the original post contained one of the frequently repeated canards about bioidenticals that you also used in your Part 1 attack: “There are no bioidentical hormones that do no undergo some sort of laboratory manipulation. Consequently there are no truly “natural” bioidentical hormones.”

As I pointed out in my response to Part 1, this is nonsense and deliberately misrepresents the whole reason why bioidenticals may well be safer – not because they haven’t been manipulated, but simply because they are identical to the ones in your body.

Glad that you agree that its unfortunate to refer to bio-identical hormones as ‘natural’. The article’s headline was “Should middle-aged women be taking natural HRT?”. Assuming you didn’t choose this headline yourself, perhaps you might have a word with the Mail about it?

let me think, who might benefit if lots of women were warned off bioidenticals?

We don’t benefit if this happens.

Although you claim to be objective the tone is set by the opening sneer. You say you came across a long post by Burne (on a blog about bio-identical hormones) “recommending his own research”. Actually what you came across was a detailed critique of bioidentical hormones with a comment by me pointing out some favourable evidence. It’s odd to describe an informed contribution as “recommending my research” Isn’t that what sites like this are about? Already it’s clear this is not a disinterested analysis.

Interestingly, the original post contained one of the frequently repeated canards about bioidenticals that you also used in your Part 1 attack: “There are no bioidentical hormones that do no undergo some sort of laboratory manipulation. Consequently there are no truly “natural” bioidentical hormones.”

As I pointed out in my response to Part 1, this is nonsense and deliberately misrepresents the whole reason why bioidenticals may well be safer – not because they haven’t been manipulated, but simply because they are identical to the ones in your body.

Then we come to the nub of your critique. You say that the shorthand version of the whole critique it is that in response to question: Should middle aged women be taking HRT ? That the answer is: “Not if you are relying upon the Holftorf review to provide a comprehensive overview of the relevant evidence on efficacy and safety.”

And then you plunge into a remarkably detailed assault on the Holtorf paper, saying that you are not arguing about bioidentical hormones but only about the “scholarship of the Holtorf paper and Burne’s use of it and its influence on the balance of the reporting in Burne’s article.” And you further state: “Burne relies quite heavily upon Dr Kent Holtorf’s paper.”

But this is a total misrepresentation. I don’t know whether to assume it was wilful or whether you don’t know what “relies heavily” means. Either way the Holtorf paper is a straw man. I can’t imagine why anyone would believe that I was only relying on the Holtorf paper, not least because it takes less than 150 words in a 2000 word article. That is the extent of its influence on the balance of my reporting.

In fact there are four other strands of evidence in the article on which I rely, as you must realise. First and foremost that bioidentical hormones are currently available on the NHS, a fact which you totally ignore, You can get them from your doctor like any other drug. They have gone through the whole lengthy evidence based licensing process.

For various reasons most doctors and their patients are not aware of this fact and so the main function of the article was not to set out a peer reviewed journal-style assessment of the evidence of these strange things but essentially to let women know that they were there and had already been approved.

This fact alone demolishes the whole slant of your critique which is that the article was pushing some wacky treatment of doubtful value without any real understanding of what a sound evidence base means.

The second strand of evidence was a comment from another American doctor – also s supporter of bioidentical hormones – but one heading a society that has 250 members who are also doctors. So maybe they know something about evidence.

Thirdly and also pretty relevant is the fact that a UK gynaecologist who is also a member of the UK menopause society is quoted at some length as saying that bioidenticals should be thought of as a reasonable alternative to the regular non-bioidentical version, although all the evidence for greater safety wasn’t in yet.

Fourthly there was the case of France. There a bio-identical version of progesterone has been used for decades and a large observational study recently found that it was safer than the non-bioidentical version

So what on earth are you doing directing all that firepower on Holtoff? Let alone attempting to suggest that the very fact that I mentioned it raises serious doubts about the thrust of the whole article. Could it be that, far from being a piece of evidence that I relied heavily on, it was in fact the only one you could find to criticise?

But there is a broader problem with your exclusive concentration on the Holtorf article which goes to the heart of your whole project which appears to be a ruthless attempt to discredit anyone who writes about anything to do with medicine that doesn’t adhere to medical orthodoxy.

The central issue is the extent to which it is reasonable to expect working journalists, many of whom myself included do go to considerable lengths to be fair and accurate, to write their articles as if they were tenured academics critiquing something that had appeared in a peer-reviewed journal.

You make 12 specific critiques of Holtofs research methods, referring to criteria set out for Cochrane reviews and concluding: “Holtorf has not supplied sufficient information about his literature search strategy nor his inclusion-exclusion criteria: this may have resulted in an incomplete and partial view of the research literature.”

Now I am not about to go through all your points and evaluate them; it is possible to critique any paper and I have no doubt that Holtorf would have a number of points to make in response. But are you seriously suggesting that any journalist writing on science topics should devote that much attention to every piece of research that is used in an article to? Certainly no doctor would do that. Instead both journalists and doctors rely on peer reviewed journals to do some of that heavy lifting.

As it happened Holtorf’s paper was far from the only one that I looked at when preparing the article but I didn’t include them for the simple reason that I was writing for a consumer pages of a newspaper whose pages are not designed to be written to the standards of a Cochrane review. As I pointed out in my comment to Part 1 of your critique, my other background reading included: “Could transdermal estradiol + Progesterone be a safer postmenopausal HRT? A review by Marc L’Hermite et all in Maturitas – July/August 2008. The conclusion was that it “might offer significant benefits and added safety.”

Or how about a case control study from France involving 271 consecutive cases with “a first documented episode of idiopathic VTE (venous thromboembolism). Conclusion: “oral but not transdermal estrogen is associated with increased VTE risk. In addition our data suggest that norpregnane derivates may be thrombogenic whereas the micronized progesterone and pregnane derivatives appear to be safe with respect to thrombotic risk.” Circulation Feb 20 2007

It was on the basis of these and other papers that I considered the quote I used from Holtorf perfectly justified. This was: “Many physicians state there is no evidence they are safer,’ says the author Dr Ken Holtorf, ‘but the medical literature clearly shows they are highly effective and have some distinctly different, often opposite, physiological effects to regular HRT.’

And there are flaws in your critique of Holtorf. You complain that he didn’t include an FDA review that referred to “false or misleading claims…(that). these products are “bio-identical” implying that these products are natural or identical to hormones made by the body.” Actually it is very clear that is precisely what these products are. Coming on top of the whole “natural” confusion it is obvious that there is a lot of misrepresentation about bioidenticals. My article does clear them up, it’s a pity you didn’t read it carefully.

At the end you claim that Holtorf’s article is a good example of “Cargo cult science” – something that (and I heavily précis) has all the trappings of science but actually lacks the essential ingredient, And what is it that is missing in cargo cult science? It is, you solemnly suggest, “a kind of scientific integrity, a principle of scientific thought that corresponds to a kind of utter honesty–a kind of leaning over backwards. For example, if you’re doing an experiment, you should report everything that you think might make it invalid–not only what you think is right about it.”

Now the assumption behind this site and its relentless attacks on anyone who strays from the solid evidence base that supports mainstream biomedicine (although there is actually nothing about bioidenticals that is at odds with biomedicine) are practising a version of “cargo cult science”.

In light of this it is interesting that a study published this week in PLoS Medicine seems to have identified a clear cut case of “cargo cult science”. Researchers from the University of California, San Francisco compared the information that drug companies had supplied to the American FDA when applying for a license, which legally has to be comprehensive, with the versions of that data eventually published in medical journals to inform doctors.

The study found a yawning gap between the two. Only three-quarters of the original trials were ever published, and it turned out that those with positive outcomes were nearly five times as likely to be published as those that were negative. Not quite a “principle of scientific thought that corresponds to a kind of utter honesty” then.

Which raises the question of what really are you up to? You lurk behind a pseudonym, drum up detailed and half-baked attacks on responsible journalists doing their job while ignoring ongoing distortions of scientific evidence being done to promote the sale of pharmaceuticals. It is precisely because of this kind of dishonesty that so many women are looking for something else to help with the menopause, your deliberate muddying of the water does no one any favours. Except, let me think, who might benefit if lots of women were warned off bioidenticals?