Public Health or Private Profit?

Taken from the September/October 2013 issue of the Women's Health Activist Newsletter.

I’m always upset when I see yet another article promoting the scientifically unsound view that hormone therapy is essential for women – and that title immediately made me suspect that the article was going to contain more opinion than actual scientific fact.

I’m used to seeing those types of articles in journals with close ties to Big Pharma. But in a public health journal? And such an important one? I knew I needed to find out more about this right away, so the NWHN could be ready to deal with the inevitable questions we’d be getting from women trying to decide about hormone therapy. (Hormone therapy can use either estrogen or a combination of estrogen and progesterone.)

When I read the article, my worst fears were confirmed. Its authors strongly promote estrogen as a life-saver for certain women. They claim that, over the last 10 years, more than 40,000 women have died unnecessarily because they were afraid to take estrogen therapy – “estrogen aversion,” the authors call it. They urge women under age 60 who have had a hysterectomy to get over their fear, and get some estrogen.

The authors made their opinions very clear. But where were the facts guiding their promotion of hormone therapy? Did they base their opinion on the results of a new, randomized clinical trial — the gold standard for research analysis? A case control study? Death certificates? No – none of the above.

The authors made their sensationalistic claims based on a mathematical model. Yet, all mathematical models start with assumptions! In this case, the authors first assumed that estrogen therapy prevents death from cardiovascular disease in women who have had a hysterectomy; once they made that assumption, then their study “results” on “estrogen-aversion’s” impact on cardiovascular health were pre-determined.

The authors justified their assumption by pointing to a statistic published in one of the many study reports from the Women’s Health Initiative (WHI), which, they believe, showed that death rates are lower among women taking estrogen therapy.2 They conveniently ignored many other statistics from the same WHI report, including ones that showed no effect on mortality.

So, if evidence doesn’t explain these authors’ assumptions, what might? Could it be ties to industry? We did some quick investigating and what we found disturbed and upset us. The lead author, Dr. Philip M. Sarrel, has ties to several pharmaceutical companies that market hormone therapy. He is a paid consultant for Noven Therapeutics, makers of Minivelle, an estrogen patch. He’s also received funding from Solvay Pharmaceuticals for research studies on hormone therapy in menopausal and post-menopausal women.

Financial ties to industry don’t prove that a writer is biased – but they do present the appearance of a conflict of interest. Consumers depend on the editors of reputable publications to look carefully at the quality of studies to make sure that an author’s possible conflict of interest didn’t influence the results. And, clearly, to not publish biased and misleading “research.” By doing so, the APHA and the American Journal of Public Health editors both let women down. They published bad science based on flawed methodology, which got picked up and sensationalized by mainstream publications like the LA Times. Who knows how many more women are confused about the risks of estrogen therapy now? We’ve been in touch with the Journal, and they’re going to publish a Letter to the Editor expressing our concerns. Let’s hope next time they do better!

Cindy Pearson was the NWHN’s Executive Director from 1996 to 2021. One of the nation's leading advocates for women's health, Cindy often testified before Congress,  NIH and the FDA and was frequently featured in the news as a consumer expert on women’s health issues. When she retired, Cindy received a Congressional Resolution in honor of her outstanding contributions to the health of women and girls.

Read more from Cindy Pearson.

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1. Sarrel, PM, et al. “The Mortality Toll of Estrogen Avoidance:  An Analysis of Excess Deaths Among Hysterectomized Women Aged 50 to 59 Years,” AJPH, published on-line ahead of print July 18, 2013.

2.  LaCroix AZ, Chlebowski RT, Manson JE, et al., “Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial,” JAMA2011; 305(13):1305-1314.