Testing What We Think We Know
By H. GILBERT WELCH
Published: August 19, 2012
BY 1990, many doctors were recommending hormone replacement therapy to healthy middle-aged women and P.S.A.screening forprostate cancer to older men. Both interventions had become standard medical practice.
But in 2002, a randomized trial showed that preventive hormone replacementcaused more problems (more heart disease and breast cancer) than it solved (fewer hip fractures and colon cancer). Then, in 2009, trials showed that P.S.A. screening led to many unnecessary surgeries and had a dubious effect on prostate cancer deaths.
How would you have felt — after over a decade of following your doctor’s advice — to learn that high-quality randomized trials of these standard practices had only just been completed? And that they showed that both did more harm than good? Justifiably furious, I’d say. Because these practices affected millions of Americans, they are locked in a tight competition for the greatest medical error on record.
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