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.
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.
The story didn’t quantify the benefits. The competing NY Times did a somewhat better job, although it got an unsatisfactory score as well.
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.
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:
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.
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.
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.
Estrogen is widely available, so the story does not need to dwell on this.
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.
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.
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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