Intended for healthcare professionals

Rapid response to:


Hormone replacement therapy

BMJ 2002; 325 doi: (Published 20 July 2002) Cite this as: BMJ 2002;325:113

Rapid Response:

Why are commentators on WHI not mentioning.....?

I sincerely hope it (The WISDOM study) does continue. The more I
examine the WHI figures the more I feel all it has done is muddy the
waters. Why are commentators not addressing the obvious flaws? For

The average age on entry was 63.2 yrs - 66% were between 60 and 79,
meaning the figures are largely those of women who have already suffered
significant accelerated degenerative changes before they got the
replacement. We may slow the clock, but we cannot turn it back - that is
these figures showing negative effects on cardiovascular disease would
seem to show.

Add the fact that with an oestrogen dependent tumor you would expect
them to be growing faster locally, being picked up earlier, (thereby
improving the
outcome by removal before metastasis one might well infer - other studies
support that), and therefore giving the illusion early on of increased
incidence. If only they had recruited more newly menopausal women, and
continued it longer?

Consider also the fact that elderly women untreated are hypo-
coagulable if anything - they bleed easier, ask any anaesthetist, - think
about their GI susceptability to NSAIDs - which might well mean their
favoured status re thrombo-embolism is the perverse effect of a lower than
normal thrombosis incidence. We may never know now, and this is serious.
We really need to know the truth here, but with this study, I find myself
wondering why they bothered? Two thirds of them were already out the
stable door. This may well be a case of 'the Emperor's clothes.'

Competing interests: No competing interests

24 July 2002
Peter R Bradley
General Practitioner
Springwood, QLD, 4127