Will HRT Mistakes Be Repeated?

During the hormone replacement heyday, millions of women were encouraged to take estrogen and progesterone to prevent everything from hot flashes and heart disease to dementia and cancer. There were even claims that HRT could prevent wrinkles and improve libido.
The trouble is that most of the claims were based on poor science. So-called observational studies don’t really tell researchers whether a drug is responsible for a beneficial outcome or whether it is purely coincidence.
In the case of HRT, many of the claims mentioned above turned out to be bogus. In fact, a new report from a double-blind trial (JAMA June 30, 2004) suggests that HRT may actually increase the risk of cognitive decline and dementia.
One reason doctors may have reached false conclusions was that women who took hormone replacement therapy were healthier overall. It is theorized that they were better off financially, visited their doctors more regularly, ate healthier food and exercised more frequently. Their use of hormones may have been merely coincidental.
The lesson from the Women’s Health Initiative goes beyond estrogen and progestin (Prempro). This large, long-term, carefully controlled study demonstrates that randomized, placebo-controlled trials give information that is unavailable from other studies.
But the media and drug companies are quick to promote miracle cures. Just as HRT was touted for so many different problems a few years ago, so too cholesterol-lowering drugs are being hyped today.
Statin-type medications are great at reducing bad LDL cholesterol and lowering the risk of heart disease. But now we are reading stories about statin-type medications being good against arthritis, depression, dementia, multiple sclerosis, glaucoma, prostate and colon cancer, infection and osteoporosis.
It is entirely possible that drugs such as Lipitor, Zocor, Pravachol and Crestor will be prove to be effective in preventing certain kinds of cancers or even reducing the risk of glaucoma or multiple sclerosis. But long-term, placebo-controlled studies have not been carried out for such uses.
Some doctors are so enthusiastic about statins that they have recommended the drugs be put in the water supply. Others have suggested that salt-shakers in steak houses be replaced with “statin-shakers.” The meat eater would just sprinkle a statin drug on top of his steak and he would be good to go.
As well as these medications may work against heart disease, however, certain people cannot tolerate them. They can cause debilitating muscle pain and weakness.
Some patients complain that they have trouble exercising as they once did or even getting out of a chair. Back, neck, shoulder or leg pain can be unbearable. A few people actually wind up bedridden or in wheelchairs before the weakness is traced to cholesterol medication. Other side effects, though rare, may include nerve damage or sexual dysfunction.
Statins save lives. Most people do well on them. But like HRT, statins are being pushed beyond the scientific evidence. Until there is good research to support other uses, doctors will need to stick to the evidence and prescribe these drugs only for the uses that have been proven.