cancer Archives - Page 3 of 3

Pondering Cancer: the Hubris of Innovation

Published on October 5, 2011

3.9K views

This week begins breast cancer awareness month, a movement started 25 years ago largely by women and family members affected by cancer. The efforts of these men and women have been extraordinarily successful. Who doesn’t associate the pink ribbons with breast cancer? To boot, the public awareness catalyzed the need for research. The War on Cancer was born and a staggering amount of federal and private dollars research dollars have poured into cancer research. Federal breast cancer research dollars totaled $763 million in 2010.

And yet, except for the years between 1999-2005, which saw a 2% decline in new diagnoses (NCHS, SEER), largely attributed to the post-WHI decline in HRT use, breast cancer rates have increased steadily over the last two decades. The incidence of breast cancer is now 1 in 8 women (SEER). It seems the war on breast cancer has not been won.

I am not a cancer researcher and so my thoughts on cancer are offered with some trepidation. Sure, I did the requisite pharmacology papers and presentations in graduate school and even taught the basics in some of my undergraduate courses, but I don’t really know cancer, not like I know other disease processes. And so, as I pondered the state of cancer and reviewed the statistics, looking for an angle into this post, somewhere I could add to the conversation and not just regurgitate existing pablum, what became clear was a nagging sense of intellectual unease. Despite the billions spent on cancer research and the bevy of new treatments, more women are getting cancer than ever before. Perhaps better diagnostics explain the ever increasing incidence of breast cancer. Perhaps not.

Like so many modern diseases, cancer sits at the nexus between high and low science, between medicine and marketing. It is one of those diseases that at once benefits from 20th-21st century science and technology, and suffers immensely from the hubris of those same innovations.

A case and point: a report by the Personalized Medicine Coalition published three years ago and discussed last year in Bloomberg BusinessWeek indicates that of the $292 billion dollars spent on prescription medications in 2008 almost 50% went to medications that didn’t work. That means in one year, we spent $145 billion on medications that didn’t work. The report goes on to suggest that billions more were spent treating the side effects and adverse reactions.

Aside from the ridiculous amount of money spent on medications that don’t work and the billions more spent mitigating the potentially serious side-effects of these medications, both of which threaten our national economy in a very tangible manner; aside from the economics, the point that may be lost in this conversation, is that we are ingesting these medications and trusting them to work or at least not make us worse.

What happens when medications originally intended for one use are marketed for another? What happens when the need for blockbuster drug sales overshadows the actual benefits of a medication or worse yet, hides the dangers (DES, HRT, Vioxx, Yaz/Yasmin)? What happens when we disregard basic genetics, basic science and common sense when prescribing a medication? What happens when we use the one-size-fits-all or the one pill-cures-all approach?

Are we creating the very cancers we are trying to treat?

Women’s Hormones: An Intellectual and Ethical Cul de Sac

by Chandler Marrs, PhD

Published on September 21, 2011

9K views

Menopause is barreling down with a ferocity that is difficult to ignore. Like many women my age, I’ve had my share of health challenges and, until recently, blindly trusted the pharmaceutical industry to fix all that ailed me. Health by chemistry was a great thing; oral contraceptives, a fabulous invention, allergy meds – ditto, pain killers – wonderful, and on, and on. Take a pill and feel better, isn’t that what we all want? But I, like so many women, have lost faith in pharmaceuticals. It’s not because the science isn’t cool, it is, in every area of pharmacology, except women’s hormone therapies. Here, intellectual curiosity and innovation have been replaced by status quo. Little has changed in this area of hormones and health in 60 years.

Hormones, Hormones, Everywhere and No Innovation in Sight

Since their inception, hormone replacement therapies (HRT) and oral contraceptives have dominated women’s health, immediately moving from seemingly narrow applications when first introduced to the almost mythical status as cure-alls for any female and many general health ailments. The history of both these pills is strikingly inglorious and utterly dumbfounding. Just on general principle, why would anyone believe any medication could be so widely beneficial for so many apparently disparate conditions? It is physiologically impossible.

For HRT especially, if one believes the marketing, the pills provide a veritable fountain of youth. Where is the science? But believe we did, and generations of women may now be paying the consequences.

From the very first estrogens synthesized and marketed to women everywhere (diethylstilbestrol- DES), through today’s HRTs and OCs, profit appears to override health concerns. Even in the 1930’s and 1940s before these drugs came to market, the carcinogenic risks were well known, and yet, they garnered FDA approval and were sold to millions, upon millions of women.

Synthetic Hormones

I have personal experience only with the often ignored side effects of oral contraceptives, as I have yet to reach the age of menopause. In my 20s, while on the presumable high estrogen dose of oral contraceptives that were common then, I had intense bouts of vertigo that would develop even when lying down and ever increasing blood pressure. After years of expensive testing could find no neurological cause for the vertigo and after repeated prescriptions to lower my blood pressure, I stopped taking the pill. I had enough. The vertigo stopped fairly soon thereafter and the blood pressure returned to normal. Over those several years, there was not a single physician that suggested I stop taking the pill, indeed I was prescribed more and more meds to counter the apparently unknown side effects of oral contraceptives and it was recommended I see a shrink because the vertigo had to be psychosomatic.

I look back at that time and I wonder how many other women suffered similar circumstances. What is this propensity to prescribe and continue prescribing medications in the face of apparent ill effects? Why are we ignoring, even at the patient level, the possibility that some meds may not work for some women (or men). The statistics bear this out, but there seems to be a natural inclination to minimize these risks. This is compounded of course, by intense marketing.

As I approach this menopausal stage, I again will be faced with yet another hormone-issue for which the choices are bad and worse. We know from the Women’s Health Initiative (WHI) in 2002, that HRT is not the panacea it was marketed to be and the risks associated with this medication are not benign.

Over a one year period, for every 10,000 women taking and estrogen plus progestin, the risk of developing these conditions increases by:

• Heart disease: 7 additional cases
• Breast cancer: 8 additional cases
• Stroke: 8 additional cases
• Blood clots: 18 additional cases

For estrogen only:

• Stroke: 12 additional cases
• Blood Clots: 6 additional cases

Consider however, the millions of women who will take or have taken HRT for years. As of 2010, over eight million women in the US alone take HRT, and will likely do so for at least a couple years. In this light, the increased risk of disease looks a lot scarier.

• Heart disease: 5600 new cases per year; 28,000 in five years
• Breast cancer: 6,400 new cases per year; 32,000 in five years
• Stroke: 6,400 new cases per year; 32,000 in five years
• Blood clots: 14,400 new cases per year; 72,000 in five years

When the WHI was published, some 17 million women in the US had been taking HRT for many, many years, even decades. That’s 13,600 new cases of breast cancer per year, 68,000 in five years! Despite these data, and the thousands of lawsuits that followed, HRT is still one of the most frequently prescribed medications worldwide. I think we can do better.

Statistics from the Mayo Clinic

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