Science, Public Health, and Public Awareness: Lessons from the Women's Health Initiative

In science, as in life generally, no good deed goes unpunished. One very good deed was the decision to conduct the Women's Health Initiative (WHI) study on hormone therapy. Another was ending the combination estrogen and progestin arm of the trial once it became clear that many of the supposed preventive benefits of the hormone drug therapy were illusory and that for many women, the drugs were actually harmful. So it was perhaps inevitable that the July 2002 announcement of the study's end would provoke a punishing backlash.

Countless women stopped taking hormones cold turkey and voiced a bitter sense of betrayal that the medical establishment had assured them for so long of the drugs' benefits. Across the country, many stunned physicians lapsed into a sort of post-WHI shock syndrome; in denial or disbelief at the trial's results, some doctors simply told their patients to ignore them. Meanwhile, professional groups such as the American College of Obstetricians and Gynecologists (ACOG) went into overdrive. An ACOG task force hastily drew up recommendations for what physicians should tell their worried patients. Along with other clinical and professional groups, ACOG complained that the National Institutes of Health (NIH) hadn't given it any warning of the study's results or a chance to review the data.

In reaction to this firestorm, the NIH scheduled the October 2002 scientific workshop described in this issue by Kirschstein (1). The conference was partly an exercise in damage control and partly an effort to paint the broadest possible picture of our current understanding of the benefits and harms of hormone therapy. Staging the workshop, too, was a good deed …