users may have explained the lower heart risk; women on HRT, for example, tended to more affluent and in better overall health. But such cautions, as well as negative study findings, Krieger and her colleagues contend, "were dwarfed by the proliferation of studies favorable to HRT." In their view, an aggressive pharmaceutical industry, the regulatory framework and a general perception of menopause as a "disease" were all central to the issue. Once a drug is approved for a specific use, doctors are free to prescribe that medication for other conditions as well. This fact, coupled with industry influence, the report authors contend, were key to the growth of HRT. There was reason to believe HRT could have offered heart benefits, Krieger acknowledged, noting, for instance, that it was "biologically plausible" and had support from animal research. But, she argued, given the known cancer risks of estrogen, the evidence for HRT should not have been enough. Among the recommendations Krieger and her colleagues make is that the "precautionary principle" be applied to any drug being studied for preventive medicine. That is, Krieger said, "You don't prescribe healthy people potentially dangerous drugs." --SP 2112 Local Time 1812 GMT
