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What I've learned from the emotional and political response to WHI

By Leon Speroff, MD

When I finished my presentation at the annual meeting of the North American Menopause Society, I was amazed to see the audience stand and applaud. It was heartwarming, but as I thought about it, I realized the applause was not for me, it was because I had struck an emotional chord with the audience. The emotional and political polarization that followed the publication of the results from the Women's Health Initiative (WHI) left clinicians angry and confused about postmenopausal hormone therapy. My plea was to find a middle ground, and the audience expressed in its ovation its desire and need to do so.

I am an academic clinician. Each and every one of us has emotional biases, derived from our own learning and experience. In my view, the response to the WHI has suffered from biased, inconsistent analyses. As clinicians, we must be vigilant in balancing our personal biases with objective data because we have an obligation to bring benefit and do no harm to patients through our thinking and teaching. We must be as correct and as fair and balanced as we can be—and that takes time.

The medical editor of a major television network uses his e-mail list to solicit individual opinions regarding medical publications that are still under embargo, have not been published, and are not available for analysis. When I engaged in an e-mail dialogue protesting this method of operation, I was removed from his list. Motivated by that event, I recorded the time it took me to write an editorial for Maturitas: 20 hours to finish a 5-page commentary on The Million Women Study. Consideration and analysis of medical publications takes time and effort.

This experience moves me to urge clinical academicians to be conscious and aware of our obligations to clinicians and their patients, to be consistent and balanced in our analysis. In the last few months, I have listened while presenters explained to audiences study results that agreed with their theses—but without confidence intervals. I was familiar with the data and knew that the conclusions were not statistically significant. Unsupported conclusions that are incorporated into a clinician's practice have an enormous potential to cause harm or deprive an individual patient of an important benefit.

My message to clinicians is this: Pay no attention to the "experts" who are quoted by the media on the day of and during the week that a research report first appears. As Claus Christensen reminded the audience at a recent European meeting, "It takes 2 months to publish a conclusion and 10 years to correct it." I am not that pessimistic. In the last 2 years, we have learned a lot from the controversies over postmenopausal hormone therapy. We have learned that the forces of analysis do bring balance to controversy, and it does take time (but not 10 years). We have learned that research data add to the art and science of medicine but do not replace it. We have learned that a clinician's expertise, the individual needs of a patient, and the breadth of our knowledge are all required components in the practice of medicine.

I believe that over time, consistent and appropriate analyses allow research results to play their appropriate role in clinical decision making. I am an optimist and have faith in our system, in which clinicians and academicians work together to benefit patients.

DR. SPEROFF is Professor of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Ore. He has served as President of the American Fertility Society (now the American Society for Reproductive Medicine) and was the founding President of the Society of Reproductive Endocrinologists. He is known worldwide for his textbook, Clinical Gynecologic Endocrinology and Infertility, due out in its 7th edition in October.