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Default Slate: Estrogen uncovered Have women been victims of hormone experiments? (dementia miscarriage penicillin cholesterol heart)

Slate: Estrogen uncovered Have women been victims of hormone

By Eliza McCarthy SLATE.COM

Aug 25 — Hyperion Books recently published The Greatest
Experiment Ever Performed on Women: Exploding the Estrogen Myth, by
Barbara Seaman. Generally speaking, a new volume on estrogen would
hardly merit a mention. After all, such books area dime a dozen. On, for example, there are
448 books listed under “Women’s Health, Menopause,”
and 95 under “Contraceptives, Oral.”

BUT A BOOK by Barbara Seaman on the topic is something special.
Published in 1969, her first book, The Doctors’ Case Against the
Pill, caused an anti-estrogen sensation. At that time, the Food and
Drug Administration had received reports of blood clots, strokes, and
other less serious side effects, such as nausea, associated with the
birth-control pill, but most doctors failed to mention these risks to
their patients. Seaman’s book, containing chapters such as
“The Silence That Could Kill You,” changed all that: After
its publication, congressional hearings were called to discuss the
then high-dose Pill; pharmaceutical companies subsequently lowered the
Pill’s concentrations of estrogen and its oft-ignored hormonal
cousin, progestin; the FDA also required that companies include those
now-ubiquitous patient-information inserts listing a drug’s
potential risks. All these years later, after writing several more
books and co-founding the National Women’s Health Network, a
feminist activist group, Seaman is back to estrogen. It is a
tumultuous time in the public life of the hormone: Last summer (in
case you were hibernating or are a man) the government announced that
it was halting a portion of its Women’s Health Initiative, a
15-year study, in part devoted to investigating hormone use, of more
than 100,000 postmenopausal women. In the WHI, it turned out,
postmenopausal women taking hormone therapy containing both estrogen
and progestin ran a 24 percent increased risk for heart disease, even
though hormones had been thought to protect the heart. The study also
confirmed that combination therapy increases the risk for breast
cancer by
24 percent; surprisingly, the hormones also doubled the risk for
dementia, when they had been hypothesized to prevent cognitive
decline. (Interestingly, no such risks have been discerned among women
taking only estrogen; these women are still being tracked, with many
doctors predicting the results will turn out to be similarly

As a result of the WHI findings and of the writings of estrogen
skeptics like Seaman and Dr. Susan Love, the conventional wisdom on
estrogen, particularly on postmenopausal hormone use, has recently
been transformed: Whereas the hormones were once presented as
potential lifesavers, they are now looked upon with intense suspicion.
News anchor Ann Curry’s reaction on a recent episode of Today is
representative of the shift: “What accounts for this …
immoral positioning, immoral development?” she asked Seaman.
“I think many of us are angry about what has transpired.”
Seaman is angry, too. In her book, Seaman places the blame for what
she calls the “dirty secrets” of estrogen’s history
on drug manufacturers and doctors who recommended hormone products for
what they “hope or believe they can do, not for what they know
the products can do,” the marketers who sold the drugs with
extravagant claims, and what she sees as the wimpy media that failed
to adequately report data on negative side effects. As for the
millions of women who’ve taken estrogen over the years, Seaman
believes they were used as “lab animals.” The not so
subtext of all these arguments is clear: The drug companies are
reckless and greedy; the media are complicit; the patients are dupes.
These are familiar tropes of health-care activism. But do these
claims, in the case of estrogen, hold up?

As a skeptical health writer, I was ripe for proselytization. And
Seaman’s book does raise lots of good, if familiar, questions
about the influence of money on estrogen-research and marketing.
Still, Seaman’s book did not convince me that all women should
swear off estrogen products entirely. (Seaman says her goal
isn’t to inspire estrogen aversion, but with chapter titles like
“Poison by Prescription” one has to wonder.) Nor did the
book convince me that the medical establishment is incapable of
improving its hormonal record. On the contrary, Seaman, perhaps
unwittingly, tells the story of a medical establishment that
has—admittedly with prodding from advocates like
her—learned to look more critically at the question of estrogen.
We’ve come a long way from the early days of the Pill, when
women were told, essentially, not to worry their pretty little heads
about it, to the huge gold-standard clinical trial that is the WHI.
The book does include loads of fascinating research, particularly on
the shoot-first-ask-questions-later development of hormonal drugs.
Seaman writes of grisly hormone experiments done on prisoners at
Auschwitz (according to Seaman’s source, the prisoners’
“rutabaga soup” was likely laced with estrogen); the
development of the synthetic estrogen DES in England (DES was used by
millions in the United States to “prevent miscarriage,”
when, horribly, it didn’t—and exposed both the pregnant
women and their children to serious health problems later in life);
and the creation of the birth-control pill after tests conducted on
what Seaman portrays as helplessly vulnerable Puerto Rican slum
dwellers. But Seaman’s fixation on estrogenic details to the
exclusion of other health data does her cause a weird kind of
disservice. In using the word “experiment,” Seaman implies
that the many forms of estrogen—from the Pill to postmenopausal
hormone therapy—have been foisted on women despite inadequate or
even nonexistent evidence. In using the word “greatest,”
she suggests that this is the largest and worst of such
“experiments” ever done unto women. But Seaman provides
little context for these claims. Nowhere is there a comparison with
other medical experiments like, say, the government’s 40-year
“Tuskegee Study of Untreated Syphilis in the Negro Male,”
in which researchers withheld known cures from sick men simply to
observe the ailment’s natural progression. OK, so the study was
done on men, but it’s a pretty good yardstick with which to
measure nasty portions of medical history. Nor does she ever compare
estrogen’s safety profile with that of other drugs. While
it’s frightening that postmenopausal hormones could cause up to
6,000 more cases of breast cancer a year, let’s put this number
in perspective. One hundred thousand people may die annually in the
hospital from adverse drug reactions. (And the truth is,
postmenopausal hormones only raise an individual woman’s yearly
breast cancer risk—yours, mine—by one-tenth of 1 percent.)
Seaman also writes with an odd kind of childish faith that finding
absolute Scientific Truth should be a piece of cake, and risk-free to
boot. Yet before the 1960s, when government agencies enacted more
stringent controls over drug experiments, some researchers—not
just those working with hormones—experimented with a derring-do
that would make us queasy today. For example: In 1941, after testing
penicillin on a measly eight mice, English researchers tried it out on
a man sick with septicemia. (After a brief rally, the man died.) A
mere two years later, the drug was being mass-produced. Estrogen is
clearly not the only drug that was put on the market before its
benefits and dangers were known to an absolute certainty.

So what do we know for certain about estrogen-containing drugs? We
know that today’s lower-dose contraceptive pills, patches, and
injections are not as dangerous as the earlier version of the Pill.
They do slightly increase the risk for blood clots and
strokes—according to recent studies, an extra 1 to 3 women per
10,000 annually will develop a blood clot while on the Pill, and an
extra 1 to 4 per 100,000 women will suffer a stroke, with smokers at
particular risk. On breast cancer, some research, though not
definitive, suggests that women on the Pill (particularly those who
start the Pill before the age of 20) may have an increased risk of
breast cancer, one that dissipates after they stop taking the drug.
Yet women who take the Pill actually develop fewer ovarian and
endometrial cancers. Besides, today’s Pill is nearly 100 percent
effective at preventing unwanted pregnancy, if taken faithfully. As
for postmenopausal hormones, Seaman’s right that the hormones
have only a very few clear-cut benefits: They do reliably quash
menopausal hot flashes and may also alleviate ******l dryness. But no
one’s studied a “safe” length of time to take the
drug for these symptoms. Furthermore, the WHI found that despite
hot-flash relief, women on hormones reported no better quality of life
than women taking a dummy pill. In light of this shaky rationale for
hormone therapy, researchers are looking to other drugs to do some of
what hormones were supposed to: It seems that the cholesterol-lowering
drugs called statins may fit the bill—some clinical trials show
that they reduce the risk of death from heart disease (even among
people with normal cholesterol levels); they also may somehow reduce
fracture risk, researchers speculate; and, at least in a test-tube,
they keep breast-cancer cells from proliferating. But let’s not
get ahead of the data—if there’s one message to glean from
the estrogen saga, it’s this.
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