This story was about the elevated cancer risks associated with the use of hormone replacement therapy by women after menopause. But while highlighing an increased cancer risk, the story never explained that there was no difference in overall risk of dying from all causes for the different groups of women. So while the story quoted someone saying "There’s no reason for alarm," this important statistic would have provided some framework for why there was no reason for alarm.
So some of the framing provided in this article (and in the scientific paper) semantically makes it seem like women would have to be crazy to choose to take HRT (experiencing "danger" and suffering from "insufficient awareness of risk") when in fact if women have a need that may be improved the tradeoff in terms of overall risk is neutral – so that personal history and informed decision-making really should take the lead.
Another point about framing: Although the story mentioned in passing the benefit of hormone replacement therapy for relief of menopausal symptoms, it failed to expand on what these symptoms were and the extent to which they were lessened by the treatment. It failed to mentioned that there was a significant decrease in overall fracture risk.
There have been many critics of the ways in which the Women’s Health Initiative study findings were communicated in 2002. This story – at times – fell into that same pattern of failing to deliver the context women may need to help make decisions.
There was no discussion of the costs involved with hormone replacement therapy although, with a story about risks of HRT, it is somewhat understandable that a discussion of costs was not vital.
Although the story mentioned in passing the benefit of hormone replacement therapy for relief of menopausal symptoms, it failed to expand on what these symptoms were and the extent to which they were lessened by the treatment. It failed to mentioned that there was a significant decrease in overall fracture risk.
The story was all about harms associated with the use of hormone replacement therapy. But it did not explain that all-cause mortality was the same whether women took HRT or not, and it did not explain that cancer risk for the entire period of follow-up was identical.
Although the story mentioned that it was based on a study published in the Journal of the American Medical Association, it really failed to provide information about the evidence in a way that was informative and useful to the reader. Rather, it invoked the Women’s Health Initiative study "mystique" repeatedly – without ever describing some of the criticisms of the framing of those original findings.
The story never explained an important finding: that whether or not women used hormone replacement therapy, all cause mortality was found not to differ. So some of the framing provided in this article (and in the scientific paper) semantically makes it seem like women would have to be crazy to choose to take HRT (experiencing "danger" and suffering from "insufficient awareness of risk") when in fact if women have a need that may be improved the tradeoff in terms of overall risk is neutral – so that personal history and informed decision-making really should take the lead.
The story included quotes from 4 clinicians.
The story did briefly explain at the very end that "there are other drugs to protect against osteoporosis and other treatments for cardiovascular disease – though not as many for symptoms of menopause." Not much, but an attempt was made.
It was possible to see from the story that hormone replacement therapy is still available.
The story accurately reported on the novelty (lack thereof) of this treatment.
Because the story quoted multiple sources, it does not appear to rely on a press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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