Allina and Ryan clearly intended a provocation, and we regret we cannot be entirely cordial in our response. The statistical rebuttal to their arguments is made in our reply to Prentice et al.,1 and need not be reiterated here.
The notion that the confluence of findings from a large, randomized controlled trial2; meta-analyses of the same topic3; and population-level mortality trends4 should all be considered “hypothesis generating” is far-fetched at best. But it is that much more so in light of the specific clinical practice change at which our article5 is directed: we are suggesting that doctors and patients talk about hormone replacement so that personalized decisions can be made.
Our article never implies that hormone replacement, either unopposed estrogen or any other approach, is right for all members of any group. We simply conclude that the available evidence makes abundantly clear that hormone replacement is not wrong for everyone, as current practice seems to suggest. With all due respect to Allina and Ryan, they are wrong that this well-supported contention should be consigned to an interminable research purgatory. Quite the contrary: if there is a legitimate case for the hypothesis that doctors and patients should not discuss hormone replacement on the basis of available evidence to inform personalized decisions, we know nothing of it.
The authors direct most of their misguided rant at the issue of financial conflict of interest. In so doing, they ignore, or willfully misrepresent, the funding of our study, which came exclusively from the Centers for Disease Control and Prevention, as we reported. There was no pharmaceutical industry involvement whatsoever. In the service of full disclosure, one author acknowledged a history of consulting for a company involved in the marketing of hormones. That author has no stake in the company or sale of hormones. That company was not involved, nor even informed, of the current study. Three of the four authors, including those responsible for the analysis, have no such ties to report.
Allina and Ryan are of course at liberty to disagree with our findings. But the ill-informed or willfully disingenuous vitriol they have chosen to direct at it is a disservice to an honest research effort in the service of public health, and the rigorous and equally honest peer review process to which this journal subjected the article.
References
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