Therapy revered today may be shunned tomorrow

Commentary. By Eric Anderson, MD, AMNews contributor. Aug. 12, 2002.

COMMENTARY

Observations on the state of medical practice and medical life

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The recent furor over the value and dangers of hormone replacement therapy is a reminder of how medicine may be more art than science. It suggests we stumble at times as we meander through the field of medicine even when we hope, fervently, we're on a scientific basis and treading a precise path.

Graduating in 1958, I'm old enough to remember the impact the late New York ob-gyn Robert A. Wilson, MD, made on my female patients in the 1960s with his book Feminine Forever. When they read "all postmenopausal women are castrates," they knew what they wanted. The logic of the day seemed valid. They got their estrogen.

And do you know something? It seemed to help.

Then in 1975, the New England Journal of Medicine created a sensation when it published a report on the increased uterine cancer rate in estrogen users. A lot of us stopped writing scripts for estrogen as our ardor cooled.

I remember going to a medical convention in the late 1970s and seeing Dr. Wilson standing forlornly at his pharmaceutical booth. A few years before he would have been mobbed by colleagues; now he was no longer the guru of gynecology.

Our protocols had become: Use the smallest possible dose of estrogen to combat menopausal symptoms then taper the dose. Only women who had symptoms were going to get estrogen.

A fresh approach was to add synthetic progesterone. That protected both the uterus and pharmaceutical sales. Under the new name hormone replacement therapy, women started back on estrogen; our protocols being that every woman, postmenopause, should take HRT unless they had contraindications. [...]