Older women: Fodder for profit mill?

Historically ageism and sexism have come together nicely in the arena of menopause – nicely for profit-making, that is. Menopause is a normal, natural part of women’s aging, but has been transformed into a medical problem, complete with lab tests for diagnosis, a disease label, and a treatment that threatens women’s health-hormone replacement therapy (HRT).

In Victorian days menopause was seen as a sign of sin and decay. Freud came along and softened the view to one of neurosis. Today, with hard, objective science, we are more sophisticated than this. In the1960s the development of synthetic hormones gave the pharmaceutical industry a treatment that lacked only a disease. The medical community came to the rescue with menopause, redefining it as a hormone deficiency disease.

Hormone replacement therapy (HRT) was born. The benefits touted for this therapy have included relief of menopausal symptoms, such as hot flashes; the prevention of osteoporosis, wrinkles, thinning hair, and heart disease; and hints that it cures aging itself. Early promotions of HRT to physicians openly played on stereotypes of older women as unattractive, hopeless and anxious burdens. These were so effective that in 1975 half of all post-menopausal women had used hormones. In the ’80s doctors were being advised to treat all menopausal women, regardless of symptoms, and by the mid-’90s Premarin was the bestselling prescription drug in the U.S.

Surely these drugs wouldn’t have been prescribed if there were concerns about their safety, right? Wrong. There has been discussion of an HRT and breast-cancer link from the beginning, with at least some research to support the link since the early ’80s. HRT has also been connected to endometrial cancer, blood clots and other problems. Yet the scrips continued to be written.

In 2002, early results of the Women’s Health Initiative study of HRT were a wake-up call. Researchers found that HRT was tied to increased risk of heart attacks, blood clots, strokes and invasive breast cancer. These findings were so strong that the study was stopped years ahead of schedule. But go on the internet today and you’ll find site after site that downplays these findings and/or continues to encourage HRT as treatment for “hormone deficiency.” Now, a year later, the British Million Women Study shows again that HRT increases the risk of breast cancer.

How could this situation continue for so long? For decades healthy aging women have been cold-bloodedly treated as a market by pharmaceutical corporations, with heavy, unceasing promotions to physicians of risky drugs. Physicians, the majority of them male, have been too slow to question the need for and value of these drugs. And women have trusted their doctors.

Is there a place for HRT? How would one know? How many other drugs have similarly cloudy histories? The problems in our current profit-driven health care system go well beyond issues of insurance and cost of medications. Medical research, education, and practice are all poisoned by the profit motive. As we demand access to health care and prescription drugs, we also have to insist that the care and medications are designed not to line private pockets, but to treat our illnesses and promote our health.

The author can be reached at pww@pww.org