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Lessons from the HRT story

BMJ 2003; 326 doi: (Published 04 January 2003) Cite this as: BMJ 2003;326:58
  1. Melissa Sweet, freelance journalist specialising in health and medicine in Australia (

    The media must become more critical of unproven interventions

    One of the more fascinating medical stories of recent times was that surrounding the findings of the women's health initiative trial of hormone replacement therapy.

    This was not simply because the findings were so significant, in challenging long held assumptions about the merits of hormone replacement therapy (HRT) in disease prevention. Of equal interest has been the diversity of the medical profession's response to the findings.

    The trial, part of which was published last year (JAMA 2002;288:321-33), showed increased risk of cardiovascular events from continuous combined oestrogen-progestogen hormone replacement, although it showed benefits for hip fractures and bowel cancer. The relative risks for invasive breast cancer, coronary heart disease, and stroke were increased, although the absolute risks were small.

    Soon after the study's publication, Canadian epidemiologist Professor David Sackett wrote of the “arrogance” of preventive medicine in promoting unproven interventions and estimated that hundreds of thousands …

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