If you work in any field remotely related to health care in the US, each week brings with it a raft of new horrors and abominations. Last Monday, The Women’s Health Initiative (WHI) investigators were informed that the Department of Health and Human Services (led by Robert F. Kennedy) was cancelling their funding at the end of the fiscal year. By the way, their annual funding is just under $10 million a year, which represents a tiny fraction of US federal government spending on health programs and services– which in FY2024, was $1.9 trillion.
By Friday, however, an HHS spokesperson announced that there had been a reversal of cuts to WHI. HHS secretary RFK even called the Monday announcement “fake news”. However, WHI investigators have receipts, like this notice in the NIH reporter site.
But has the funding actually been restored? On the WHI government site header page as of Sunday April 27, we see this:
While we catch our breaths here: What is the Women’s Health Initiative, and what research has it done? Glad you asked. Here’s info from this WHI site.
WHI was launched in 1991 to study the causes and prevention of heart disease, cancer, and other serious conditions. In the decades since, the WHI has made large strides in research on aging and heart health. The WHI has collected data from over 161,000 postmenopausal women from diverse backgrounds across the United States.
The WHI has three arms: (1) Clinical trials to study health effects of low-fat dietary modifications, hormone therapies, and calcium and Vitamin D supplements. These clinical trials are now complete, and the WHI has started an extension study to monitor the health of over 93,000 original participants. (2) An observational study to track medical histories or changes in health that might point to health problems. (3) A community prevention study to create programs that encourage women to eat healthy, exercise, and stop smoking.
The Women’s Health Initiative is the largest women’s health prevention study ever conducted.
Here’s what an article JAMA this week says about the WHI’s most wide-reaching research conclusions from their long-running randomized clinical trials.
For postmenopausal women, the WHI randomized clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases.
Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms among women in early menopause, without contraindications, who are interested in taking hormone therapy.
The WHI evidence does not support routine supplementation with calcium plus vitamin D for menopausal women to prevent fractures or a low-fat diet with increased fruits, vegetables, and grains to prevent breast or colorectal cancer.
A potential role of a low-fat dietary pattern in reducing breast cancer mortality, a secondary outcome, warrants further study.
Where does the WHI stand today, given that their main research trials have concluded? Garnet Anderson, a biostatistician who runs the WHI coordinating center, was quoted in this article in Science:
WHI currently enrolls 42,000 women, who update the researchers regularly on their health. The contract cut will prevent researchers at WHI’s four sites from continuing to interact with the women in this cohort, which has enabled researchers to create the country’s largest data set on women in their 80s and 90s. “Our ability to understand what’s going on with those women will be severely curtailed,” Anderson says. “They’ve been dedicated to this process for 30 years and provide their data generously. They’ve told us they want to be followed. It’d be disrespectful not to do that.”
Now, to the big question: why in the world would anyone cut this program, which costs peanuts and stands out as a shining example of the power of medical research to improve the lives of women worldwide? After all, 55 million people in the US and 1.1 billion people worldwide are post-menopausal women. The WHI is the main research instrument used to investigate women’s aging and health conditions like cardiovascular disease.
My answer is this: there is no rhyme or reason to be found in the Trump administration’s deadly flailings-about, crashing programs, repairing some, promising restoration to others, and with no accountability on follow-through.
Take a look here at this article by STAT on “Day by day, Trump is roiling science and health”. You’ll see a chaotic and destructive pattern of cancelling programs for women, poor people, LGBTQ populations, health monitoring and international cooperation, and basic medical research. Some programs have been told that their funding would be restored, but we don’t know when or if or how that would happen.
This CNN article offers a bigger-picture view of the breadth of harms being imposed by the Trump administration’s attacks on health prevention and research programs. No state, however red it may be, is protected by these program cancellations. Health needs transcend politics, and we are starting to see the responses from health workers and patient groups all over the US.
Speaking out, following up, writing, signing, marching, donating, holding officials accountable, making people uncomfortable– it’s having effects, however small so far.
One thought that is making me smile: the idea of some percentage of those 55 million post-menopausal women marching, going on strike, taking to the airwaves and social media, reminding the administration and all their collaborators that we are out and about, taking names, organizing and voting.