Women’s Health and the Women’s Health and the Media: Media:

Where do we find Where do we find trustworthy information?trustworthy information?

What are the key challenges?What are the key challenges?

Media portrayals of new Media portrayals of new medical research often medical research often inaccurate inaccurate

A societal embracing of A societal embracing of the “quick fix” or “pill for the “quick fix” or “pill for every ill” approachevery ill” approach

Key Challenges….Key Challenges….

Increasing influence of the Increasing influence of the pharmaceutical industry pharmaceutical industry over physician prescribing over physician prescribing practices as well as the practices as well as the educational and advertising educational and advertising materials aimed at the materials aimed at the consumer or patientconsumer or patient

Amidst the plethora of Amidst the plethora of websites, ads and other websites, ads and other sources, how does one sources, how does one find trustworthy find trustworthy information?information?

Know the source of your Know the source of your information and look out for information and look out for conflicts of interestconflicts of interest

Utilize non-commercial websites Utilize non-commercial websites prepared by those who know prepared by those who know how to evaluate the quality of how to evaluate the quality of the research that they citethe research that they cite

Use more than one sourceUse more than one source

EXAMPLE OF CHILDBIRTH EXAMPLE OF CHILDBIRTH AND THE RISING AND THE RISING

CESAREAN SECTION RATES CESAREAN SECTION RATES IN THE UNITED STATESIN THE UNITED STATES

Reasons for Rising Cesarean Reasons for Rising Cesarean RatesRates

(IOM 1989 report)(IOM 1989 report) 30% of the rise due to diagnosis of 30% of the rise due to diagnosis of

dystocia (abnormal or difficult dystocia (abnormal or difficult labor)labor)

25-30% due to repeat cesarean 25-30% due to repeat cesarean sectionsection

10-25% due to breech presentation10-25% due to breech presentation 10-15% due to fetal distress10-15% due to fetal distress

Current reasons for rising Current reasons for rising cesarean ratescesarean rates

Primarily changes in obstetrical Primarily changes in obstetrical practice, such as:practice, such as:

- More repeat cesareans- More repeat cesareans

- More refusals to allow - More refusals to allow VBACsVBACs

- Concerns about malpractice- Concerns about malpractice

- More advocates of - More advocates of medically-medically- unnecessary unnecessary cesareanscesareans

NCHS TRACKING IN 2004NCHS TRACKING IN 2004 ““CCesarean delivery rate rose 6 esarean delivery rate rose 6

percent in 2004 to 29.1 percent percent in 2004 to 29.1 percent of all births, the highest rate of all births, the highest rate ever reported in the United ever reported in the United States”States”

From: From: http://www.cdc.gov/nchs/products/pubs/puhttp://www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths04/prelimbirths04hbd/hestats/prelimbirths04/prelimbirths04health.htmealth.htm

TRACKING in 2004 (cont.):TRACKING in 2004 (cont.):

“The rate has increased by “The rate has increased by over 40 percent since 1996. over 40 percent since 1996. For 2003–04 the primary For 2003–04 the primary cesarean rate rose 8 percent, cesarean rate rose 8 percent, and the rate of vaginal birth and the rate of vaginal birth after cesarean delivery (VBAC) after cesarean delivery (VBAC) dropped 13 percent. The dropped 13 percent. The primary rate has climbed 41 primary rate has climbed 41 percent and the VBAC rate has percent and the VBAC rate has fallen 67 percent since 1996.” fallen 67 percent since 1996.”

NIH MeetingNIH Meetingon Cesareans by “Maternal on Cesareans by “Maternal

Request” (March 27-29, Request” (March 27-29, 2006)2006)

Will media coverage of this Will media coverage of this meeting and its report meeting and its report

result in more cesareans result in more cesareans with no medical indication with no medical indication

(elective surgery)?(elective surgery)?

QUESTIONS ADDRESSED AT THE NIH QUESTIONS ADDRESSED AT THE NIH MEETING:MEETING:

What is the trend and incidence What is the trend and incidence of cesarean delivery in the US of cesarean delivery in the US and other countries?and other countries?

What are the benefits and What are the benefits and harms of cesarean “by harms of cesarean “by request” vs. attempted vaginal request” vs. attempted vaginal birth (both short-term and birth (both short-term and long-term)?long-term)? (Cont.) (Cont.)

QUESTIONS (cont.)QUESTIONS (cont.)

What factors influence What factors influence benefits and harms?benefits and harms?

What research should be What research should be done to get better evidence done to get better evidence for making decisions for making decisions regarding cesarean delivery regarding cesarean delivery “on request” vs. attempted “on request” vs. attempted vaginal delivery?vaginal delivery?

Panel’s RecommendationsPanel’s RecommendationsFinal report atFinal report at www.consensus.nih.gov/2006www.consensus.nih.gov/2006

Insufficient evidence, so more Insufficient evidence, so more research needed on benefits and research needed on benefits and risks of cesarean delivery on risks of cesarean delivery on maternal request vs. planned vaginal maternal request vs. planned vaginal deliverydelivery

Until better evidence is available, Until better evidence is available, any decision to do cesareans upon any decision to do cesareans upon “maternal request” should be “maternal request” should be carefully consideredcarefully considered

Recommendations (cont.)Recommendations (cont.)

Not recommended for women desiring Not recommended for women desiring several children given rising risks of several children given rising risks of placenta previa and accreta with each placenta previa and accreta with each cesarean deliverycesarean delivery

No cesareans upon “maternal No cesareans upon “maternal request” prior to 39 weeks or without request” prior to 39 weeks or without verification of lung maturity (because verification of lung maturity (because of significant risks of neonatal of significant risks of neonatal respiratory complications)respiratory complications)

Recommendations (cont.)Recommendations (cont.) Effective pain management Effective pain management

services should be available for services should be available for all women so that fear of pain is all women so that fear of pain is not a motivating factor for an not a motivating factor for an elective cesareanelective cesarean

NIH (or other appropriate NIH (or other appropriate Federal agency) establish a Federal agency) establish a website with up-to-date website with up-to-date informationinformation

The final report did not The final report did not adequately consider many adequately consider many recognized long-term adverse recognized long-term adverse outcomes associated with outcomes associated with cesarean surgery and did not cesarean surgery and did not take into account the impact take into account the impact that avoidable obstetric that avoidable obstetric practices can cause during practices can cause during vaginal birth.vaginal birth.

From the national Listening to Mothers II From the national Listening to Mothers II Survey of the Childbirth Connection in Survey of the Childbirth Connection in NYC NYC ((http://www.childbirthconnection.org/article.asp?ck=10401http://www.childbirthconnection.org/article.asp?ck=10401))::

56% of women who wanted a vaginal 56% of women who wanted a vaginal birth after having had a cesarean said a birth after having had a cesarean said a doctor denied them that option.doctor denied them that option.

1 out of every 4 women polled who had 1 out of every 4 women polled who had caesarean said they felt pushed into caesarean said they felt pushed into having the surgery.having the surgery.

Excellent discussions of this Excellent discussions of this meeting:meeting:

Diony Young’s editorial in the Diony Young’s editorial in the September 2006 issue of BIRTH –’ September 2006 issue of BIRTH –’ “Cesarean Delivery on Maternal “Cesarean Delivery on Maternal Request”: Was the NIH Conference Request”: Was the NIH Conference Based on a Faulty Premise?’Based on a Faulty Premise?’

Henci Goer’s piece in Lamaze e-news Henci Goer’s piece in Lamaze e-news (June 2006)(June 2006)

Rona McCandlish’s article in MIDWIFERY Rona McCandlish’s article in MIDWIFERY (v.22, 2006): “Meeting maternal request (v.22, 2006): “Meeting maternal request for Cesarean section – paving the road for Cesarean section – paving the road to hell?”to hell?”

Possible consequences of Possible consequences of these Recommendationsthese Recommendations

An increasing trend towards An increasing trend towards considering cesarean birth as a considering cesarean birth as a “normal” birth with benefits/harms “normal” birth with benefits/harms on par with vaginal birthon par with vaginal birth

Misleading coverage in the mediaMisleading coverage in the media Continued distortion of the concept Continued distortion of the concept

of “women’s right to choose”of “women’s right to choose”

““Maternal mortality and severe Maternal mortality and severe morbidity associated with low-morbidity associated with low-risk planned cesarean delivery risk planned cesarean delivery versus planned vaginal delivery versus planned vaginal delivery at term”at term”

Liu et al. CMAJ Feb 2007 Liu et al. CMAJ Feb 2007

(This study used a breech group (This study used a breech group as a surrogate for an elective as a surrogate for an elective cesarean group)cesarean group)

Among healthy women in the Among healthy women in the study:study:

27.3 per 1,000 women in the 27.3 per 1,000 women in the planned cesarean group planned cesarean group (breech births) had severe (breech births) had severe complications (such as major complications (such as major infections or blood clots) vs. infections or blood clots) vs. 9 per 1,000 women in the 9 per 1,000 women in the planned vaginal groupplanned vaginal group

From the CMAJ commentary: From the CMAJ commentary:

““This study provides This study provides additional support to a additional support to a growing body of evidence growing body of evidence suggesting that primary suggesting that primary elective cesarean birth may elective cesarean birth may place both mother and place both mother and newborn at greater risk for newborn at greater risk for adverse outcomes than adverse outcomes than planned vaginal birth” planned vaginal birth”

COSMETIC SURGERY is COSMETIC SURGERY is the fastest growing the fastest growing medical specialty in medical specialty in

the U.S.the U.S.

Breast implants solely for Breast implants solely for cosmetic purposes are cosmetic purposes are increasing in popularity increasing in popularity despite substantial risks despite substantial risks associated with both associated with both silicone and saline silicone and saline implants.implants.

See the booklet prepared by the See the booklet prepared by the US Food and Drug Administration US Food and Drug Administration for photographs and descriptions for photographs and descriptions of adverse implant outcomes of adverse implant outcomes such as disfigurement, capsular such as disfigurement, capsular contracture (when the breast contracture (when the breast becomes hard and misshapen), becomes hard and misshapen), and deflation: and deflation:

www.fda.gov/cdrh/breastimplantswww.fda.gov/cdrh/breastimplants))

Sample Photo from Sample Photo from Implant Maker’s WebsiteImplant Maker’s Website

Photo of Capsular Photo of Capsular ContractureContracture

From FDA BookletFrom FDA Booklet

This is the same 27-year old This is the same 27-year old woman after her painful woman after her painful implants were removedimplants were removed

Necrosis in mastectomy Necrosis in mastectomy patient with implants for patient with implants for

one weekone week

After removal of one After removal of one woman’s leaking silicone woman’s leaking silicone

implants implants

According to the According to the American Society for American Society for Aesthetic Plastic Aesthetic Plastic Surgery, 364,610 Surgery, 364,610 women got breast women got breast implants in 2005. The implants in 2005. The number was up 9 number was up 9 percent from 2004.percent from 2004.

““It's like being set free, from It's like being set free, from being trapped in a bad body, being trapped in a bad body, to being set free in a nice to being set free in a nice body.”body.”

From: ‘From: ‘More women having ‘mommy More women having ‘mommy makeovers’ makeovers’ by Kim Baerby Kim BaerThe Free Lance-StarThe Free Lance-Star

(Fredericksburg, VA) March 13, 2007(Fredericksburg, VA) March 13, 2007

A survey by the American A survey by the American Society of Plastic Surgeons Society of Plastic Surgeons showed that nearly 40 percent showed that nearly 40 percent of plastic surgery patients of plastic surgery patients believe they should have been believe they should have been more proactive in learning more proactive in learning about potential side effects about potential side effects and complications before and complications before surgery. surgery.

““There are over-the counter There are over-the counter creams and lotions. And creams and lotions. And

then there’s Botox then there’s Botox Cosmetic. My doctor says Cosmetic. My doctor says they’re just not the same. they’re just not the same. She said only prescription She said only prescription Botox is approved by the Botox is approved by the

FDA to treat the frown lines FDA to treat the frown lines between your brows…”between your brows…”

A large coalition of groups:A large coalition of groups:

See See www.safecosmetics.orgwww.safecosmetics.org

“ “Skin Deep” a report of the Environmental Skin Deep” a report of the Environmental Working Group, helps consumers and workers Working Group, helps consumers and workers to better protect themselves from known or to better protect themselves from known or suspected carcinogens and reproductive toxins.suspected carcinogens and reproductive toxins.

In October 2005, Governor Schwarzenegger signed the Safe Cosmetics Act into California law. As of January 1, 2007, cosmetics manufacturers in the state will be required to disclose any product ingredients that cause cancer or birth defects. 

Harmful Substances to AvoidHarmful Substances to Avoid

Para-phenylenediaminePara-phenylenediamine, a chemical , a chemical found in some dark hair dyes (may found in some dark hair dyes (may increase risk for bladder cancer in increase risk for bladder cancer in humans)humans)

Phthalates,Phthalates, typically used as a typically used as a solvent and plastic softener and also solvent and plastic softener and also found in many shampoos and other found in many shampoos and other hair products, cosmetics, deodorants hair products, cosmetics, deodorants and nail polish (has been linked to and nail polish (has been linked to cancer and to birth defects of the cancer and to birth defects of the male reproductive system). To learn male reproductive system). To learn more, go to more, go to www.nottoopretty.orgwww.nottoopretty.org. .

To avoid (continued):To avoid (continued):

Talc,Talc, in talcum powder (has in talcum powder (has been linked to a 60% increase been linked to a 60% increase in the risk for ovarian cancer in in the risk for ovarian cancer in women who use it in the women who use it in the genital area).genital area).

Propylene glycolPropylene glycol, an ingredient , an ingredient found in some moisturizing found in some moisturizing products and skin creams (may products and skin creams (may damage the kidneys and liver). damage the kidneys and liver).

What to do to minimize riskWhat to do to minimize risk

Read labels carefully and Read labels carefully and choose all-natural choose all-natural alternatives, such as alternatives, such as products made with olive products made with olive oil, safflower oil or oatmeal, oil, safflower oil or oatmeal, whenever possible.whenever possible.

Direct-to-Consumer Direct-to-Consumer Advertising of Advertising of

Prescription Drugs:Prescription Drugs:

Misleading Ads and How Misleading Ads and How They Hurt UsThey Hurt Us

The Public Gets MisinformationThe Public Gets Misinformation

Benefits are often overstated, Benefits are often overstated, while risks are understatedwhile risks are understated

FDA warning letters are FDA warning letters are issued issued after after the ads runthe ads run

Corrective ads are rarely Corrective ads are rarely requiredrequired

Withdrawal of an ad is the Withdrawal of an ad is the only penaltyonly penalty

Ads are geared primarily to Ads are geared primarily to selling more drug product, selling more drug product, not educating the usernot educating the user

The ads work: the most The ads work: the most highly advertised drugs, highly advertised drugs, accompanied by accompanied by promotional campaigns promotional campaigns geared to physicians, sell geared to physicians, sell extremely wellextremely well

Top selling drug in the Top selling drug in the world?world?

Lipitor (Pfizer)Lipitor (Pfizer)

(with more than 13 (with more than 13 billion dollars in sales in billion dollars in sales in 2005)2005)

Drugs can be quite useful, Drugs can be quite useful, but “Pills for Prevention” but “Pills for Prevention” may not be the best may not be the best approach. approach.

Important to promote a Important to promote a view of public health that view of public health that stresses primary stresses primary prevention – identifying prevention – identifying and eliminating disease-and eliminating disease-causing agents in our causing agents in our food, water, and air. food, water, and air.

Precautionary Principle of Public Precautionary Principle of Public HealthHealth::

When an activity raises threats of When an activity raises threats of harm to the environment or harm to the environment or human health, precautionary human health, precautionary measures should be taken even if measures should be taken even if some cause and effect some cause and effect relationships are not fully relationships are not fully established.established.

Science and Environmental Health Network: Science and Environmental Health Network: www.sehn.orgwww.sehn.org

Consider the example of an Consider the example of an ad for SARAFEM (Prozac ad for SARAFEM (Prozac repackaged as a pink and repackaged as a pink and purple capsule) at purple capsule) at www.sarafem.comwww.sarafem.com

(ad since removed):(ad since removed):

  

””Think it’s PMS? Think Again…Think it’s PMS? Think Again…it could be PMDD…”it could be PMDD…”

Picture of a young woman Picture of a young woman trying to zip her jeans (too trying to zip her jeans (too bloated?); picture of another bloated?); picture of another woman seemingly distressed…woman seemingly distressed…

Then text follows:Then text follows:

““Irritability, sadness, sudden Irritability, sadness, sudden mood changes, tension, mood changes, tension, bloating. If you suffer from bloating. If you suffer from many of these symptoms many of these symptoms month after month and they month after month and they clearly interfere with your clearly interfere with your daily activities and daily activities and relationships you could have relationships you could have PMDD… PMDD…

“…“…PMDD, Premenstrual PMDD, Premenstrual Dysphoric Disorder, is a Dysphoric Disorder, is a distinct medical condition distinct medical condition that is characterized by that is characterized by intense mood and physical intense mood and physical symptoms right before symptoms right before your period.”your period.”

““Sarafem can help. Doctors Sarafem can help. Doctors can treat PMDD with can treat PMDD with

medication for PMDD”medication for PMDD”

Constantly flashing, each Constantly flashing, each shown consecutively:shown consecutively:

“ “Mood swings---irritability---Mood swings---irritability---bloated feeling”bloated feeling”

Drug regulators in Europe Drug regulators in Europe forced Eli Lilly to drop forced Eli Lilly to drop PMDD as one of the PMDD as one of the approved uses for Prozac approved uses for Prozac (Sarafem), as the data did (Sarafem), as the data did not provide adequate not provide adequate evidence of efficacy.evidence of efficacy.

Current content at this website Current content at this website has changed. Sample quote:has changed. Sample quote:

“ “Many physicians believe Many physicians believe that Sarafem helps to that Sarafem helps to correct the imbalance of correct the imbalance of serotonin that could serotonin that could contribute to PMDD.”contribute to PMDD.”

“ “Antidepressants increased the risk of Antidepressants increased the risk of suicidal thinking and behavior in suicidal thinking and behavior in children and teenagers with depression children and teenagers with depression and other psychiatric disorders.and other psychiatric disorders.

Patients starting therapy should be Patients starting therapy should be observed closely for worsening observed closely for worsening depression symptoms, suicidal depression symptoms, suicidal thoughts or behavior, or unusual thoughts or behavior, or unusual changes in behavior.changes in behavior.

Sarafem is not approved for use in Sarafem is not approved for use in patients under the age of 18.”patients under the age of 18.”

The ad was misleading because it The ad was misleading because it mixed “relative risk” with mixed “relative risk” with “absolute risk,” noting, for “absolute risk,” noting, for example, the following:example, the following:

44% fewer breast cancers in 44% fewer breast cancers in women taking tamoxifen vs. women taking tamoxifen vs. women taking a placebowomen taking a placebo

But there was NO mention of the But there was NO mention of the following following relative riskrelative risk: a 252% : a 252% increased risk of endometrial increased risk of endometrial cancer cancer

The ad also noted a risk of The ad also noted a risk of serious problems such as serious problems such as endometrial cancer or blood endometrial cancer or blood clots at “only” 1-2% clots at “only” 1-2% ((absolute riskabsolute risk))

But left out was any mention But left out was any mention that women have only a that women have only a 1.8% chance of benefiting 1.8% chance of benefiting from the drug (from the drug (absolute absolute benefitbenefit))

Unpaid advertising also a problem:Unpaid advertising also a problem:

ParadeParade magazine, for example, put magazine, for example, put model Lauren Hutton on its cover model Lauren Hutton on its cover for a piece on celebrity beauty tips, for a piece on celebrity beauty tips, and quoted her saying her "No. 1 and quoted her saying her "No. 1 secret is estrogen. It’s good for secret is estrogen. It’s good for your moods, it’s good for your skin. your moods, it’s good for your skin. If I had to choose between all my If I had to choose between all my creams and makeup for feeling and creams and makeup for feeling and looking good, I’d take the looking good, I’d take the estrogen.”estrogen.”

The article didn’t mention The article didn’t mention that Hutton was a paid that Hutton was a paid spokesperson for Wyeth spokesperson for Wyeth Ayerst, and that she Ayerst, and that she appeared in their ads. It also appeared in their ads. It also didn’t mention that Hutton's didn’t mention that Hutton's claims for estrogen's benefits claims for estrogen's benefits were not backed up by valid were not backed up by valid scientific evidence.scientific evidence.

““Female Sexual Female Sexual Dysfunction”Dysfunction”

Is this a serious problem Is this a serious problem requiring primarily requiring primarily biomedical solutions, or biomedical solutions, or is a different approach is a different approach most often called for?most often called for?

In 1999, Pfizer consultants In 1999, Pfizer consultants analyzed analyzed oneone question question from a 1994 survey and from a 1994 survey and

produced an overly produced an overly simplisticsimplistic conclusion – conclusion – that 43% of American that 43% of American women “suffer from” women “suffer from” sexual dysfunctionsexual dysfunction

Idea MarketingIdea Marketing A A disease disease

awareness awareness campaigncampaign is is now building a now building a drug market drug market usingusingthe 43% FSD the 43% FSD statistic.statistic.

(Slide Courtesy of Leonore (Slide Courtesy of Leonore Tiefer)Tiefer)

To To promote promote

“The Hunt “The Hunt for the for the

Pink Pink Viagra”Viagra”

(Slide Courtesy of (Slide Courtesy of Leonore Tiefer)Leonore Tiefer)

For more information For more information about female sexual about female sexual problems, see the problems, see the website of the Campaign website of the Campaign for a New View of for a New View of Women’s Sexual Women’s Sexual Problems:Problems:

www.fsd-alert.orgwww.fsd-alert.org

MenopauseMenopause

Every day 5,000 women in the U.S. enter menopause, the so-called “change of life”

What do we think about What do we think about menopause?menopause?

Some women see it as “the end Some women see it as “the end of sex” or the “end of youth”of sex” or the “end of youth”

Some see a passport to freedom Some see a passport to freedom (no fear of getting pregnant, no (no fear of getting pregnant, no messing with pads and tampons, messing with pads and tampons, no more “shoulds” about how no more “shoulds” about how one needs to “look”)one needs to “look”)

Possibly more time for oneselfPossibly more time for oneself

What influences our What influences our thinking?thinking?

Media messages that worship Media messages that worship youth, thinness, and suggest youth, thinness, and suggest “it’s not OK to grow old”“it’s not OK to grow old”

Conversations with other Conversations with other women about their actual women about their actual experiences with menoapuseexperiences with menoapuse

Opportunities for Opportunities for MedicalizationMedicalization

Less/no interest in sexLess/no interest in sex

Hot flashes/vaginal dryness Hot flashes/vaginal dryness and loss of elasticityand loss of elasticity

Loss of bone densityLoss of bone density

More “spreading More “spreading waistlines” and sagging waistlines” and sagging skin skin

Memory problemsMemory problems

DepressionDepression

Problems with sleepProblems with sleep

Approaches to dealing with Approaches to dealing with sleep problems other than sleep problems other than prescription sleeping drugs prescription sleeping drugs

such as Ambien and Lunesta:such as Ambien and Lunesta:

Yoga/exerciseYoga/exercise Avoiding caffeineAvoiding caffeine Deep breathing/massage at Deep breathing/massage at

bedtime from a partnerbedtime from a partner Sleep in a cool roomSleep in a cool room

Non-hormonal approaches Non-hormonal approaches to dealing with hot flashesto dealing with hot flashes

Wear layered clothingWear layered clothing Use fansUse fans Put palms or bare feet on a cold Put palms or bare feet on a cold

surfacesurface Cold pack under the pillowCold pack under the pillow Exercise, yoga, deep breathingExercise, yoga, deep breathing Less caffeine, less spicy foods, Less caffeine, less spicy foods,

less alcohol (especially red wine)less alcohol (especially red wine)

Removing health ovaries Removing health ovaries US federal data from the late US federal data from the late

1990s:1990s: 78% of women 45-64 who 78% of women 45-64 who

have had a hysterectomy have had a hysterectomy also had healthy ovaries also had healthy ovaries removed (even though most removed (even though most were not at particular risk of were not at particular risk of developing ovarian cancer).developing ovarian cancer).

Latest research shows that Latest research shows that for women without a family for women without a family history of ovarian cancer history of ovarian cancer there is a significant there is a significant reduction in death from heart reduction in death from heart disease and complications of disease and complications of osteoporosis IF THE OVARIES osteoporosis IF THE OVARIES ARE KEPT, especially until ARE KEPT, especially until the age of 65.the age of 65.

KEY FINDINGS OF WILLIAM PARKER et KEY FINDINGS OF WILLIAM PARKER et al study in 2005:al study in 2005:

For 10,000 women 50-54 yrs old For 10,000 women 50-54 yrs old who undergo a hysterectomy who undergo a hysterectomy with oophorectomy, there will be with oophorectomy, there will be 47 fewer cases of ovarian 47 fewer cases of ovarian cancer by the time these women cancer by the time these women reach 80 when compared with a reach 80 when compared with a similar group who keep their similar group who keep their ovaries.ovaries.

BUT the oophorectomy group BUT the oophorectomy group will suffer 838 additional will suffer 838 additional deaths from coronary heart deaths from coronary heart disease as well as 158 more disease as well as 158 more deaths from hip fractures. deaths from hip fractures. (Numbers reflect women who (Numbers reflect women who do NOT have estrogen therapy do NOT have estrogen therapy – there is a smaller survival – there is a smaller survival benefit to keeping the ovaries benefit to keeping the ovaries in women taking estrogen.) in women taking estrogen.)

Ads for bone density screening Ads for bone density screening now pitched at women around 50 now pitched at women around 50 yrs of ageyrs of age

Creation of the ”T” score and a Creation of the ”T” score and a new classification called new classification called osteopenia (for -1 to -2.5 scores)osteopenia (for -1 to -2.5 scores)

Merck stopped by the FDA from Merck stopped by the FDA from using the claim “menopause is the using the claim “menopause is the single most important cause of single most important cause of osteoporosis” in their adsosteoporosis” in their ads

Cloning, Stem Cells and Cloning, Stem Cells and Inheritable Genetic Inheritable Genetic

ModificationModification

Special case of embryo Special case of embryo cloning (somatic cell cloning (somatic cell

nuclear transfer)nuclear transfer)

Research: the promises and Research: the promises and the challengesthe challenges

Balancing our interest in Balancing our interest in developing new medical developing new medical therapies with the need to therapies with the need to protect research subjects and protect research subjects and the need to preserve values of the need to preserve values of social justice and equitysocial justice and equity

Developing technologies that will Developing technologies that will be accessible to mostbe accessible to most

Often Ignored ConcernsOften Ignored Concerns

Risks to women’s healthRisks to women’s health

Gateway to “designer babies”Gateway to “designer babies”

Unethical experimentation on Unethical experimentation on humanshumans

Fueling of a new eugenics Fueling of a new eugenics movementmovement

Risks to Women’s Health from Risks to Women’s Health from Research CloningResearch Cloning

Also known as “therapeutic Also known as “therapeutic cloning” or “somatic cell cloning” or “somatic cell nuclear transfer” (SCNT), SCNT nuclear transfer” (SCNT), SCNT requires the collection of many requires the collection of many eggs from women willing to eggs from women willing to undergo egg extraction undergo egg extraction procedures.procedures.

Some Concerns about Multiple Some Concerns about Multiple Egg ExtractionEgg Extraction

Use of leuprolide acetate (LupronUse of leuprolide acetate (Lupron™™), ), a GnRH agonist, to “shut down” the a GnRH agonist, to “shut down” the ovaries, is not FDA-aproved for this ovaries, is not FDA-aproved for this purpose (Antagonpurpose (Antagon™, a GnRH ™, a GnRH antagonistantagonist that is also used, is that is also used, is approved for this use.)approved for this use.)

Use of drugs that hyper-stimulate Use of drugs that hyper-stimulate the ovaries to produce multiple the ovaries to produce multiple folliclesfollicles

As Spring of 1999, US Food As Spring of 1999, US Food and Drug Administration and Drug Administration (FDA) had received 4228 (FDA) had received 4228 reports of adverse drug reports of adverse drug events from women using events from women using Lupron.™ 325 of the adverse Lupron.™ 325 of the adverse events for women reported to events for women reported to the FDA resulted in the FDA resulted in hospitalization, and hospitalization, and additionally, 25 deaths were additionally, 25 deaths were reported.reported.

The Research Cloning DebateThe Research Cloning Debate

The most vocal participants have The most vocal participants have beenbeen

Anti-choice conservatives Anti-choice conservatives opposed to the destruction of opposed to the destruction of embryos, who favor a embryos, who favor a permanent banpermanent ban

Biomedical researchers and Biomedical researchers and their allies, who are wary of or their allies, who are wary of or opposed to regulatory oversightopposed to regulatory oversight

Good ResourcesGood Resources National Women’s Health Network (DC)National Women’s Health Network (DC) Breast Cancer Action (SF)Breast Cancer Action (SF) Collaborative on Health and the EnvironmentCollaborative on Health and the Environment Science and Environmental Health NetworkScience and Environmental Health Network Silent Spring Institute (Newton, MA)Silent Spring Institute (Newton, MA) Teen Voices magazine (Boston)Teen Voices magazine (Boston) Center for Medical Consumers (NYC)Center for Medical Consumers (NYC) Canadian Women’s Health Network (CWHN)Canadian Women’s Health Network (CWHN) www.ourbodiesourselves.orgwww.ourbodiesourselves.org

www.ourbodiesourselves.orgwww.ourbodiesourselves.orgMay 2005May 2005