Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
Copyright 1999 American Medical Association.
All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999
To the Editor: Dr
Petitti1 does not do complete justice to the recent history
of epidemiology when discussing the HERS results2 as a
triumph of experimentation over observation. Over the past decade,
several researchers have consistently presented evidence that the
findings of several observational studies on the beneficial effect of
HRT on cardiovascular disease were too optimistic.3,4 Of
course, there were others who at every opportunity—especially
sponsored symposia—presented the case for HRT as "almost proven"
and ignored or downplayed the contrary evidence. This created the
overall impression of universal support for a preventive effect. As
such, the story of hormone supplementation and cardiovascular disease
is not fundamentally different from that of passive smoking or calcium
channel blockers, wherein the messages of the published studies
depended on the authors' source of funding.5 It is not
observational epidemiology that is proven wrong by HERS but a one-sided
representation of the epidemiologic literature.
Vandenbroucke JP. Hormone Replacement Therapy for Secondary Prevention of Coronary Heart Disease. JAMA. 1999;281(9):794-797. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-9-jbk0303