Is Hormone Replacement Therapy Worth the Risks?

Pamela Merritt

News that there may be a link between hormone replacement therapy and lung cancer has renewed questions about the use of hormones to treat the symptoms of menopause.

It’s easy to miss reproductive health care news for all of the health care reform news breaking and unfolding of late, but recent news about a link between hormone replacement therapy and lung cancer is worthy of attention.  Hormone replacement therapy (HRT), once widely recommended to treat the symptoms of menopause, has been questioned since a 2002 study revealed an alarming increased risk of breast cancer for women on long-term HRT.

Lung cancer is the leading cause of cancer deaths for women in the United States.  Despite the alarm raised by the 2002 HRT study – it was halted as a result of the increased risk of developing breast cancer – short-term use of HRT (specifically estrogen and progestin) to treat the symptoms of natural menopause continues and many doctors and patients have determined that the risks of short-term treatment are acceptably low.  Now, with news that there may be a link between HRT and lung cancer, the use of hormones to treat the symptoms of menopause is once again being called into question.

HRT is the use of medications that contain female hormones to replace the hormones women no longer make after menopause.  Up until 2002, it was thought that HRT had long-term health benefits.  In 2002, a medical study was halted when it was discovered that study participants had an alarming increased risk for invasive breast cancer.  As a result of the 2002 HRT study, long-term use of HRT is no longer widely recommended.  Short-term use of HRT to treat the symptoms of menopause remains an option, with doctors and patients making the decision of whether or not to begin treatment on a case-by-case basis.

It is important to understand that short-term use of HRT is believed to have benefits above and beyond treating the symptoms of menopause.  Women are typically put on HRT, usually estrogen and progestin (man-made progesterone), during nonsurgical menopause. Estrogen is prescribed with progestin because estrogen can increase the risk of uterine cancer (women who undergo menopause after a hysterectomy can take estrogen alone.)  HRT can ease symptoms of menopause such as vaginal dryness, itching, burning and discomfort with intercourse.  It can also help ease the intensity and frequency of hot flashes associated with menopause.  Additional benefits of short-term HRT may include protection against osteoporosis, colorectal cancer and heart disease.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

There are also risks associated with HRT.  Patients taking estrogen and progestin may experience an increased risk of heart disease, breast cancer, stroke, blood clots and abnormal mammograms.  Women taking estrogen alone may have an increased risk of stroke, blood clots and abnormal mammograms.

Now, there is news that a new study has found patients between the ages of 50 and 76 taking estrogen with progestin may have an increased risk of lung cancer. 

Here’s what we know – the increased risk to patients on HRT developing lung cancer is connected with the duration of therapy.  The study, published in the pre-print online edition of the Journal of Clinical Oncology, found that women on HRT for 10 or more years had the greatest risk of developing lung cancer.  The risk of developing lung cancer for women on HRT (estrogen and progestin) for 10 or more years is 50 percent higher than for women not on HRT.  It is important to note that the increased risks associated with HRT are considered small compared to the risks associated with smoking.

For women who are considering whether to begin or continue HRT, these studies can be frustrating and alarming.  There is still no clear directive on what a “safe “duration of HRT is, but doctors will use these new finding to better counsel women about the risks and benefits of treatment.  There are risks associated with most medicine and women currently on HRT should consult with their doctor about what, if any, impact these new findings have regarding their individual treatment. 

Analysis Politics

The 2016 Republican Platform Is Riddled With Conservative Abortion Myths

Ally Boguhn

Anti-choice activists and leaders have embraced the Republican platform, which relies on a series of falsehoods about reproductive health care.

Republicans voted to ratify their 2016 platform this week, codifying what many deem one of the most extreme platforms ever accepted by the party.

“Platforms are traditionally written by and for the party faithful and largely ignored by everyone else,” wrote the New York Times‘ editorial board Monday. “But this year, the Republicans are putting out an agenda that demands notice.”

“It is as though, rather than trying to reconcile Mr. Trump’s heretical views with conservative orthodoxy, the writers of the platform simply opted to go with the most extreme version of every position,” it continued. “Tailored to Mr. Trump’s impulsive bluster, this document lays bare just how much the G.O.P. is driven by a regressive, extremist inner core.”

Tucked away in the 66-page document accepted by Republicans as their official guide to “the Party’s principles and policies” are countless resolutions that seem to back up the Times‘ assertion that the platform is “the most extreme” ever put forth by the party, including: rolling back marriage equalitydeclaring pornography a “public health crisis”; and codifying the Hyde Amendment to permanently block federal funding for abortion.

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

Anti-choice activists and leaders have embraced the platform, which the Susan B. Anthony List deemed the “Most Pro-life Platform Ever” in a press release upon the GOP’s Monday vote at the convention. “The Republican platform has always been strong when it comes to protecting unborn children, their mothers, and the conscience rights of pro-life Americans,” said the organization’s president, Marjorie Dannenfelser, in a statement. “The platform ratified today takes that stand from good to great.”  

Operation Rescue, an organization known for its radical tactics and links to violence, similarly declared the platform a “victory,” noting its inclusion of so-called personhood language, which could ban abortion and many forms of contraception. “We are celebrating today on the streets of Cleveland. We got everything we have asked for in the party platform,” said Troy Newman, president of Operation Rescue, in a statement posted to the group’s website.

But what stands out most in the Republicans’ document is the series of falsehoods and myths relied upon to push their conservative agenda. Here are just a few of the most egregious pieces of misinformation about abortion to be found within the pages of the 2016 platform:

Myth #1: Planned Parenthood Profits From Fetal Tissue Donations

Featured in multiple sections of the Republican platform is the tired and repeatedly debunked claim that Planned Parenthood profits from fetal tissue donations. In the subsection on “protecting human life,” the platform says:

We oppose the use of public funds to perform or promote abortion or to fund organizations, like Planned Parenthood, so long as they provide or refer for elective abortions or sell fetal body parts rather than provide healthcare. We urge all states and Congress to make it a crime to acquire, transfer, or sell fetal tissues from elective abortions for research, and we call on Congress to enact a ban on any sale of fetal body parts. In the meantime, we call on Congress to ban the practice of misleading women on so-called fetal harvesting consent forms, a fact revealed by a 2015 investigation. We will not fund or subsidize healthcare that includes abortion coverage.

Later in the document, under a section titled “Preserving Medicare and Medicaid,” the platform again asserts that abortion providers are selling “the body parts of aborted children”—presumably again referring to the controversy surrounding Planned Parenthood:

We respect the states’ authority and flexibility to exclude abortion providers from federal programs such as Medicaid and other healthcare and family planning programs so long as they continue to perform or refer for elective abortions or sell the body parts of aborted children.

The platform appears to reference the widely discredited videos produced by anti-choice organization Center for Medical Progress (CMP) as part of its smear campaign against Planned Parenthood. The videos were deceptively edited, as Rewire has extensively reported. CMP’s leader David Daleiden is currently under federal indictment for tampering with government documents in connection with obtaining the footage. Republicans have nonetheless steadfastly clung to the group’s claims in an effort to block access to reproductive health care.

Since CMP began releasing its videos last year, 13 state and three congressional inquiries into allegations based on the videos have turned up no evidence of wrongdoing on behalf of Planned Parenthood.

Dawn Laguens, executive vice president of Planned Parenthood Action Fund—which has endorsed Hillary Clinton—called the Republicans’ inclusion of CMP’s allegation in their platform “despicable” in a statement to the Huffington Post. “This isn’t just an attack on Planned Parenthood health centers,” said Laguens. “It’s an attack on the millions of patients who rely on Planned Parenthood each year for basic health care. It’s an attack on the brave doctors and nurses who have been facing down violent rhetoric and threats just to provide people with cancer screenings, birth control, and well-woman exams.”

Myth #2: The Supreme Court Struck Down “Commonsense” Laws About “Basic Health and Safety” in Whole Woman’s Health v. Hellerstedt

In the section focusing on the party’s opposition to abortion, the GOP’s platform also reaffirms their commitment to targeted regulation of abortion providers (TRAP) laws. According to the platform:

We salute the many states that now protect women and girls through laws requiring informed consent, parental consent, waiting periods, and clinic regulation. We condemn the Supreme Court’s activist decision in Whole Woman’s Health v. Hellerstedt striking down commonsense Texas laws providing for basic health and safety standards in abortion clinics.

The idea that TRAP laws, such as those struck down by the recent Supreme Court decision in Whole Woman’s Health, are solely for protecting women and keeping them safe is just as common among conservatives as it is false. However, as Rewire explained when Paul Ryan agreed with a nearly identical claim last week about Texas’ clinic regulations, “the provisions of the law in question were not about keeping anybody safe”:

As Justice Stephen Breyer noted in the opinion declaring them unconstitutional, “When directly asked at oral argument whether Texas knew of a single instance in which the new requirement would have helped even one woman obtain better treatment, Texas admitted that there was no evidence in the record of such a case.”

All the provisions actually did, according to Breyer on behalf of the Court majority, was put “a substantial obstacle in the path of women seeking a previability abortion,” and “constitute an undue burden on abortion access.”

Myth #3: 20-Week Abortion Bans Are Justified By “Current Medical Research” Suggesting That Is When a Fetus Can Feel Pain

The platform went on to point to Republicans’ Pain-Capable Unborn Child Protection Act, a piece of anti-choice legislation already passed in several states that, if approved in Congress, would create a federal ban on abortion after 20 weeks based on junk science claiming fetuses can feel pain at that point in pregnancy:

Over a dozen states have passed Pain-Capable Unborn Child Protection Acts prohibiting abortion after twenty weeks, the point at which current medical research shows that unborn babies can feel excruciating pain during abortions, and we call on Congress to enact the federal version.

Major medical groups and experts, however, agree that a fetus has not developed to the point where it can feel pain until the third trimester. According to a 2013 letter from the American Congress of Obstetricians and Gynecologists, “A rigorous 2005 scientific review of evidence published in the Journal of the American Medical Association (JAMA) concluded that fetal perception of pain is unlikely before the third trimester,” which begins around the 28th week of pregnancy. A 2010 review of the scientific evidence on the issue conducted by the British Royal College of Obstetricians and Gynaecologists similarly found “that the fetus cannot experience pain in any sense prior” to 24 weeks’ gestation.

Doctors who testify otherwise often have a history of anti-choice activism. For example, a letter read aloud during a debate over West Virginia’s ultimately failed 20-week abortion ban was drafted by Dr. Byron Calhoun, who was caught lying about the number of abortion-related complications he saw in Charleston.

Myth #4: Abortion “Endangers the Health and Well-being of Women”

In an apparent effort to criticize the Affordable Care Act for promoting “the notion of abortion as healthcare,” the platform baselessly claimed that abortion “endangers the health and well-being” of those who receive care:

Through Obamacare, the current Administration has promoted the notion of abortion as healthcare. We, however, affirm the dignity of women by protecting the sanctity of human life. Numerous studies have shown that abortion endangers the health and well-being of women, and we stand firmly against it.

Scientific evidence overwhelmingly supports the conclusion that abortion is safe. Research shows that a first-trimester abortion carries less than 0.05 percent risk of major complications, according to the Guttmacher Institute, and “pose[s] virtually no long-term risk of problems such as infertility, ectopic pregnancy, spontaneous abortion (miscarriage) or birth defect, and little or no risk of preterm or low-birth-weight deliveries.”

There is similarly no evidence to back up the GOP’s claim that abortion endangers the well-being of women. A 2008 study from the American Psychological Association’s Task Force on Mental Health and Abortion, an expansive analysis on current research regarding the issue, found that while those who have an abortion may experience a variety of feelings, “no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.”

As is the case for many of the anti-abortion myths perpetuated within the platform, many of the so-called experts who claim there is a link between abortion and mental illness are discredited anti-choice activists.

Myth #5: Mifepristone, a Drug Used for Medical Abortions, Is “Dangerous”

Both anti-choice activists and conservative Republicans have been vocal opponents of the Food and Drug Administration (FDA’s) March update to the regulations for mifepristone, a drug also known as Mifeprex and RU-486 that is used in medication abortions. However, in this year’s platform, the GOP goes a step further to claim that both the drug and its general approval by the FDA are “dangerous”:

We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

Studies, however, have overwhelmingly found mifepristone to be safe. In fact, the Association of Reproductive Health Professionals says mifepristone “is safer than acetaminophen,” aspirin, and Viagra. When the FDA conducted a 2011 post-market study of those who have used the drug since it was approved by the agency, they found that more than 1.5 million women in the U.S. had used it to end a pregnancy, only 2,200 of whom had experienced an “adverse event” after.

The platform also appears to reference the FDA’s approval of making emergency contraception such as Plan B available over the counter, claiming that it too is a threat to women’s health. However, studies show that emergency contraception is safe and effective at preventing pregnancy. According to the World Health Organization, side effects are “uncommon and generally mild.”

Analysis Violence

Gun Violence Is a Public Health Crisis, So Why Isn’t the CDC Researching It?

Martha Kempner

As the nation’s official agency charged with protecting public health, the Centers for Disease Control and Prevention's mission is to conduct "critical science" and provide "health information that protects our nation against expensive and dangerous health threats." Except, apparently, when it comes to gun violence.

As the nation’s official agency charged with protecting public health, the Centers for Disease Control and Prevention (CDC)’s mission is to conduct “critical science” and provide “health information that protects our nation against expensive and dangerous health threats.” Except, apparently, when it comes to gun violence.

Despite the fact that firearms cause more than 33,000 deaths each year, the CDC operates under a congressional prohibition—first passed in the 1990s—that prevents the agency from undertaking the kind of in-depth research on gun violence that it does on all other sorts of threats to American lives, from infectious diseases and food hazards to Anthrax and motorcycles.

The original author of the rule, former Rep. Jay Dickey (R-AR), has since said he feels that our country has missed opportunities to make gun ownership safer because of it, and President Obama has tried to change the landscape of the research using an executive order. But Congress has held firm—refusing to repeal the ban or to bestow gun violence research funds to the CDC or other agencies. In the wake of yet another mass shooting in San Bernardino, California, it seems unconscionable that an agency designed to keep us safe can’t even try.  

Not surprisingly, the restrictions began at the behest of the National Rifle Association (NRA) and its allies, who argued the CDC was using its research to lobby for gun control. In 1996—after a failed attempt to defund the CDC’s $46 million Center for Injury Prevention altogether—Rep. Dickey stripped the agency’s budget of $2.6 million. It was not a coincidence that this was the exact amount of money being used to research gun violence. The funding was later restored before the passage of the bill authorizing appropriations for the agency, but allocated to different areas of study. And, significantly, restrictive language was added: “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”

Like This Story?

Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Donate Now

The wording is vague, but those at the CDC interpreted it to mean that they should pretty much avoid the topic altogether, though the agency does still collect simple data on firearm deaths. Mark Rosenberg, who was director of the CDC’s National Center for Injury Control and Prevention at the time, told the Washington Post in January: “It basically was a shot across the bow by Congress on the part of the NRA. All federally funded research was shut down.”

It wasn’t just research directly funded by the CDC that was affected. The National Institutes of Health was later added to the ban, and scientists all over the country have the felt the ripple effects since. The prohibition on research, the controversial nature of the topic, and the potential for backlash have limited the scope of the field, leading to a lack of existing data for other researchers to work with.

Eric Fleegler, a pediatric emergency medicine physician and health services researcher at Boston Children’s Hospital, told Rewire via phone interview that he could count on his fingers the number of people who have dedicated their careers to researching gun violence. “I can literally name the six people in the United States who are firearms researchers,” he said. “If you asked me to do that for cancer or anything else it would be laughable. I’d need hundreds of fingers.”

Fleegler explained:There’s no data on gun sales. There’s no good data on the criminology. There’s no good data on the injuries caused by guns.” In addition to the Dickey amendment and other federal policies, practices for collecting, or not collecting, these kinds of data are set at the local level as well, often making it harder for would-be studies to take place.

Fleegler and his colleagues ran into this obstacle when trying to study whether they could find a relationship between laws limiting gun ownership and gun deaths. With no broad federal database with more detailed information available, Fleegler and colleagues had to rely on the CDC’s limited numbers on gun deaths and on the nonprofit Brady Center to Prevent Gun Violence’s records of gun laws. After giving each state a “score” based on its numbers of gun laws, they found a direct relationship between a state’s score and the number of gun deaths in that state. The states with the highest score, or strongest laws, had 6.64 fewer deaths per 100,000 residents than the states with the lowest score, or weakest laws. States with strong laws had fewer homicides and suicides, even when demographics such as population density, firearm ownership, non-firearm violent deaths, education, poverty, age, sex, race, and unemployment were taken into account.

Moreover, when gun deaths went down, the rate of other violent deaths did not go up, which suggests a major flaw in the oft-heard mantra “guns don’t kill people, people kill people.” It turns out that when you impose harsher regulations on guns, people kill fewer people.

This correlation is very telling, but correlations are never enough to prove causation. Fleegler explained that there just isn’t enough data to get to causation, which could advance research tremendously. “If we had good data, we could track one million people with guns and one million people without guns for 20 years,” he said. Such tracking could confirm the correlations he found as well as other research that strongly suggest that having a gun in the house increases the occupants’ risk of death. And it’s that kind of data that could inform public policies.   

Earlier this year, former Rep. Dickey told the Huffington Post that he looks at simple, effective advances in safety, such as barriers on highways, and wonders what could have been done for guns. “If we had somehow gotten the research going, we could have somehow found a solution to the gun violence without there being any restrictions on the Second Amendment,” he said. “We could have used that all these years to develop the equivalent of that little small fence.”

Fleegler agrees that if this were any other issue, widespread research would be taking place right now. According to the Center for American Progress, gun violence is the second-most frequent cause of death among young adults. With any other “disease, any health issue, any genetic condition,” Fleegler said, “there would be an all-hands-on-deck approach to reduce and eliminate that threat. And yet with firearms we have gone in the opposite direction.”

In 2012, after the Sandy Hook shooting of elementary school children, President Obama used an executive order to effectively retract the Dickey Amendment and specifically ask the CDC to conduct research “on the causes and prevention of gun violence, including links between video games, media images, and violence,” as well as research to “better understand how and when firearms are used in violent deaths.” He has also asked Congress for $10 million to fund this research, but it has refused. Without the dedicated funding, there has been no move by the CDC or other agencies to increase research into this topic. And in fact, an attempt to explicitly overturn the Dickey Amendment this summer in Congress failed just days after the mass shooting in Charleston, South Carolina.

Courtney Lenard, a CDC spokesperson, told Rewire in an email: “Public health research is fundamental to understanding the problem and developing scientifically sound solutions.” In the email, Lenard referenced a report commissioned by the CDC and written by the Institute of Medicine and National Research Coalition, which concluded that a public health approach should be one of the strategies used to combat gun-related injuries. She also noted that President Obama’s request for funding for such research has been repeatedly denied by Congress. Lenard concluded that the CDC’s “Injury Center has very limited discretionary funding to dedicate to firearm violence research and prevention. In order to pursue many of the research priorities … the funding requested in the FY16 President’s Budget would be necessary.”

Just hours before the mass shooting in San Bernardino last Wednesday, a group of doctors and lawmakers released a call for the ban to be officially lifted and for research on this topic to move forward. At an event presenting a petition signed by more than 2,000 physicians, Rep. David Price (D-NC), vice chair to the House of Representatives’ Gun Violence Prevention Task Force said, “Gun violence is among the most difficult public health challenges we face as a country, but because of the deeply misguided ban on research, we know very little about it. Regardless of where we stand in the debate over gun violence, we should all be able to agree that this debate should be informed by objective data and robust scientific research.”

In an age in which there appears to be a mass shooting almost every day, it would seem that everyone should be desperate for information on how to prevent gun violence. Instead, scientists and public health researchers are stuck. Despite the claims made in the 1990s, research is not the same as advocacy; rather, it’s the quest for understanding in the hopes of giving elected officials the tools to set laws and policies that might save lives. We do it in all other aspects of our lives, from car seats to bicycle helmets; there is no reason we can’t do it here. Well, no reason, except for the efforts of the NRA, its congressional allies, and all other pro-gun apologists in this country.