NEWS: JAMA weighs in on the WHI reappraisals

The Journal of the American Medical Assoc. has weighed in on rethinking hrt as the ongoing re-analyses of the Women's Health Initiative Study progress.

The article is good in picking over the problems with WHI data and practices as well as some of the implications of the results. Where we have reservations—and we think these are important because of all sources of medical education and news, a JAMA piece is most likely to be seen and carry weight with our doctors—is that their advice specifically deals with natural menopause and has nothing to do with us: it's all about weathering a brief period of hot flashes and then giving up hrt.

Even more worrisome, though, is their flat statement that benefits like osteoporosis and colon cancer prevention cannot be taken into account in evaluating the risks of using hrts. Now this is a particularly medical attitude and is part of what we mean when we talk about medicine being focused on treatment of disease, where we as individuals tend to be a bit more focused on maintenance of our health.

From a medical standpoint, it's acceptable to risk experiencing a disease state if medical treatment exists, even if that treatment carries risks itself. Since colon cancer can be detected via colonoscopy and treated with surgery and since osteoporosis is now medically defined as being dealt with entirely satisfactorily with bisphosphonates, then, it's fine to accept not preventing them them because there is no real negative connotation attached to a treatable disease in medical terms. While that may make absolutely no sense to us, who might not feel the same way about our bodies, it is entirely sensible and consistent with the philosophy of medical practice...and medicine as a business of selling diagnosis and treatment.

Where else can we quibble? Their equation of hrt risks as oral synthetic = all hrts, something that other research data is significantly questioning and not for the most part really accepting, has always been a sticking point in WHI analysis and one that some other policy-setting groups are seemingly taking into account in a more nuanced way. We think this is a simplistic stance, this general equivalence, and it disappoints, although not surprises, us that JAMA is holding to it.

Overall, there are some good points in this piece and it's well worth reading by all of us. And by reading it, we can better prepare ourselves to counter arguments we may get from our doctors, who may seek to apply a narrow interpretation of its points to our situation.