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The Failure of Mare Urine

Would a Chinese apothecary know how to handle hot flashes?

I must confess this to my Asian Pacific American sisters out there. I had no idea what hot flashes were all about. That is, until I delved into the Hormone Replacement Therapy story that’s made headlines this summer.

For you men who have not read your girlfriend’s copy of Our Bodies, Ourselves, hormone replacement, or HRT, as it is commonly known, is a popular treatment for menopause and its symptoms. That would include those aforementioned hot flashes, not to mention the occasional “night sweats.”

My take on hot flashes was fairly male and chauvinistic. When guys hit that age we merely develop an irrational urge to drive hot red sports cars. And think Viagra should come in a Pez dispenser.

So when we hear a woman complain of hot flashes, the average guy’s response is, “So open the windows, already. And drink some ice water while you’re at it.”

Fortunately, my callous reporter side has bonded with that sensitive side of mine, my “inner female,” and now I understand just how clueless I have been.

About as clueless as the average doctor studying HRT.

When I recently asked some of the country’s top doctors at the Harvard Medical School what caused hot flashes, the easy thing for them to say is that’s what happens when a woman stops making estrogen — all hell breaks loose.

But the truth is, doctors don’t really know. They’re just guessing. All they can do is treat the symptoms. For some women, hot flashes are so debilitating, so uncontrollable and so unpleasant, women are willing to turn to just about anything.

And for years that anything has been mare’s urine. Pee-pee from a female horse.

Honest to God.

The stuff is full of estrogen, it provides relief from all those damn hot flashes and night sweats. For decades, the drug company Wyeth has made mega-millions dispensing horse pee in a pill-brand name, Premarin. With 46 million prescriptions a year, it’s the staple of this so-called hormone replacement business, er, therapy. You’d think they’d know of all the dangers from the stuff, especially since they’re dispensing it like candy. But of course, they don’t.

In fact, it was only five years ago that the government embarked on the largest publicly funded study of HRT to date — an eight year, double-blind, randomized study of tens of thousands of women nationwide, at a cost of $700 million dollars.

And so the news this past July was extremely significant. How many times do you see a well-funded study with three years left stopped dead in its tracks?

The Women’s Health Initiative was studying women on Prempro, another Wyeth product that’s a mixture of Premarin (estrogen) with Progestin.

They weren’t expecting the study to produce disease. But it did. Based on 10,000 women using Prempro versus 10,000 who did not, the research resulted in eight more invasive breast cancers than normal.

More startling was the cardiovascular disease. Doctors for years have actually prescribed Prempro to prevent heart disease. Instead, the trial produced seven more heart attacks than normal. There were also eight more strokes. 18 more blood clots.

You might say the old gray mare’s urine just ain’t what it used to be. Oh, there were some pluses. The Prempro produced six fewer colon cancers. And five fewer hip fractures. The numbers may seem small, but the fact was that Prempro was supposed to prevent these problems altogether — so the fact that they cause even one case of cancer is problematic.

So menopausal women still taking Prempro can expect healthy colons and the ability to breakdance ‘til dawn. But all at the additional risk of breast cancer and heart attack. Wanna spin the wheel?

Because of the dangers, all the women on Prempro in the study were immediately taken off the medicine. And women all over the country were back to square one when it comes to understanding HRT.

And what about APA women? What about them?

As usual with general health research, the racial makeup was just plain pathetic. Eighty-four percent of the women were white. Just 6.5 percent were Black. Latinos were 5.5 percent. And Asian Pacific Americans? A whopping 2.3 percent — that’s just 194 people.

I’m not looking for the study to reflect the racial makeup of the country. HRT doesn’t necessarily have to “look like America.” But I think it is significant that the samples in the survey of ethnic women were so small as to be meaningless. In other words, it virtually ignores you.

You can blame a lack of outreach, language barriers, or perhaps even a low number of middle class ethnic women of menopausal age who are put on the horse pee pills in the first place.

But we’re still left with a white women’s health study.

As a public health matter, it would have been nice for a $700 million study to cover more of the public. Instead, the study clearly focused on Wyeth’s target market. White middle class women who want the convenience of new hormones.

Could race be irrelevant here? Hmm. Is race irrelevant in health issues?

Ever been to an APA ice cream social? Did it sound like a tuba convention afterwards?

As many of you know by experience, 90 percent of APAs are lactose intolerant vs. 30 percent of all Americans. If only whites were studied, you’d never know that an APA ice cream social calls for a decent gas mask.

So where does that leave us with all the alarming news the media brought us on HRT? Same place we’ve always been. Nowhere.

The most expensive and thorough study to date on HRT has left you APA women out in the cold with your hot flashes. You’re on your own, experimenting with your horse urine pills.

Next time you’re feeling a little hot and bothered, here’s a tip: Get thee to a Chinese apothecary. He could give you yam extract, which has natural estrogens. Or soy, which could take care of both hot flashes and lactose intolerance. He may not cure you. But he sure can’t kill you.

Reach Emil Guillermo at emil@amok.com.