Tony Hall, just before leaving Congress in September, sat in his office
in Longworth House Office Building and thought of something that had
stuck with him since a trip to Appalachia.
How many of you believe that crucial healthcare issues are falsely
represented by corporate America for profit or political advantage?
As one of the largest private employers in Africa, the Coca-Cola Company could
dramatically alter the course of HIV/AIDS.
How genetically engineered American corn has altered the global
Medical treatment in women's prisons ranges from brutal to nonexistent.
The recent news about the harmful effects of hormone replacement was
played in the media as a health story, but it is much more than that. In
fact, it may be the hot-flashiest corporate scandal to date: Let's call
If other corporate scandals have been about fudging figures, this one
is about fudging science--something that seems to have been surprisingly
easy to do. And such is the corporate culture that we have apparently
preferred to believe the drug companies rather than the women's health
advocates who have been lobbying for decades simply to get the
scientific evidence to back the companies' claims. The director of the
North American Menopause Society (NAMS), Dr. Wulf Utian, called the bad
news about hormones a bombshell, but it really isn't. Information has
been slowly accumulating about hormone replacement therapy's risks, even
as Wyeth and other manufacturers have been pushing their product as an
elixir for a widening group of symptoms. In recent years, this
potentially carcinogenic drug has been marketed with the nonchalance of
a vitamin pill: HRT advertising suggests that almost no woman over 50
couldn't benefit from it somehow.
Estron is the latest in a long line of scandals pitting women's health
against the interests of Big Pharma--scandals like the sale of faulty
Dalkon Shield contraceptives, which caused infertility, and medications
like DES, which caused severe illnesses in users and their children.
What all these cases have in common is that--like the manufacturers of
menopausal hormones--the drug companies, in their rush for profits,
insufficiently tested their wares before selling them to millions. What
these scandals suggest is that somewhere in the swampy landscape of
medical research funding, unhealthy relationships incubate between
medical practitioners and the drug-company reps who manage to dazzle
them with quasi science and quasi truths. The industry spends around $15
billion a year to promote its products--more than it spends to develop
them. Clearly, even those doctors who resisted the
luxury-cruise-lectures approach to sales found themselves suckered in.
The manipulation of HRT's scientific credentials began back in the
mid-1960s, when Wyeth paid gynecologist Dr. Robert Wilson to extol its
new wonder drug, estrogen replacement. In an evocatively named book,
Feminine Forever, Wilson declared that by replacing the estrogen
lost at menopause, women would remain attractive and easier to live
with. Over the decades since, Wyeth and other hormone manufacturers have
revised dosages and combinations to fit new medical revelations and
poured billions into sophisticated propaganda to get their message out.
The message is that menopause is not a natural life stage but a
disease--estrogen deficiency--and it will make you old. HRT is the cure,
and it will keep you young.
In recent years the manufacturers have claimed protective qualities for
HRT way beyond its original ambitions. First, it promised (and
delivered) relief from menopausal symptoms. Next came claims for
protection against heart disease in women already affected, and then in
healthy women. Then came its role as a treatment against osteoporosis,
which, manufacturers warned (falsely), becomes an instant risk at the
moment of menopause (it's a gradual risk over many years).
The truth is that the manufacturers didn't exactly know what HRT did or
didn't do, because they never ran a big, randomized national study
stringent enough to meet medical standards. For more than twenty years,
the companies used observational studies showing that women who took
hormones were healthier, but they didn't look at why: Was it that the
hormones themselves made women healthier, or that health-conscious women
were more likely to take hormones to begin with? There were many other
uncertainties. Yet calls to answer these questions, from women's health
groups and even from prominent politicians like Pat Schroeder and
Olympia Snowe, went unheeded.
For all the hype, there has been plenty of evidence, both scientific and
epidemiological, that estrogen, named a carcinogen by the FDA two years
ago, is not a wonder drug for everyone. Thirty percent of prescriptions
for estrogen remain unfilled, and the growing search for alternative
menopause products shows that increasing numbers of women are
uncomfortable with the prospect of a lifetime of swallowing synthesized
horse urine. And for all the spin, there has also been accumulating
evidence of serious side effects. As early as 1975 the FDA identified
links between estrogen and higher rates of uterine cancer. (Wyeth
responded by adding another product, progestin, to offset the risk.) In
1990 the Nurses Health Study reported that women on estrogen faced a 36
percent greater risk of breast cancer. That same year the FDA refused to
approve Premarin as a treatment to prevent heart disease, because the
company's evidence didn't convince them. The 2000 HERS study, actually
funded by Wyeth, found that hormone therapy increased risks in heart
disease patients in the first few years. (Wyeth countered that
long-term, it works.)
And people have been trying to warn us. As far back as the mid-1990s,
The Menopause Industry, by Australian reporter Sandra Coney,
presented heavily researched evidence of uterine bleeding, gallbladder
disease and increased cancer rates in hormone takers. In 1997 breast
cancer specialist Dr. Susan Love's Hormone Book returned to the
link between HRT and increased breast cancer risk and came under attack
for raising an alarm. Earlier this year Cindy Pearson, executive
director of the National Women's Health Network, published The Truth
About Hormone Replacement Therapy, outlining many other
discrepancies between hormone hype and science. The medical
establishment barely paid attention.
Finally, the scientific evidence that we have now, based on two large
randomized trials, is definitive, according to one of the study's
leaders, Dr. Deborah Grady. The trials have shown that not only does HRT
do more harm than good for women with existing heart disease, but it
doesn't protect healthy women either; in fact, during the trial it
increased incidence of heart attacks, breast cancer, strokes and blood
clots--enough to have caused the study to be abandoned three years
early. And yet belief in the hormone was so strong that researchers
feared it would be unethical to put women on placebos.
How is this possible? Dr. Utian of NAMS has admitted that many different
parties--from the drug companies to their paid researchers and
spokespeople to the prescribing gynecologists--have had a vested
interest in the success of hormone replacement, and for them, he told
the New York Times, the issue is about more than data. For them,
Utian said, truth is opinion. But that seems a risky precept for
physicians to work with. It sounds like something Arthur Andersen would
In June, the New England Journal of Medicine, one of the most respected medical journals, made a startling announcement.
At the fourteenth international AIDS conference, the gulf between the
United States and the rest of the world widened as US officials touted
policies that world health experts agree are ineffective strategies for
stemming the pandemic. Without stepped-up prevention efforts, 45 million
more people will become infected with HIV by 2010, according to the
Global HIV Prevention Working Group. Yet 29 million of these people
would never contract the virus if leaders ratcheted up preventive
strategies--most crucially teaching the use of condoms.
In European countries, including the Netherlands and Sweden, the
promotion of a variety of safe sex practices--abstinence, monogamy and
condom use--has reduced teen pregnancies and sexually transmitted
diseases. In Senegal and Uganda, it has cut the rate of new HIV
infections in half. In all these countries and in others, national
governments have supported such programs both rhetorically and
The White House, however, wants to expand programs enacted under the
Clinton Administration that tie federal funding of sex education to the
promotion of abstinence-only curriculums. While the vast majority of US
schools provide information about what HIV is and how it is transmitted,
less than half give students information about what condoms are or how
to use them, according to Centers for Disease Control surveys.
In a speech drowned out by angry protesters in Barcelona, US Secretary
of Health and Human Services Tommy Thompson touted the Administration's
$500 million drug initiative to prevent babies in Africa and the
Caribbean from becoming infected with HIV during birth or through
breastfeeding. He seemed confused when reporters later suggested that
preventing women, girls and their partners from becoming infected in the
first place might be a more productive strategy.
The evidence is clear: Campaigns that rely only on abstinence and drugs
to protect babies from AIDS won't slow the world pandemic. HIV
prevention does work when it is part of reproductive health programs
that recognize that sex is an integral component of human behavior.