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Good news, bad news for former estrogen users

Rating

3 Star

Good news, bad news for former estrogen users

Our Review Summary

In its brevity, this piece lacks that all-important context that more expert comment might have provided. In addition, it fails to answer key questions that any reader will ask:  DOES THIS APPLY TO ME? The story does not emphasize clearly enough the fact that this study concerned estrogen ALONE, vs estrogen plus progestin in combination. So women who took estrogen with progestin may think the results apply to them. Not until the last line is this crucial difference addressed.

Also, if there were risks or benefits, how big are they? There is no quantitative, and little qualitative information about the size of benefits and risks. In addition, some of the statements are misleading – see details below.

 

Why This Matters

Millions of women have already taken hormone replacement, and more are poised in the delicate transition where such therapy may be considered. The medical confusion is tricky for them, and this story will be widely read. Giving a true picture of this confusion is vital to helping women maneuver among unknowns.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory
The story does not mention costs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story didn’t quantify the benefits.  The competing NY Times did a somewhat better job, although it got an unsatisfactory score as well.

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

The Post tries but fails to do justice to the mixed picture of longer-term outcomes for women who took estrogen-only therapy. There is no quantitative statement about the risks, or the benefits. Some of the findings are misstated: “Risk for heart disease during the follow-up period was similar to that seen while women were taking the hormone.” The point of the study is that there was no increased risk in heart disease in estrogen-alone users (as opposed to findings with estrogen/progestin arm); and longer followup confirmed no increase. As stated, the story seems to imply there was an increased risk for heart disease that did not diminish during followup.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

This story didn’t do as good a job as the competing NY Times did on this criterion.  While the Post mentioned an accompanying editorial, it didn’t emphasize some expert skepticism.  The expert comments in the Times piece were more clear and concise in their questioning of the relative relevance and importance of the evidence. For example, the Times reported: 

 

  • An accompanying editorial in the journal was skeptical about the results, arguing that the design of the initiative, which is skewed toward older women and stopped all forms of hormone treatment after several years of use, does not match the way doctors typically prescribe treatment to women in their 50s at the onset of menopause. Dr. Graham Colditz, an author of the editorial and professor of surgery at Washington University School of Medicine in St. Louis, said he thought data collected from observational studies that show a higher risk of breast cancer associated with estrogen use were more reliable than the data gathered from the Women’s Health Initiative clinical trial. “The finding doesn’t reflect how hormones are used in the U.S. at the moment,” Dr. Colditz said.”

Does the story commit disease-mongering?

Satisfactory

This short story avoids mongering, although our medical editor on this review thought the tone hypes the dangers of estrogen when the data show that the risks, though real, are small in absolute terms.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

We’ll give the story the benefit of the doubt here, as it at least cited an accompanying editorial – although, as noted in the “evidence” criterion above, the NY Times did a better job in eliciting clear quotes about context from its sources.

Does the story compare the new approach with existing alternatives?

Satisfactory

Although not as thorough as the NY Times on this point, the story at least stated:

“In an editorial accompanying the study, Emily Jungheim and Graham Colditz of Washington University School of Medicine in St. Louis wrote that the findings indicate that while there “may still be a role for short-term use of unopposed estrogen for treating some women with menopausal symptoms … this role may be vanishing as existing and emerging data continue to be better understood.”

Rowan Chlebowski, one of the researchers who worked on the analysis, stressed that the study only looked at women who were taking estrogen alone. Women who took a combination of estrogen and progestin face increased risk for breast cancer, previous studies have shown, Chlebowski said.”

We’ll give it a satisfactory score on this, but for reader comprehension, we think the Times piece was much better.

 

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

Estrogen is widely available, so the story does not need to dwell on this.

Does the story establish the true novelty of the approach?

Satisfactory

The story didn’t make any inappropriate claims of novelty about estrogen use, and it appropriately characterized the study as a new analysis of the landmark Women’s Health Initiative.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This story does not appear to rely solely on a news release. No one is quoted in the story – only apparent paraphrasing from the study and editorial.

Total Score: 5 of 9 Satisfactory

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