03/18/2010 05:12 am ET Updated Nov 17, 2011

Menopause: Marketing Fear

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.