Research Article: Sources of information influencing the state-of-the-science gap in hormone replacement therapy usage

Date Published: February 3, 2017

Publisher: Public Library of Science

Author(s): Fiona Chew, Xianwei Wu, Pablo Dorta-González.


Medical reviews and research comprise a key information source for news media stories on medical therapies and innovations as well as for physicians in updating their practice. The present study examined medical review journal articles, physician surveys and news media coverage of hormone replacement therapy (HT) to assess the relationship between the three information sources and whether/if they contributed to a state-of-the-science gap (a condition when the evaluation of a medical condition or therapy ascertained by the highest standards of investigation is incongruent with the science-in-practice such as physician recommendations and patient actions).

We content-analyzed 177 randomly sampled HT medical reviews between 2002 and 2014, and HT news valence in three major TV networks, newspapers and magazines/internet sites in 2002–2003, 2008–2009 and 2012–14. The focus in both analyses was whether HT benefits outweighed risks, risks outweighed benefits or both risks and benefits were presented. We also qualitatively content-analyzed all 19 surveys of US physicians’ HT recommendations from 2002 to 2009, and 2012 to 2014.

Medical reviews yielded a mixed picture about HT (40.1% benefits, 26.0% risks, and 33.9% both benefits and risks). While a majority of physician surveys were pro-HT 10/19), eight showed varied attitudes and one was negative. Newspaper and television coverage reflected a pro and con balance while magazine stories were more positive in the later reporting period.

Medical journal review articles, physicians, and media reports all provide varying view points towards hormone therapy use thus leading to limited knowledge about the actual risks and benefits of HT among peri- and menopausal women and a state-of-the-science gap.

Partial Text

A growing number of recent reports contends that the benefits of hormone replacement therapy (HT) can be optimized and risks mitigated for newly menopausal [1–5] and postmenopausal women [6,7]. In contrast, the US Preventive Services Task Force recommends against the use of HT for the prevention of chronic conditions in postmenopausal women because the risks outweigh the benefits [8]. The recommendation was predicated on the findings of the Women’s Health Initiative (WHI), a large-scale, longitudinal, randomized, controlled trial involving 16,608 women aged 50 to 79 which established that HT use increased the risks of breast cancer, heart attack, stroke, and blood clots [9,10]. Later analyses of the WHI data further differentiated effects by age of initiation, time from menopause and HT used (estrogen with progestin or estrogen alone) [11,12]. These studies reported that menopausal HT use was appropriate for vasomotor symptom management but not for the prevention of coronary heart disease [9–12]. To better understand the gap between favorable and unfavorable HT recommendations, this study examined key sources of information about HT to assess their valence and influence, and how these may contribute to the state-of-the-science gap.

To address the above hypotheses, we used content analysis in our study. First, we content-analyzed a random sample of post WHI HT medical review articles from 2002 to 2014. Next we qualitatively content-analyzed all HT attitude surveys of US physicians from 2002 to 2009, and from 2012 to 2014 after the US Preventive Services Task Force (USPSTF) issued its report in October 2012 reaffirming the WHI recommendations [55]. Both types of articles were published in peer reviewed journals. Finally, we content analyzed all HT usage coverage by three television networks, three newspapers and three magazines (which targeted a sizeable proportion of the menopausal woman aged 50 to 60) for three key periods, 2002–2003 (just after the WHI results), 2008–2009 (five to six years after the WHI results) and 2012–2014 (after the USPSTF report’s release).

A mixed orientation was found. The valence of the 177 review articles was mixed (Chi-Square = 5.32, df = 2, p


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