Latest news with #H.H.S.
New York Times
02-05-2025
- Health
- New York Times
Kennedy Orders Search for New Measles Treatments Instead of Urging Vaccination
With the United States facing its largest single measles outbreak in 25 years, Health and Human Services Secretary Robert F. Kennedy Jr. will direct federal health agencies to explore potential new treatments for the disease, including vitamins, according to an H.H.S. spokesman. The decision is the latest in a series of actions by the nation's top health official that experts fear will undermine public confidence in vaccines as an essential public health tool. The announcement comes as Mr. Kennedy faces intense backlash for his handling ofthe outbreak. It has swept through large areas of the Southwest where vaccination rates are low, infecting hundreds and killing two young girls. On Friday, the Centers for Disease Control and Prevention reported more than 930 cases nationwide, most of which are associated with the Southwest outbreak. Critics have said Mr. Kennedy has focused too much on untested treatments — such as cod liver oil supplements — and offered only muted support for the measles vaccine, which studies show is 97 percent effective in preventing infection. The decision to put more resources into potential treatments, rather than urging vaccination, could have grave consequences at the center of the outbreak. 'We don't want to send the signal that you don't have to get vaccinated because there's just a way to get rid of it,' said Jennifer Nuzzo, an epidemiologist at the Brown University School of Public Health. Scientists have already thoroughly studied various vitamins and medications as potential treatments for measles, said Michael Osterholm an epidemiologist at the University of Minnesota. Decades of research have turned up no miracle treatment for the measles virus, which can cause pneumonia, making it difficult for patients to get oxygen into their lungs, and brain swelling, which can cause blindness, deafness and intellectual disabilities. 'It's not that there's been a lack of studies,' he said. Measles patients are typically offered 'supportive care' to help make them more comfortable while the virus runs its course, like Tylenol to bring down their fever, supplemental oxygen and IV fluids. The decision to look for new treatments is meant to help people who chose not to vaccinate, the H.H.S. spokesman, Andrew Nixon, said. He added that the C.D.C. still recommends the measles, mumps and rubella shot as the most effective way to prevent measles. But, he said, 'Our commitment is to support all families, regardless of their vaccination status, in reducing the risk of hospitalization, serious complications and death from measles.' As an example of such a community, Mr. Kennedy pointed to the Mennonites in West Texas, who have experienced the brunt of the cases and hospitalizations in the current outbreak. Mr. Nixon said the C.D.C. will collaborate with universities to test new treatments for a 'host of diseases,' which may include a combination of existing drugs and vitamins. The news of this effort was first reported by CBS News. Public health experts were baffled by Mr. Kennedy's decision to hunt for new treatments, rather than endorse shots that have decades of safety and efficacy data. They said this seemed to contradict his longstanding focus on disease prevention instead of treatment. 'This is akin to saying, 'Go ahead and eat whatever you want, don't exercise, smoke like a chimney — we're going to invest all of our resources in heart transplants,'' said Dr. Jonathan Temte, a former chairman of the C.D.C.'s vaccine advisory committee. Over the course of the current measles outbreak, Mr. Kennedy has offered inconsistent, and at times contradictory, messaging about the M.M.R. shot. At some points, he has described the vaccine as 'the most effective way to prevent the spread of measles.' Other times, he has questioned its safety: 'We don't know the risks of many of these products because they're not safety tested,' he said in an interview with CBS News last month. Doctors in West Texas have said Mr. Kennedy's focus on treatments, rather than vaccines, has already made their jobs difficult. Early in the outbreak, he said on Fox News that he had heard of 'almost miraculous and instantaneous recovery' with treatments like cod liver oil, which he said was 'the safest application of vitamin A.' While doctors sometimes administer high doses of vitamin A in a hospital to manage severe measles, experts do not recommend taking it without physician supervision. Shortly after, doctors said they had encountered measles patients who had delayed critical medical treatment in favor of staying home and treating themselves with some of the supplements Mr. Kennedy promoted. Some children with measles were given toxic levels of vitamin A, they said. Dr. Osterholm said Mr. Kennedy's plan also assumed that people's beliefs about vaccines were fixed, when in reality, clear information about their purpose and safety had encouraged thousands of vaccinations in past outbreaks. Despite Mr. Kennedy's claims that Mennonites have 'religious objections' to shots because they contain 'fetus debris,' historians who study the community say it has no religious doctrine that bans vaccination, and vaccine experts say there is no fetal tissue in the M.M.R. shot. Local doctors have instead pointed to misinformation about the safety of the shot — which Mr. Kennedy has helped perpetuate — as the primary reason their Mennonite patients opt their children out of vaccination.
New York Times
02-05-2025
- Health
- New York Times
Trump Administration Live Updates: President Vows to Defund PBS and NPR
The report relied on scientific evidence reviews of such treatments as hormone therapy and puberty blockers that were published when these treatments were first made available to transgender adolescents. Federal health officials published a report on Thursday declaring that the use of hormonal and surgical treatments in young people with gender dysphoria lacked scientific evidence and expressing concern about long-term harms, a stark reversal from previous agency recommendations and the advice of top U.S. medical groups. The report instead prioritized the role of psychotherapy, a divisive intervention to treat gender dysphoria that many advocates and physicians have equated with so-called conversion therapy. Other parts of the review seemed to call into question the very notion that some people have a gender identity that does not align with their sex at birth. In January, President Trump signed an executive order titled 'Protecting Children From Chemical and Surgical Mutilation' giving the Department of Health and Human Services 90 days to produce a report on the best practices for treating young people who say their gender does not align with their birth sex. But the order made it clear that the administration had already reached its own conclusion about gender transition treatments for minors, characterizing the 'blatant harm done to children' as a 'stain on our nation's history.' The 400-page report took a more sober tone but reached a similar conclusion. In a remarkable departure from the standard for medical evidence reviews, the authors were not identified pending a post-publication review process that would begin in 'the coming days.' H.H.S. officials declined to answer questions about what the review process would entail. The department noted that the contributors included doctors, medical ethicists and a methodologist, all from 'a wide range of political viewpoints' who were chosen 'for their commitment to scientific principles.' The report specified that the new assessment was not intended to set a standard for medical care or to make policy recommendations. It relied predominantly on an analysis of reviews of the scientific studies of puberty blockers, hormone therapies and surgeries that have been published in the last few decades, when these treatments were first made available to adolescents. The assessment concluded that while the benefits of medical interventions were uncertain, the harms, which can include loss of fertility, were less so. The 'clinical practice in this field of medicine is exceptional and concerning,' the report said, and it criticized American medical groups for fostering intolerant work 'environments in which clinicians feel compelled to self-censor.' The question of whether and when treatments like puberty blockers, hormone therapies or surgery are appropriate for young people has been the subject of fierce debate. Several European countries have limited the treatments in recent years, after scientific reviews finding poor quality of evidence to support their benefits and uncertainty about long-term risks. In the United States, 24 states have passed laws barring physicians from offering such treatments to adolescents. The American Academy of Pediatrics is conducting its own review of the evidence. The academy and most major medical groups in the United States continue to endorse these treatments as effective in relieving the psychological distress many transgender youths experience. 'This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care,' said Dr. Susan Kressly, president of the academy. 'The report prioritizes opinions over dispassionate reviews of evidence.' Transgender rights advocates criticized the new assessment as seeking to paint over an ideological view with scientific gloss. During Mr. Trump's first 100 days in office, his administration has sought to limit recognition of transgender identities in public life. The administration has threatened to end funding for hospitals that provide gender-transition treatments to people under 19 and to bar openly transgender people from serving in the military. The administration has moved to house transgender women in federal prisons with men and to no longer reflect the gender identities of transgender people on passports. 'Is the administration's hostility to this medical care based on actual scientific research, or is it ideologically driven by this administration's open disapproval of transgender people and belief that transgender identity is false?' said Shannon Minter, legal director at the National Center for Lesbian Rights. The center represents transgender individuals in several lawsuits challenging the constitutionality of the administration's policies. Casey Pick, director of law and policy at the Trevor Project, a nonprofit organization focused on suicide prevention among L.G.B.T.Q. young people, said, 'To the extent that this is a document that is challenging even the ability of a young person to identify as transgender, that is an ideological statement — that is not a medical statement.' The report is a victory for those who have described this field of medicine as part of a broader project that denies the realities of biological sex. Roger Severino, vice president for domestic policy at the Heritage Foundation, a conservative think thank, applauded the H.H.S. report and blamed 'profit-seeking doctors and ideological groups' for persuading families that 'a child's sex is whatever they say it is.' About 3 percent of high school students identify as transgender, according to government data, a number that has risen substantially over the last decade. A much smaller percentage of those adolescents seek medical interventions. The issue of medical transition for minors has nonetheless become a political flashpoint. Mr. Trump made it a focus of his campaign, and some Democrats believe the strategy helped him win. The new H.H.S. report goes further than similar reports in European countries that have introduced new restrictions on gender treatments for adolescents. An independent review of clinical services for young people in England, led by Dr. Hilary Cass, former president of the Royal College of Pediatricians, reached similar conclusions about the quality of evidence to support the use of puberty blocking and hormonal treatments in minors. (Surgeries are not available for minors in Britain.) But that review, conducted over a four-year period, interviewed young patients, transgender adults, parents and clinicians to gain a broad picture of the medical field. Dr. Cass concluded that the evidence on both the benefits and the risks of the treatments was 'remarkably weak' but said that some young people were still likely to benefit from early intervention. 'There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access — under a research protocol, because we need to improve the research — but not assume that that's the right pathway for everyone,' Dr. Cass said in an interview last year. That review concluded by recommending that England's National Health Service restrict the use of puberty blocking drugs to research trials only, and clinicians were advised to prescribe hormones to teenagers with 'extreme caution.' Other clinicians who have voiced concerns about the field of youth gender medicine were ambivalent about how the new report might be used. 'I am glad that authorities in the United States are finally taking into account what's been going on in Europe in recent years,' said Erica Anderson, a child psychologist and former president of the U.S. Professional Association of Transgender Health. She has been vocal about her concerns that youth gender clinics have moved away from careful mental health assessments as the population of children seeking gender treatments has grown. But Dr. Anderson, who still supports early intervention for some young people, noted that it was impossible to ignore the inflammatory executive order that led to the report. 'It's kind of like calling out to someone a rank insult and then deciding you want to have a conversation with them,' she said. 'Well, that doesn't really work very well with actual human beings with feelings and histories.' Mr. Minter, of the National Center for Lesbian Rights, said that by emphasizing psychotherapy over medical interventions, the H.H.S. report effectively endorsed conversion therapy, intended to change a minor's gender identity or sexual orientation. Leading medical groups have supported bans on the practice, citing evidence that it causes depression, anxiety and self-hatred. But the Supreme Court has agreed to hear a First Amendment challenge to a Colorado ban on conversion therapy next term, brought by a licensed professional counselor whose Christian faith includes the belief that 'people flourish when they live consistently with God's design, including their biological sex,' according to court documents. Other therapists, including Dr. Anderson, have argued that so-called 'exploratory' therapy with supportive clinicians can be helpful for helping to disentangle mental health issues from gender identity for adolescents. Kellan Baker, who studies transgender health policy at Whitman Walker, a nonprofit community health center in Washington, said the report was a departure from how health policy had typically been shaped in the United States. 'It is important that medicine be practiced by those with expertise in it, by trained clinicians operating according to standards of care that are set out by their respective medical fields — not by the federal government,' Dr. Baker said. He said he worried that the report might be cited by the government as justification for refusing to cover medical care for transgender young people. The Centers for Medicare and Medicaid Services, a division of H.H.S., sent a letter to state Medicaid agencies last month urging them not use Medicaid funds for gender-transition care for minors. Pam Bondi, the attorney general, has directed the Justice Department to investigate doctors who provide such care. 'This document is not a standard of care, but it's going to be cited by the government as justification for refusing to cover medical care for transgender young people,' Dr. Baker said.
New York Times
02-05-2025
- Health
- New York Times
Federal Report Denounces Gender Treatments for Adolescents
Federal health officials published a report on Thursday declaring that the use of hormonal and surgical treatments in young people with gender dysphoria lacked scientific evidence and expressing concern about long-term harms, a stark reversal from previous agency recommendations and the advice of top U.S. medical groups. The report instead prioritized the role of psychotherapy, a divisive intervention to treat gender dysphoria that many advocates and physicians have equated with so-called conversion therapy. Other parts of the review seemed to call into question the very notion that some people have a gender identity that does not align with their sex at birth. In January, President Trump signed an executive order titled 'Protecting Children From Chemical and Surgical Mutilation' giving the Department of Health and Human Services 90 days to produce a report on the best practices for treating young people who say their gender does not align with their birth sex. But the order made it clear that the administration had already reached its own conclusion about gender transition treatments for minors, characterizing the 'blatant harm done to children' as a 'stain on our nation's history.' The 400-page report took a more sober tone but reached a similar conclusion. In a remarkable departure from the standard for medical evidence reviews, the authors were not identified pending a post-publication review process that would begin in 'the coming days.' H.H.S. officials declined to answer questions about what the review process would entail. The department noted that the contributors included doctors, medical ethicists and a methodologist, all from 'a wide range of political viewpoints' who were chosen 'for their commitment to scientific principles.' The report specified that the new assessment was not intended to set a standard for medical care or to make policy recommendations. It relied predominantly on an analysis of reviews of the scientific studies of puberty blockers, hormone therapies and surgeries that have been published in the last few decades, when these treatments were first made available to adolescents. The assessment concluded that while the benefits of medical interventions were uncertain, the harms, which can include loss of fertility, were less so. The 'clinical practice in this field of medicine is exceptional and concerning,' the report said, and it criticized American medical groups for fostering intolerant work 'environments in which clinicians feel compelled to self-censor.' The question of whether and when treatments like puberty blockers, hormone therapies or surgery are appropriate for young people has been the subject of fierce debate. Several European countries have limited the treatments in recent years, after scientific reviews finding poor quality of evidence to support their benefits and uncertainty about long-term risks. In the United States, 24 states have passed laws barring physicians from offering such treatments to adolescents. The American Academy of Pediatrics is conducting its own review of the evidence. The academy and most major medical groups in the United States continue to endorse these treatments as effective in relieving the psychological distress many transgender youths experience. 'This report misrepresents the current medical consensus and fails to reflect the realities of pediatric care,' said Dr. Susan Kressly, president of the academy. 'The report prioritizes opinions over dispassionate reviews of evidence.' Transgender rights advocates criticized the new assessment as seeking to paint over an ideological view with scientific gloss. During Mr. Trump's first 100 days in office, his administration has sought to limit recognition of transgender identities in public life. The administration has threatened to end funding for hospitals that provide gender-transition treatments to people under 19 and to bar openly transgender people from serving in the military. The administration has moved to house transgender women in federal prisons with men and to no longer reflect the gender identities of transgender people on passports. 'Is the administration's hostility to this medical care based on actual scientific research, or is it ideologically driven by this administration's open disapproval of transgender people and belief that transgender identity is false?' said Shannon Minter, legal director at the National Center for Lesbian Rights. The center represents transgender individuals in several lawsuits challenging the constitutionality of the administration's policies. Casey Pick, director of law and policy at the Trevor Project, a nonprofit organization focused on suicide prevention among L.G.B.T.Q. young people, said, 'To the extent that this is a document that is challenging even the ability of a young person to identify as transgender, that is an ideological statement — that is not a medical statement.' The report is a victory for those who have described this field of medicine as part of a broader project that denies the realities of biological sex. Roger Severino, vice president for domestic policy at the Heritage Foundation, a conservative think thank, applauded the H.H.S. report and blamed 'profit-seeking doctors and ideological groups' for persuading families that 'a child's sex is whatever they say it is.' About 3 percent of high school students identify as transgender, according to government data, a number that has risen substantially over the last decade. A much smaller percentage of those adolescents seek medical interventions. The issue of medical transition for minors has nonetheless become a political flashpoint. Mr. Trump made it a focus of his campaign, and some Democrats believe the strategy helped him win. The new H.H.S. report goes further than similar reports in European countries that have introduced new restrictions on gender treatments for adolescents. An independent review of clinical services for young people in England, led by Dr. Hilary Cass, former president of the Royal College of Pediatricians, reached similar conclusions about the quality of evidence to support the use of puberty blocking and hormonal treatments in minors. (Surgeries are not available for minors in Britain.) But that review, conducted over a four-year period, interviewed young patients, transgender adults, parents and clinicians to gain a broad picture of the medical field. Dr. Cass concluded that the evidence on both the benefits and the risks of the treatments was 'remarkably weak' but said that some young people were still likely to benefit from early intervention. 'There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access — under a research protocol, because we need to improve the research — but not assume that that's the right pathway for everyone,' Dr. Cass said in an interview last year. That review concluded by recommending that England's National Health Service restrict the use of puberty blocking drugs to research trials only, and clinicians were advised to prescribe hormones to teenagers with 'extreme caution.' Other clinicians who have voiced concerns about the field of youth gender medicine were ambivalent about how the new report might be used. 'I am glad that authorities in the United States are finally taking into account what's been going on in Europe in recent years,' said Erica Anderson, a child psychologist and former president of the U.S. Professional Association of Transgender Health. She has been vocal about her concerns that youth gender clinics have moved away from careful mental health assessments as the population of children seeking gender treatments has grown. But Dr. Anderson, who still supports early intervention for some young people, noted that it was impossible to ignore the inflammatory executive order that led to the report. 'It's kind of like calling out to someone a rank insult and then deciding you want to have a conversation with them,' she said. 'Well, that doesn't really work very well with actual human beings with feelings and histories.' Mr. Minter, of the National Center for Lesbian Rights, said that by emphasizing psychotherapy over medical interventions, the H.H.S. report effectively endorsed conversion therapy, intended to change a minor's gender identity or sexual orientation. Leading medical groups have supported bans on the practice, citing evidence that it causes depression, anxiety and self-hatred. But the Supreme Court has agreed to hear a First Amendment challenge to a Colorado ban on conversion therapy next term, brought by a licensed professional counselor whose Christian faith includes the belief that 'people flourish when they live consistently with God's design, including their biological sex,' according to court documents. Other therapists, including Dr. Anderson, have argued that so-called 'exploratory' therapy with supportive clinicians can be helpful for helping to disentangle mental health issues from gender identity for adolescents. Kellan Baker, who studies transgender health policy at Whitman Walker, a nonprofit community health center in Washington, said the report was a departure from how health policy had typically been shaped in the United States. 'It is important that medicine be practiced by those with expertise in it, by trained clinicians operating according to standards of care that are set out by their respective medical fields — not by the federal government,' Dr. Baker said. He said he worried that the report might be cited by the government as justification for refusing to cover medical care for transgender young people. The Centers for Medicare and Medicaid Services, a division of H.H.S., sent a letter to state Medicaid agencies last month urging them not use Medicaid funds for gender-transition care for minors. Pam Bondi, the attorney general, has directed the Justice Department to investigate doctors who provide such care. 'This document is not a standard of care, but it's going to be cited by the government as justification for refusing to cover medical care for transgender young people,' Dr. Baker said.
New York Times
29-04-2025
- Politics
- New York Times
Trump Plan to Dismantle Head Start Is Illegal, Lawsuit Argues
The American Civil Liberties Union and other groups have sued the Trump administration over what they say is a plan to illegally dismantle Head Start, the federal program that funds early education for America's youngest and poorest children. The lawsuit, filed in federal court in Washington State on Monday, was filed on behalf of Head Start associations and parent groups in several states. It argues that the Trump administration cannot reduce or eliminate Head Start, because the program is funded by Congress. Head Start, a $12 billion-a-year program, provides child care, preschool and other services for children in poverty from birth to age 5, before they start formal school. The program, under the Department of Health and Human Services, has been subject to spending cuts and layoffs as part of President Trump's efforts to reduce federal spending. The Trump administration is expected to propose eliminating the Head Start program as part of its 2026 budget, which could be released as soon as this week, according to a series of draft documents reviewed by The New York Times. The White House previously said that no final funding decisions have been made, and any plan would require the support of Congress. But Jennesa Calvo-Friedman, a lawyer with the A.C.L.U, said the Trump administration had already found ways to diminish Head Start 'through a series of executive actions which make it harder and harder for Head Start programs to stay open.' A spokeswoman for H.H.S. declined to comment on the lawsuit, citing ongoing litigation. The lawsuit argues that the Trump administration has withheld and reduced spending for Head Start, money that is appropriated by Congress. From January to mid-April, H.H.S. spent nearly $1 billion less for Head Start than in the same period the previous year, the lawsuit says. The administration also abruptly closed half of Head Start's regional offices and cut their employees, as part of other layoffs at H.H.S. at the start of this month. That has resulted in funding delays and other hiccups, which caused at least one child care provider in Washington State to temporarily close and forced Head Start employees in Oregon to take unpaid days off, according to the lawsuit. The suit also takes issue with a Trump administration ban on diversity, equity and inclusion, which it says conflicts with other requirements needed for Head Start to effectively serve a diverse population of families, including many children with disabilities. The lawsuit argues the Trump administration is violating the constitutional separation of powers between Congress and the president, an issue that has been at the center of President Trump's second term, as he has sought to exert his power over federal spending. 'Head Start is a program established by law,' said Lori Rifkin, a lawyer with Impact Fund, which filed the lawsuit along with the A.C.L.U. 'It is illegal for the Trump administration to unilaterally end it, or alter its basic function and purpose.' The Head Start program, which was created in 1965 as part of President Lyndon B. Johnson's war on poverty, sends federal dollars to local child care and preschool providers in communities all over the country. About 30 percent of participants live in rural areas, according to the lawsuit. The program includes dental care, meals and other services beyond early childhood education.
New York Times
24-04-2025
- Health
- New York Times
U.S. Officials to Cut Funding for Landmark Study of Women's Health
Federal health officials plan to cut funding to the Women's Health Initiative, effectively shuttering one of the largest and longest studies of women's health ever carried out. Its findings changed medical practice and helped shape clinical guidelines, preventing tens of thousands of cases of cardiovascular disease and breast cancer. The study, which began in the 1990s when few women were included in clinical research, enrolled over 160,000 participants across the nation. It continues to follow some 42,000 women, tracking data on cardiovascular disease and aging, as well as frailty, vision loss and mental health. Researchers have hoped to use the findings to learn more about how to maintain mobility and cognitive function and slow memory loss, detect cancer earlier and predict the risks of other diseases. The Department of Health and Human Services is terminating contracts for the W.H.I.'s regional centers in September. The clinical coordinating center, based at Fred Hutch Cancer Center in Seattle, will be funded through at least January 2026. The budget for 2025 is $9.3 million. Whether the center will continue to receive support next year remains uncertain. Even if funding continues, the coordinating office relies on the regional centers to gather data from participants, and so its functions will be limited. H.H.S. did not immediately respond to a request for comment. Recently, a spokeswoman said cuts to such funding 'are designed to ensure that every dollar is used more efficiently while continuing to focus on our core mission of improving public health and services.' Senator Patty Murray, Democrat of Washington, said shutting down the trial was 'a devastating loss for women's health research.' Not only did the initiative lead to major advancements in women's health, 'it has paved the way for a generation of researchers focused on women's health — which has long been overlooked and underfunded,' Ms. Murray said. The president of the American College of Obstetricians and Gynecologists, Dr. Stella Dantas, called the shutdown of the trial 'shortsighted and tragic.' 'It is disheartening to see studies that allow us to better support, care for, and increase quality of life for our patients now and in the future terminated,' Dr. Dantas said. The W.H.I. included a number of randomized controlled trials and has contributed to more than 2,000 research papers. But it is probably best known for a study of hormone replacement therapy that was abruptly halted in 2002, after investigators found that older women who took a combination of estrogen and progestin experienced a small but significant increase in the risk of breast cancer. Until then, hormone replacement therapy was widely believed to protect women from cardiovascular disease. But the trial found that even though the hormone combination reduced colorectal cancer and hip fractures, it put women at higher risk for heart attacks, strokes and blood clots. Dr. JoAnn Manson, one of the long-term principal investigators of the study and a professor of medicine at Harvard Medical School and Brigham and Women's Hospital, called the funding cuts 'heartbreaking.' The decision also was perplexing, she added, given statements by Robert F. Kennedy Jr., the nation's health secretary, about the importance of reducing chronic disease in America. 'There is no better example of the scientific impact of research on chronic disease prevention than the W.H.I.,' Dr. Manson said. 'So the slashing of funding of a trial that has contributed enormously to our knowledge of the prevention of chronic disease and healthy aging and extending the healthy span — I mean, it is really puzzling and shocking.' The lessons learned from the hormone study have resulted in enormous savings in health care costs, researchers have found — about $35 billion between 2003 and 2012, according to one study, because of the number of cancer and cardiovascular disease cases that had been averted. For every dollar spent on the W.H.I., $140 was saved. One randomized trial carried out by the W.H.I. looked at the impact of a low-fat diet, high in fruits and vegetables. Though researchers initially found a reduction only in ovarian cancer, long-term follow-up showed that the diet also reduced deaths from breast cancer. Another study of calcium and vitamin D found that supplements provided a modest benefit for preserving bone mass and preventing hip fractures in older women, but did not prevent other fractures or colorectal cancer. The findings influenced medical guidelines, which currently do not recommend that all women routinely take the supplements. The participants in the initiative are now aged 78 to 108, and some scientists conceded that an argument could be made for winding down the trial. But careful planning is typically given to closing out such a large and wide-ranging study. The abrupt decision to shut down the W.H.I. — which was made without consulting the researchers — was highly unusual, they said. 'There's still so much we need to learn,' said Garnet Anderson, senior vice president and director of the public health science division at Fred Hutch Cancer Center and a principal investigator of the initiative. 'No one has ever studied 13,000 women over the age of 90 to know: What are their health needs? How to live such a long and health life?' she said. 'We'd love to know the secrets of success for healthy aging.' One reason that the study was begun in the 1990s was that there was a dearth of information and research on women's health, and little evidence on which to base clinical recommendations, said Marian Neuhouser, who heads the cancer prevention program at Fred Hutch Cancer Center and is chair of the W.H.I. steering committee. 'Women are half the population,' Dr. Neuhouser said, 'but they had not been included in research. It had mostly been men, and the results were so-called extrapolated to women.'
