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The importance of the results from the “Women’s Health Initiative” (WHI) has perhaps not yet been fully comprehended by doctors and public health professionals. There has been a lot of criticism about the hormone formulations, entry age for the study, lower absolute risk of coronary disease and cancer, biological plausibility, benefits in relation to osteoporosis, and potential bias due to subclinical atherosclerosis. Unfortunately, we doctors are more and more disposed to disseminate information through the press in an imprecise and sometimes vulgar manner. We just have to recall how many colleagues have been appearing in all the media advising all menopausal women to seek out a gynecologist in order to have hormone replacement. This behavior continues to prevail in other specialties too, and it has serious ethical implications. We have a duty to no longer accept such abusive personalistic appearances in the media. Such attitudes transform the noble art of our “confessional consultation office” into a media show that resembles those of the “electronic ministers of religion”. The second point extrapolated from discussion of the WHI is in relation to primary prevention, whether this relates to cancer, coronary disease or dementia. The doctor’s responsibility when proposing an untested intervention for healthy individuals is much greater than in the prescription of medications or other types of therapeutic intervention that we seek out to mitigate pain and suffering. I will cite the example of betacarotene administration for the prevention of lung cancer. Smokers, who ought to be the ones getting greatest benefit from this, have presented a paradoxical increase in the incidence of and mortality from lung cancer. 1 Because of this, it is not admissible to utilize the argument that is spread around in favor of hormone replacement therapy (HRT), in which the absolute risk of myocardial infarct and breast cancer is small. In primary prevention, there is no such thing as a “small” risk, or a large one! Any risk represents a contraindication for adoption, as can be seen in the precautions and the time required for vaccines to be approved for use by the general public. The third point is in relation to biological plausibility, such as suggested in the Bradford-Hill rules of causation. 2

são paulo medical journal

After the hype, HOPE (and HPS): some lessons from the Women's Health Initiative trial, the Heart Outcomes Prevention Evaluation study and the Heart prevention study