台灣低劑量荷爾蒙補充療法的爭議:知識、實作與標準化

Author Info
楊舒琴
盧孳豔
國立陽明大學護理學系、萬芳醫院預防醫學暨社區醫學部
國立陽明大學臨床暨社區健康照護研究所
  過去更年期婦女使用荷爾蒙補充療法的主要爭議,在於醫療化女性身體的自然過程。自 2002 年美國婦女健康行動(WHI)大型臨床試驗研究指出該療法的罹癌風險後,引發社會多方關注,「低劑量荷爾蒙」在臨床指引和臨床實作中於焉展開。本文剖析「低劑量荷爾蒙」的知識與實作,如何於風險爭議未歇時,嵌入台灣特定的文化時空,展現在爭議發生後,醫療化如何改變其樣貌,持續在地進行之過程。
  「低劑量荷爾蒙」知識出現在 WHI 報告之前,起源於找尋預防荷爾蒙缺少導致骨質流失疏鬆的藥物劑量,而台灣醫界在 2002 爭議後,一方面接受國際更年期醫學會的治療指引,宣稱其藥物的有效性;另一方面強調亞洲婦女身體體質與體型的特殊性,企圖發展獨特的在地生物學知識以鞏固專業體制,透過隱身的藥廠進行主導和串接,以泛亞區聯盟的方式,爭取國際對亞洲婦女更年期特殊性的重視。本文以婦女、醫師及醫師團體能動性的展現,看見爭議如何與在地的政治,作不同層面的結合,以及「低劑量荷爾蒙」知識及實作於台灣的生成及演變,所具備的獨特性格。

The Controversy over Low-dose Hormone Therapy in Taiwan: Knowledge Production, Clinical Practice and Politics of Standardization

  The Women’s Health Initiatives (WHI) randomized controlled trials in 2002 highlighted both the increased cancer risks of hormone replacement therapy (HRT) for menopausal women and HRT’s role in medicalizing women’s bodies. As a result, "low-dose" hormone therapy has becomethe prevailing regimen in medical guidelines and clinical practices. This paper explores how "low-dose hormone" therapy emerged from the risk controversy and was adopted into regular gynecological clinical practice, continuing the process of medicalization in Taiwan. Before the publication of WHI’s report "low-dose hormone" had a already emerged as a standard regimen for bone health displaced the risk of hormonal deficiency with the risk of an osteoporotic menopausal body. The Taiwan Menopause Society endorsed the International Menopause Society’s hormone therapy guidelines and claimed the effectiveness of "low-dose" hormone therapy, while questioning the potential effects ofbodily differences betweenAsian and Euro-American women. Subsequent clinical trialsby the Pan-Asian menopausal medical societies reveal efforts to produce knowledge of Taiwanese local biology. The risk controversy travelled and became embedded in local politics at individual and group levels;. this articleexplores the agency of gynecologists and menopausal women in shaping reactions to the controversy and the emergence of "low-dose hormone" therapy in Taiwan. 

Citation: 
《科技、醫療與社會》,第23期,頁203-256,2016年10月出版