Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-15T16:47:07.520Z Has data issue: false hasContentIssue false
  • English
  • Français

The Use of Combined Estrogen-Progestin Replacement Therapy: An Example of the Dissemination of New Indications for an Old Technology

Published online by Cambridge University Press:  10 March 2009

Elina Hemminki
Elina Hemminki
Affiliation:
University of Helsinki
Get access Rights & Permissions [Opens in a new window]

Extract

The evaluation of innovations which use old technology poses different problems than does the evaluation of new technologies. The main necessity is the targeting of its use rather than the technology itself. The need to evaluate the extent of use and its problems is illustrated by the example of progestin use among menopausal and postmenopausal women in the United States. There progestins are not of ficially approved for use in menopause, even though they have been on the market for a long time with other indications. Estrogen-replacement therapy was widely used from the early 1960s until 1975, when the claim that estrogens cause endometrial cancer notably decreased their use. The use of estrogens increased again in the early 1980s, and one reason for this revival was the claim that progestins offered protection against endometrial cancer. When recommendations for combined estrogen-progestin therapy have been made, other health effects have been ignored. Two consensus conferences as well as the drug control authority have recommended against combined estrogen-progestin therapy until further research is completed. Absence of good research, specialization in medicine, and advantages for prescribers and the drug industry may have contributed to the wide use of this unassessed treatment. Possible solutions for prevention of the diffusion of these kinds of innovations are discussed.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 4 , Issue 4 , October 1988 , pp. 511 - 519
Copyright
Copyright © Cambridge University Press 1988

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. American College of Gynecology and Obstetrics. Estrogen replacement therapy. ACOG Technical Bulletin, No. 93, 1986.Google Scholar
2. Barrett-Connor, E.Postmenopausal estrogen, cancer and other considerations. Women and Health, 1986, 11, 179–95.CrossRefGoogle ScholarPubMed
3. Barrett-Connor, E.Postmenopausal estrogen–current prescribing patterns of San Diego gynecologists. Western Journal of Medicine, 1986, 144, 620–21.Google ScholarPubMed
4. Bush, T. L., & Barrett-Connor, E.Noncontraceptive estrogen use and cardiovascular disease. Epidemiological Reviews, 1985, 7, 80–104.CrossRefGoogle ScholarPubMed
5. Chalmers, T. C.Informed consent, clinical research and the practice of medicine. Transactions of the American Clinical and Climatological Association, 1982, 94, 204–12.Google Scholar
6. Davies, R., & Saha, S.Osteoporosis. American Family Physician, 1985, 32, 107–14.Google ScholarPubMed
7. Ernster, V. L., & Cummings, S. R.Progesterone and breast cancer. Obstetrics and Gynecology, 1986, 68, 715–717.Google ScholarPubMed
8. Food and Drug Administration. Estrogens for osteoporosis. FDA Drug Bulletin, 1986, 06 5–6.Google Scholar
9. Gambrell, R. D.The menopause: Benefits and risks of estrogen-progestogen replacement therapy. Fertility and Sterility, 1982, 37, 457–74.Google ScholarPubMed
10. Gambrell, R. D. Jr. Prevention of endometrial cancer with progestogens. Maturitas, 1986, 8, 159–68.CrossRefGoogle ScholarPubMed
11. Gastel, B., Cornoni-Huntley, J., & Brody, J. A.Estrogen use and postmenopausal women: A basis for informed decisions. Journal of Family Practice, 1980, 11, 851–60.Google ScholarPubMed
12. Greenblatt, R. B.Estrogen use and endometrial cancer. New England Journal of Medicine, 1979, 300, 921.Google ScholarPubMed
13. Hammond, C. B., Jelovsek, F. R., Lee, K. L., Creasman, W. T., & Parker, R. T.Effects of long-term estrogen replacement therapy, II neoplasia. American Journal of Obstetrics and Gynecology, 1979, 133, 537–47.CrossRefGoogle ScholarPubMed
14. Haspels, A. A.Oestrogen therapy in the pen-menopause: A practical approach. Acta Endocrinologica, 1980 (suppl.) 233, 57–61.Google ScholarPubMed
15. Hemminki, E., Kennedy, D. L., Baum, C., & McKinlay, S. Prescribing of noncontraceptive estrogens and progestins in the United States 1974–1986. American Journal of Public Health, in press.Google Scholar
16. Hemminki, E., Brambilla, D., McKinlay, S. M., & McKinlay, J. B. Use of estrogens among mid-aged Massachusetts women. Unpublished.Google Scholar
17. Hemminki, E.Commercial information on drugs: Confusing the physician. Journal of Drug Issues, 1988, 18, 245–57.CrossRefGoogle Scholar
18. Horwitz, R. I., & Feinstein, A. R.Estrogens and endometrial cancer. American Journal of Medicine, 1986, 81, 503–07.CrossRefGoogle ScholarPubMed
19. Judd, H. L., Cleary, R. E., Creasman, W. T., Figge, D.C., Kase, V., Rosenwaks, Z., &Tagatz, G. E.Estrogen replacement therapy. Obstetrics and Gynecology, 1981, 58, 267–75.Google ScholarPubMed
20. Kaufert, P. A., & McKinlay, S. M. Estrogen-replacement therapy: The production of medical knowledge and the emergence of policy. In Lewin, E. & Olesen, V. (eds.), Women, health and healing. London: Tavistock Publication, 1985, 113–38.Google Scholar
21. Kaunitz, A.M.Prescribing FDA-approved drugs in nonapproved ways. Contetnporary Obstetrics and Gynecology, 1983, 22, 27–28.Google Scholar
22. Kistner, R. W. (ed.) Gynecology. Principles and practice. Chicago: Year Book Medical Publishers, Inc., 1964, 1971, 1979, 1986Google Scholar
23. Knopp, R. H.Arteriosclerosis risk. The roles of oral contraceptives and postmenopausal estrogens. Journal of Reproductive Medicine, 1986, 31 (suppl.), 913–21Google ScholarPubMed
24. Korenman, S. G.Menopausal endocrinology and management.Archives of Internal Medicine, 1982, 142, 1131–36.CrossRefGoogle ScholarPubMed
25. Lock, M. Models and practice in medicine: Menopause as syndrome or life transition? In Hahn, R. A. & Gaines, A. D. (eds.), Physicians of western medicine. Boston, MA: D. Reidel Publishing Company, 1985, 115–39.CrossRefGoogle Scholar
26. McMahon, B. Cardiovascular disease and non-contraceptive estrogen therapy. In Oliver, M. F (ed.), Coronary heart disease in young women. New York: Churchill Livingstone, 1978, 197–207.Google Scholar
27. Miettinen, O. S.The need for randomization in the study of intended effects. Statistics in Medicine, 1983, 2, 267–71.CrossRefGoogle Scholar
28. Nachtigall, L. E., Nachtigall, R. H., Nachtigall, R. D., & Beckman, E. M.Estrogen replacement therapy II: A prospective study in the relationship to carcinoma and cardiovascular and metabolic problems. Obstetrics and Gynecology, 1979, 54, 74–79.CrossRefGoogle Scholar
29. National Institutes of Health. Consensus development conference statement: Osteoporosis. April 2–4, 1984. Bethesda, MD: NIH, 1984.Google Scholar
30. Pasley, B. H., Standfast, S. J., & Katz, S. H.Prescribing estrogens during menopause: Physician survey of practices in 1974 and 1981. Public Health Report, 1984, 99, 424–29.Google ScholarPubMed
31. Paterson, M. E. L., Wade-Evans, T., Sturder, D. W., Thom, M. H., & Studd, J. W. W.Endometrial disease after treatment with oestrogers and progestogens in the climacteric. British Medical Journal, 1980, 280, 822–24.CrossRefGoogle ScholarPubMed
32. Persson, I.Endometrial and breast cancer after estrogen treatment Acta Obstetrica & Gynecologica Scandinavica, 1985 (suppl.), 130, 59–66.CrossRefGoogle ScholarPubMed
33. Persson, I. R., Adami, H-O., Eklund, G., Johansson, E. D. B., Lindberg, B. S., & Lindgren, A.The risk of endometrial neoplasia and treatment with estrogens and estrogen-progestogen combinations. Acta Obstetrica & Gynecologica Scandinavica, 1986, 65, 211–17.CrossRefGoogle ScholarPubMed
34. Physicians' Desk Reference 1986. Oradell, NJ: Medical Economics Company, Inc., 1986.Google Scholar
35. Strom, B. L., Melmon, K. L., & Miettinen, O. S.Post-marketing studies of drug efficacy:Why? American Journal of Medicine, 1985, 78, 475–80.CrossRefGoogle ScholarPubMed
36. Thom, M. H., White, P. J., Williams, R. M., Sturdee, D. W., Paterson, M. E. L., WadeEavans, T., & Studd, J. W. W.Prevention and treatment of endometrial disease in climacteric women receiving oestrogen therapy. Lancet, 1979, ii, 455–57.CrossRefGoogle Scholar
37. Upton, G. V.Therapeutic considerations in the management of the climacteric. Journal of Reproductive Medicine, 1984, 29, 71–80.Google ScholarPubMed
38. World Health Organization. World Health Statistics Annual 1986. Geneva: WHO, 1986, 256–60CrossRefGoogle Scholar