I am fairly confident that most women—certainly those post-menopausal or peri-menopausal—are aware of the extensive media coverage and dire warnings following the release of the results of the Women’s Health Initiative (WHI) study on hormone replacement therapy (HRT) in 2002.  At that time, it was stated that HRT is detrimental to a woman’s health, with risks outweighing the benefits.  It stated, pretty unequivocally, that HRT increased risk of breast cancer, cardiac events and stroke.

It would be overstating to say that all of the 2002 results were inaccurate, since, as we know, science is rarely definitive and more information is constantly emerging and being revised; however, women should know that many of the initial results have been found to have been distorted, misunderstood, over-generalized, and in some cases flat out wrong.  While the updated findings have been published in various scientific papers and journals, the mass media continues to refer almost exclusively to the 2002 WHI negative results.  Having received the attention they wanted, they have moved on.  But what if some of the findings turned out to be wrong…

A few recent examples highlight this continuing problem of misinformation:

-The New York Times recently published an article on what is currently known about what causes cancer and what prevents it.  The underlying thesis was that we know very little, but two things we do know:  first, that smoking causes cancer (okay, we can all agree on that); second, that HRT causes breast cancer.

-A November 29 article on sex and menopausal issues, also in The Times, stated that many women stopped taking hormone therapies because of their link to small increases in breast cancer, heart attacks and strokes.

-A November 12 article in HealthDay News posited that the “declining use of HRT” may be driving down rates of a condition called atypical ductal hyperplasia—a known risk factor for breast cancer.  Other articles have gone even further, to say that the incidence of breast cancer is down for the same reason.

Seemingly no one in the mainstream media is quoting the analyses and research that questions all of the 2002 results.  For example, in an article published in The Cancer Journal in 2009, Dr. Avrum Bluming, Clinical Professor of Medicine at the University of Southern California and Master of the American College of Physicians, along with Dr. Carol Travis, debunk many of the previous 2002 research findings.  Their work joins a growing list of reports on the WHI results and newly published research studies, chipping away at the theory that HRT is bad for all women, all of the time.

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The following post represents my personal opinion and not that of any groups or organizations with which I am affiliated.

Okay, it’s enough already! Why is it that women are always the target? First it’s abortions, then mammograms, pap smears following closely, behind and now cosmetic surgery (although that’s not only women!) It looks like the Congress is desperate to find any savings anywhere. Why not tell it like it is, it’s raising taxes. Whether it is through so called elective procedures or levying taxes on devices and diagnostics, to be passed on to the patients, it’s a tax.

Instead of rewriting the rules on mammograms which will cost lives, maybe not that many, but if it is your life that’s all that matters and focusing on false positives and unnecessary screening, why not invest money in better mammograms that are more effective in identifying a lump or even distinguishing a fast growing one from a slow one. Taxing companies who make these diagnostics, while lowering reimbursement rates is not exactly a motivator for more research and innovation.

And by the way, these recommendations for mammograms are a classic example of “comparative effectiveness”, which it very well may be, but the reaction from the American public is an indication of how difficult cutting any services will be—not a great start. And no sooner does the US Preventive Services Task Force come out with recommendations then the Sec of HHS tell us to ignore them. Will private insurers ignore them?

Let’s talk about cosmetic surgery, according to the physician groups, in a survey done of people who are planning on having cosmetic surgery in the next two years, 60% reported a household income of $30K to $90K, 40% of the 60% reported incomes of $30K to $60K, this is the middle class and insurance does not pay for it. While some of the procedures may be considered elective by some, it is in the eye of the beholder and who is to make that distinction, the doctor, the patient or the government? Another bad idea.

Why are women being targeted? I thought this was all about giving women more access to health care, many of the changes in regulations are definitely positive, but what the government gives with one hand, it seems to take away with the other.

With all the chatter and perhaps now “ twitter” about health care reform, one area has gotten a lot of attention and it is an issue that is near and dear to the Society for Women’s Health Research—that is comparative effectiveness research (CER).

Since it is accepted knowledge that women and minorities were not, and are still not, to the degree they should be, included in clinical trials, there is much we are learning and still do not know about sex and ethnic differences in terms of prevention, diagnosis and treatment. My concern with CER, therefore, is how differences in effectiveness and treatment will be determined. Several genetic, hormonal, environmental factors influence health and disease in particularly different ways in women and men. Because of that, CER must study both men AND women and analyze fully any sex based difference in disease prevalence, treatment options and procedures. Those decisions must correlate to real world experiences.

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