If you answered yes and were a post-menopausal female in my practice roughly a decade ago, odds are I’d have talked you into taking combination hormone therapy.
Besides the fact you’d probably feel better, having ditched those inconvenient hot flushes without hugely altering your lifestyle, I was after bigger fish. I’d embraced the preventive mindset, and the Nurses’ Health Study said I’d be protecting your heart and nervous system, not to mention your bones.
Expert opinion backed me, too, and by that I mean brilliant people who’d read the same studies and reached the same conclusions. Good local clinicians. The type of person you could call in the middle of the night to say, “I have a feeling I’m in trouble with this delivery,” and there’d be no second-guessing. They’d show up in ten minutes flat with bed-head and a willing heart. The sort who wouldn’t let an incompetent resident through the system, even if the cost of being a whistle-blower was time and vilification by colleagues. No shortcuts for these folks.
As for me, I was passionate and persuaded. Since there’s little more compelling than a doctor without an agenda, other than the betterment of their patients’ health, I was extraordinarily effective at winning compliance.
Then the Women’s Health Initiative came out.
The promise: hormones would protect a woman’s vascular system.
The reality: an increase in heart attacks and strokes significantly above baseline levels. To add insult to injury, in the two years following, as millions of North American women shucked their medication, the incidence of breast cancer declined by 2-3% per year. If hormones weren’t causing the outright development of breast cancer, even in properly screened patients, they certainly seemed to ignite its growth.
Lots of data, lots of expert opinion, lots of misery and fatalities in the name of preventing suffering.
Was this an unusual experience in medicine? I wish. I recall a long list of new sleeping agents that weren’t going to be addictive, except when they were. I remember the weight loss drugs that got you skinnier while damaging your heart valves; the lipid-lowering drugs that improved cholesterol numbers while increased rates of death.
You’ll notice I’m not even discussing issues like falsified results, suppressed data, or bought experts—in other words, fraudulent science. I’m only addressing the fact that even under the best of terms, even with thousands of data points and a team for analysis, evaluation has its limitations.
“Prescriptions” in the literary world
By now you’re saying, “Fine, Jan. We’re done with hearing stories about your ancient youth. What does this have to do with writing?”
And I’d ask, what are discussions like these, except attempts to diagnose, treat, or prevent literary malaise?