Education And Debate

Controversies in Management: Not for everybody

BMJ 1996; 313 doi: (Published 10 August 1996) Cite this as: BMJ 1996;313:351
  1. H S Jacobs, professor of reproductive endocrinologya
  1. a Cobbold Laboratories, Middlesex Hospital, London W1N 8AA

    In thinking about this debate I suggest two broad themes to consider before turning to precise clinically based contraindications. The first is that if hormone replacement therapy really is so good for you why do so few women take it? The figures may be changing slightly, but at present in the United Kingdom fewer than 15% of eligible women are thought to start the treatment and fewer than 5% persist with it for more than a couple of years. When patients reject our advice doctors tend to lapse into omnipotence and berate them for their ignorance or fecklessness. It is therefore of great interest that Isaacs et al recently published the results of a study of 1200 women doctors aged between 40 and 60: they found that 40% of those who were postmenopausal had never even tried hormone replacement therapy.1 Is it that our medical colleagues are feckless and ignorant, or is there something they know that Toozs-Hobson and Cardozo and I don't?

    Paucity of solid data

    The second consideration is the very real lack of solid data on which to base decisions about recommending universal prescription of hormone replacement therapy. It would be wonderful to have to hand the results of at least one randomised prospective trial that evaluated the outcome of treatment in terms of clinical events such as rates of fracture or heart attacks. All …

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