A much ballyhooed U.S. research trial in which healthy women were given hormonal treatment meant 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, hormone replacement therapy (HRT) touted as a magic bullet to prevent heart disease for millions of women actually seems to have caused it in previously healthy Womens Health Initiative (WHI) participants. The U.S.-based WHI, which began in 1991, comprises several, mostly drug-based studies of over 150,000 healthy, post-menopausal women that seek to determine whether hormone use will prevent heart disease, osteoporosis, colorectal cancer and breast cancer.
Adding to the wounds from this ricocheting bullet is evidence that long-term use of HRT may also increase the risk of invasive breast cancer, stroke and blood clots a high price to pay for the possible relief of menopausal symptoms, especially when symptoms are mild for most women and other options for relief are available.
While apparent decreases in hip fractures and colorectal cancer among study participants are two possibly positive outcomes of HRT, good nutrition and physical activity are low-tech, safe alternatives for protecting against the same.
Womens groups in the U.S. can take credit for initiating the WHI research over a decade ago. Womens health advocates, concerned by the increasing medicalization of womenslives and by physicians tendency to push pills for prevention (of everything from hot flashes to memory lapses), pressured the government to fund the WHI. They believed that federally-funded research was the only way to get results not tainted by pharmaceutical company interests, and they argued that this unbiased information was what women needed if they were to make informed decisions about their health.
Without the intervention of the U.S. National Womens Health Network and others, millions more would be getting prescriptions for HRT merely due to what the Network has called the triumph of marketing over science. Drug companies have been spending billions in ads to doctors in Canada and the U.S., and to the American public, lauding the wondrouseffects of HRT.
Now we know that HRT was, as many womens health advocates suspected all along, no cure-all. But beyond the clear health message of the WHI study results dont use estrogen/progestin to prevent chronic disease there is a broader lesson: Pills for healthy people can be dangerous! And the burgeoning advertisements and other marketing activities of pharmaceutical companies are serious, potentially lethal, threats to our well-being.
We know this from past experience. Take DES (diethylstilbestrol), a hormone heavily prescribed in the 40s, 50s and 60s for women thought to be at risk of miscarrying. The drug led to severe damage to the womens children about which we are still learning. (DES was advertised in major medical journals in the 50s with text that read: Recommended for routine prophylaxis in ALL pregnancies... Bigger and stronger babies.... No gastric or other side effects...)
And we continue to use drugs whose long-term safety has not been proven. Today, tamoxifen is recommended to healthy women for breast cancer prevention, even though we still dont know the full effects and potential harms of the drug.
Drug company marketing sets women up as at risk and in need of intervention. Women succumb to these manufactured fears, and their doctors do, too. Multinational pharmaceutical companies spend billions hawking their wares, over $16 billion U.S. in the States last year alone. Their influence spreads to the content of research, medical journals, continuing education programs and professional conferences.
While much of this marketing expenditure comes in the guise of medical education, particularly in Canada where advertising drugs directly to consumers is illegal, marketings main purpose is to sell drugs, not to provide education. Drug companies are first and foremost big business.
Perhaps not surprisingly, the stock market responded to the WHI study results even faster than physicians did. Within hours of halting of the study, shares of Wyeth, the company that makes the drug used in the study (a drug that generated over $2 billion U.S. in sales in 2001), fell 19 per cent.
Drug company execs and public relations crews initiated rescue procedures immediately, 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!
It is time to turn from the lure of a drug fix and the lore of pills for prevention and to ensure instead that pharmaceutical companies arent setting the health agenda. Large doses of community resources available to all, healthy food and workplaces, and socially and physically active lives are well-established ways to promote health and prevent disease. These may not mint billions for drug companies but, in the words of a current womens health campaign, they do put people first.
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