECT_STATUS | "200" |
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| REDIRECT_SSL_TLS_SNI | "rct.dev.bbntimes.com" |
| REDIRECT_STATUS | "200" |
| REDIRECT_UNIQUE_ID | "aAFaNoWy1c_PnVmKlNqSNQAAAIw" |
| REDIRECT_URL | "/public/science/menopause-hormone-replacement-and-mortality-a-research-reality-check" |
| REMOTE_ADDR | "18.116.61.213" |
| REMOTE_PORT | "58852" |
| REQUEST_METHOD | "GET" |
| REQUEST_SCHEME | "https" |
| REQUEST_TIME | 1744919095 |
| REQUEST_TIME_FLOAT | 1744919095.4288 |
| REQUEST_URI | "/science/menopause-hormone-replacement-and-mortality-a-research-reality-check" |
| SCRIPT_FILENAME | "/var/www/vhosts/dev.bbntimes.com/rct.dev.bbntimes.com/public/index.php" |
| SCRIPT_NAME | "/public/index.php" |
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| SCRIPT_URL | "/science/menopause-hormone-replacement-and-mortality-a-research-reality-check" |
| SERVER_ADDR | "5.196.1.209" |
| SERVER_ADMIN | "[no address given]" |
| SERVER_NAME | "rct.dev.bbntimes.com" |
| SERVER_PORT | "443" |
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| current_article | App\Entity\Article {#1094 -id: 1245 -title: "Menopause, Hormone Replacement, and Mortality: A Research Reality Check" -slug: "menopause-hormone-replacement-and-mortality-a-research-reality-check" -introtext: "<p>Perhaps you are in a hurry. If so, here’s the bottom line at the top: it turns out women can use hormone replacement to manage symptoms at menopause with, at worst, no adverse, long-term effect on <a href="http://www.medscape.com/viewarticle/885292?nlid=117947_431&src=WNL_mdplsfeat_170919_mscpedit_diab&uac=27759FZ&spon=22&impID=1437080&faf=1" target="_blank" rel="nofollow noopener noreferrer">the risk of mortality</a> or any major chronic disease.</p>\r\n" -content: """ \r\n <p>If you have a few more minutes, here’s the rest of the story.</p>\r\n <p>To state the obvious, every woman who lives long enough passes through menopause. One might think that medicine would long since have worked out with considerable confidence the health implications, from symptoms to safety, of menopause left to run its native course, versus any particular compensatory “treatment.” One would be wrong.</p>\r\n <p>Rather, the medical management of menopause is a precautionary tale about the tribulations of clinical trials; the critical value but inescapable subtleties of science; the frequent trespass of <a href="http://www.huffingtonpost.com/david-katz-md/science-and-medicine-fool_b_8432022.html" target="_blank" rel="nofollow noopener noreferrer">pecuniary motives</a> where purer pursuits of evidence ought (and are thought) to prevail; the requirement for sense in putting science to good use; and a reminder that no single tool is best for every job. </p>\r\n <p>The immediate prompt for this column is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/28898378" target="_blank" rel="nofollow noopener noreferrer">major new report in <em>JAMA</em></a>, examining the long-term (i.e., 18 years) outcomes in the nearly 30,000 women randomized in the <em>Women's Health Initiative (WHI) Estrogen Plus Progestin </em>and<em> Estrogen-Alone Trials- </em>finding no net harms of HR. By way of reminder, it was the <a href="https://www.nhlbi.nih.gov/whi/" target="_blank" rel="nofollow noopener noreferrer">WHI</a>, along with another randomized trial called <a href="https://www.nhlbi.nih.gov/news/press-releases/1998/the-hers-study-results-and-ongoing-studies-of-women-and-heart-disease" target="_blank" rel="nofollow noopener noreferrer">HERS</a>, that spawned headlines and <a href="http://healthread.net/hrtfinale.htm" target="_blank" rel="nofollow noopener noreferrer">stark warnings</a> over a decade ago that hormone replacement at menopause was not only not protective in all the ways hoped, but decisively harmful.</p>\r\n <p>The WHI and HERS were both randomized trials, and thus the early results of both, suggesting increased risk associated with hormone replacement at odds with hope and expectations, provoked considerable drama. Neither study ever showed anything much worse than nearly comparable outcomes with and without use of hormone replacement; I am among those who have been writing about the <a href="https://www.ncbi.nlm.nih.gov/pubmed/18083455" target="_blank" rel="nofollow noopener noreferrer">exaggerated responses to these trials</a> since they first issued. </p>\r\n <p>But <a href="https://www.linkedin.com/pulse/20140410203327-23027997-science-stupid-headlines-sir-isaac-and-self-defense-the-gravity-of-misinformation/?published=t" target="_blank" rel="noopener">Newtonian forces</a> prevailed: for every action, an equal and opposite reaction. On the basis of earlier, observational studies, a general and perhaps excessive enthusiasm for every variety of hormone replacement had become the norm. The equal and opposite reaction to the results of the new (as of a decade or so ago) RCTs was to renounce hormone replacement wholesale.</p>\r\n <p>But even <a href="https://www.linkedin.com/pulse/truth-tribulations-randomized-diet-trials-david/?trk=mp-reader-card" target="_blank" rel="noopener">randomized, clinical trials only ever answer the questions they pose</a>; and only provide answers insofar as the data are interpreted. Such, then, are the tribulations of even the best of trials, and the fallacy in the currently popular notion that RCTs are always best, necessary, and perfectly reliable. <a href="http://advances.nutrition.org/content/7/6/994.abstract" target="_blank" rel="nofollow noopener noreferrer">None of that is true</a>.</p>\r\n <p>In brief, summary judgment about the HERS and WHI results, even after laying aside the massive exaggeration of observed harms that populated headlines, <a href="https://www.forbes.com/sites/davidkatz/2017/05/22/reprising-the-wrong-verdict-for-hormone-replacement-at-menopause/#9acf58571211" target="_blank" rel="nofollow noopener noreferrer">obscured many critical subtleties</a>. Among them were these: the kind of hormone replacement used almost certainly matters; the timing of treatment relative to menopause and the age of the women treated almost certainly matters; and the effects of estrogen alone differ markedly from those of estrogen in combination with progesterone.</p>\r\n <p>Even as we pursue “evidence based” medicine, we are perennially at risk of profit-based medicine. The form of hormone replacement studied in both HERS and WHI is one which every <a href="http://www.menopause.org/" target="_blank" rel="nofollow noopener noreferrer">colleague expert in women’s health</a> tells me they would virtually never choose: <a href="https://www.drugs.com/premarin.html" target="_blank" rel="nofollow noopener noreferrer">Premarin</a>, which is estrogen derived from the urine of pregnant horses (pre-mar-in = pregnant mare’s urine); and <a href="http://www.webmd.com/drugs/2/drug-6996/provera-oral/details" target="_blank" rel="nofollow noopener noreferrer">Provera</a>, or medroxyprogesterone acetate, a synthetic and high-potency progesterone. These were chosen to study because they were most widely used at the time. But they were most widely used never because they were best, but because they were profitable for, and made popular by, the pharmaceutical industry. Even if the worst of news we had ever received about so-called “Prem-Pro” had been true, it would still not clearly have pertained to other forms of hormone replacement deemed far preferable by those <a href="http://www.empowher.com/" target="_blank" rel="nofollow noopener noreferrer">best qualified to know</a>. </p>\r\n <p>Then, there was the problem of lumping where the subtleties of splitting were required. The WHI included women who had just gone through menopause, and others who were a decade past that. The responses to hormone replacement in these two groups may not quite be night and day, but they differ fundamentally. Lumping them together into a summary judgment or hyperbolic headline is an archetypal failure to distinguish baby from bathwater.</p>\r\n <p>Even more so the differential effects of combined hormone replacement with those of estrogen alone. Millions of women in the U.S. – almost certainly too many- <a href="http://www.empowher.com/ahah" target="_blank" rel="nofollow noopener noreferrer">have undergone hysterectomy</a>. These women can use unopposed estrogen as their hormone replacement, since progesterone is only needed to safeguard against uterine cancer, which those who no longer have a uterus cannot get. Colleagues and I <a href="https://www.ncbi.nlm.nih.gov/pubmed/23865654" target="_blank" rel="nofollow noopener noreferrer">conducted an analysis</a> based directly on the WHI data for this group showing a decisive mortality benefit from use of estrogen right around menopause. Our study revealed that a generalized aversion to all forms of hormone replacement, propagated by hyperbolic messaging regarding the risks, had resulted in tens of thousands of premature deaths among women who would have benefited, both in terms of symptoms and safety, from use of replacement estrogen.</p>\r\n <p>We can leave the hormone replacement story there. The <a href="https://eurekalert.org/pub_releases/2017-06/tnam-n2p062017.php" target="_blank" rel="nofollow noopener noreferrer">current understanding</a> is that hormone replacement is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/28276200" target="_blank" rel="nofollow noopener noreferrer">most effective</a> treatment of symptoms at menopause; that there are better and worse hormone preparations from which to choose; that use right around menopause is safer and more beneficial than delayed use; that unopposed estrogen is likely to confer net benefit; that combination hormone replacement generally does not increase long-term harms; and that the best choice for any given woman should be individualized. We’ve come a long way, baby, from “it’s all good” and “it’s all bad,” but we spent costly years mired in both before getting here.</p>\r\n <p>The other important message in this tale is not specific to menopause or hormone replacement, but generalizable to how science works- a topic beautifully encapsulated in <a href="https://www.youtube.com/watch?v=y1MZ8U8C9c8" target="_blank" rel="noopener">brief comments by astrophysicist Neil DeGrasse Tyson</a>, addressing the topic of climate change for CNN. What is true of climate science is true of science in general- with particularly urgent implications for menopause and <a href="https://www.linkedin.com/pulse/diet-health-puzzling-past-paradox-pure-understanding-david/?trk=mp-reader-card" target="_blank" rel="noopener">nutrition</a>, among crucial public health topics we seem so adept at muddling.</p>\r\n <p>No single study design is best for answering all questions. Randomized trials, too, are subject to the tribulations of interpretation. No study answers the questions we fail to ask. Evidence is most meaningful when aggregated over time. Absence of evidence is not evidence of absence. Understanding science involves sense. There is more than one way to be wrong. Each new study adds to what was known before; it does not replace it, whatever the headlines may say.</p>\r\n <p>Science is a great tool kit, the best ever devised for answering challenging questions. Everything in a tool kit can be used well or poorly, however. The idea that any one tool is right for every job, or that the character and aptitude of those using the tool don't matter, is as invalid for science as for carpentry. There is much to learn from the muddled history of menopause management by all concerned with the efficient construction of genuine understanding.</p> """ -user: Proxies\__CG__\App\Entity\User {#1092 …} -createdAt: DateTime @1520823695 {#1145 : 2018-03-12 03:01:35.0 UTC (+00:00) } -updatedAt: DateTime @1628450906 {#1150 : 2021-08-08 19:28:26.0 UTC (+00:00) } -deletedAt: null -category: App\Entity\Category {#445 …} -status: "published" -imageCard: Proxies\__CG__\App\Entity\File {#1184 …} -ImageHeader: Proxies\__CG__\App\Entity\File {#1184 …} -featured: false -mainView: false -clicks: 3069 -comments: Doctrine\ORM\PersistentCollection {#1125 …} -reviewed_at: DateTime @1520823698 {#1148 : 2018-03-12 03:01:38.0 UTC (+00:00) } -metakey: "" -metadesc: "Perhaps you are in a hurry. If so, here’s the bottom line at the top: it turns out women can use hormone replacement to manage symptoms at menopause with, at worst, no adverse, long-term effect on the risk of mortality or any major chronic disease." -robots: null -publishedAt: DateTime @1520823698 {#1147 : 2018-03-12 03:01:38.0 UTC (+00:00) } -canonical: null -superTag: null } |
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