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Home / New Zealand

<i>Barbara Sumner Burstyn:</i> 'Disease' of middle-age helped to ignite HRT time bomb

25 Aug, 2002 05:44 AM5 mins to read

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With the high-profile backtrack on hormone replacement therapy (HRT), the latest women's wonder drug, thousands of women have gone on high alert. They are terrified, as one of my Ponsonby friends reported over her soy latte, that the medical profession has again used women's bodies to rack up huge profits.

And
certainly, with half the women aged 50 to 65 in North America using HRT, and more than 194,520 prescriptions for HRT written in New Zealand last year, that's undoubtedly a lot of profit from a drug touted to cure everything from hot flushes to Alzheimer's.

The drug, in fact, has been shown to increase the relative risk of breast cancer by 30 per cent, and to raise the risk of heart attack and uterine cancer.

But perhaps we should not be so quick to lay the blame at the medical profession's doorstep.

A 1966 book Feminine Forever started it all. The author, Dr Robert Wilson, sang the praises of HRT, claiming it could keep women young and sexually attractive. And it is this basic premise that has fuelled the HRT frenzy.

Sure, as women came out of the kitchen and into the professional world, the marketing profile of HRT gradually changed to encompass a range of more specialised medical promises.

But, as a recent New Zealand study on HRT use confirmed, the most common reason for starting treatment was to relieve symptoms or enhance "emotional stability", sex drive and appearance.

This is little different from Dr Wilson's recommended use 36 years ago - especially in white middle-class communities where until a couple of weeks ago, going on the hormone had become almost a coming-of-middle-age ritual. (In a 1997 study, European women were more than twice as likely to be using HRT as Maori or Pacific Island women.)

"Why wouldn't you use it?" the same enthusiastic latte buddy asked me just a couple of years ago.

Perhaps the question she should have been asking was much simpler. Just what is hormone replacement therapy?

The principal ingredient in Premarin, one of the two drugs under fire, is PMU, or pregnant mares' urine. If you love horses, you probably don't want to read this. It turns out that the pungent, frothy yellow stuff is rich in oestrogen and the demand for it so strong there are about 40,000 horses being farmed for their urine in North America.

Although Premarin can now be 100 per cent synthesised, the industry prefers the organic nature of the real stuff.

So for most of their 11-month pregnancy the mares are confined to the pee-line, standing in stalls often no more than a metre wide, with no exercise, strapped into urine-collection harnesses with pouches cupping their genitals, their urine sucked from them.

The mares are constantly pregnant and worn out by the time they are five. That they suffer for our drug of choice goes without saying.

It's not just the mares that suffer. In the United States, the pleasure horse market is saturated, so the foals, the byproduct of PMU farming, are shipped off for human and animal consumption.

The pharmaceutical company that buys the urine says 8000 foals in its farms are slaughtered each year but insiders report that it is more like 30,000.

Susan Wagner, the founder of US organisation Equine Advocates, says that she had always hoped the treatment of PMU horses would be enough to put women off using the drugs. But, of course, it hasn't.

It has taken a medical misadventure and good old self-interest to end what Wagner calls "a 60-year catastrophe for horses".

But horses aside, some commentators, viewing the HRT debacle, have once again asked that old feminist question: who owns women's bodies?

The answers are typical. The male-dominated medical profession gets its share of blame and, of course, the pharmaceutical companies that market HRT have been accused of exploiting vulnerable women. And, yes, Wyeth-Ayerst, the makers of Premarin, were revealed to have paid Dr Wilson handsomely for his 1966 best-seller.

But surely we are not still that stupid. The predominant users of HRT are educated professional women. We consider ourselves media-savvy. We pride ourselves on seeing through glossy advertising.

They did not sell us another medical travesty. We bought it. For all our "our bodies, ourselves" feminist rhetoric, we are still in revolt from the natural process of our bodies.

The question we should be asking is not how did the medical profession allow the time bomb of HRT to happen, but why do we, the end-users, treat our middle-age as a disease, virulent enough to have its cures subsidised by Pharmac?

Ultimately it is us, the latte women of Ponsonby, who should re-evaluate our own roles in this debacle.

What will happen to the mares now the bottom has dropped out of the urine market is anyone's guess. Possibly they will be put out to pasture but more likely they will end up in some trendy new burger.

Or maybe Wyeth-Ayerst will discover that PMU miraculously cures another illness. Wrinkles perhaps.

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