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    "When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov

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    Thursday, July 11, 2002

    The Elephant in the Rooom: Try as I might, I can no longer ignore the news about the demise of hormone replacement therapy. It’s everywhere. My ears are still ringing from all the telephone calls I got yesterday about it. All the hoopla comes from this study sponsored by the NIH. It was designed to confirm the supposed benefits of estrogen replacement therapy, but had to be stopped because women taking estrogen were developing more breast cancer and other complications than those who weren’t. As a result, the NIH made this announcement :

    The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has stopped early a major clinical trial of the risks and benefits of combined estrogen and progestin in healthy menopausal women due to an increased risk of invasive breast cancer. The large multi-center trial, a component of the Women's Health Initiative (WHI), also found increases in coronary heart disease, stroke, and pulmonary embolism in study participants on estrogen plus progestin compared to women taking placebo pills. There were noteworthy benefits of estrogen plus progestin, including fewer cases of hip fractures and colon cancer, but on balance the harm was greater than the benefit. The study, which was scheduled to run until 2005, was stopped after an average follow-up of 5.2 years.

    The part of the study that was stopped was only that involving women taking both progesterone and estrogen. It isn’t clear yet if women taking estrogen alone have the same risks. My guess is that they would. Although it is possible that progesterone is somehow modulating the effect of the estrogen, it is estrogen receptors that are present on breast cancer tumors and that can make them more aggresssive. Estrogen still has a role to play in relieving hot flashes. It’s really the only thing we have to treat them. It’s also the only thing we have to treat the vaginal dryness that results from menopause; a dryness that can be so bad it makes sex impossible.

    Estrogen therapy has always been one of those treatments that patients have too often been bullied into taking. With very little evidence women were told to take it, no questions asked. It never really should have been given the status it was given, as this article from the NY Times makes clear. Turns out that the whole widespread notion that estrogen replacement therapy was essential, had its roots in a slick drug company campaign:

    The tale of estrogen therapy began in 1966, when an enthusiastic doctor, Robert Wilson, wrote a best-selling book. He called it "Feminine Forever" and flew around the country promoting it, telling women and doctors alike that estrogen, the feminine hormone, could keep women young, healthy and attractive. It was just so natural — women would be replacing a hormone they had lost at menopause just as diabetics replace the insulin their pancreas fails to make.

    "At age 50, there are no ova, no follicles, no theca, no estrogen — truly a galloping catastrophe," Dr. Wilson wrote in 1972 in The Journal of the American Geriatric Society, referring to the eggs and surrounding tissue. But, he continued, estrogen can save these women. "Breasts and genital organs will not shrivel. Such women will be much more pleasant to live with and will not become dull and unattractive."

    Dr. Wilson died in 1981, but his son, Ronald Wilson, said yesterday that Wyeth-Ayerst had paid all the expenses of writing "Feminine Forever" and financed his father's organization, the Wilson Research Foundation, which had offices on Park Avenue in Manhattan.

    Mr. Wilson, who lives in Cary, N.C., said the company had also paid his parents to lecture to women's groups on the book. Wyeth said it could not confirm the account because it was so long ago.

    By 1975, Wyeth's product, Premarin, had become the fifth leading prescription drug in the United States, said Nadine F. Marks, an associate professor at the University of Wisconsin at Madison, who co-wrote a research paper on hormone therapy. "Even textbooks for gynecologists and obstetricians in the 1960's would explain how a woman's life could be destroyed if she didn't have estrogen in her body," Dr. Marks said.

    Even now, Wyeth is busy protecting its profitable hormone therapy. Last night, at 7:30pm, while I was doing the dishes, a knock at the door brought a a letter from the company, hand-delivered by UPS overnight air, alerting me to the study and reminding me that it only pertained to women using estrogen and progesterone together, and that estrogen was still useful for osteoporosis prevention, and menopausal symptoms. And we wonder why drugs cost so much.

    posted by Sydney on 7/11/2002 06:29:00 AM 0 comments


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