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Confused About Health Recommendations? Here's Why

By unusualsuspect     Sep 17, 2007 in Health
Hormone Replacement Therapy was touted as the magic bullet that would keep women young forever. Studies showed that it could ward off osteoporosis and heart attacks in older women. By 2001, 15 million women were taking estrogen. Then the other shoe fell.
With the news, in the summer of 2002, that H.R.T was a health hazard, the weaknesses of medical research were exposed to the world. Thousands of women wanted to know why a treatment that they had adopted in good faith was now putting them at increased risk for breast cancer, strokes, and heart disease. Jerry Avorn, an epidemiologist at Harvard University, called it the "estrogen debacle” and said that it was a “'case study waiting to be written' on the elusive search for truth in medicine."
The public is constantly barraged with information about health care and medical issues—cholesterol, smoking, obesity, exercise, aspirin, and fiber are just a few of the topics that have been hot topics in the media. Do this, but not that for your health; eat this, but not that; take this supplement, but not that one. And, as often as not, the recommendations are modified or reversed as more research is done, or as old research is scanned more closely for its flaws. Today's authoritative information contradicts yesterday's, leaving consumers confused and angry, and ever more distrustful of any recommendations.
A good part of the problem is a lack of understanding about how science works. Most people assume that when a study is published its results are the final word on a subject. But science is a process of forming hypotheses based on observations, and then trying to prove those hypotheses. It's very rare that all the necessary facts are known, so there may be a necessity for many studies of the same subject, each incorporating or correcting the information from earlier studies, or finding facts which may completely invalidate the earlier ones.
The modern combination of media that are always on the hunt for something new and sensational, and the concept of our "right to know," means that early studies and tentative conclusions are overhyped and turned into premature and unwarranted recommendations for lifestyle changes.
At issue is the science of epidemiology, which has a noble history in its defense of public health. Epidemiology "evolved over the last 250 years to make sense of epidemics — hence the name — and infectious diseases." But identifying the cause of a disease like typhoid or cholera, each of which is the result of infection by a specific bacteria, is very different from trying to identify the causes of chronic disease, which is the role that epidemiology has been given in contemporary society. When a direct relationship between a disease and a suspected cause can't be proved, as in heart disease or cancer, the waters become very murky.
The case of H.R.T. is typical of the complex problems which medical science is being called on to solve. The safe use of hormone therapy depends on the age when a woman starts to take it, on family medical history, and on the dosage, among other factors. While it reduces some risks, it increases others, requiring judgments about benefits vs risks. To complicate things further, various biases in the way a study is set up can change the results. An almost universal bias is the use of only healthy individuals in drug trials and other studies. In other words, the populations studied are not typical, and this turned out to be a major flaw in the years-long study which led to the judgment that H.R.T. was both beneficial and completely safe.
It may be that the best way to deal with the confusing flow of information about medical advancements is the same that some people take about new technologies—don't be an early adopter. Today's advice may turn into tomorrow's retraction, so sit back and wait for the "kinks" to be worked out.
More about Hormone replacement therapy, Public health, Epidemiology
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