When practices, promises, profits, and policies outpace hard evidence: the post-menopausal hormone debate

Currently, there is widespread controversy regarding the risks and benefits of hormone therapy for women over 50. The history of hormone therapy provides an excellent example of how different constituencies with competing objectives can produce health practices and policies of questionable benefit. We examine this history from the perspectives of women who now live longer, expecting higher quality of life throughout their later years, healthcare providers who are influenced by the real and perceived needs of their patients as well as information provided by drug manufacturers, the pharmaceutical industry which seeks to identify and promote drugs that offer the most promise for both patients and shareholders, and medical researchers —including the National Institutes of Health and the Federal Drug Administration .