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MAKING CONTACT Transcript: #08-99 Marketing Menopause Phillip Babich: Welcome to Making Contact an international radio program seeking to create connections between people, vital ideas, and important information. This week on Making Contact:- Ruby Gold: Menopause, which is a perfectly natural part of any woman's life, is now seen as a problem and as an illness which has to be medicated against. Dr. Adriane Fugh-Berman: The baby-boomers are becoming menopausal, and this is big business. Lisa Rudman: Over 40 million women in the US will go through menopause in the next 20 years. Their experience of this life transition will be profoundly affected by society's attitudes about women, aging, sexuality, healthcare and drugs. Pharmaceutical companies are spending millions of dollars to persuade women to boost their naturally declining levels of estrogen, and claiming that Hormone Replacement Therapy, or HRT, has more benefits than risks. On this program, the Women's Desk examines what's behind the marketing of menopause. I'm Lisa Rudman, your host this week on Making Contact. Menopause, the end of a woman's monthly bleeding, is the result of changes in hormone levels in the blood. Unlike an on/off switch, menopause is a transitional phase that can start somewhere between ages 35 and 55 and can last as long as 10 years. Common signs of menopause include hot flashes and vaginal dryness. The medical establishment links osteoporosis, heart disease, and possibly Alzheimer's with menopause. These links are coming under scrutiny. The history of estrogen based drugs reveals how menopause became widely viewed as an illness. In the early 1900's when scientists first realized how the estrogen hormone functioned in the body, doctors began dispensing it with very little research. So little that University of Pittsburgh epidemiologist Lewis Kuller calls it "the largest uncontrolled experiment ever perpetuated on the human population." Estrogen was not widely used until the mid-1960's when the pharmaceutical giants Searle, Upjohn, and Wyeth-Ayerst hired a physician named Robert A. Wilson to write a book entitled "Feminine Forever." Harriet Beinfield, author of "Between Heaven and Earth: A Guide to Chinese Medicine" writes that "Wilson's book suggested that without estrogen replacement therapy, bones would dissolve, hearts clog, vaginas shrivel, breasts sag and skin crinkle." Beinfield continues, "The myth that estrogen prevented these conditions was securely seeded deep within the minds of women and their doctors. A market was created by industrially manufacturing consciousness." In the years after "Feminine Forever" was published, estrogen sales soared. Now, as the number one prescription drug, estrogen brings in over a billion dollars in profits annually. Cindy Pearson is the Executive Director of the National Women's Health Network in Washington DC. She says the negative mindset toward menopause continues today, cloaked in scientific terms: Cindy Pearson: We haven't outgrown the effects of institutionalized sexism. So there are many if not the majority of doctors who believe that once women stop menstruating, it is really the end of their "normal life." I mean these are quotes from the sixties that were published in lay literature and in medical textbooks -- that women are subject to painful crises caused by raging hormones at the time of the menopause, and shouldn't be in positions of responsibility. And, after those raging hormones pass, women are dried up husks and enter a vapid cow-like state. Now, a similar message is communicated to doctors in training, and sort of practiced by them on their patients. That it sounds much more scientific now, and it's talked about, you know "outliving your ovaries" and "estrogen levels stopping" and being a "deficiency state" like diabetes is a deficiency state. And so there appears to be this cloaking of scientific justification. But the message is still the same: You're only a woman when your ovaries are functioning and they don't function after menopause. You're not a woman. You won't be happy or healthy, and so we need to fix this mistake that nature made and put you on hormones. Dr. Adriane Fugh-Berman: Menopause is a culturally-constructed concept. Lisa Rudman: Dr. Adriane Fugh-Berman is Assistant Clinical Professor of Health Care Sciences at George Washington University School of Medicine. Dr. Adriane Fugh-Berman: The symptoms that are associated with menopause also vary across cultures. Mayan women, for instance, don't report hot-flashes. Asian women don't report the same level of hot flashes. Japanese women are more likely to associate shoulder pain with menopause than hot-flashes. So there are a lot of cultural differences. Now some of these might be due to dietary factors. There also might be factors involving respect for age, et cetera, that might come into play. But we are definitely, in this culture, sort of taught to fear and dread aging. There are no diseases that are specific to menopause. Men get osteoporosis. Men get cardiovascular disease. Lisa Rudman: According to Dr. Fugh-Berman, concerns about menopausal women's sexuality are based on attitudes about women and men, rather than medical fact. Dr. Adriane Fugh-Berman: It marks the end of child bearing. It doesn't mark the end of sexuality in any way. And certainly men have changes in libido and function as they get older. The only symptoms that are specific to menopause are vaginal dryness and hot flashes. In fact, there is one, quite lovely survey. It was done in Europe. I can't remember where now, but, where men and women were asked questions about symptoms that are normally considered menopausal symptoms. But the men weren't told that this was a menopause questionnaire of course. And I think that hot flashes were sort of hidden under a term "excessive sweating", something like that. And it found that men... that symptoms normally attributed to menopause, like depression, irritability, fatigue, sexual dysfunction, things like that, were equally prevalent in men and women. Lisa Rudman: Fugh-Berman does say a limited use of Hormone Replacement Therapy, for the 25% of women who experience extreme discomfort, can be beneficial. HRT is typically prescription drugs that consist of estrogen, progestine and other pharmaceuticals. Sometimes this treatment is referred to as combination therapy. Fugh-Berman does object to over-prescribing HRT to women without symptoms, and is concerned about HRT's possible links to cancer. She also questions the drug companies' claims that HRT helps prevent heart disease. A major study was published in the Journal of the American Medical Association in August 1998. Dr. Fugh-Berman: Dr. Adriane Fugh-Berman: We have results from the first ever prospective placebo controlled trial, or actually the first prospective control trial of hormones in women with heart disease, that found no benefits from Hormone Replacement Therapy. And that's really stuck a pin into the bubble of people who have been saying how wonderful hormones are in preventing cardiovascular disease. Lisa Rudman: Health practitioners and activists are exploring healthcare options, but they do so within a context of bias against women and old age. Making Contact correspondent Judy Campbell has more: Judy Campbell: It's a full page spread in a magazine. A stylish, perky woman of indeterminate age. She tosses a carefree smile to the camera, her hands are thrown up, she's shrugging, and the caption underneath her reads "What menopause?" How did she get so lucky? is the implied question. The ad's answer: Hormone Replacement Therapy. This ad promises immortality. Other advertisements are a little more threatening. Nancy Wooster teaches Women's Studies at the University of Wisconsin. Nancy Wooster: I think one of the most powerful one's I remember first seeing was when you saw a healthy woman, literally before your eyes in a few seconds she would crumble up as if menopause is the beginning of dying. Judy Campbell: Marketing for menopause certainly isn't new. The Hormone Replacement Therapy Premarin has been on the market since 1942. And the drug companies have successfully pushed their products for decades. The biggest boost for estrogen came in 1966 with the publication of "Feminine Forever", a book funded by Wyeth-Ayerst, the manufacturer of Premarin. "Feminine Forever" lauded estrogen drugs as a youth pill that would save women from a menopause that turns them into "castrates". But then in the 70s, estrogen, when taken alone, was linked with higher rates of cancer. Sales plummeted. Combination therapy, deemed safer, was put on the market and a bold new marketing strategy was needed to re-capture lost customers. Nancy Wooster: Nancy Wooster: The end of the 70s into the 80s... that all coincides with a time when the shift was not just to convince health care providers of what to do, but to go directly to women. So ads on television, ads marketing in women's mail boxes... What I often talk about is selling drugs to women in the same way that soap powders or detergents or hand lotion or candy had been sold to us before. So public marketing agencies got involved in figuring out how to run campaigns that would appeal to women. Judy Campbell: So came the situation we're in today. Click on a company's website, and you're offered free samples of Hormone Replacement Therapy. Turn on your TV and see concerned women discussing their "change". And this shift to direct-marketing, argues Wooster, allowed drug companies to broaden their scope. Nancy Wooster: In addition to marketing just to women who were going through menopause, there was a change to marketing for long term use. And that's just the stage when into the population came the words... things like osteoporosis and heart disease. So instead of just taking hormones for a few years, or to keep a woman younger or to help her through menopause, it became a life long decision. Judy Campbell: Wooster describes a magazine ad placed by the drug company Merck. Nancy Wooster: It's a young woman on a bicycle looking very young. And the shadow is of a wheelchair. And the reading is "The shadow of osteoporosis doesn't have to threaten future independence." And what's interesting about that ad is that was an ad that didn't even advertise a particular product. You just see a company listed. At that stage the product they were going to try to market wasn't even on the market yet. But what it was very much doing is playing on women's fears that if they don't do something right away, that somehow the wrong decision or no decision is going to mean that they end up with something that causes a disability. Judy Campbell: The campaign has been successful. Premarin is currently the number one selling drug in the country. But how did osteoporosis become a household word? Maryann Napoli is the Associate Director at the Center for Medical Consumers. She traced the history of the drug Fasomax, made by Merck. Fasomax boasts of being the first and only non-hormonal therapy for osteoporosis. But Merck not only produces Fasomax, it has also entered a financial relationship with the manufacturer of bone density measurement equipment. So, Napoli says, first the company encourages the testing of bone density. Then, it sells the cure. Maryann Napoli: And you can see what's going to happen if they're successful doing that. The more women who have their bone density measured around menopause, the more customers you have for these drugs that prevent bone loss. Judy Campbell: But, Napoli says, it's not certain just what the bone density measurement show. Maryann Napoli: Bone loss at menopause doesn't inevitably mean that you will fracture in old age. But a lot of these tests make women fear that that will happen. You could, for example, show evidence of bone loss at the age of fifty. And then, you know, that's it. You don't lose much more after that. And you could live to a ripe old age and never fracture. And conversely, you could look live you've got strong bone density at age 50 and then rapidly lose bone. So these tests are not predictive at middle age. But that's the age that's being encouraged to undergo bone density testing. You know, women just going into menopause. Judy Campbell: Which is not to say, Maryann Napoli emphasizes, that the drugs don't work. Maryann Napoli: The drugs are successful in preventing bone loss. So is estrogen, not just Fasomax. But what's less clear is whether that translates to a lower rate of hip fracture. And after all, that is what the ultimate goal is. And you can preserve bone density, but you might not necessarily be preventing hip fracture. Judy Campbell: A look at Merck's corporate literature shows the push. Merck said it established the Bone Measurement Institute, a non-profit organization, to "increase the accessibility and affordability of bone measurement technology." "In all", says Nancy Wooster at the University of Wisconsin, "what we're seeing is a shift in marketing from the sick to the healthy." Nancy Wooster: It's as if the health care system can't make enough money any more out of sick people. And so we've seen a real change where there's more and more things that are marketed for healthy people. And that's, of course, partly since consumers really really want to be aware of prevention. So when it's healthy stuff that's really good. But any time you can sell something to healthy women... So it's the same thing if you look at menstruation products -- if you can invent something new and make more money off of every woman that's menstruating, then you've got a huge market. Judy Campbell: For Making Contact, I'm Judy Campbell. Laura Livoti: You're listening to Making Contact, a production of the National Radio Project. If you want more information about the subject of this week's program, or you would like to learn how you can get involved with Making Contact, please give us a call. It's toll-free: 800-529-5736. Call that same phone number for tape and transcript orders. That's 800-529-5736. We also welcome comments and suggestions for future programs. Lisa Rudman: The concept of menopause as preventable illness is not a universal view. According to Luz Alvarez Martinez, the Director of the National Latina Health Organization, Latino and indigenous cultures traditionally have revered elders. This fact, along with a holistic approach to health, made mid-life a celebrated time of transition for women. Rituals defined the move from childbearing to caring for the whole community. These rituals are being reclaimed and reconstructed. Ruby Gold has been practicing and teaching Chinese Medicine for 25 years. She explains the limits of the pharmaceutical model of menopause. Ruby Gold: We are talking about the United States and Northern Europe and, even at that, only the dominant cultures of those areas. And this view that menopause is an illness and that it's something to be avoided and is something that is so devastating that it warrants taking drugs that are so extreme that we have to worry about side effects like cancer. The side effects are not only medical either, because part of the problem with taking Hormone Replacement Therapy is that now you've begun to identify menopause as an illness. This has a tremendous emotional impact on women and a mental and spiritual impact. If we start to focus in on menopause as an illness than we are not looking at it in the other many ways possible. There's a tremendous amount of resistance to looking at menopause in any way other than as an illness. But it can be narrowed down to just two, I think, to a couple of very simple causes. One is that the medical establishment and the pharmaceutical industry use a tremendous amount of fear to get people to... to get women to take the medications that they're selling. And most women are very frightened of having heart attacks and osteoporosis and other things that -- Alzheimer's and dementia -- which the industry has now made synonymous with menopause. So it's very difficult to let go of these ideas if you think that these terrible things are going to happen to you. That would be one reason. The other reason is that the partners of most women start to make demands, or the women believe they're going to make demands anyway. That they're afraid that they're going to have decrease sexual desire or they won't be as attractive. And so that becomes a huge motivation. Again, of course, that's still fear. But now for another reason. And it's very difficult to get people off the track of fear and onto something that is celebratory and optimistic. There's a tremendous amount of opportunity for us to come together in community ways. First of all, if women would share information with each other, and share their experiences with each other, and voice their fears so that first of all we just get that out on the table and a lot of the misconceptions. Rather than going to the corporations to try to find out what's happening to us. Lisa Rudman: So what is some of that alternative information? Dr. Fugh-Berman: Dr. Adriane Fugh-Berman: Hormone Replacement Therapy is associated with increased risk for breast cancer, gall stones, asthma, a few other things. So other things that women can do to help prevent osteoporosis are exercise, especially weight bearing exercises, strengthening exercises, not smoking, reducing alcohol, making sure that they're getting adequate amounts of calcium, magnesium, and vitamin D. And also in the elderly population is really making efforts to prevent falling. Ruby Gold: We have many options. There's change in diet. Lisa Rudman: Ruby Gold: Ruby Gold: There are herbs, which are basically really an extension of the diet. There are certain exercises that can be used: meditation, visualization, stress reduction, yoga, those are just to name a few. But even one of my favorites is to really help every individual woman understand what she might want to be doing with this next part of her life. That means generally, for most women, this marks a period where there's a good, at least twenty to thirty years. Twenty to thirty years is enough time to do something big. Lisa Rudman: Deborah Adams is a physician's assistant who spends the majority of her week in a traditional Obstetrics and Gynecology doctor's office. Her other work is at Center for Black Women's Wellness in Atlanta. Deborah Adams: In the traditional setting, Hormone Replacement Therapy and prescription intervention is really pushed, I guess, maybe because of the pharmaceutical influence. And the ladies are really encouraged, strongly encouraged to seek treatment through Hormonal Replacement Therapy. Whereas at the Center for Black Women's Wellness, more of the women are interested in controlling menopausal symptoms. The diet, or estrogen replacement in the form of plants and herbs opposed to the prescription medications. Well I've noticed a trend with women of color that the literature for OB-GYN’s for predicting menopause, the average age for menopause is age 52. And I'm noticing that that seems to be changing within the black population. More and more women of color are experiencing menopausal symptoms at an earlier age. Some women as early as 35. And I'm noticing that average with our population of women that I'm seeing, average a woman is starting to notice menopausal symptoms at age 42. Lisa Rudman: And why do you think that might be? Deborah Adams: That's, you know, we're just trying to figure it out. But some of the things we're noticing is that the ladies that are noticing the early menopausal symptoms are under a lot of stress. So we're noticing those that have a poor diet and are under a lot of stress are noticing the symptoms a lot earlier than say their foreparents -- grandmothers and mothers. And so, you know, their grandmothers ate more fruits and vegetables. And they took the time and had more balanced meals. Whereas now we're kind of more of in the fast lane. More people are eating McDonalds and not really having the time to sit down and prepare the traditional meals that their mother or grandmother might have been used to eating. Some of the supplements that we're finding that have natural estrogen in them: soybeans and yams and things of that sort. So years ago women of color had the time to eat healthier. Lisa Rudman: Diet is only one factor, Adams adds that African-American women and other women of color have higher rates of hysterectomies -- removal of the uterus and sometimes the ovaries. Deborah Adams: Black women have a higher incidence of fibroids occurring at a young age. And some of the research has shown with complementary medicine and alternatives is that some of the things that contribute to the growth of fibroids is diet, stress and then some hormonal influence. So since so many black women have a history of fibroids, many women by the age of 45 have already had hysterectomies. Depending on what type of complications they've had with the surgeries, many times when they have the hysterectomies they have the bilateral ooferectomies, where the ovaries are removed also. And that takes them into a surgical menopause at a earlier age. Usually those women are put on Estrogen Replacement right away, as opposed to being allowed to go through the regular phase of menopause. We're in the information age where everybody's given this information. And we're being bombarded with what's best, what's right, for black women, what's right for women in general. The advantages of drugs versus the side effects and the bottom line is you can't believe everything that is just kind of shoved to you. And there are also alternatives that exist. Lisa Rudman: Seeking to empower women with information, The National Women's Health Network operates independently, without pharmaceutical company funding. Cindy Pearson recalls their beginning. Cindy Pearson: Our first ever action was to protest menopausal drugs being to sold to women who didn't need them and weren't told the risks. In December of 1975, we had a memorial service and protest on the steps of the Food and Drug Administration. And we honored the memory of women who had died unnecessarily because they were encouraged to take a Hormone Replacement Therapy and not told that it had a life-threatening side effect: cancer of the uterus and also blood clots. That was how we got our start as an organization, protesting this abuse of women and, you know, this twisting of what menopause is about. And what we want to do is get women and their doctors to take a step backwards and say, "Here I am. I'm getting into the middle age. What, given my personal life and the history of people in my family, what might happen to me in my fifties, sixties and seventies? What's most likely to happen to me? Am I at higher than average risk for any of the diseases of aging, whether or not they have screening or prevention things associated with them? If so, let's talk now about health promoting ways I can prevent them." Menopause is natural. Women were meant to live many years beyond menopause. Some women have an uncomfortable time and it's right to look for relief. But if you don't have an uncomfortable time, you don't need to think of menopause as a sign of impending doom. You just need to look at your health with a global look, a holistic look, and think of yourself as a person aging and how can you best age healthfully? And if you're being encouraged to use Hormone Replacement Therapy, take all the time you think you need to make the decision. Because estrogen use is never an emergency. Lisa Rudman: That was Cindy Pearson. If you want more information about the National Women's Heath Network, you can call them at (202) 628-7814. That's (202) 628-7814. You can also ask them about their booklet on menopause. That's it for this special Women's Desk edition of Making Contact, a look at the Marketing of Menopause. Thanks for listening. For a resource packet and information on this week's guests, you can call us at the National Radio Project. You'll hear the toll free number in a moment. Special thanks this week to associate producers Caryatis Cardea, Amanda Huron, and Judy Campbell. Also thanks to Susan Celli, Michelle Wolfe and Laurie Drabble for production assistance. Laura Livoti is our managing director. Our managing producer is Phillip Babich. Peggy Law is executive director. Our production assistant is Shereen Meraji. Norman Solomon is senior advisor. Our national producer is David Barsamian. And I'm your host, Lisa Rudman. Phillip Babich: If you want more information about the subject of this week's program, call the National Radio Project at 800-529-5736. Call that same phone number for tapes and transcripts. That's 800-529-5736. Making Contact is an independent production. We're committed to providing a forum for voices and opinions not often heard in the mass media. If you have suggestions for future programs, we'd like to hear from you. Our theme music is by the Charlie Hunter Trio. Bye for now. |