12 Leaders The EconomistDecember 14th 2019
2 ple, to help governments track terrorists or investigate organised
criminals. Unfortunately, in some cases, these surveillance tools
have ended up in the hands of autocratic governments with
more sinister aims.
A recent lawsuit brought by WhatsApp, for instance, alleges
that more than 1,400 users of its messaging app were targeted us-
ing software made by nsoGroup, an Israeli firm. Many of the al-
leged victims were lawyers, journalists and campaigners. (nso
denies the allegations and says its technology is not designed or
licensed for use against human-rights activists and journalists.)
Other firms’ hacking tools were used by the blood-soaked regime
of Omar al-Bashir in Sudan. These technologies can be used
across borders. Some victims of oppressive governments have
been dissidents or lawyers living as exiles in rich countries.
Western governments should tighten the rules for moral,
economic and strategic reasons. The moral case is obvious. It
makes no sense for rich democracies to complain about China’s
export of repressive digital technologies if Western tools can be
used to the same ends. The economic case is clear, too: unlike
conventional arms sales, a reduction in spyware exports wouldnot lead to big manufacturing-job losses at home.
The strategic case revolves around the risk of proliferation.
Software can be reverse-engineered, copied indefinitely and—
potentially—used to attack anyone in the world. The smart-
phone apps targeted by such spyware are used by everyone, from
ordinary citizens to prime ministers and ceos. There is a risk
that oppressive regimes acquire capabilities that can then be
used against not just their own citizens, but Western citizens,
firms and allies, too. It would be in the West’s collective self-in-
terest to limit the spread of such technology.
A starting-point would be to enforce existing export-licens-
ing more tightly. These rules were designed for an earlier age, but
the principle remains the same: if firms cannot offer reasonable
assurances that their software will be used only against legiti-
mate targets, they should be denied licences to sell it. Rich coun-
tries should make it harder for ex-spooks to pursue second ca-
reers as digital mercenaries in the service of autocrats. The arms
trade used to be about rifles, explosives and jets. Now it is about
software and information, too. Time for the regime governing
the export of weapons to catch up. 7I
t is knowncolloquially as “the change”. The end of a woman’s
natural child-bearing years is a moment of transformation
that is welcome to some and miserable for others. But for too
many, menopause is also a painful process that can damage their
bones, heart and brain. As societies age, the question of how best
to preserve women’s health during menopause is becoming
more urgent. In 1990 nearly half a billion women were 50 or older
(the age when menopause typically begins). Today there are al-
most twice as many.
About 47m women around the world reach the age of meno-
pause each year. In Western countries, where most research has
been conducted, up to 80% will experience symptoms such as
hot flushes, night sweats, depression, insom-
nia, anxiety and memory loss. Symptoms can
last up to 12 years. Around a quarter of women
going through menopause feel so wretched that
their quality of life is dimmed, according to
studies in rich countries. Almost half of British
women experiencing it say that their work suf-
fers as a result.
Twenty years ago, doctors would routinely
have prescribed hormone-replacement therapy (hrt) to women
entering menopause. But in 2002 the results of a huge rando-
mised trial were published, showing that the treatment brought
health risks, including a slightly raised chance of breast cancer
after five years. Women and doctors were alarmed. Around the
world they abandoned hormonal therapy in droves. Before the
study, 22% of menopausal women in America took hrt. Six
years later that figure had fallen below 5%. In Australia, around
15% of menopausal women with moderate or severe symptoms
receive the treatment. Take-up of hrtis now low in most coun-
tries. Women are scared and doctors wary.
And yet the conclusions of the study in 2002 were rapidly de-bunked (see International section). A re-examination of its re-
sults showed that women aged between 50 and 59 who took hrt
were 31% less likely to die of any cause during their five to seven
years of treatment with the hormones than those who did not.
For a woman who has had her uterus removed or who starts
menopause before the age of 45, hrtgreatly reduces the risk of
heart disease, a life-saving effect. It can also prevent osteoporo-
sis, a disease in which bones become brittle. One study of post-
menopausal American women over a ten-year period found that,
of those who had had hysterectomies, between 18,000 and
91,000 died prematurely because they had shunned hormone
therapy. hrtalso lowers women’s risk of uterine and colon can-
cers. Fears about the increased risks of breast
cancer have been overplayed.
Hormonal therapies are typically off-patent
and inexpensive. In Britain the annual price tag
is only £125 ($165); in the United States generic
pills are similarly affordable. And the benefits
vastly outweigh the costs. Nothing else controls
the symptoms of menopause so well, and a
heightened risk of any one disease must be
weighed against the lowered risks of contracting several others.
Hormonal therapies are not appropriate for all menopausal
women. For some, the symptoms are insufficiently severe for it
to be worthwhile. The treatment might not be suitable for those
with liver disease, or a history of blood clots, or breast or ovarian
cancer. But for serious symptoms, alternative treatments are
worse than taking hrt. Herbal supplements, yoga and faddy di-
ets—to which some turn in the absence of medical help—may al-
leviate the unpleasantness of menopause but do not offer the
long-term health benefits of hrt. Moreover, the symptoms can
portend serious health problems in the future. Doctors could
usefully prescribe hrtfar more widely than they do today. 7Second spring
Hormone-replacement therapy is safer than people think. More women should take itMenopauseWomen aged 50 and over
Worldwide, bn
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