Aging women need dose of skepticism

July 15, 2002|By Ellen Goodman

BOSTON - When they write the history of hormone therapy, you can bet that they'll begin with Robert Wilson.

In the 1960s, Dr. Wilson promoted estrogen as the older woman's salvation - and I mean that literally. Feminine Forever, his blockbuster book on menopause as an illness and estrogen as the cure, begins with a husband's complaint about "the change" in his wife.

"Doc," the man says, "they tell me you can fix women when they get old and crabby." His complaint? "She's driving me nuts. She won't fix meals. ... She picks on me all the time." Then comes the clincher. The husband reaches into his pocket and lays a gun on the doctor's table: "If you don't cure her, I'll kill her."

Dr. Wilson finishes this tale by musing, "I have often been haunted by the thought that except for the tiny stream of estrogen ... this woman might have died a violent death at the hands of her own husband."

Does this sound like a scene from The Vagina Monologues? The doctor's book and speeches that put hormones on the map and in the medicine cabinet were, according to his son, funded by Wyeth, the company that made the drug.

But Dr. Wilson's saga of hormone "salvation" is just the opening tale in this history lesson. In the 1980s, an compelling ad showed a middle-aged woman anxiously observing an elder with a dowager's hump. The choice was humps or hormones. In the 1990s, another ad promoted hormone replacement therapy (HRT) as the one beauty treatment to take to a desert island. In this century, Lauren Hutton and Patti LaBelle model their medicated menopause.

But now we may have read the final page of the hormone history book - or at least its denouement. It comes in a letter to the women who took a combination of estrogen and progestin as participants in the massive Women's Health Initiative (WHI) study: "Stop taking your study pills." HRT does more harm than good.

This is not just another in the dueling studies that have driven us more "nuts" than the husband in Dr. Wilson's fantasy. For a decade we've had a raging hormonal debate over heart disease and breast cancer, osteoporosis and uterine cancer.

But this is the gold standard of research, comparing placebos and HRT among 16,000 women over an average of 5.2 years. The women who had not had hysterectomies and took the combination therapy faced risks that outweighed benefits. They experienced small but real increases in breast cancer, heart attacks, strokes and blood clots that outbalanced decreases in colorectal cancer and hip fractures. The National Institutes of Health called an early halt because the verdict was in: Stop.

What, then, is the history lesson for the 6 million women on HRT? Is hormone therapy a massive drug company conspiracy? Were doctors duped and patients conned? It's not that simple by a long shot. HRT is no fen-phen, the deadly diet drug. Hot flashes aren't fantasies, and hormones offer relief to symptoms. The smorgasbord of observational studies did indeed seem to promise protection against heart disease.

But it's also fair to ask whether the millions of prescriptions that put healthy women on a drug for life were, as Cynthia Pearson says, "a triumph of marketing over science."

As head of the National Women's Health Network, Ms. Pearson has every reason to say, I told you so. When the drug was promoted for everything from A to Z or Alzheimer's to Zest, the network kept demanding proof. When Wyeth wanted to promote HRT as a way to prevent heart disease, these advocates joined the women in Congress lobbying for a random, controlled study.

Now 6 million alarmed women - surely even Patti LaBelle - are asking what's next. Cold turkey, hot flashes? Will some use HRT for short-term symptoms? Will others decide that the individual risks are minimal and keep taking pills?

Somewhere a drug company or an advertising agency also is asking what's next.

Will they now market hormones, like Femhrt, as a "cosmeceutical," an anti-wrinkle pill? Will they produce and promote a lower-dose, different hormone that isn't the "bad" one? Jacques Rossouw, the WHI study's director, noting the power of marketing to doctors and patients, says, "We hope that truth will win out over advertising."

We have come far since Dr. Wilson declared that "all post-menopausal women are castrates." This generation of middle-aged women invented "post-menopausal zest" and wears buttons boasting: "These aren't hot flashes, they're power surges."

But most of us, I suspect, are still vulnerable to fears of aging, to hopes and hype for health. What we can take from this stunning chapter of history is that other side effect of age: Experience. And with it a healthy dose of skepticism.

Ellen Goodman is a columnist for The Boston Globe. Her column appears Mondays and Thursdays in The Sun. She can be reached via e-mail at ellenngoodman@globe.com.

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