Medicine Swings Like A Pendulum Do

In 2002, the NIH Stopped the Women's Health Initiative (WHI) Study of the use of estrogen and progestin in postmenopausal women because of a small increase in breast cancer incidence and a lack of overall benefit. The study's findings were thought controversial at the time for many reasons, among them being the use of a study group comprised mostly of older women who wouldn't have benefited from hormones anyway. Moreover, this group did not reflect the standard of care at the time.

Today, we learn the results of an updated WHI analysis. Its conclusion -

Thousands of postmenopausal women have died prematurely over the past decade because they avoided estrogen therapy after hysterectomy, a new analysis of a landmark study showed.

The most conservative estimates placed the total number of deaths at 18,601, and the toll could be as high 91,610.

What happened here? This new analysis was limited to the use of estrogen only in younger women who had undergone hysterectomy.

The updated analysis was limited to younger women (50 to 59) who had undergone hysterectomy. In that subgroup of patients, unopposed estrogen significantly reduced the mortality risk, Philip Sarrel, MD, of Yale University, and co-authors reported online in the American Journal of Public Health.

"The finding is so dramatic -- reporting thousands of women dying every year -- if this gets the attention that it deserves, we hope it will change clinical practice," co-author David Katz, MD, the Yale-Griffin Research Center, said in an interview. "We hope that clinicians will start routinely talking to their patients who have had a hysterectomy and bringing up the issue that taking estrogen may save your life. We have data to show that it can save your life.

"Frankly, our paper should do that. It's not every paper that has the potential to change clinical practice. This one should. It occurs in the context of a growing awareness of the damage we have done by talking women out of all forms of hormone replacement."

Props to the researchers for going back and re-evaluating the data, bucking the tide of conventional wisdom. This happens more than people realize in medicine. It's called the Sleeper Effect, after an early scene in the Woody Allen film Sleeper.

Medicine Swings Like A Pendulum Do.