Premarin — the Hidden Costs

by Holly Stewart and Vivienne Murray

For decades, one of the best-kept pharmaceutical secrets has been the abuse of horses involved in the production of Premarin. Women who have been prescribed Premarin for estrogen-replacement therapy (ERT) may be shocked to know that its main ingredient is pregnant mare's urine (PMU). Taken by an estimated 8 million women worldwide, Premarin is the only ERT drug made from animal waste. Produced by Wyeth-Ayerst Laboratories, Premarin is taken by millions of post-menopausal women. In 1992, sales of the drug amounted to $642 million - 14 percent of Wyeth-Ayerst's $4.5 billion revenue. With production of the drug raising serious humane concerns for the pregnant mares kept in factory-farming conditions, and the serious side-effects experienced by women using hormone replacement therapy, many are looking for alternatives.

Humane Concerns

As many as 100,000 mares are on the production line of 600 farms in North Dakota and western Canada, Manitoba. The mares are tied in stalls so small they cannot turn around or comfortably lie down, for 7 months of their 11-month pregnancies. Irritating rubber sacks are strapped to the mares' haunches to their urine can be collected to make Premarin, and the horses are denied free access to water so their urine will yield a more concentrated estrogen. After the mares give birth to foals each spring, they are impregnated again and put back in the stalls. The foals are an unfortunate by-product of the production line, and most are sent off to slaughter to end up as food in Europe and Japan.

A recent issue of The Animals' Agenda reported on an inspection of more than 30 Pregnant Mare Urine Farms in Alberta, Saskatchewan and Manitoba in 1995, by an international team of 12 equine experts organized by the Canadian Farm Animal Care Trust (CANFACT). "In February in central Canada, temperatures can drop to 40 below zero, enough to freeze exposed flesh in one minute. On such a day, the team of inspectors arrived at a Manitoba PMU farm." From a window inside a barn where dozens of mares were tethered in their stalls, inspector Joe Silva saw a mare lying motionless on the ground outside, and another struggling to rise. Silva and the two veterinarians on the inspection team went outside with the farmer's son to examine the downed mares. The farmer said, "Yeah, we noticed them last night, so we threw them out to see if they would come around." That night the temperature outside was -33 degrees C before the wind chill factor. One horse was dead on the ground. The visiting veterinarians reported that the struggling mare was colicky, and in trouble. The farmer was told to summon his veterinarian, but by the time the inspection team left, the veterinarian had not arrived.

Silva, representing the World Society for the Protection of Animals (WSPA) said "We saw for ourselves that the conditions in those barns do not meet our standards for basic humane care of equines. The horses are kept in tiny stalls for months at a time without what we consider a sufficient amount of exercise, water, and veterinary oversight. We feel strongly that Wyeth-Ayerst has a moral responsibility to these horses and to the consumer, to either provide a more comfortable environment for the mares or to stop producing Premarin altogether."

Concerns about PMU farming practices extend beyond the treatment of the pregnant horses. The thousands of foals born to the mares are considered a by-product of the PMU industry, and their fate is grim. According to the Winnipeg Humane Society, 31,000 of the 37,000 foals born in Manitoba and Saskatchewan in 1995 will be sold to feedlots, where they will be fattened for slaughter. Thousands more foals born on Alberta and North Dakota farms face similar deaths.

Will Anderson, Campaign Coordinator for the Progressive Animal Welfare Society (PAWS) in Washington, has documented the shipment of live horses to Japan for human consumption, where the meat is considered fresher and more of a delicacy if it is killed just before being eaten. Shipping live horses overseas is extremely difficult and can cause injuries to the animals. Horses sent to Japan are supplied by Schrono Agribusiness (in Washington) and are shipped via Federal Express. According to Anderson, many of these horses are about two years old and are purchased as foals from PMU farms. Mares on PMU farms are "in production" for about eight or nine years, after which they, too, usually are sent to slaughter.

Hormone Replacement Therapy Raises Health Concerns

In the Autumn 1995 issue of Good Medicine, (Physicians Committee for Responsible Medicine), Dr. Neal Barnard addressed the hormone replacement issue: The New England Journal of Medicine of June 15, 1995, reported that hormone replacement therapy increases the risk of breast cancer. This was not news to most doctors. But many have continued to prescribe hormones because they feel that the benefits to the heart and bones outweigh the cancer risk. Estrogen supplements can have serious side effects. They are particularly risky for women with clotting disorders, undiagnosed vaginal bleeding, liver disease, and a past personal or family history of breast cancer. They increase the risk of uterine cancer, unless progesterone (or a synthetic progesterone-like drug) is added to the regimen. Women taking estrogen have 30 to 80 percent more breast cancer risk than other women.

So why are so many doctors prescribing them? Most of the push relates to osteoporosis and heart disease. Osteoporosis is very common in Caucasian women (less so among other races), about a quarter of women having compression fractures of their vertebrae, and many developing hip fractures due to the gradual loss of bone. But estrogens are not nearly as good at protecting the bones as women may be led to believe, and they rarely arrest bone loss. At their best, estrogens simply slow the rate of bone deterioration.

Other approaches can be much more effective, and they do not cause cancer. For example, a major article in the American Journal of Clinical Nutrition reported last year that eliminating animal protein from the diet can cut urinary calcium losses in half, resonating with other studies showing that populations that follow plant-based diets have enviably low rates of hip fracture. Cutting salt intake can reduce your calcium losses even further. Limit your caffeine consumption to no more than two cups of coffee per day, and you will hold onto still more calcium. If you don't smoke, you'll also avoid the 10 percent loss of bone that plagues chronic smokers. If you put these factors together, they are a powerful and safe approach for strong bones."

For heart disease, hormones are no match for lifestyle changes. As Dr. Dean Ornish's pioneering work has shown, a combination of low-fat vegetarian diet, mild exercise, stress reduction, and smoking cessation is powerful enough to actually reverse heart disease in 82 percent of patients in one year.

There Is No Japanese Word For Hot Flashes

It has long been known that menopause is much easier for Asian women than it is for most Westerners. Hot flashes are reported by only about 10 percent of Japanese women at menopause. Not only are hot flashes much rarer, but bone strength is not assaulted to the extent it often is among Western women. Broken hips and spinal fractures are much less common.

The most likely explanation is this: Throughout their lives, Western women consume much more meat and about four times as much fat as do women on traditional rice-based diets, and only one-quarter to one-half the fibre. The result is a chronic elevation of estrogen levels. Asian women have lower levels of estrogen both before and after menopause, and the drop appears to be less dramatic. The resulting symptoms are much milder or even non-existent. Those who enter menopause on a low-fat, vegetarian diet often breeze right through it. This does not mean that women who have more symptoms have somehow failed, but it is a good reason to learn about how foods can affect this aspect of health.

Safer Alternatives

Following diet and lifestyle changes, women still looking for a hormone replacement alternative to Premarin can ask their doctor about the following products:

• Estrace
• Estraderm
• Ogen
• Ortho-Est
• Estratab
• Menest
• Estinyl
• Estrovirus
• Ortho-Dienestrol, and
• Tace.

A number of herbal and dietary alternatives to estrogen may produce the same beneficial results.

To express your concern about the PMU industry, write to: Mr. Robert Essner, President, Wyeth-Ayerst, P.O. Box 8299, Philadelphia, PA 19101.

Sources:

"A Pill Full of Problems" The Animals' Agenda, Vol. 16, No. 2
"Hormone Replacement Increases Cancer Risk" Good Medicine, Vol. 4, No. 3
"Premarin: Just Say No!" Animal Protection Institute
"Results of Pharmacist Servey on Premarin Released" Press Release by PETA Dec. 20, 1995