WASHINGTON, July 12 (UPI) -- The big research news of the week has been the bombshell that hormone replacement therapy, or HRT, can be seriously damaging to women's health. Millions of women worldwide undergo the treatment, so the news that the National Institutes of Health were stopping their trials prematurely was enough to send panic waves around the globe. Headlines in the UK screamed "Millions in HRT Danger," women in Canada jammed their doctors' phone lines and pharmaceutical industry stocks plummeted in the United States. Yet very little of this reaction was justified.
The particular HRT treatment being studied was a combined dose of estrogen and progestin. Estrogen is prescribed to counter the physical and psychological effects of menopause, which leads to a fall in the body's natural estrogen levels. These effects include osteoporosis, hot flashes and depression. In women who have not had their uterus removed, however, estrogen can be carcinogenic, so progestin was added to the dose to protect against uterine cancer. Scientists have long known that this combination could possibly lead to a small increased risk (of breast cancer), but previous studies had shown benefits in a reduced risk of cardiovascular problems associated with the treatment.
The study, by the Women's Health Initiative of the National Heart, Lung and Blood Institute, contradicted earlier research by claiming to have found significantly increased risks of coronary heart disease, stroke, deep vein thrombosis/embolism and breast cancer. Although these amounted to only 31 more cases in every 10,000 women, the researchers felt that this was enough of a variance to stop the trial and recommend against the therapy. The researchers did find some benefits in reduced risks of colon cancer and hip fracture, but they concluded that these small benefits were not enough to sway their decision.
The validity of this decision has so far gone unchallenged, but its grounds are much more shaky than has been let on. These studies rely on something called hazard ratios to sort out actual effects from what might be the results of pure chance. A heavy smoker, for instance, has a hazard ratio of 30:1 for the risk of contracting lung cancer compared with a non-smoker. Generally speaking, risk ratios of under 3:1 are regarded as suspect. The closer one gets to 1:1, the more likely some random or unsuspected factor is to blame rather than the factor being studied. The risk factors for heart attack, stroke and breast cancer identified in this study were 1.3, 1.4 and 1.26 to 1 respectively. The risk factors for death from these causes were even smaller. Moreover, when the ratios were adjusted to take account of the long time period of the study, they all ceased to be statistically significant.
Meanwhile, the principal benefits of HRT were not taken into account in the researchers' conclusions. The large number of broken bones (other than the hip) prevented by the therapy's effect on osteoporosis were ignored, as were the effects on many other debilitating symptoms of menopause. Hot flashes, headaches, cramps, depression and loss of libido are serious quality of life issues. HRT has protected millions of women worldwide from these distressing symptoms. It is mystifying that the researchers chose to ignore these well-proven benefits.
Overall, HRT continues to have much to recommend it. While the doctors may have been acting out of good conscience in stopping the trial of the drug, their grounds for recommending that doctors no longer proscribe it to patients are much thinner. Given that the minuscule health risks identified in the WHI study may simply be the result of chance, why should women not be allowed to weigh these tiny risks against the significant benefits HRT has been proven to give them?
Readers of The Washington Post familiar with the advertising industry will have been surprised to see the headline "When Sex Doesn't Sell; Study: Bawdy, Violent TV Erases Viewers' Memories of Ads" on June 17. The study it covered claimed to show that sexual and violent programming led to a reduced ability to recall advertisements among viewers. People who watched World Wrestling Entertainment or Comedy Central's raunchy The Man Show identified fewer brands on average than people who watched PAX channel's It's a Miracle or Candid Camera. The research implied that advertising media buyers should stop placing advertisements on the edgy programs and switch to the more wholesome one instead.
Unfortunately, for an advertiser brand recall is only half the equation. Ads have to be seen by a significant number of people, and that's where sex and violence still win out. The wrestling show Smackdown gets four times as many viewers as anything on the PAX channel and The Man Show is the leading show on cable for the coveted young adult male demographic. Bluntly put, all this research shows is that wrestling fans forget more ads than are seen on the PAX channel.
One other important factor was missed in the coverage of this story. The research was paid for by a contract from Paxson Communications, the owners of, you guessed it, the PAX channel.
Latest research from the Department of the Obvious: according to a report in the British Medical Journal of June 27, disorganized medical students are more likely to struggle and subsequently fail their end of year examinations.
(Iain Murray is director of research at STATS -- the Statistical Assessment Service, a Washington-based non-profit, non-partisan public policy organization dedicated to analyzing social, scientific and statistical research. This column examines the facts behind recent statistical studies that have made the news but been misinterpreted, failed to make the news for some reason or are just plain weird.)
