Resisting cookbook medicine

“It is now the standard of care that every postmenopausal woman be given replacement hormones for the rest of her life unless there is a medical reason not to; to practise otherwise may be considered malpractice.” These words, passionately spoken at a 2001 medical education conference by a foremost authority on women's health, left some listeners feeling uneasy. Unable to find randomised controlled trials that validated the presumed benefits of long term hormone replacement therapy (HRT), we concluded that HRT for disease prevention represented an experiment on women.

Today, two years after the release of the results of the women's health initiative study showing that HRT has more potential for harm than for good in healthy postmenopausal women taking a combination of oestrogen and progestogen to prevent chronic disease, the questions of 2001 remain relevant. Do individual doctors have the freedom to critically …