In this monologue, Dr. Aaron Hartman examines major medical blind spots that have harmed patients, focusing on two recent reversals: hormone replacement therapy (HRT) and dietary fat guidance. He recounts how the 2002 Women’s Health Initiative (WHI) study led to a black‑box warning on HRT, which was only removed in November 2025 after decades of under‑treatment and an estimated 140‑160 k premature deaths among women. Hartman explains methodological flaws in the WHI (use of oral Premarin/Prempro, lack of blood‑level monitoring, and a high‑risk study population) and presents newer data showing HRT can cut heart‑disease risk by up to 50 %, lower dementia risk by 38 %, reduce invasiveness of breast cancer, and treat osteoporosis. He argues that fear of litigation drives physicians to practice defensively, perpetuating such errors. He then shifts to nutrition, describing the 2026 reversal of the food pyramid that reinstates healthy fats as essential for cardiovascular, brain, and metabolic health—a correction of a half‑century of misinformation. Throughout, Hartman frames these issues as examples of “medical gaslighting” and calls for a medical feminist perspective that prioritizes women’s health. He urges listeners to identify current blind spots, educate themselves, and help reduce medical error, which he cites as the third leading cause of death in the United States.
Chapters
Medical blind spots— things our healthcare system has got just plain wrong. This is going on today, it's gone on in the past, and one of the things I 100% believe is you have to know the past in order to prevent things like this from happening in the future. You know, there's a saying, history doesn't repeat itself but it rhymes a lot. So point of that is if you know what things we've gotten wrong in the past, what blind spots, medical gaslighting things, you can actually take charge of your health and be more aware and be more educated so you can pick up things up today. So I wanna talk about two specific recent things that have happened as of I'm recording this, February of 2026. You may know that hormones are back and fat is back. What am I talking about? So 2002 Women's Health Initiative, Canadian study came out. Don't wanna go into the details, but basically it said hormone replacement therapy can cause breast cancer, increase your risk for cancer, strokes, thickens your blood. It's a bad for women. And hormone replacement therapy got a black box warning. It was just removed November of 2025. So 23 years went by before those were removed. What has been the result of these last 23-odd years? Depending on what you read and how you look at the numbers, potentially 140,000 to 160,000 women have died prematurely due to lack of access to care to hormones. That's a pretty staggering number. Another number is between 40 to potentially 70 million women have been undertreated in general for all things related to hormone replacement therapy. So how does this even happen, and what's the current data? Well, when the study came out, it was really interesting. This— within 2-3 weeks, the physicians like myself were looking at the study, asking questions, saying, wait a second, this doesn't look right. It's a smoking population, it's older women, it's nurses. Like, there's so many different things about it. One big oops with that study is they were taking oral Premarin, Prempro, and Premarin. So some of you may know that Premarin is conjugated equine horse estrogen, so basically horse urine estrogen by mouth, and medroxyprogesterone, which is a synthetic progestin. The synthetic progestins were already known to research to cause tumors in lab rats. And the oral estrogen, in order to get it systemically, to get your levels high, you have to take anywhere from 5 to 6 times like a topical or pellet dose by mouth, your liver breaks it down to a lot of metabolites. And based on your genes and SNPs, which are these little typos in your genes, you can actually turn it into cancer-causing metabolites. Um, and also they weren't checking blood levels and they weren't looking for metabolites. So lots of errors with it, but they're using a product that hopefully no one's using anymore. I know people are still using it and shouldn't be doing hormones by mouth, by the way, because of this whole phenomenon. And even sublingual ones, you still swallow a significant amount of the hormone, but that's another topic. We've talked about that on previous podcasts. I won't play with that here. It just does so many wrong things with it because it got out. The horse was out of the barn. It got pushed in the media. Lots of women were scared and no one wanted to get sued. Physicians don't want to get sued. And unfortunately, a lot of medicine we practice in the court of law. If you go to courtroom, something's a bad outcome, Dr. Hartman, Dr. XYZ, you know, why did you do this knowing XYZ? And then you lose your license. And so a lot of times you practice medicine more from a place of fear than facts and more of a place from avoidance, avoiding risks, than actually trying to help people. So fast forward, what do we now know about hormone replacement therapy? Hormone replacement therapy for women will lower your risk for heart disease up to 50%. So to put this in perspective, if you're a female and you have high blood pressure, high cholesterol, and you're in menopause, you know, treating your blood pressure will lower your risk for heart disease about 35-36%, plus or minus. Hormone replacement, 50%. So hormone replacement therapy is literally more helpful for lowering your risk for heart disease than actually treating blood pressure, which is a crazy statistic. The other thing is that hormone replacement therapy can lower your risk for dementia as a woman up to 38%. So the number one killer in our country is heart disease, number two is cancer. And here's another thing that is interesting. If you're on hormone replacement therapy and you're diagnosed with breast cancer, it's less likely to be invasive. So my question— hopefully they're going to start research on this— but my assumption is if being on it means if you get cancer, it's less invasive, is, is hormone replacement therapy actually protective? Is actually breast protective? Great question. It's suggestive that that's the case. Point being is we got this wrong for almost a quarter of a century. And this kind of bleeds into the topic of being a medical feminist. There are women, typically women physicians, pushing for this to be available. Because they, a lot of women physicians go through middle age. They all go through middle age if they, as they age. And then all of a sudden you're like, oh my gosh, you know, brain fog. I'm actually kind of experiencing that now with a lot of females I'm close to and a lot of patients that have been seeing me for years going through change of life. And it's horrible. You lose your brain, you lose your energy. It's, it's Gibby, you know, my wife lovingly calls it the suck. It's just not pretty, not good. But the point is, is that we took away the major treatment for that. Osteoporosis, you know, the major medication to treat osteoporosis is actually hormone replacement therapy. And we took that away from women. Another thing we got 100% wrong is fat. We just— fat's back. There's no fat's back. Well, as of, um, January of 2026, we flipped the food pyramid upside down. Now fat is back. Another great example of the blind spot that we got totally wrong. So you say fat's back. How's fat back? Well, now we know that good fat's good, bad fat's bad. We now know that you actually need healthy fat for heart, your heart to work, your brain to work. You need fat for appropriate metabolism, for you not to have sugar spikes. If you don't eat enough healthy fats, you can actually be more prone to obesity, diabetes, metabolic syndrome, and a whole host of things. And we got that so wrong for over half of a century. And now the food pyramid's changed. If you notice, one of the things I think was funny, the things that are politically driven and politically motivated, this is one of the things that, you know, for the first week it came out, people like, oh my gosh, this is wrong. You know, not to get in politics at all, but it died away within a week. You know, we're out maybe a month and change now and no one's arguing. It's funny how many groups on both sides were like, yeah, this is a pretty good idea. Yeah, processed foods are bad. Yep. Lots of carbs are bad. Yeah. We need more protein. Like it's the consensus was already there. It was just under the, um, surface waiting to pop up. And how long did we get fat wrong? Half a century, half a century. So the point is with this idea of blind spots, there's, this happens all the time. We get these things wrong a bunch. So the question I have for you is, are there things you think that we're getting wrong right now? There probably are. Are there things in your, your own loved ones, yourself? Yes. And if medical error, which I believe this fact to be true, is the third most common cause of death in our country, all of a sudden knowing these blind spots, looking for them and preventing them can be a huge way you can help maintain your health and avoid medical error. Anyway, we're gonna keep on going through this series over the next several weeks talking about blind spots, medical gaslighting, and being a medical feminist and what that means. Most of my patients at this stage of my career are women, about 80% of the population I care for. And so it becomes a big issue 'cause we wanna take care of everybody. Especially one group of our population that's really been mistreated, miscared for a long, long time. We need to reverse that. And so we'll keep on talking about these things that we get wrong, and the goal that you can be educated, practitioners can become educated, we can start getting things right and do better going forward. Thanks, take care, we'll talk to you soon.
