It has been almost ten years since a US government study found that hormone replacement therapy (HRT) did not prevent heart disease and memory loss as advertised butÃ‚Â increasedÃ‚Â the risk of heart attacks by 29 percent and doubled the risk of dementia. Oops!
That was not all the bad news that emerged about HRT. It also increased the risk of breast cancer by 26 percent, stroke by 41 percent, doubled the risk of blood clots and increased the risk of hearing loss, gall bladder disease, urinary incontinence, asthma, the need for joint replacement, melanoma, ovarian, endometrial and lung cancers and non-HodgkinÃ¢â‚¬â„¢s lymphoma, according to medical journals.
It was not exactly the fountain of youth it was billed as by hormone drug maker Wyeth (now Pfizer) in high-budget menopause awareness TV ads starring model Lauren Hutton.
In fact, HRT was such a scourge against women, in the first year that millions quit, 2003, the incidence of US breast cancer fell seven percent. It fellÃ‚Â 15 percentÃ‚Â among women whose tumors were fed by estrogen. Fourteen thousand women who were expected to get breast cancerÃ‚Â didnÃ¢â‚¬â„¢tÃ‚Â said news reports. And it wasnÃ¢â‚¬â„¢t just breast cancer women were spared: heart attack and ovarian cancer ratesÃ‚Â alsoÃ‚Â fell when women quit HRT, said news reports.
The statistics must have been embarrassing to cancer researchers and public health officials. Not only was a major cause of breast cancer hidden in plain sight, the war on cancer should apparently have been a war onÃ‚Â cancer-causing drugs!
It was even more embarrassing because the whole sequence happened before! In 1975, a Food and Drug Administration (FDA) panel found a link between Premarin (a Wyeth HRT drug) and endometrial cancer and when women quit the drug by the millionsÃ¢â‚¬“the same thing happened. Ã¢â‚¬Å“There was a sharp downward trend in the incidence of endometrial cancer that paralleled a substantial reduction in prescriptions for replacement estrogens,Ã¢â‚¬Â reported theNew England Journal of MedicineÃ‚Â (NEJM)Ã‚Â in 1979.
Not wanting to lose its billion dollar HRT franchise, WyethÃ¢â‚¬â„¢s medical director wrote doctors at the time that HRT still had Ã¢â‚¬Å“proven benefitsÃ¢â‚¬Â at the Ã¢â‚¬Å“the lowest maintenance doseÃ¢â‚¬Â and that it was Ã¢â‚¬Å“simplistic indeed to attribute an apparent increase in the diagnosis of endometrial carcinoma solely to estrogen therapy.Ã¢â‚¬Â
Thirty years later, when cancer rates again dropped, Wyeth also bit back. It announced the reason women werenÃ¢â‚¬â„¢t seeing prevention of heart disease and memory loss from HRT was theyÃ‚Â werenÃ¢â‚¬â„¢t taking it soon enough.Ã‚Â They needed to start treatment sooner. Ka-ching.Ã‚Â The early treatment campaign was called the Ã¢â‚¬Å“timing theory.Ã¢â‚¬Â
Soon a National Institute on Aging trial and privately funded trials on Ã¢â‚¬Å“menopausalÃ¢â‚¬Â primates, both led by Wyeth-funded investigators, were underway at major medical centers. After all, before 2002, millions of American women, perhaps the majority, had been on HRT. WasnÃ¢â‚¬â„¢t there a way to get them back?
Last month the hormone revival campaign hit pay dirt. Women Ã¢â‚¬Å“who took treatments such as Pfizer Inc.Ã¢â‚¬â„¢s estrogen pill Premarin within five years of menopause lowered their chance of Alzheimers by 30 percent,Ã¢â‚¬Â wrote theWashington PostÃ‚Â about a study in the journalÃ‚Â Neurology.
Ã¢â‚¬Å“ItÃ¢â‚¬â„¢s really important to distinguish between studies that are able to look at early use of hormone therapy versus later use,Ã¢â‚¬Â said Pauline M. Maki, PhD on WebMD about the same study. Maki has received research support from Wyeth according to a July 2010 article in the journalÃ‚Â Menopause. WebMD just imported a new CEO from Pfizer.
The study was funded by the National Institute on Aging (NIA) not Big Pharma. But NIA is so collegial with hormone makers, it funded the North American Menopause SocietyÃ¢â‚¬â„¢s entireÃ‚Â 2009 annual meetingÃ‚Â replete with Wyeth-funded doctor presenters and even WyethÃ‚Â employeeÃ‚Â presenters. It also invited top Wyeth officials for a Ã¢â‚¬Å“Where Are We Now?Ã¢â‚¬Â meeting soon after its products were linked to cancer/heart disease/blood clots/stroke/dementia.
Even if HRTÃ‚Â didÃ‚Â lower Alzheimer riskÃ¢â‚¬“would it be ethical to prescribe it in light of its other risks or evenÃ‚Â conduct trials?Ã‚Â HRTÃ¢â‚¬â„¢s negative cognitive effects are so well known, a 2006 Reuters story began, Ã¢â‚¬Å“Regular exercise may prevent the mental decline associated with the long-term use of hormone replacement therapy (HRT).Ã¢â‚¬Â And two studies in the January 13, 2009 issue ofNeurologyÃ‚Â link HRT to brain shrinkage.
Hormone markers have also floated the idea that early HRT would prevent heart disease and/or cancer. But a 2011 analysis from the Million Women Study, sponsored by EnglandÃ¢â‚¬â„¢s National Health Service, found women who took hormones the earliest, before or soon after the onset of menopause, were at theÃ‚Â greatestÃ‚Â risk of getting breast cancer.
Why does the government letÃ¢â‚¬“and even helpÃ¢â‚¬“Big Pharma market HRT like itÃ¢â‚¬â„¢s a brand new product instead of the cause of two cancer epidemicsÃ¢â‚¬“so far? Would anyone tell cigarette smokers to start smoking earlier?
Martha Rosenberg is a columnist/cartoonist who writes about public health. Her first book, titledÃ‚Â Born with a Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp the Public Health, has just been released by Prometheus Books. She can be reached at:[email protected].Ã‚Â Read other articles by Martha.