WOMEN'S HEALTH Author takes a critical look at history of estrogen therapy

The hormone has cycled through favor and disfavor.
By MARIE McCULLOUGH
KNIGHT RIDDER NEWSPAPERS
"The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth," by Barbara Seaman (Hyperion, $24.95)
Recently, journalists have been getting drug-company news releases dismissing the world's best study of postmenopausal hormone therapy.
The Women's Health Initiative randomly assigned more than 16,000 healthy women to take a placebo or estrogen-progestin therapy. The therapy was expected to protect good health. Instead, as announced last year, hormone-takers had more heart attacks, stroke, dangerous blood clots, breast cancer and dementia than women taking phony pills.
Although drug companies don't come right out and bad-mouth the study, they suggest that it applies only to Prempro, the popular Wyeth Pharmaceuticals brand used in the federally funded research. Their own products, the companies say, may still be wonderful for women.
Initially, I figured this sales pitch would go over like flat-Earth theories. After all, the Food and Drug Administration last year asked all manufacturers to put warnings on their estrogen-progestin therapies. But after reading Barbara Seaman's new book, "The Greatest Experiment Ever Performed on Women: Exploding the Estrogen Myth," I'm not so sure.
Previous cycles
Seaman, a veteran activist in women's health, has written a flawed but fascinating chronicle of the centurylong evolution of estrogen products, showing how the quintessential female hormone has repeatedly gone through cycles of being ballyhooed, then booed.
The cycle happened with DES. The synthetic estrogen was prescribed to prevent miscarriages despite evidence that the drug can trigger them, and it turned out to cause a rare vaginal cancer in DES daughters. The cycle happened with the birth-control pill, initially made with ultrahigh hormone doses that induced blood clots and strokes. (Seaman's first book, "The Doctors' Case Against the Pill," spurred congressional hearings and regulatory changes.)
Seaman traces the new formulas, new uses, and most of all, new marketing behind the continual resurgence of estrogen. After the endometrial-cancer link, for example, estrogen was prescribed with a counterbalancing hormone, progestin, and touted for protecting bones.
Faster than a hot flash, menopausal women returned to the pharmaceutical fold. Then came ad campaigns suggesting that hormones prevent heart attacks and Alzheimer's disease.
How cynical was such marketing? Seaman quotes Harry Loynd, a president of Parke-Davis, telling his sales staff: "If we put horse manure in a capsule, we could sell it to 95 percent of those doctors."
Anecdotes and flaws
Seaman is co-founder of the Women's Health Network in Washington, an advocacy organization that has decried for decades the hyping of hormone therapy. Having rubbed elbows with many key figures in her book, she is a font of anecdotes.
Robert Wilson, the drug-company-funded gynecologist whose 1966 book, "Feminine Forever," billed estrogen as a youth pill, declared that 50-year-old estrogen users "still look attractive in sleeveless dresses or tennis shorts." Seaman shot back: "How do you know that it isn't from the tennis?"
Seaman sometimes pulls her punches based on personal impressions. Endocrinologist Robert Greenblatt, a pioneer of the notion that menopause is a deficiency disease, prescribed dangerously hefty doses of estrogen and testosterone. Even so, Seaman is confident that he made "most of his patients comfortable, even 'in the pink.'" Apparently, she concludes this simply because she found him "not ... too pushy."
The book has a few other weaknesses. Seaman jumps back and forth in history, and the sequences can be confusing.
Still, Seaman's bottom line, like her book, deserves attention. "Estrogen products won't go away, and they shouldn't. One can only wish, as I do, that they will be used now with caution, based on evidence and facts, not illusion."