Ambiguous Evidence: The Rhetorical Work of Interpreting Clinical Trial Evidence after the Women's Health Initiative

Abstract

The early termination of the Women's Health Initiative (WHI) hormone therapy trial in 2002 significantly reshaped clinical discourse surrounding menopause treatment and the safety of hormone replacement therapy. Although the WHI was widely interpreted as evidence that hormone therapy increased risks such as breast cancer and cardiovascular disease, clinicians in medical journals quickly began deliberating how the trial's findings should be interpreted and applied to clinical care. This dissertation examines how clinicians reasoned about and interpreted WHI evidence during the early years following the trial's publication. Drawing on qualitative coding and rhetorical analysis of scientific discourse, this study applies a retroactive risk communication framework to analyze a corpus of twenty-seven editorials and review articles published in medical journals between 2002 and 2007. These genres are particularly influential spaces where clinicians interpret emerging evidence and guide professional understanding of clinical research for practice. Through this analysis, the study identifies how clinicians acknowledged methodological limitations in the WHI, including issues related to study design, participant population, and the generalizability of the trial's findings. Despite these critiques, clinicians did not dismiss the WHI as invalid evidence. Instead, they preserved the trial's authority and clinical utility of its' evidence using what this dissertation terms risk topoi. Risk topoi function as interpretive mechanisms that allow clinicians to narrow, reinterpret, or create conditions around trial findings to align them with existing clinical knowledge and patient care practices. By tracing how these risk topoi operate within clinical argumentation, this dissertation demonstrates how clinicians maintain the utility of large clinical trials even amid methodological uncertainty and debate. This study contributes to the scholarship of the rhetoric of health and medicine, technical communication, and science and technology studies by showing how clinical knowledge is produced not only through the generation of new evidence but also through the rhetorical work of interpreting and stabilizing that evidence within professional discourse.