Subversive Thinking?

I had this really interesting interaction at a med-spa the other day.  Everything was proceeding just fine until the nurse practitioner asked what I did for a living – she was visibly upset when I told her about my supplements and that I advocated a non-hormonal approach to perimenopause and menopause.  “We do hormones here,” she said, and wondered why I would spread “misinformation” about nutrition and supplements being helpful.  “It’s dangerous not to replace hormones, especially testosterone. A lot of bad things happen without it. And of course you need to replace estrogen, too.”

Well, okay.  Not wanting to start a fight with a woman pointing a laser at my face, I just replied that I thought the current cultural environment made it pretty difficult to discern real facts from marketing when it comes to the whole hormone issue, and that access to complete information before resorting to medical intervention is super important.  She didn’t like that (and I started to fear for my face), when she said that “women have all the information they need! We don’t even have to advertise HRT – women come in asking for it.”

Exactly.

Hormone therapy is big business - $8.16 billion in 2020, and growing by > 6% per year, estimated to reach nearly $40 billion by 2027.[1]  This is not lost on manufacturers, and “aggressive marketing and direct selling campaigns by the key players… creates an attractive market for these therapies,” according to one industry research report. (For context, these are the types of reports that companies in every industry study as they look to expand or diversify their product lines – it’s one of the ways they determine viability of a particular line of effort before they commit resources.)  Menopause beats out every other category by “type of disease” for global hormone replacement therapy by double digits, giving estrogen the greatest market share.[2]  To wit, “estrogen-based products have been studied to generate the largest number of prescriptions thus making it the largest segment.  The presence of various branded and generic drugs and increasing awareness among women are anticipated to be the vital impact of rendering drivers.”  In other words, it’s game on in the race for your dollars in the pharmaceutical world.

Look, I get it – these companies are not charities. They are businesses, and their single mandate is to make as much money as possible for their shareholders and for the business itself so that they can continually bring new drugs to market.  It’s why they exist. If they DIDN’T try to find the fastest-growing market to cater to with new products and constantly develop new marketing campaigns to drive demand for their products, they would be derelict in their duties. 

But too often now, women conflate these marketing messages asserting that there is no other (effective) way to address what we may be feeling, and that our health and relationships and even our lives could be at risk without them, with settled scientific fact.  When we hear claims like this about a blender or a diet or a hair product (“it will change your life!”), we understand that the superlatives and hyperbole are not to be taken seriously – we’re actually in on the game - but when it comes to menopause, the filter doesn’t seem to work in quite the same way.

To complicate matters, since these are prescription medications we are talking about here, the marketing is supported by various facts and figures to give it more weight, never mind that they are generally cherry-picked from research funded by the manufacturers themselves and often even ghost-written by industry reps.[3] [4]  While all this messaging is soaking into our brains through constant repetition, someone – maybe a media figure, a celebrity or influencer, or an Association of some type – picks up on the message and runs with it, and a grown-up version of the Telephone game is born.  Every iteration of the message becomes increasingly alarmist and impossible to unravel.  And why would you try, anyway?  Trust the Science, as they say.

This is the problem. You can see it unfolding real-time in the U.K., where a whole hashtag moment – an “HRT crisis” - is happening now, and it is quickly infiltrating a North American newsfeed near you.  Media outlets are increasingly trumpeting a narrative insisting that women are unable to “work competently”[5] because of shortages of hormone replacement therapy products; that “it can be life-threatening not getting women’s HRT;” and even, “women take their own lives out of the anger and the frustration and the insecurity and anxiety they suffer from being without the medication.”[6]

Under normal circumstances, I suspect that most women would be able to take all this in with a healthy dose of skepticism, and cooler heads (pun intended) would prevail.  But when you don’t feel so great in the first place, and this message is literally all you see in the media, of course you are going to beat a path to the nearest purveyor of HRT – shit, I don’t want to lose my job or die! - and if anyone discourages you or refuses to write the prescription, it makes sense that outrage would ensue.

So here we are.

On the one hand, there is a medical intervention that has proven extremely effective in eliminating two of the most bothersome symptoms of menopause, hot flashes and vaginal dryness.  Nobody denies that for many women, it is the fastest route to relief.  But it is not the ONLY one, probably not even the best one, especially long-term, and it doesn’t come without risks.

It’s great that women have a quick, easy option available to them when the discomfort of menopause becomes a little too much.  But the poetic truth of these alarmist sound bytes fly in the face of logic.  We have just heard them repeated so often that we have stopped questioning their validity and instead take it all for settled fact.

Which brings me back to the angry nurse practitioner pointing a laser at my face.  The choice to buy a particular product out of convenience or comfort is one thing, and I’m all for it.  The choice, that is.  But when opting out or advocating for a different approach is viewed as subversive or “dangerous” in some way, well, that’s when you know that you are being sold a bill of goods.

[1] https://www.imarcgroup.com/hormone-replacement-therapy-market

[2] https://www.grandviewresearch.com/industry-analysis/hormone-replacement-therapy-market

 [3] https://www.sourcewatch.org/index.php?title=Medical_paper_ghostwriting

[4] https://www.classaction.com/news/medical-journal-ghostwriting-problem/

[5] https://money.yahoo.com/women-struggling-sleep-competently-due-082928477.html

[6] https://www.independent.co.uk/news/uk/hormone-replacement-sajid-javid-women-b2064298.html

[7] https://inews.co.uk/news/health/hrt-shortage-why-uk-menopause-patches-supply-crisis-meaning-treatment-explained-1592603?ico=in-line_link