SuggestionsEvaluateScience

SuggestionsEvaluateScience - NPB 132 Lecture 1 1 Do We...

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NPB 132 Lecture 1 Do We Really Know What Makes Us Healthy? By GARY TAUBES Once upon a time, women took estrogen only to relieve the hot flashes, sweating, vaginal dryness and the other discomforting symptoms of menopause. In the late 1960s, thanks in part to the efforts of Robert Wilson, a Brooklyn gynecologist, and his 1966 best seller, “Feminine Forever,” this began to change, and estrogen therapy evolved into a long-term remedy for the chronic ills of aging. Menopause, Wilson argued, was not a natural age-related condition; it was an illness, akin to diabetes or kidney failure, and one that could be treated by taking estrogen to replace the hormones that a woman’s ovaries secreted in ever diminishing amounts. With this argument estrogen evolved into hormone-replacement therapy, or H.R.T., as it came to be called, and became one of the most popular prescription drug treatments in America. By the mid-1990s, the American Heart Association, the American College of Physicians and the American College of Obstetricians and Gynecologists had all concluded that the beneficial effects of H.R.T. were sufficiently well established that it could be recommended to older women as a means of warding off heart disease and osteoporosis. By 2001, 15 million women were filling H.R.T. prescriptions annually; perhaps 5 million were older women, taking the drug solely with the expectation that it would allow them to lead a longer and healthier life. A year later, the tide would turn. In the summer of 2002, estrogen therapy was exposed as a hazard to health rather than a benefit, and its story became what Jerry Avorn, a Harvard epidemiologist, has called the “estrogen debacle” and a “case study waiting to be written” on the elusive search for truth in medicine. Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem. In the case of H.R.T., as with most issues of diet, lifestyle and disease, the hypotheses begin their transformation into public-health recommendations only after they’ve received the requisite support from a field of research known as epidemiology. This science evolved over the last 250 years to make sense of epidemics — hence the name — and infectious diseases. Since the 1950s, it has been used to identify, or at least to try to identify, the causes of the common chronic diseases that befall us, particularly heart disease and cancer. In the process, the perception of
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SuggestionsEvaluateScience - NPB 132 Lecture 1 1 Do We...

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