There Be Monsters Here

Yesterday's NY Times had an absolutely riveting story on the pushing of hormone replacement therapy (hrt) for menopausal women by the pharmaceuticals. The story is long and it is detailed, but it deserves a careful read.

The story deals with two parts of the issue. The first describes the lengths Wyeth (which was subsequently absorbed by Pfizer) went to promote sales of Prempro even in the face of increasing evidence of its connection to breast cancer.

MILLIONS of American women in the 1990s were told they could help their bodies ward off major illness by taking menopausal hormone drugs. Some medical associations said so. Many gynecologists and physicians said so. Respected medical journals said so, too.

Along the way, television commercials positioned hormone drugs as treatments for more than hot flashes and night sweats — just two of the better-known symptoms of menopause, which is technically defined as commencing one year after a woman’s last menstrual cycle.

One commercial about estrogen loss by the drug maker Wyeth featured a character named Dr. Heartman in a white coat discussing research into connections between menopause and heart disease, Alzheimer’s disease and blindness. ...

PREMPRO is a combination of Premarin, an estrogen drug derived from the urine of pregnant mares and first approved by the Food and Drug Administration in 1942, with an additional hormone, progestin.

Part of the Premarin saga shows how a drug maker successfully and cannily expanded a franchise whose central ingredient is horse estrogens into a billion-dollar panacea for aging women. Yet several hundred pages of court documents also raise questions about another aspect of Premarin’s trajectory: how Wyeth worked over decades to maintain the image and credibility of its hormone drugs even as the products were repeatedly under siege.

Pfizer representatives say court documents paint an unfair picture of Wyeth’s practices and that plaintiffs’ lawyers have cherry-picked documents for out-of-context comments to sway juries.

Still, the documents offer a snapshot of Wyeth’s efforts. Taken together, they 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: “Dismiss/distract.”) [Emphasis added]

Now, this horrific chain of events is not surprising. We've seen this several times in the last few years, usually as part of lawsuits (about which the article has some interesting things to say) in which plaintiffs claim, and often establish, that the drug makers knew that there were dangerous side effects but hid that knowledge from the government and from medical providers. The second part of the article shows how in this case the deception was not all that difficult.

MENOPAUSAL hormone therapy has long been pitched as a way to stave off what some doctors viewed as the undesirable aspects of female aging.

In the popular 1966 book “Feminine Forever,” Dr. Robert A. Wilson, a gynecologist, used disparaging descriptions of aging women (“flabby,” “shrunken,” “dull-minded,” “desexed”) to upend the prevailing idea of menopause as a normal stage of life. Women and their physicians, Dr. Wilson wrote, should regard menopause as a degenerative disease that could be prevented or cured with the use of hormone drugs.

Disease, not normal stage of life.

In our culture women are seen not as "maiden, mother, crone," but as either arm-candy or walking-womb. Once those phases have been passed through, women no longer have any value (something which actors of the female persuasion have long lamented). Is it any wonder that women would be susceptible to the advertising? Even Barbara Ehrenreich went through hormone replacement therapy. She also went through chemotherapy after being diagnosed with breast cancer.

It is also the reason that women (and now even some men) go through the agonies of botox and plastic surgery and spend billions of dollars each year chasing the latest skin toner, wrinkle remover, hair restorer, and exercise regime lest they be seen as flabby, shrunken, dull-minded, or desexed. That is, those who live through the strokes and cancer treatments do.

There's something dreadfully and fatally wrong with this picture, but it's one we rarely sit back and consider. Thankfully, this NY Times article provided us a chance to do so, and for that I am grateful.