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Hormone Replacement Therapy, the "Magic Bullet" Ricochets

octobre 2003

par Abby Lippman, geneticist , McGill University in Montreal

A major component of a much bally-hooed USA research trial in which healthy women were given hormonal treatment that was supposed to protect them from a range of diseases came to an abrupt halt in early July when data showed the medication to be harmful, not helpful.

In fact, the hormone replacement therapy (HRT) touted (on the basis of wishes more than science) as a "magic bullet" to prevent heart disease for millions of women actually seems to have caused it in previously healthy volunteers participating in the USA-based Women’s Health Initiative (WHI).

A counter-productive treatment

And adding to the "wounds" from this ricocheting bullet is evidence that HRT also appears to increase the risk of invasive breast cancer, stroke and blood clots in women taking it, pretty high prices for the possible relief of their menopausal symptoms, especially when there are other options for women.

Moreover, even some possible decreases in hip fractures and colorectal cancer among study participants hardly justifies the risks of HRT, since diet and exercise are low-tech very safe alternatives for protecting against these events.

A necessary intiative

Women’s groups can claim great credit for having gotten the WHI research going. And for a reminder, the WHI is a 15-year study of over 150,000 healthy postmenopausal women in the USA. It comprises several related studies all of which are testing ways — using drugs for the most part — to prevent heart disease, colorectal and breast cancer, and osteoporosis.
The overall project was begun in 1991, and several studies are ongoing.

Women’s health advocates, concerned by the increasing medicalization of women’s lives and by physicians’ tendency to push pills for prevention of everything from hot flashes to memory lapses, without any evidence that these drugs were safe, pressured the US government to fund the WHI. They believed that federally-funded research would be the only way to get some information not tainted by pharmaceutical company interests.
And they argued correctly that this was the kind of information women needed if they were to make important informed decisions about their health.

Without the intervention of the US Women’s Health Network and others at the time, millions more would be getting prescriptions for HRT merely because of what has been called a triumph of marketing over science, since drug companies have been spending billions in ads to doctors, and to the general public (in the USA), lauding the wondrous effects of HRT.

Is good health curable ?

Now we know that HRT was, as many argued all along, no panacea. Not even a limited help. But beyond the direct and clear health message in the WHI study results — do not use estrogen/progestin to prevent chronic disease — we need to listen to what may be more basic lessons in this newest chapter in the biomedical colonization of women’s lives. Pills for healthy people can be dangerous !

And the advertisements and other marketing activities of pharmaceutical companies are serious, potentially lethal, risks to well-being.

The stock market is worried

Not surprisingly, the stock market responded to the study results even faster than did physicians. Within hours of the halting of the study, the shares of Wyeth, the company that makes the drug used in the study, a drug that generated over $2 billion in sales in 2001, fell 19%.

But similarly not surprising, the drug company execs and public relations people went right into rescue mode, arguing that other drugs would fill the corporate profit gaps. It was, after all, the combination of estrogen and progestin that rang alarm bells ; still under study was estrogen alone ! And probably other formulations, something that will give us protection from the gamut of ailments to which we are prey.

The siren song of industry

But before we run to the pharmacy, and certainly before we succumb to the siren song of industry and once again contribute to the escalation of drug costs, we need to take some time to consider the other messages implicit in the halting of this study. And the most important of these is that pill-popping makes millions for the drug companies but is dangerous medicine for the rest of us.

Women and their physicians are being terribly misled by marketing and advertising that sets us up as "at risk" and in need of intervention.

The medical community is further misled because of the control of pharmaceutical companies over the content of research, of medical journals, of continuing education programs, of professional conferences.

Their advertising and their marketing is to sell drugs, NOT to provide education. And if this was not the case, would they have spent over $16 billion (US) last year to influence us all to use their products ?

Time to turn from the lure of a drug fix

It is time to turn from the lure of a drug fix and from the lore of pills for prevention. We need to insist that NO drug be used with a healthy person until its safety and efficacy have been rigorously established by well-designed clinical trials. We need to insist that the precautionary principle be firmly enforced in our health and our environmental policies.

And we need to ensure that pharmaceutical companies to not set the health agenda but that community-based resources are made available to allow women — and men and children — to eat well, work in safe conditions, engage in exercise and other physical activities and experience enriching social lives. Doses of these are well-established ways to promote health and prevent disease !

Sisyphe, October 2003

Abby Lippman, geneticist , McGill University in Montreal

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