Health Insite

Hormone Replacement Scare and Scandal

August 2002

By now everyone has heard the alarming reports about hormone replacement therapy (HRT). It's a dog, as they say. A loser. Bad medicine through and through. We won't expound on the research findings, all heavily reported over the past month, but you can read for yourself the Journal of the American Medical Association report as well as the press release from the National Institutes of Health, by clicking the links at the end of this article.

To sum it all up-the new reasons why hormone replacement therapy is bad medicine-researchers were alarmed by specific findings that caused them to call for women to stop using the drugs:

  • A 41 percent increase in strokes
  • A 29 percent increase in heart attacks
  • A doubling of rates of blood clots
  • A 22 percent increase in total cardiovascular disease
  • A 26 percent increase in breast cancer

What interests us most is not these alarming statistics, though alarming they are. The real story, we believe, is how these drugs (a combination of estrogen and progestin) made it into so many people's hands (and bodies) in the first place. An estimated six million American women were taking the drugs when the alarm was sounded in early July. Like other recent missteps in the medical world, the question isn't simply one of bad medicine, but of bad marketing and poor policy as well.

A History of Hoopla and Harm

HRT came of age in the late 1960s, although it had been studied as early as the 1930s. According to Sherrill Sellman, in her book Hormone Heresy, the early research (using hormones and organs from monkeys) showed little effectiveness and even resulted in dire consequences. But in 1966, after years of re-focusing research on synthetic estrogen instead of animal-derived products, the pharmaceutical companies emerged triumphant, changing the medical landscape-and women's bodies-forever.

In 1966, Dr. Robert Wilson, a New York gynecologist, wrote a bestseller called Feminine Forever. His message, says Sellman, was that estrogen replacement would save women "from the tragedy of menopause which often destroys her character as well as her health." The book, it turns out, was paid for by Wyeth-Ayerst. The author's foundation, the Wilson Research Foundation, also was financed by Wyeth, along with other drug companies who had interests in creating a market for their new drugs.

An important side-note here is that unlike today, drug makers could not advertise direct to consumers in 1966. Their marketing was obscured, hidden in books like Dr. Wilson's, which rarely, if ever, noted their corporate ties and were championed as groundbreaking works of medical literature. In fact, they might be better represented as groundbreaking works of guerilla marketing.

Lo and behold, thanks to Dr. Wilson's book and lectures, Wyeth's estrogen replacement drug, Premarin, became the fifth leading prescription drug in the U.S. by 1975, just about the time researchers found that such drugs could increase the risk of uterine cancer at remarkable rates. The solution: don't stop the estrogen; just add progestin. Progestin seemed to counter the effects of estrogen replacement on the uterine lining, making the "wonder cure for women" safe againÂ…for a while.

A Cash Cow or Gender Conspiracy?

Sellman and others argue that the pharmaceutical companies' push to popularize HRT fits right in with a patriarchal society's view of women. Cynthia Pearson, executive director of the National Women's Health Network, recently told New York Times reporters that the message was "sexist and ageist," essentially telling women that these drugs would help them stay young, stay sexy, and "be less of a pain to your husband."

In fact, the Times quotes a 1972 article by Dr. Wilson, in which he wrote, "Such women [who use estrogen replacement] will be more pleasant to live with and will not become dull and unattractive." Statements such as these would never appear in journals today, but in the less "politically correct" times of the early '70s, they were not out of the norm.

Though the gender card may have come into play here, our feeling is that the greatest motivator of all for the medical community's drive toward HRT was money, pure and simple. From the beginning, the goal was to show that every woman needs hormone replacement. Not as a luxury, not as a short-term treatment, but as a medical necessity at menopause, after menopause, and for the rest of your life. Just think of all the prescriptions!

Of course, it's not just drug makers that benefit. There's a trickle-down effect, a process that results in more office visits ($$), more lab tests ($$), and ultimately, more prescriptions ($$). If you think you have dollar signs floating in front of your eyes, just imagine what the executives at Wyeth saw when they considered their future in HRT.

What to Do Without HRT

While the drug companies were extraordinarily successful at creating the "need" for HRT, the question now is whether or not women ever really needed it. Menopause is a normal, healthy, natural part of life. In another recent New York Times piece, Dr. Susan Love of the UCLA Medical School writes, "The symptoms of menopause are really not the symptoms of low estrogen but the symptoms of hormonal change-puberty in reverse. And, as with puberty, the symptoms are transientÂ…"

Some women, of course, can still benefit from HRT. The new dangers concern only women who still have their uterus; the risks do not appear in women who have undergone hysterectomy. For the 16 percent of women who have really troublesome menopausal symptoms, it is "perfectly reasonable," says Dr. Love, to take HRT for up to four years. But at four years, that's enough. Long-term use is just not warranted.

Ms. Sellman's book, Hormone Heresy, details a variety of products and practices that can help women make the transition easier without resorting to HRT-everything from exercise and meditation to foods and supplements. Now in its third edition, it's one of the most popular books around for exploring the issues of women and their hormones.

The most important lesson to be learned, however, is that you are always in control. Marketing efforts are only successful when they convince you that something you desire, or maybe something you've never even heard of, is something you need. Now that drug companies can advertise directly to us, a practice they have embraced wholeheartedly, it's more important than ever (and, perhaps, more difficult) to realize the difference between a marketing pitch and a medical necessity. Don't, as the advertisements say, "ask your doctor if product X is right for you;" ask yourself first. Do some research. Learn the facts. And know that when it comes to your body and your health, you're the best expert in the field.

Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA, 288:321-333, 2002.

NIH News Release: NHLBI stops trial of estrogen plus progestin due to increased breast cancer risk, lack of overall benefit. National Institutes of Health website, www.nih.gov, July 9, 2002.

Sellman S.: Hormone Heresy.Oklahoma: Get Well International, 2000.

Love S.: Preventive medicine, properly practiced. The New York Times on the Web July 16, 2002.

Kolata G., Petersen, M.: Hormone replacement study a shock to the medical system. The New York Times on the Web, July 10, 2002.

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