Women’s health: Understanding hormone risk – National Consumers League

Hormone health – whether related to health promotion, disease prevention, or optimal nutrition – is a critical issue for women and the health care providers who treat them. Issues such as hormone therapy, breast cancer prevention and treatment, and soy consumption are challenging health topics made more complicated by the ever-growing, and sometimes conflicting, information available to the public.  In this confusing environment, how do women and their health care providers access reliable information to make wise choices?

This question and others were explored at the National Consumers League’s Women’s Health Forum: Navigating Health Information, held on January 18, 2007 in Washington D.C., at the National Press Club. 

The forum provided attendees with background on these topics and explored how women and their health care providers must sift through vast amounts of often conflicting resources in order to find credible and reliable information. The American Nurses Association co-provided the forum and offered up to six hours of continuing education credit for nurses who attended. In addition to nurses, audience participants included other health care providers, consumer advocates, researchers, policy makers, and representatives from government and industry.

Tips for Identifying Reliable Resources

At the Women’s Health Forum, speakers and participants discussed the challenge of finding dependable information about the confusing and often controversial issues within women’s health. How’s a consumer to know whether what he or she is reading is trustworthy? The forum produced the following tips for judging the quality of health information:

1) When the resource includes information focusing on research for a specific medical treatment, consider the following:

  • What is the observed relative risk/benefit of the treatment, as well as the absolute risk/benefit? (See box below on the difference between absolute and relative risk) Are the findings statistically significant? Is this true for all populations or sub-groups evaluated?
  • Do the treatment studies have disease outcome results, or just surrogate markers?
  • If there is no evidence of harm or benefit available for the treatment, consider whether this is because the research findings are contradictory or not performed/available to the public; and
  • Is there a placebo effect – meaning that the patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work.

2) Always consider the source of information (does it appear in a peer-reviewed journal, or is it a sponsored white paper that has not undergone external scientific review?), the completeness of the research, and the financial ties of the source. Keep in mind that results from industry-sponsored studies are sometimes more favorable to that industry’s products than those conducted by independent third parties.

3) When reviewing health information, consider it in the context of your immediate concern (e.g., any symptoms you are trying to relieve or health conditions you want to treat now) AND your longer-term concerns (e.g., conditions or future health problems you are trying to avoid). Looking at the information in terms of both current and future health implications should help you make more informed and complete decisions.

Understanding risk

There are two main ways to talk about risk – relative risk and absolute risk.

Absolute risk refers to a person’s risk (or chance) of developing a disease over a certain time period.

Relative risk compares the risk of getting a disease in two different groups of people – such as a group taking medicine A compared to a group taking medicine B.

Although reports on new treatments often highlight the relative risk reduction of a treatment, the absolute risk gives a better sense of your individual risk. Both absolute and relative risk are important to consider, but relative risk can be misleading.

For Example:

Say 2 in 10,000 women risk developing cataracts by the time they are 70 years old. Research shows that a new treatment reduces the relative risk by 50%, meaning that a woman’s risk is reduced by half. In this example, the absolute risk of developing a cataract now falls from 2 in 10,000 women (.02%), to 1 in 10,000 women (.01%). A woman’s relative risk may be reduced by 50% with treatment, but a .02% absolute risk without treatment is still a pretty small risk.

This difference is particularly important for patients to consider when they look at the risks of particular treatments as well as benefits. If you have a very low absolute risk for a disease even before treatment, then the side effects associated with that treatment may not be worth the relative benefit you might get from taking it.

Trends in medicine: What is evidence-based medicine? – National Consumers League

Doctors and health care professionals are attempting to help patients make sense of the overload of health information by gathering, evaluating, and sharing well–tested, proven medical research. This process of bringing the best available evidence from scientific research to patient care is known as evidence-based medicine (EBM).

The emphasis with EBM is on applying research to medical care: when there is evidence that a treatment works and benefits the patient, it is practiced; where there is evidence that a treatment has not benefited the patient, is ineffective, or harmful, it is not practiced; and where there is not enough evidence, healthcare professionals should proceed carefully.

Many patients are educating themselves about their health, self-diagnosing, and pursuing care on their own.

Some patients are using health information to self-diagnose their conditions and asking doctors to prescribe treatments based on their own research, others are confused by the overload of health information.  To improve health outcomes, doctors and patients should share the responsibility for making health care decisions.

  • Patients are bringing in articles and ads and self-diagnosing specific conditions. This presents an opportunity for doctors and patients to discuss the patient’s actual situation and make appropriate decisions based on shared information.
    • Pharmaceutical ads are a major source of tension because they tell patients to ask the doctor for certain prescriptions by name without knowing if it’s appropriate. Doctors should take the time to explain to patients why the drug is or is not appropriate for them and then discuss other treatment options as well.
  • Doctors can start the dialogue to help patients sort out their questions and concerns.
  • Learning about medical treatments from friends, family and co-workers is a significant source of information that is credible to patients.
  • Often times, patients feel they know what is wrong before seeing a doctor and the challenge is communicating this knowledge to the doctor.
  • Doctors who disagree with their patients’ diagnosis or do not provide them with the desired treatment are often criticized. Shared decision making helps avoid disagreements and leads to successful patient outcomes.

All of the health information now available to consumers is changing the patient/doctor relationship.

Patients’ increased access to medical information is changing the relationship between patient and health care professional.

  • Patients have access to more medical information than ever before through magazine articles, advertisements and online searches, and health care professionals can play a critical role in helping patients differentiate the good from the bad.
  • More patients are taking more responsibility for their own care and want doctors to be partners, not bosses, in this relationship.
  • As America becomes more diverse, we need to pay special attention to cultural, linguistic, and economic barriers that may inhibit consumers from getting the information they need to make appropriate health care decisions.

To help doctors and patients make treatment decisions, it is necessary to sort through health information and find the best medical treatment based on what has been proven to work and is effective

Many doctors and other health care professionals are attempting to help patients make sense of the overload of health information by gathering, evaluating, and sharing well-tested, proven, medical research.  With this research, the health care professional and patient make treatment decisions together based on what works and is effective.

  • Health care systems are working towards a decision-making process incorporating medical research evaluation along with good stewardship – if there is evidence a treatment works and benefits the patient, it is practiced; if there is evidence a treatment has no benefit or may harm the patient, it is not done.  In cases where there is insufficient evidence about a treatment or if evidence doesn’t exist, a consensus is developed among health care professionals and they proceed carefully.  It is a shared decision-making process between patient and doctor.
  • Your doctor uses clinical judgment, incorporating the best research, his/her knowledge and experience, to present you with treatment options.
  • Making decisions based on what has been proven to work helps ensure that you and your health professional choose the most effective and beneficial treatment for you.  Understanding what works most effectively helps spend your health care resources wisely and benefits everyone.

Ask your doctor or other health care professional about how you can decide together what is the best medical treatment for you.

Patients and doctors need to engage in a dialogue about making the best medical treatment decisions.

  • Health care providers are working at bringing together the best available information about health care practices to create and implement programs that help people live healthier lives.
  • Health care providers have created specific care management programs for many diseases, including diabetes, asthma, congestive heart failure, coronary artery disease and depression.
    • Health care professionals stay up-to-date by using a computer system of well-tested medical research that can be used right in your doctor’s office.

Additional Resources about Evidence Based Medicine

To learn more about making health care decisions based on the best medical evidence, check the following resources for quality health information:

Cochrane Consumer Network.  This Web site is part of the Cochrane Collaboration, an international organization that aims to review all healthcare evidence and publishes the reviews electronically. The consumer network website summarizes the reviews for consumers.

MEDLINEplus at www.medlineplus.gov has extensive health information for consumers from the National Library of Medicine and the National Institutes of Health.

The National Committee for Quality Assurance (NCQA) consumer Web site at www.healthchoices.org explains how to choose a health plan based on quality. Includes a Health Plan Report Card.

Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) website at www.jcaho.org has information on the quality of care at your local health care facility.  JCAHO evaluates the quality and safety of care for health care organizations.

Kaiser Permanente’s Care Management Institute, www.kpcmi.org, establishes care management programs for patients based on the best available evidence.

To learn more about evidence-based health care and how healthcare professionals are making treatment decisions, Check out the online course developed by CUE (Consumers United for Evidence Based Health Care) on Understanding Evidence Based Healthcare: A Foundation for Action.

About this Web page

These messages were developed by the NCL, in partnership with Kaiser Permanente, to educate consumers about the concept of Evidence-Based Medicine. For more information, contact NCL’s health policy team.