The overselling of hormone replacement therapy.

Abstract

The news that part of the Women’s Health Initiative (WHI) was stopped early because women treated with combined estrogen-progestin therapy experienced higher rates of breast cancer, cardiovascular disease, and overall harm has rocked women and physicians across the country. But the most important part of this story has received little attention: why did the medical and research community ever believe that hormone replacement therapy (HRT) prevented or treated disease? Not a single controlled trial has ever shown that HRT prevented cardiovascular disease, stroke, Alzheimer’s disease, or wrinkles, nor that it was an effective treatment for depression or incontinence. For decades, physicians have acted as an unwitting volunteer sales force for pharmaceutical companies that have promoted HRT for disease prevention in the complete absence of controlled trials supporting this claim. Advertising and detailing have been only a small part of this campaign; far more effective is the hidden influence that pharmaceutical companies have on the information that physicians receive through continuing medical education activities, where the benefits of HRT had been espoused for decades.