Scientific Knowledge as Resource and Risk: Hormone Replacement Therapy as a Test of Fundamental Cause Theory

• In Event: Fundamental Cause Theory at 30: Rethinking Health Inequities

Abstract

The history of medicine and public health is replete with cases where initial evidence suggested a therapy was beneficial, but subsequent research showed that it provided little or no benefit, its benefits had been overestimated, or it posed significant health risks. What are the implications of such discoveries for the distribution of health across a population? How might they contribute to the emergence and persistence of health disparities? Fundamental cause theory (FCT) offers potential for examining these questions, proposing that socioeconomic status (SES)-based health disparities endure despite changing disease and risk patterns, because SES embodies an array of resources (e.g., money, knowledge, prestige, power, and beneficial social connections) that protect health no matter what mechanisms are relevant at any given time. Yet, tests of FCT in understanding dynamics of SES-based health disparities have extensively focused on medical discoveries, interventions, and innovations that, since their formal adoption or endorsement, have been found to be generally effective, safe, and beneficial. Less considered are the implications for existing or new SES disparities when the safety or effectiveness of an already-adopted intervention is called into question due to new scientific evidence and concern. We propose and test predictions from FCT for such unfortunate circumstances using the empirical case of hormone replacement therapy (HRT) for women in Denmark. Analyzing Danish national health registry data, we examine SES disparities in HRT use during a period preceding and following a 2002 controversy triggered by the published findings from the Women’s Health Initiative study, which suggested that HRT was associated with an increased breast cancer and cardiovascular disease risk, particularly in older women, yet subsequent evidence showed HRT benefits for younger and early post-menopausal women. Our discussion will focus on thinking about FCT in light of this and other health controversies (e.g., adverse events, misinformation).

Authors

• Vibeke Tornhoej Christensen, VIVE

• Andrea N. Polonijo, University of California-Merced

• Brian Christopher Kelly, Indiana University-Bloomington

• Richard M. Carpiano, University of California-Riverside