History | (1) Disciplinary boundaries affecting understanding and awareness of risk. |
| (2) Definition, production, and use of pharmaceutical substances. |
| (3) Definition and practice of medical subspecialties. |
| (4) Comparative histories of medical practice. |
| (5) Impact of previous and contemporary medical and public health debates on HRT use. |
Women’s health advocates | (1) “Expose the abuse, critique the science, light the fire”: critical role of women’s health advocates. |
| (2) Political clout of pharmaceutical industry and manipulation of “consumer” fears and desires as “choice.” |
| (3) Contrast between “curative” and “risk management” treatments. |
| (4) Role of medical-industrial complex in manufacturing and marketing drugs for profit. |
| (5) Debates on drugs rarely linked to debates over structure of health care system. |
Epidemiology | (1) Inadequate use of appropriate study design (RCT), over-reliance on observational data, disregard for RCTs not favourable to HRT, and poor interpretation of epidemiological studies. |
| (2) Disregard of socially patterned confounding, vis a vis who does and does not take HRT. |
| (3) Disregard for risk in relation to age (risk of breast cancer greater than coronary heart disease among women in their 40s and 50s), and discounting of adverse risk of breast cancer relative to risk reduction for cardiovascular disease. |
| (4) Disregard for distinctions between absolute and relative risk. |
| (5) Impact of pharmaceutical industry on epidemiological research, including emphasis on alleged benefits over risks and revised view of “acceptable risks” for healthy populations. |
Biology | (1) Hormones by definition are global signallers in the body, such that “side effects” of hormonal therapies are inevitable. |
| (2) Steroid hormones affect more than the reproductive system and are involved in cell growth and differentiation, as well as immunity, metabolism, and behaviour. |
| (3) Endogenous and exogenous hormones, including xenoestrogens, are typically studied in systems that show only a small portion of their biological activity. |
| (4) Ignorance vastly exceeds knowledge about the full range of biological functions of endogenous hormones and exogenous hormone-like agents. |
| (5) The complexity of biological systems precludes accurate quantitative “risk assessment” and is not compatible with non-precautionary “command and control” approaches to regulating and licensing safe levels of individual chemicals. |
Clinical medicine | (1) Among the wealthier countries in which pharmaceutical companies have their principal markets, the pharmaceutical industry increasingly underwrites conferences and research, plus offsets journal costs through extensive advertising. |
| (2) In these same countries, the “best selling” drugs currently are “risk reducing” drugs, consonant with an increasing trend to focus on eliminating individual risk. |
| (3) Limited time, low reimbursement for counselling (cognitive services), and defensive medicine shape medical practice, increasing medical conformity and encouraging physicians to prescribe “risk reducing” drugs. |
| (4) Clinical guidelines encourage physicians to prescribe treatments even if there is not conclusive evidence that drugs are the best way to approach risk reduction. |
| (5) Until recently, physicians in the USA were encouraged at least to counsel women about the use of HRT as a standard of care for women during and after menopause, but have now been discouraged from routinely prescribing it. |