Opposition to unpopular research results: Finnish professional reactions to the WHI findings.
OBJECTIVE
Preventive hormone therapy (HT) has been popular. This article describes what happened, when unexpected results that speak against HT were published.


METHODS
The article describes what happened in Finland after a large US randomised study. Women's Health Initiative (WHI) showed preventive HT to be harmful. The data used in the present study came from statistics, surveys, participatory observations, and written material.


RESULTS
Use of HT increased in Finland in the 1990s, and long-term therapy became common. The opinions of Finnish physicians on HT were positive. After the WHI results were published in July 2002, they received wide publicity, and recommendations to reduce HT use were made in the United States. In Finland, the initial critical comments on HT were soon replaced by criticism of the WHI study in both the professional and the lay press. The criticism concerned the type of the drug used (not used in Finland), the population ("not healthy, too old"), and outcome measures; the results were said not to apply to Finland. The value of a trial in contrast to the non-experimental evidence was rarely stressed. Odd information supplied and the uniformity of the formulations used by gynaecologists and medical journalists suggested that these professionals had been trained by the drug firms preparing competing HT drugs.


CONCLUSIONS
This case shows that when a well-done trial results in a negative assessment of a widely used drug, those benefiting from its continued use may aggressively resist, even despite weak evidence for their position.
National Research and Development Centre for Welfare and Health (STAKES), Social and Health Services, P.O. Box 220, 00531 Helsinki, Finland. elina.hemminki@stakes.fi
Elina
E
Hemminki
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003431:Cross-Cultural Comparison; D015914:Estrogen Replacement Therapy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D006801:Humans; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D012959:Socioeconomic Factors; D014481:United States