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Susan Kim

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Menopause: Marketing Fear

Posted: 12/15/09 04:11 PM ET

Years ago, I spoke with a retired advertising executive of the Mad Men school, who confided that the key to a good pitch lay in the skillful manipulation of two emotions: fear and desire. Having just co-written a book on the cultural story of menstruation, I know that this has certainly been the case in the way hormone replacement therapy has been sold to women over the decades.

Estrogen was first synthetically isolated in 1929, but it took aggressive and often misleading claims to make HRT standard treatment for middle-aged and older women in America. The book that put Premarin, the pregnant-horse-urine-derived hormone drug, on the map was Feminine Forever, written by gynecologist Dr. Robert A. Wilson in 1966. The battered copy I read recently featured a dewy, 40-ish babe on the cover; and inside, Wilson used a potent mix of both fear and desire, promising women the moon while playing off their insecurities: "Instead of being condemned to witness the death of their own womanhood . . . they will remain fully feminine." "Women... shouldn't have to live as sexual neuters for half their lives. Many physicians simply refuse to recognize menopause for what it is--a serious, painful and often crippling disease."

It turns out Wilson wasn't a disinterested nonparticipant, a kindly and even chivalrous guy who was just trying to help out the ladies. Although it was barely mentioned at the time and is nowhere to be found in his book, both his research and Forever Feminine were in fact quietly funded by the makers of Premarin, Wyeth.

Eventually, the FDA banned Wilson from certain research because of his unsubstantiated claims that HRT could prevent aging. Yet thanks to Feminine Forever, the HRT genie was out of the bottle. Magazines like Time sang its praises; in his bestselling 1969 book, Everything You Always Wanted to Know About Sex*... Dr. David Ruben wrote, "As the estrogen is shut off, a woman comes as close as she can to being a man... To many women, the menopause marks the end of their useful life."

This weekend, the New York Times ran an article by Natasha Singer and Duff Wilson that hints at the more recent skullduggery and showmanship that lies behind the marketing of a hit drug. Suits brought by thousands of women against Wyeth, the maker of the popular menopausal hormone therapy drug Prempro, have brought to light hundreds of pages of corporate communication that may back up claims that the drug company willfully oversold the benefits of their hormone replacement therapy, while downplaying its very real risks.

Pfizer merged with Wyeth this year, and its lawyers protest that the documents in question have been unfairly selected and are being presented out of context; they also state that Pfizer plans to appeal any HRT cases it loses. Yet what's clear is that during the 1990s, Wyeth spent tens of millions of dollars aggressively wooing the medical community along with the public to embrace Prempro: the former with hefty payments to influential doctors, medical associations and journals, and the latter with upbeat, celebrity-studded commercials. Throughout, Wyeth stayed doggedly on message and again, that message was fear: hormone drugs were good for not only for hot flashes and night sweats, but might even stave off heart disease, Alzheimer's, and blindness.

Currently, hormone therapy is realistically marketed for short-term symptom relief and not as either an elixir of youth or a way to stave off heart disease, blindness, and Alzheimer's; and certainly, there are many who are willing to take an informed risk to deal with hot flashes, night sweats and vaginal dryness. But what about the countless women who didn't have that information in the 1990s? By listening to their doctors, who were all the while listening to the pharmaceutical companies, they increased their risk of not only cancer, but also heart attack, stroke, blood clots in the lungs, and dementia.

The HRT boom of the 1990s was fueled in part by doctors who almost certainly believed that the supposed benefits of heart health and even decreased chance of Alzheimer's outweighed the known risk of breast cancer. But ever since the 1960s, the selling of HRT has been a campaign fueled by fear - fear of being ugly and unfeminine, of growing old, of dying, of becoming senile or going blind -- baseless fears that were instilled in millions of women all to sell a pill.

 
Years ago, I spoke with a retired advertising executive of the Mad Men school, who confided that the key to a good pitch lay in the skillful manipulation of two emotions: fear and desire. Having just ...
Years ago, I spoke with a retired advertising executive of the Mad Men school, who confided that the key to a good pitch lay in the skillful manipulation of two emotions: fear and desire. Having just ...
 
 
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01:02 PM on 01/21/2010
Menopause is perhaps the most difficult period that a woman will experience in her life and to deal with this issue they are best to see a doctor. Menopause is a period of hormonal change, indicated by the end of menstruation and often accompanied by symptoms that are more or less specific in nature. It marks the turning point in a woman’s life, characterizing the end of her child-bearing years.

There are as well a lot of side effects associate’s with menopause and they include vaginal dryness, hot flashes, insomnia, depression, loss of libido, etc. Any woman who experiences these situations, should definitely see a doctor to get hormone replacement drugs.
dessertsfirst
because life is too short!!
11:53 PM on 12/16/2009
Well, as a 70 yr old having been post menopausal since age 45, I've learned a thing or two. I did fall into the HRT propaganda, and must say that for a few years, it did make a difference in how I felt about myself, and my capabilities... however I didn't like being on estrogen and the dangers of long term use, not to speak what it did for the horse, and I stopped taking it. I've been HRT free for the past 15 years. I've read w/ interest about women embracing their inner crone! Good for them. The wrinkles don't bother me so much, I figure I've earned them. However my body has changed shape, and keeping weight off is an enormous problem. And I have to say it ain't pretty. I do take vits and minerals, eat decent food, and walk at least 5 days a week. But to "get in shape" would take a major effort, and it would need to be a priority. However I have a life, and I don't want to spend so much of it battling the bulges. Beauty is more than skin deep. Beauty is a serene, loving and generous spirit... you know, giving back, but also totally enjoying living and the people in your life. People may forget what you look like, but they will not forget you as a person who matters and makes a difference.
07:45 AM on 12/17/2009
Bravo! Thank you!
04:30 PM on 12/16/2009
Hmmm. It's "the end of my useful life" if I don't want to / can't have sex anymore? I beg to differ.
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jacquelinenh
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08:06 AM on 12/28/2009
I liked how the Women to Women clinic summed up the Times article and what it means for real life choices... "Menopause, as Brought to You by Big Pharma" in the NYT is a reminder to stay educated about all the solutions being recommended to us by our healthcare practitioners. This article (http://bit.ly/7qSuqX) gives a nice overview of the business and politics surrounding hormone treatment for women. Our take: know your options and begin with the least invasive measures possible. More here: http://bit.ly/2Q7r6s
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csavage
08:31 AM on 12/16/2009
As opposed to the other posters to this blog, I've actually discussed HRT with actual people. There is a reason to use it or not to use it for every woman patient I've had. People can do very well with menopause, that's true. But to have the fantasy that drugs like Prozac can help quell all hot flashes is to believe in the same big pharma manipulation of statistics that you profess to disbelieve. I will continue to discuss HRT or Evista to my patients with osteoporosis that are postmenopausal. I will address concerns with my patients about breast and uterine cancer. I will not be so cold as many of you when I have women coming into my office crying because their sex drive has disappeared or they have severe vaginal dryness that precludes sex so, in essence, they can't even though they want to. Blanket statements are never fair in anything, especially medicine. And, as an FYI, I continued to prescribe HRT even after the hugely unfair blanket statement put out by the USPTF earlier this decade. Also, to believe that 'Bio-Equivalent" HRT is of any benefit healthwise is worse than absurd. There are no studies backing up any of the manufacturers' claims and, believe me, studies are being done. Purchasing bio-equivalent hormones benefits one group of people, the people manufacturing the bio-equivalent hormones.
07:24 AM on 12/17/2009
Actually bio-equivalent hormones gave me my life back, but whatever.
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tlgeiger62
A woman of substance.
08:29 AM on 12/16/2009
Due to the economic crisis and my family unemployment, I had to go off all my anti-depressants back in early 2008. To say I felt the effects of going off such meds is an understatement. The one drug I still needed to function was my anti-anxiety Klonopin. After about 8 months I returned to my doctor to ask him for a refill on the Klonopin but he was adament that I need to be on an anti-depressant. I told him I could not afford to be back on anti-depressants and that I was relieved to have gotten off the anti-depressant after months of weaning. I was astounded by his big push and left the office with a prescription for the Klonopin which I filled and a prescription for an anti-depressant which I tossed into the trash as I left his office.

There is A LOT of truth behind the big push for drugs in this country. And it is fueled by GREED.
06:51 AM on 12/16/2009
I really don't understand the fear- I'm so ready for menopause. The end of all the fuss and bother of being a fertile female is looking like the pot of gold at the end of the rainbow. Our society is so squicky about natural processes that it is a wonder that we even have time and energy to treat the odd and dangerous ones.

I've been the Warrior maiden, I am the Mother, bring on the Crone because I am ready for that challenge too.
12:38 PM on 12/16/2009
Lucky you hitting all three stages of feminity in one lifetime. For me, going straight from warrior maiden to crone wasn't what I had in mind, but early menopause decided it for me. Losing one's fertility isn't the pot of gold at the end of the rainbow for everyone. Sure, if I had lovely healthy teenaged kids, like many menopausal women, I wouldn't feel the least bit bad about giving up cramps and tampons. Being menopausal when most of my friends are having babies isn't so much fun. But, you play the hand you're dealt.
03:39 PM on 12/16/2009
Playing the hand you are dealt is really the whole point. If you have sound medical reasons to try to change things and I know women who started menopause just out of puberty then interventions are the way to go. It is the marketing eternal youth through fear that is the problem. You don't stop being a woman when you experience menopause and phase into the next part of the adult female experience. You don't stop being a woman if you don't or can't have children. The marketing is the problem.
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MightyMeno
Frustrated Floridian
07:19 PM on 12/16/2009
Menopause (albeit of the surgical variety) was a blessed relief at age 47; no more cramps, no more heavy bleeding, no more PMS. I was happy to be done with the whole mess. I did take Premarin (low dose) for five years and then took a variety of herbs, vitamins and minerals for another three years to tame the hot flashes and night sweats. Now that it's all behind me, I'm loving my Inner Crone! Most of my girlfriends are the same age and we are FIERCE.
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05:05 AM on 12/16/2009
Menopause is bad, especially if your system is very estrogen dependent. Not all women are. If you never had a sex drive then you won't miss hormones. PCOS, high testosterone women, others won't miss it as much. The only thing worse is a hysterectomy. First goes the sex and then, rapidly you lose even the ideation.

Replacement hormones do keep you young. They keep your skin soft and unwrinkled, your body firm and healthy and they forestall many diseases of age. What is the difference in odds of death? About 3 per 10,000 more with HRT. This year and last, the occurance of strokes in women doubled. I suspect these deaths won't be attributed to the change in hormone use. What is counted is very dependent on political correctness.

There are religionists that don't want women to use hormones, any hormones. Mostly because they want to scare the young ones out of using birth control. The insurance companies are glad to stop paying for hormones. They know that women after menopause soon stop asking for other gynocological services. The doctors only know what they are told. And they are very susceptible to medical fashion.

Propaganda is a major item in the pharma wars, liability lawsuits and stock market speculation.
We're seeing a lot of it now.
08:15 AM on 12/16/2009
No offense, but sounds like you bought the propaganda, IMO. Taking pregnant mar'e's urine so that your skin remains silky soft and your body firm (which can be attained with exercise) is strange reasoning to me. I am 61 and have never taken Premarin. My skin is good for a 61-year-old. By the way, menopause is not "bad."
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texastrixie
I invented the internet.
10:49 AM on 12/16/2009
If you're one of the women who get a bloodclot or have a stroke, all that silky skin is going to do your family (and your husband) little good. Some people "come back" from strokes, but a lot of people end up completely unable to talk or walk. And they may stay that way for years before they die. Who would take one extra chance on putting that burden on one's family just to look younger? And unless you get face-lifts, you are still going to look old at 60, 70, etc. No one is going to card you when you buy beer. Every man under 75 is going to call you 'Maam." Its part of life.
04:39 AM on 12/16/2009
In addition, the cruelty of HRT is rarely discussed, outside of animal protection circles. To make Premarin (many are oblivious that the word "mare" is contained within) horses suffer horribly, just another factor women might want to consider.
06:39 AM on 12/16/2009
It is indeed what I considered in deciding against HRT. I have never had a hot flash or any of the other ills associated with menopause. In fact, menopause was kind of a release for me. Taking Premarin because it makes your skin look good is selfish in the extreme..
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csavage
08:18 AM on 12/16/2009
Ummm, there are synthetic hormones you can take if the idea of horse pee upsets you...
01:41 PM on 12/16/2009
It is much more upsetting to the horse, believe me.
04:29 AM on 12/16/2009
Wtih a few caveats here, re: drug companies, the labeling of types of therapies available to women, and the synthetic drug you are talking about. The shame is that drug companies have put women off seeking any alternative. Synthetic hormones are not the same as naturally based ones. Menopause does have dangers and pitfalls, and many women are not being treated adequately, or being undertreated for these risks due to lumping all hormone therapy under the same label. [The symptoms mentioned in this article also apply to birth control pills]
03:49 AM on 12/16/2009
I'm with both of you on this one. I went through menopause in the late '90s and did so without HRT. I'm just so tired of being told there's something wrong with growing older. I constantly feel ripped off. Aging is a natural part of life and I want to experience all of it. Evagorman, I think I just might buy a juicer too.
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LiberalDem
09:25 AM on 12/16/2009
When I was approaching menopause I talked with my Ob-Gyn about HRT, and I told her that my prference was to deal with menopause by taking care of myself through diet, exercise and lifestyle changes rather than go on HRT. I also said that if I experienced severe symptoms I'd re-evaluate my position. I was fortunate to not have bothersome symptoms such as hot flashes. I never went on HRT, and considering that its alleged benefits have proven to be overhyped or non-existent for several conditions, I'm thankful that I didn't.
11:07 PM on 12/15/2009
There's something to be said for being too poor to be able to afford hormone replacement therapy (sorry, Suzanne Sommers) and I've managed quite well without it.

I did, however, have yearly mammograms since I was 30 and from what I understand it has greatly elevated my chances of getting breast cancer.

I've stopped listening to everyone. I bought a juicer and I'm using it.
04:33 AM on 12/16/2009
But at least Suzanne Somers is promoting bio-identical hormone therapy, not the traditional, synthetic variety.
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Decorina
Hypocrisy means your karma ran over your dogma
04:47 PM on 12/15/2009
The whole HRT scam was the first use of marketing a human condition as a "disease" in order to make someone a pile of money. The recent success of Viagra is its child. Which naturally occurring human condition is next?
11:09 AM on 12/16/2009
Exactly, when there is a chance to make money off the the weaknesses and fears of anyone women and children included. Companies like Pfizer are more then willing to take off the gloves. They will create anything to fill their needs including an ad campaign to create a need, dangerous hormone drugs with faked and flawed scientific studies tested in 3rd world countries and eased through the FDA. Just like Merck & Co.'s arthritis drug Vioxx which led to more than 27000 heart attacks at last count. You wonder just what good is the FDA when all they do is drag their feet and do everything they can to protect the pharmaceutical companies profits over the health and lives of innocent Americans.
11:39 AM on 12/16/2009
How about fibromyalgia? Drug giants are now marketing a pill for a condition that cannot even be diagnosed. Some "sufferers" don't want to accept that aches and pains are part of life; others use it as an illness du jour for attention or Disability. Either way, Pharma sees $$$.
03:43 PM on 12/16/2009
Fibromyalgia is physically debilitating and is more than just "aches and pains".
Menopause is a natural phase that sometimes occurs early or may be caused by other medical interventions. Treatments are a good way to go for some but not everyone will need them.
12:56 AM on 12/17/2009
Colossal Fail.