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How Big Pharma keeps shape-shifting menopausal hormone therapy

Almost as soon as the New York Times posted a long article this weekend on how the pharmaceutical industry turned “horse estrogen into a billion-dollar panacea for aging women,” the article jumped onto the newspaper’s most e-mailed list — right behind a recipe for oatmeal buttermilk blueberry pancakes.

It remained there this morning.

Women taking hormones (and the people who care about them) must be sharing the article with each other, I thought.That’s good.But the popularity of the article also bewildered me.

Are there still any women taking hormones for hot flashes, night sweats and vaginal dryness (the only three menopausal “complaints” for which the drugs have been proven effective), given what we know about the drugs’ long list of health risks (blood clots in the lungs, stroke, heart attacks, breast cancer, colon cancer, gall bladder disease and dementia)?

In other words, can it be that the information in this article is news to any middle-aged woman?

Apparently it is.And, really, I shouldn’t be that surprised. For the disease-mongering of menopause continues. Big Pharma seems determined to resuscitate the $2-billion-plus (at its heyday) hormone “replacement” therapy market.  

And, despite the fact that there are other, safer solutions for hot flashes, night sweats and vaginal dryness, hormones continue to be prescribed to women.

Uncovering the disease-mongering
The Times article is partially based on new court documents obtained by the newspaper from recent product-liability lawsuits women have brought against drug manufacturers for overselling the benefits of menopausal hormones and failing to warn of its risks.

The documents not only show how one drug company, Wyeth (maker of Premarin and Prempro) was able to spread “like wildfire” the now disproved claim that menopausal hormone therapy protected the heart from disease, but also how the company (acquired earlier this year by the drug giant Pfizer) “worked over decades to maintain the image and credibility of its hormone drugs even as the products were repeatedly under siege.”

Write Times reporters Natasha Singer and Duff Wilson:

[T]hey depict a company that over several decades spent tens of millions of dollars on influential physicians, professional medical societies, scientific publications, courses and celebrity ads, inundating doctors and patients with a sea of positive preventive health messages that plaintiffs’ lawyers say deflected users’ attention from cancer concerns.
Even as evidence mounted of an association of the drugs with cancer — first in the 1970s with Premarin and endometrial cancer, then in the 1990s with Prempro and breast cancer — Wyeth tried to contain the concerns, the court documents show. (A note handwritten in 1996 by a Wyeth employee responding to a new report of breast cancer risks associated with hormone therapy said: ‘Dimiss/distract.’)

By 1996, Wyeth had begun to successfully reposition menopausal hormone therapy as a protective drug for heart and other diseases, even though the FDA had approved such drugs only for the treatment of hot flashes, night sweats, vaginal dryness and osteoporosis.

“Wyeth used proxies to promote a wide range of health benefits from hormone therapy,” report Singer and Wilson, “paying millions of dollars to influence doctors and medical groups and helping them develop abstracts for medical conferences and articles for medical journals.”

In 1997, the reporters add,

Wyeth began working with DesignWrite, a company in Princeton, N.J., that is paid by drug makers to develop manuscripts for publication in medical journals. The specific objective of a publication plan for Premarin was to “increase physician awareness on the multitude of benefits that hormone replacement therapy provides” and “diminish the negative perceptions associated with estrogens and cancer,” according to a 1997 DesignWrite proposal prepared for Wyeth.
Over the next decade, Wyeth paid DesignWrite to prepare at least 60 articles for publication in medical journals on the potential benefits of hormone therapy for cardiovascular disease, Alzheimer’s disease, diabetes, colon cancer, vision loss and other health problems.

New iterations, old concerns
The court papers uncovered by the Times “illustrate a pattern in the history of hormone therapy,” write Singer and Wilson. “First, many doctors enthusiastically prescribe hormone therapy drugs. Then a few researchers publish studies cautioning about risks, causing sales to fall. And finally, some doctors start prescribing a new iteration of hormone drugs.”

Today, that “new iteration” includes the claim that “bio-identical” hormones and/or low doses of older versions of the drugs are safe.  But, as the Times reporters point out, these claims have not been proven, and “even with lower-dose hormones, doctors do not have a uniform view on what constitutes the optimal duration.”

Like shape-shifters in folklore and fantasy fiction, menopausal hormone therapy keeps returning in a difference form.

Women, don’t be fooled. Demand the evidence.

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Comments (2)

  1. Submitted by Ginger Kulka on 12/14/2009 - 02:56 pm.

    I rarely comment on anything, especially on the internet, but feel I must in this case. Doctors “enthusiastically prescribe hormone therapy drugs” according to the “Times reporters”. Of course they do – because they work – and because their patients beg for relief. I am living proof that after 28 years of this therapy, I have experienced none of these “other diseases.”

    I have been on Premarin (a completely natural medication consisting entirely of a “pregnant mare’s urine” – hence the name “PreMarIn”)since 1981 when I had a total hysterectomy – a total of 28 years. Were it not for Premarin, I would be a crazed female whom no one would want to be around and would spend her life sleeping or in isolation. I wouldn’t give my Premarin up if you held a gun to my head. Life would not be worth living. I have tried, and it was not pretty.

    If you (mostly men who do this research and write these articles) would have to live with hot flashes, night sweats, mood swings, stomach upset, bloating, etc., etc., every day of your life, you would gladly take ANY medication that would relieve these miseries and take a chance on the unproven consequences. My doctor (graduate of Harvard, board-certified) told me 25 years ago to quit reading the articles and just believe what she tells me. She, too, is on Premarin and says they would not get hers away from her.

    I am in perfect health and don’t want to jinx myself, but my doctor can’t believe that at 74 years of age I do not have any signs of high blood pressure, heart problems, diabetes, arthritis, or any health problems at all!! Pretty good after 28 years on hormone replacement therapy, wouldn’t you say?! I’ve taken my chances and am glad I did.

    I guess the above reasons are why women who are on these meds wouldn’t give them up for anything. We would rather live with the unproven risks than not be able to live a life free of the symptoms and unable to enjoy life.

    Thank you.

  2. Submitted by Jacqueline Tourville on 12/31/2009 - 10:40 am.

    Hi Susan,

    Always glad to read your take on things. I love how you pointed out it was the second most emailed article behind a recipe for blueberry pancakes. I would say that somehow implies Times readership leans female — even this one which appeared in the business section. I guess women still do need to hear this message — I think that even if they knew the risks of HRT, the shady, shape shifting nature of Big Pharma is what made this article so gaspingly interesting (at least for me). For the above poster and anyone else interested in more on the risks of HRT, here’s a pretty balanced article that was my own education on this very tricky subject.. Hormone replacement therapy: what we know now — from Dr. Dixie Mills, an OB in Maine.

    Happy 2010!

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