- The Washington Times - Wednesday, July 17, 2002

Primitive people used to burn witches when faced with mysterious and unwelcome events. We're too smart to believe in witches. But the impulse to blame scapegoats endures. Just look at the response to the discovery that hormone replacement therapy creates more problems for women than it solves.

Doctors and scientists are always looking for new ways to treat human ailments. Some of the ideas turn out to be helpful, and some turn out to be useless or worse. Knowledge often advances by taking two steps forward and one step back and, occasionally, three steps back.

Hormone replacement therapy has long been used to treat the more unpleasant problems that come with menopause, like hot flashes and night sweats. It was also assumed to protect middle-aged women from heart disease. But last week, researchers stopped a major study of this treatment after concluding that it created unacceptable risks to patients.

For many doctors, the discovery came as a shock. But to suspicious-minded observers, it exposed an outrage. Cynthia Pearson of the National Women's Health Network said the therapy has always been "sexist and ageist," putting pressure on women to risk their health in a vain search for youth. An editorial in the New York Times blamed "desperate drug companies" that had created a "marketing juggernaut."

Before we start heating the tar and bagging the feathers, we might consider what the study revealed. The researchers did find that instead of reducing the danger of heart attacks, the hormone pill raises the risk. It also increases the incidence of breast cancer and stroke (though it protects against hip fractures and colorectal cancer).

But the danger is small. Only about 1 percent of women on the therapy would be adversely affected in a given year meaning that 99 percent would not. Of 1,000 women who are not taking estrogen, three can be expected to get breast cancer in a year. Of 1,000

women who are taking estrogen, the number is 3.8.

Some physicians will continue to recommend it for menopause symptoms. Said Isaac Schiff, chief of obstetrics and gynecology at Massachusetts General Hospital, "I think there is a place for estrogen replacement therapy that it will get its rightful place for symptom relief."

It's not as though pharmaceutical companies and physicians had to invent excuses for this regimen. There was a wealth of evidence to support it. The most notable was a study at Harvard's Brigham and Women's Hospital, which tracked the health of 122,000 women. It found that those on hormone replacement therapy had a lower rate of heart attacks not a tiny bit lower, but 50 percent lower. Other studies backed up that finding.

"If you look at this evidence and it's part of the mind-boggling aspect of this whole story boy, the evidence for estrogen looked really strong," Deborah Grady, head of the Mount Zion Women's Health Clinical Research Center at the University of California at San Francisco, told the New York Times.

It's not hard to understand why 6 million women are on these drugs. Hormone replacement provides the surest relief for menopause symptoms that many women find unbearable. On top of that, it appeared to prevent heart disease and osteoporosis. It was known to raise the risk of breast cancer, but since heart disease kills 5 times more women than breast cancer, the tradeoff looked like a winning bet.

Drug companies have indeed run ads touting the benefits of hormone replacement therapy, but they can hardly be blamed for trying to generate interest in the medicines they make. The ultimate control lies with physicians. Doctors prescribed the therapy not because they've been duped by Lauren Hutton but because they perceived it as an effective remedy for real ailments.

Now they'll have to reconsider. But that's not because bad people misled us. It's because figuring out what promotes better health, and what doesn't, is a complex process that often yields surprises. Asked the secret of his hitting prowess, Ted Williams once answered, "Trial and (bleeping) error." Science and medicine, alas, have to use the same method.

The alternative is to withhold any innovation from patients until it has been put through the most rigorous and time-consuming trials. That would keep patients from taking some dangerous drugs and some beneficial ones. And it would deny patients options they might choose in the face of imperfect knowledge.

Many women may wish now that they had forgone hormone replacement therapy, just as a lot of bettors wish they hadn't put money on War Emblem in the Belmont Stakes. All we can do is act on the best information available at any given time. If that leads to occasional mistakes, don't blame drug companies. Blame reality.

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