Earlier this month, the National Women’s Health Network received the Grassroots Activism Award from the National Breast Cancer Coalition for its years of work challenging the wisdom of widespread use of menopausal hormone replacement therapy, especially estrogen/progestin therapy known to raise women’s risk of breast cancer.

NWHN Director Cindy Pearson, in response to the award, reminds us of how widespread HRT was in the recent past, and how little was really known at that time about the potential harms of the therapy:

You remember what she was talking about: until just about 10 years ago, it was routine practice to prescribe hormone therapy to women during menopause. This was justified by claims that it would keep us young and healthy, despite the lack of evidence supporting those claims and despite evidence suggesting that hormone therapy might increase the risk of breast cancer. But the Network knew that what the medical establishment believed had not been proven by science. And we wouldn’t stop saying that – even when the response was rolled eyes and smug looks.

Kudos to the NWHN for their persistence, getting the message out to women who needed it, and this much-deserved recognition.

Last week, the U.S. Food & Drug Administration (FDA) published a perspective piece on the long-term use of bisphosphonates for reducing bone fracture risk in the New England Journal of Medicine, describing findings from the agency’s September 2011 review of these drugs. The agency had reviewed data from a few studies on longer term (>3 years) use of the drugs, including whether they increased bone mineral density and decreased bone fractures.

We wrote about that review in more detail here. Essentially, the agency reported that long-term safety of these drugs was still something of a mystery, but there was concern about rare but serious complications – jaw osteonecrosis, atypical femoral fractures, and esophageal cancer. The agency has also previously stated that there was no apparent benefit of continuing the drug beyond 5 years for fracture prevention.

In the NEJM piece, agency authors reiterated both these concerns and the reality that more research and information is still needed on questions such as how long most people really should take the drugs, whether certain groups of patients are more likely to benefit from longer term use of the drugs, how long benefits of the drugs last after stopping them, and whether there are reliable measures to help make that decision in individual patients. While they don’t focus on it, there is also considerable concern and controversy about whether women who do not actually have osteoporosis (or who are classified as having “osteopenia”) should be getting these drugs in an attempt to prevent it.

The NEJM piece is likely to draw more attention to this issue than the previous FDA documents alone, and bolster advocates’ push to reconsider practices and get the information gaps filled. The National Women’s Health Network, a longtime advocate of looking closely at these issues, writes in response:

NWHN agrees with the FDA that long-term use of bisphosphonates isn’t helpful for most women, and urges women and their clinicians to seriously consider stopping these drugs after 3-5 years. Are there some women who should continue bisphosphonates beyond 3-5 years?…We will advocate for more studies to answer this important question.

Now that the FDA has acknowledged the problems of long-term use of these drugs, it should take the next step and address the important question – Which women should start taking bisphosphonates in the first place? We have urged the agency to change its recommendations to end the practice of prescribing bisphosphonates to healthy women for prevention. Too many women are handed a prescription for bisphosphonates after getting a bone density scan that shows normal age-related bone loss, even though they have no other risk factors for fracture. Those women are very unlikely to have a serious fracture in the next few years – and taking bisphosphonates isn’t likely to do them any good.

The NWHN has also recently sent a letter to FDA Commissioner Margaret Hamburg urging the agency “to remove the prevention indication for bisphosphonates and to take steps to alert women and their health care providers that these drugs are no longer recommended for prevention of osteoporosis.”

See also: our previous posts on bisphosphonates and osteoporosis.

Many women going through perimenopause and in menopause either don’t have have flashes and night sweats that bother them or are able to ease them with self-help approaches.  However, between 7 and 9 percent of women have symptoms severe enough to interfere with their quality of life.

In the past, the primary treatment for hot flashes and night sweats (called vasomotor symptoms) was estrogen-plus-progestin or estrogen-alone hormone therapy—both effective therapies. But as the Women’s Health Initiative (WHI) trials demonstrated, these hormone regimens unfortunately increase the risk of heart disease, stroke, blood clots and breast cancer.

Because of these risks, new treatment options for vasomotor symptoms are needed. A new study published in the journal Menopause by the Centre for Menstrual Cycle and Ovulation Research looks at the safety and effectiveness of progesterone-only therapy for alleviating hot flashes and night sweats. (Progesterone is a hormone produced in the body, while progestin, which was used in the WHI, is a synthetic form of progesterone).

In this trial, the researchers randomized 133 healthy, postmenopausal women with vasomotor symptoms to Prometrium, a brand of oral micronized progesterone, or placebo, and had them report on the frequency and severity of their night sweats and hot flashes over three months.

The researchers (one of whom, Jerilynn Prior, co-wrote the menopause chapter in the 2011 edition of Our Bodies, Ourselves) found that symptoms improved in both the progesterone and placebo groups over the course of the study. Scores, however, improved significantly more in the progesterone group, suggesting that the hormone provided greater relief of symptoms than placebo. There were few adverse effects reported in this brief trial, none of which were considered serious.

It is not clear what the breast cancer implications of progesterone-alone therapy might be – the Women’s Health Initiative trials found an increased risk of breast cancer with estrogen-plus-progestin therapy but not with estrogen-alone. In their article, the authors briefly address this issue, noting varying findings in other studies and remarking that:

Although there is reason to believe that progesterone has a more favorable safety profile than medroxyprogesterone [used in the WHI study], large safety trials of progesterone as postmenopausal monotherapy are lacking.

OBOS contacted researcher Jerilynn Prior to ask her if she had any additional comments about the potential increased risk of breast cancer. Prior answered that a large observational study in France called E3N found that estrogen with progesterone was not associated with increased breast cancer risk, while estrogen alone and estrogen with progestin were. “This suggests that progesterone alone would be safe in terms of breast cancer risk,” Prior noted.

In the published study, the researchers address certain limitations of their work, including the racial/ethnic makeup of their study population (primarily white), and participants being overall leaner and healthier than the general population. Additionally, while the placebo was identical to the active drug and neither the researchers or women could guess by the look or feel of the pill which they were taking, over time 54% of those receiving progesterone and 60% of those getting placebo were able to correctly guess their group assignment. In correspondence with OBOS, Prior said that this was likely due to the fact that many of those taking progesterone experienced improvement in their sleep.

The researchers also note that their population were postmenopausal, having not menstruated for 1-10 years, so their findings are not applicable to women transitioning into menopause.

The bottom line is that progesterone-alone may be a useful treatment for relieving hot flash and night sweat symptoms of menopause, although more investigation is needed. Many of the benefit and harms of hormone therapy may turn out to depend on the type of hormone, who’s using it, in what form, when and for how long. I hope to see more studies on this in coming years.

DES Action, an organization that provides information, education, and support related to DES exposure, is conducting a health history survey to learn more about the health issues faced by women who took DES and the daughters and granddaughters and sons and grandsons of those women.

DES (diethylstilbestrol) is a drug that used to be prescribed to women to prevent miscarriages and preterm births, and is now known to increase the risk of certain cancers and other adverse effects in the sons and daughters of women who took the drug. Researchers are now starting to look for possible effects in the women’s granddaughters and grandsons.

June 15th is the deadline for all surveys to be completed and returned. The survey is not a formal scientific study, so there is not the usual informed consent process with privacy information. DES Action hopes the collecting these surveys will help them to identify some trends and concerns to share with researchers who may be able to follow-up with further study.

Related information on DES:
DES: 40 Years of Research with More to Learn – recent article in the newsletter of the National Women’s Health Network
The DES Follow-up Study – DES timeline, health risks, and information in the National Cancer Institute’s “Linkage” newsletter.

Our 2009 post on side effects of stopping the injectable birth control Depo-Provera (depot medroxyprogesterone acetate, or DMPA) continues to generate important discussion — more than 100 women have shared their stories of adverse effects after stopping the drug.

Although a quick internet search finds many women complaining of or asking about post-Depo symptoms, there isn’t much published scientific evidence on the topic. Frustratingly, there is really not much new on the topic in the 2 1/2 years since we first posted on this. There don’t appear to be ongoing or upcoming studies on the concerns we’ve heard, either. A few studies here and there report some effects, like how long it took for menstruation to return, how long periods lasted, and how long it took to become pregnant after stopping.

Most of the existing research on women who stop using Depo-Provera seems to focus on bone mineral density. The drug comes with a “black box” warning that it may cause significant bone density losses, although research suggests that it’s possible that these losses may be made up after women stop taking the drug. The Society for Adolescent Medicine has said that “The data from all of these studies [of bone density in adolescent users] are encouraging, although it is unknown whether girls ultimately achieved the same peak bone mass as they would have in the absence of DMPA.” They also suggest that the advantages of preventing pregnancy may outweigh the risk for bone loss, but that patients should be informed of the potential for bone loss. Because of this concern, though, research on what happens when women stop using this birth control method tends to focus on understanding changes in their bone density.

Studies of “discontinuation” of birth control methods also tend to focus on the side effects of taking a drug and the reasons women stop using them, rather than what happens – aside from pregnancies – after they make that decision. It is thought that about half of women who quit Depo in order to get pregnant are able to do so by 10 months later, but that some women have longer waits before they are fertile. According to the drug label, “it is expected that 68% of women who do become pregnant may conceive within 12 months, 83% may conceive within 15 months, and 93% may conceive within 18 months from the last injection.” It also notes, though, that almost 40% of who discontinued the drug to become pregnant could not be followed up on, so they are not represented in those percentages.

What would you like to know about stopping Depo-Provera? What should researchers be examining? If you would like to share your own story of stopping Depo, please add them to the previous post.

Last December, a joint meeting of the FDA’s Reproductive Health Drugs and Drug Safety and Risk Management advisory committees met to discuss the safety of birth control pills containing drospirenone, such as Yasmin and YAZ (both Bayer products). Concerns have been raised about the increased risk from the drugs of venous thromboembolism – blood clots in the legs or that travel to the lungs, which can be fatal.

The committees were asked to consider, among other things, the conflicting evidence on these risks in reported studies, whether the benefits of using drospirenone-containing drugs for pregnancy prevention outweigh the risks, and whether users of these drugs are at an increased risk of clots (VTE) compared to users of other oral contraceptives.

According to the background documents for the advisory committee meeting, the studies funded by the drug company did not find any difference in the risk of VTE between women taking dropsirenone-containing drugs (Yasmin) compared to women taking other combined oral contraceptives.

The FDA funded a separate study combaring Yasmin to other oral contraceptives, and this study did find an increased risk of VTE with Yasmin, especially in women younger than 35 years old. They explain that because of the different designs of the different studies, and because the different results can’t be reconciled just by looking at these different study designs, “none of the studies to date provides a definitive answer” about the safety of drugs like Yasmin in terms of VTE risks.

The FDA also noted that all of the studies examined focused on Yasmin or its equivalent (3 mg drospirenone and .03 mg estrogen), while none of the studies reviewed by the committees examined YAZ (3mg drospirenone and .02 mg estrogen).

Former OBOS board member Pamela Bridgewater testified at the meeting, urging the committee to consider why “the studies that had the closest ties to Bayer show no evidence of an increase in blood clots.” Cindy Pearson of the National Women’s Health Network also testified, asking the agency to “take these more dangerous and no-more-beneficial products off the market, and get back to the arc of history and progress that protects women while supporting their contraceptive choices.”

While the committee members voted 15 to 11 that the benefits of drugs like Yasmin outweigh their risks, the transcript of the meeting provides illuminating comments they made as they voted. Many of those who voted yes said they believed that the risks of unwanted pregnancy are greater, and that the absolute risk of VTE is small. Others, however, expressed concerns about the conflicting data, and suggested that they’d change their vote to no if the standard was how the drug compared to other types of oral contraceptives. Many of the members voting no also expressed concerns that these drugs may be no better and may be more harmful that other oral contraceptives on the market.

For example, Dr. Jacqueline Gardner explained:

I don’t usually vote against choices, but this time I did. And the reason is because on the benefit side, I didn’t see any improved benefit over the existing available choices; and there are so many of them, I believe that as far as oral contraceptives are concerned, women could find alternatives. I don’t see that the alternative to this product is necessarily unintended pregnancy. That’s not the balance, but rather, other safer alternatives. And I, too, believe that when all of the studies are analyzed adequately, that we may find that the risk is even higher, and that translates to a large number of women, in public health terms.

Our Bodies Ourselves has signed onto a letter to FDA Commissioner Margaret Hamburg expressing concerns about the composition of the panel and the focus on comparison of risks and benefits of these oral contraceptives compared to pregnancy, rather than on whether the risks and benefits of drugs like Yasmin outweigh the risks and benefits compared to other oral contraceptives.

Bayer was previously required by the FDA to run corrective ads because their television commercials for the drug were found by the agency to be “misleading because they broaden the drug’s indication, overstate the efficacy of YAZ, and minimize serious risks associated with the use of the drug.” There have also been reports that Bayer previously withheld harms information about Yasmin and blood clots from the FDA.

Related reading:

• Group Seeks New FDA Vote on Birth Control Safety Risks After Industry Ties Surface – National Partnership for Women and Families
• Yaz Panel Was Filled With ‘Irregularities’: Advocates – Pharmalot
• A Conflicted FDA Panel, Bayer & Birth Control Pills – Pharmalot
• With Doubts, FDA Panel Votes For Yaz And Related Contraceptives – Shots, NPR’s health blog
• Group seeks re-vote on birth control clot risk – Reuters coverage
• Just How Safe is Yaz? Women Need to Know! – Ms. Blog

The American Civil Liberties Union has launched the “Take Back Our Genes” campaign to fight against issuing patents issued human genes. The ACLU believes that allowing one company to own the patent for a particular gene limits research on genetic health conditions and also limits patient options for genetic testing.

As the organization explains:

Myriad Genetics, which controls the patents on the genes, is able to exclude others from testing and conducting research on the patented genes. Patients who want to obtain genetic testing to determine whether they are at risk for hereditary breast and ovarian cancer have only one option for full genetic sequencing: Myriad Genetics. Myriad decides what tests are offered, which mutations are included, at what cost, and what research can be conducted without fear of patent infringement liability.

The ACLU is asking individuals to send their photos or videos explaining their opposition to gene patenting. The video below provides a great example of how gene patenting can affect patients and their access to affordable, reliable testing.

Our Bodies Ourselves is one plaintiff in the lawsuit filed by the ACLU and the Public Patent Foundation against the U.S. Patent and Trademark Office, Myriad Genetics, and the University of Utah Research Foundation to challenge the patents they hold on BRCA1 and BRCA2 genes.

See our previous posts on this topic:
OBOS Joins ACLU Lawsuit Challenging Breast and Ovarian Cancer Gene Patents
Breast Cancer Gene Patents Invalidated (see later update from the appeals court)

These two recent pieces also provide good explanation of why gene patents are an important issue for patients and researchers to consider.

Last week, we wrote about a controversial decision by HHS Secretary Kathleen Sebelius, who overruled the FDA’s decision that emergency contraception should be made available over the counter to women of all ages.

On Friday, former FDA official Susan Wood issued her response to the move in the Washington Post, rejecting Sebelius’s claim that more data is needed on safety and label comprehension for the youngest of possible emergency contraception users:

…this type of age restriction, and worries about the use of medicines by teenagers, have not been applied to other products…Indeed, for no other over-the-counter medication has the FDA ever required extra data for a particular age group. (This extra data on younger teenagers was provided to the FDA in the latest application by the company.)

But somehow, the prescription requirement for Plan B — which is very safe and impossible to overdose on — remains in place for those younger teens who are in the unfortunate situation of being at risk of pregnancy and who need emergency contraception immediately.

Wood also notes that because the age restriction remains, access for older women remains restricted – emergency contraception is available without a prescription for those over 17, but is still behind a pharmacy counter.

Wood previously served as assistant FDA commissioner for women’s health and director of the Office of Women’s Health. She resigned in 2005 because of past politically motivated delays in emergency contraception approval, stating at that time:

I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled.

Now, Wood calls out Obama for breaking his promise to the American people by allowing this overruling:

In his scientific integrity memo, the president stated: “When scientific or technological information is considered in policy decisions, the information should be subject to well-established scientific processes, including peer review where appropriate, and each agency should appropriately and accurately reflect that information in complying with and applying relevant statutory standards.”

In overturning the well-considered, scientifically based decision of the FDA, Sebelius and the Department of Health and Human Services certainly did not “appropriately and accurately reflect” the available scientific information…The president should stand by the principles of scientific integrity and restore science to its rightful place. He should support the FDA commissioner and direct the secretary to allow the agency to do its job. By doing so he will fulfill the promise of that beautiful day in March 2009 when he pledged that science would trump politics, not the other way around.

If you would like to write President Obama to object to Sebelius’s action and remind him to remember his promise about scientific integrity, you can contact the White House directly via this online form.

We have written several times here about concerns about bisphosphonates – a drug intended to prevent bone fractures – and the possibility that these drugs increase the risk of a type of femur fracture. While these fractures are relatively rare and not well understood, the FDA has said that patients should be made aware of the potential risk, especially with long-term use of the drugs. There is also debate over how much these drugs actually help prevent fractures and whether they should be used for prevention in people with “lower than normal” bone density who do not have osteoporosis.

The HealthCentral website has just published an interview on on spontaneous femur fractures with Dr. Jennifer Schneider, a physician who had been taking a bisphosphonate for several years when her thigh bone fractured as she stood on a New York City subway. In it, Dr. Schneider tells her story and explains the controversy over widespread use of bisphosphonates for osteoporosis prevention, the recovery process from drug-associated fractures, her testimony to the FDA, and other information about the drugs.

The new issue of the National Women’s Health Network’s newsletter, The Women’s Health Activist, also includes an article on this topic by Cindy Pearson. She writes about other women who told their stories of broken thigh bones to the FDA:

“They talked about turning to put a piece of paper in the trash can, stepping away from the kitchen sink, or walking down the sidewalk — and suddenly collapsing in agonizing pain as their leg gave way. All of these women had been healthy and active before their leg broke.”

The organization is working to get the FDA to make changes in how drug companies are allowed to market the drugs to healthy women. NWHN also recommends that healthy women under 65 with no risk factors for fragile bones avoid bone density scans because of concerns about accuracy and overtreatment; the US Preventive Services Task Force also focuses their recommendation for screening in women under 65 on those women who have risk factors.

On a related topic, I also have an article in this issue of NWHN’s newsletter about confusion over the risks and benefits of calcium supplements.

The November/December issue of the Journal of Midwifery & Women’s Health has an article on nitrous oxide by Judith Rooks, a nurse-midwife and epidemiologist who has long advocated for making nitrous oxide available as a pain relief option for U.S. women in labor.

Nitrous oxide (N2O) is a gas that a laboring woman can breathe in through a mask.  It works very quickly, taking effect in about a minute, and wears off quickly.  Because it is administered by the laboring woman herself, it allows her to obtain a short burst of relief only when needed, as an alternative to an epidural. It is the most commonly used form of analgesia in the United Kingdom.

However nitrous oxide is not widely available in the U.S., despite the endorsement of various childbirth advocacy organizations, including the American College of Nurse Midwives.

In her article, Rooks reviews the research and literature on the safety and risks of nitrous use. She discusses questions around high and low doses of the gas, labor progress, maternal and fetal/newborn effects, and occupational hazards.  She notes that:

Because N2O/O2 labor analgesia does not have adverse effects that could threaten the safety of the mother or fetus, laboring women who use it do not need routine intravenous access, continuous electronic fetal monitoring, or other procedures that are intrusive and restrict the mother’s freedom of movement during labor. Nitrous oxide labor analgesia is safe for the mother, fetus, and neonate and can be made safe for caregivers.

The review points out several health concerns,  including that women who have had recent ear surgery (because of potential vomiting and inner ear pressure issues) and women who at increased risk of vitamin B12 deficiency may need special review before using nitrous, and that workplaces should take care to make sure the appropriate safety measures are taken to limit birth workers’ exposure. She also points to the need for additional research on issues like brain effects and occupational exposure in birth settings.

Although it’s only available to members, the American College of Nurse-Midwives also covered nitrous oxide in their recent Quickening newsletter. In it, they speak to Michelle Collins, CNM at Vanderbilt, who was instrumental in pushing for nitrous to be an option there. Collins explains several reasons women might choose nitrous: to take the edge off contractions, reduce anxiety, relieve discomfort while waiting on an epidural or during other procedures, or simply to delay epidural and keep more time available when the woman can be mobile.

Collins shares that in one month this summer, “35 women used the nitrous during labor at Vanderbilt, and of those, 22 used it as their sole analgesia. The remain­ing 13 used it and later had an epidural.”

For more on this topic, see this previous post with further discussion from Judith Rooks.

Escrito por Rachel; traducido del orginial en inglés Sept. 20, 2011.

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Los bisfosfonatos (p.e. Fosamax, Boniva, etc.) son medicamentos para el tratamiento y la prevención de la osteoporosis en mujeres postmenopáusicas, pero hay preocupación por los posibles efectos secundarios causados por el uso de estos medicamentos por periodos largos.  Entre los posibles efectos secundarios se incluyen: fracturas atípicas de fémur (muslo), osteonecrosis (muerte de la mandíbula), y cáncer de esófago.

El otoño pasado, la FDA pidió cambios en las etiquetas de los bisfosfonatos para incluir advertencias sobre riesgos de fracturas, para explicar que no se sabe exactamente el tiempo que se debe consumir el medicamento, y recomendar que pacientes y doctores reevalúen periódicamente el uso del medicamento.

Recientemente, algunos comités de la FDA encargados de los medicamentos para la salud reproductiva y del manejo de la seguridad/riesgo de las medicinas, se reunieron para discutir el consumo extendido (>3-5 años) de bisfosfonatos, y sus posibles complicaciones.

En un documento informativo preparado para la reunión, la FDA revisó evidencias sobre estos relativamente raros pero preocupantes efectos, y concluyó: “La seguridad para el consumo prolongado de  bisfosfonatos aún no es clara, por cuanto los resultados de los estudios sobre la posible relación entre la osteonecrosis de la mandíbula, las fracturas atípicas de fémur, o el cáncer del esófago, y el uso de bisfosfonatos para la prevención y el tratamiento de la osteoporosis son conflictivos.”

La agencia concluyó que la evidencia sugiere un aumento en la incidencia de osteonecrosis de la mandíbula con un uso prolongado, especialmente de 4 años o más, pero que se necesitan estudios más profundos.  También dice, “Las fracturas atípicas….parecen tener una asociación importante con los bisfosfonatos, pero no hay actualmente consenso en cuanto a la manera como el uso acumulado de bisfosfonatos aumenta los riesgos de este tipo de fractura poco común.  Finalmente, no hay evidencia definitiva para apoyar la relación entre el cáncer de esófago y el uso prolongado de bisfosfonatos.”

En cuanto a los posibles beneficios resultantes del uso prolongado de bisfosfonatos para reducir fracturas relacionadas con la osteoporosis, la agencia no encontró beneficios evidentes.  “Los resultados sugieren que no hay ventajas de importancia en continuar usando esta medicina por más de 5 años.”

El New York Times también informa acerca de las recientes reuniones de la FDA, y destaca: “El comité convocó a más estudios para establecer la eficacia del medicamento en la meta deseada de prevenir fracturas.  Así mismo, los asesores recomendaron que la FDA examine la razón por la que el medicamento es recetado como medicina preventiva a mujeres que nunca han tenido osteoporosis.”

Para más información sobre este tema, vea nuestras previas entradas de blog, y la Red Nacional de la Salud de la Mujer (the National Women’s Health Network), la cual también pregunta si este producto debe ser comercializado y recetado como medicina preventiva para mujeres con buena salud.

Bisphosphonates (e.g. Fosamax, Boniva, and the like) are drugs prescribed for treatment and prevention of osteoporosis in postmenopausal women, but concerns have been raised about possible adverse effects of using the drugs for long periods of time, such as “atypical” femur (thigh) fractures, osteonecrosis (death of the jaw bone), and esophageal cancer.

Last fall, the FDA requested changes to bisphosphonate labels to warn of the fracture risk, explain that the optimal amount of time to take the drug is not known, and recommend that patients and their doctors periodically reevaluate whether the drug should be continued.

Recently, FDA committees on reproductive health drugs and drug safety/risk management met to discuss long-term (>3-5 years) use of bisphosphonates and these potential complications.

In a briefing document prepared for the meeting, the FDA reviewed evidence on these relatively rare but concerning effects, and concluded, “The safety of long-term bisphosphonate therapy continues to be unclear as study results are conflicting as to whether or not ONJ [jaw osteonecrosis], atypical femoral fractures or esophageal cancer are associated with use of bisphosphonates for the prevention and treatment of osteoporosis.”

The agency further concluded that the evidence suggests an increased prevalence of jaw osteonecrosis with longer use, especially of 4 or more years, but that larger studies are needed. It also writes that “Atypical fractures…appear to have a strong association with bisphosphonates but there is no current consensus on the extent to which cumulative use of bisphosphonates increases the risk of this rare type of fracture. Finally, no definitive evidence is available to support an association between esophageal cancer and long-term use of bisphosphonates.”

In discussing whether long-term use of bisphosphonates would have a benefit of reducing osteoporosis-related fractures, the agency found no clear benefit of continuing, stating, “These results suggest no significant advantage of continuing drug therapy beyond 5 years.”

The New York Times also has coverage of the recent FDA meeting, and notes: “The committee also called for more study of the overall effectiveness of the drugs in their desired goal of preventing fractures. And the advisers recommended that the F.D.A. take a close look at why the drugs are prescribed as preventive medicine for women who do not even have osteoporosis.”

For more on this topic, see our previous posts, and the National Women’s Health Network, which also raises the issue of whether these drugs should be marketed and prescribed for prevention to healthy women.

Many U.S. users of cosmetics may not realize that they do not require FDA testing or approval and the federal agency is not authorized to require a manufacturer to recall unsafe products from the market. Because cosmetics are not regulated in the same way drugs are, it’s more difficult for consumers to make informed decisions, and the FDA has less power to regulate the cosmetics industry and respond to problems.

The Safe Cosmetics Act of 2011, introduced by Janice Schakowsky (IL-D), is intended to help close some of these gaps in cosmetics regulation.

The Act would give the government the power to recall unsafe cosmetics, require better disclosure of ingredients, establish additional safety standards and require manufacturers to submit data on the safety of their products, mandate reporting of adverse health effects, allow the banning of ingredients found to have reproductive or cancer-causing effects, encourage alternatives to animal testing, address worker safety, along with other measures.

The Campaign for Safe Cosmetics, which promotes the legislation and greater consumer awareness of cosmetic safety concerns, has more information at http://www.safecosmetics.org/section.php?id=74.

More info:

• More information on the FDA’s current role in regulating cosmetics
• Rep. Schakowsky’s press release on the Act
• Additional coverage at Good and Forbes

An upcoming webinar may be of interest to readers:

Patients Before Profits: What You Should Know About the FDA, Big Pharma, and Breast Cancer
June 21, 2011 10:00AM – 11:00 AM Pacific (1:00 pm – 2:00 PM Eastern)

Featuring Miriam Hidalgo, BCAction Volunteer Program Coordinator and Jane Zones, Medical Sociologist and Former BCAction Board Member

We will focus on how the competing interests of pharmaceutical companies and regulatory governmental bodies can fail to deliver safe and effective drugs that patients need. If you sign up, you will learn about power players at the FDA, the origins of the accelerated approval process, and more.

You will need to register online for this webinar and then will receive an email with instructions on how to join in on the 21st.

by Susan  Bell

Forty years ago, the New England Journal of Medicine published an article about the synthetic estrogen DES that is now recognized as a watershed in the annals of medicine.

The authors of the study, physicians at Massachusetts General Hospital, reported an association between DES – a prescription “wonder drug” intended to prevent miscarriages – and vaginal cancer in women who were just 15 to 22 years old. From the 1940s to the 1970s, between 5 and 10 million pregnant women and their sons and daughters were exposed to DES during pregnancy. When the daughters became teenagers and some of them developed reproductive tract cancer, the MGH physicians identified DES as the first transplacental carcinogen, and the daughters took on the new identity of “DES daughters.”

When DES daughters had trouble becoming pregnant and giving birth to healthy babies, DES was connected with miscarriage and other problems during pregnancy. These characteristics – crossing the placenta, disrupting the developing fetus, and affecting the bodies of DES daughters in multiple ways that often do not appear for many years – are those that identify DES as the first endocrine disruptor.

Much has been written in the past few weeks about DES. There have been reports of current research about damaging effects of DES: of its possible effects on the children of DES daughters, of its significance for understanding how human reproductive organs develop, and of the dangers of too much haste and too little prudence in adopting medical technologies.

Physicians writing in the New England Journal of Medicine use the words “humble” and “trauma” and “unanswered questions” in looking back and looking ahead to the future of DES. All of this is wise and good. Yet there is more that must be said in this time of remembering.

The DES story is about more than a tragedy that occurred to a population in the mid-20th century and more than a humbling experience for medicine. It is also about a women’s health movement that questioned whether doctors always know best. These women were among the first to judge science based on their intimate, firsthand knowledge of their own bodies, and joined together in collective action for social change.

Thank goodness for one “DES mother” whose daughter developed vaginal cancer during the 1960s and for her doctor who worried too. This mother asked her daughter’s physician—who was also puzzled about the cause of her daughter’s very rare cancer and was searching for answers—whether it could have been caused by the DES she took during the pregnancy.

Her physician was Dr. Howard Ulfelder, who listened to her, took her question seriously and researched the possibilities. We should celebrate this mother for voicing her hunch and this physician for listening to her. Ulfelder became one of the authors of the NEJM article; the mother remains anonymous.

DES mothers and DES daughters began the grassroots organizations DES Action (in 1975) and the DES Cancer Network (in 1982). Among other things, we should be grateful to these organizations for their efforts in bringing about an interdisciplinary, international “workshop” about DES in 1992 – a watershed in DES research, legislation and funding. Lines of research and practice initiated at that 1992 workshop have transformed the doing of science by incorporating activists in the conceptualization and conduct of DES science.

Thirty years ago, I began a research project to understand DES daughters’ experiences. I interviewed DES daughters, read their letters to the editor of these grassroots organizations, and traced their participation in the DES workshop. The results, published in my book, trace story by story their individual and collective efforts that galvanized the watershed DES research, legislation and funding.

One DES daughter who had vaginal cancer in her early 20s was devastated when her surgeon told her she would need a complete hysterectomy. Years later, after she had returned to see him many times for examinations she told me, “I was one of the wonders of medical science,” a woman whose surgeon had saved her life and rebuilt her body. For her surgeon – one of the pioneers in surgery for DES cancer – her body was “the most wonderful thing in the world.”

By the time she told me her story, “it was nothing abnormal to have five or six guys standing around” watching and learning as her surgeon examined her during follow-ups. They learned both from him and from her. As she put it, during those exams, “I used to tease him a lot you know, ‘Oh yeah, I know what to do now.’” The repeated examinations and displays of her body had educated her as well as doctors. She too, became a bearer of knowledge about the clinical contours of DES.

In taking care of themselves these patients and their mothers created new pathways, transformed relations of power and knowledge, and contributed to making new spaces and bringing world wide attention to DES. So on this 40th anniversary of that publication, let us celebrate the courage and the unique contribution of women’s health activism to the DES story.

Susan E. Bell is Professor of Sociology and A. Myrick Freeman Professor of Social Sciences at Bowdoin College in Brunswick, Maine. She is the author of “DES Daughters: Embodied Knowledge and the Transformation of Women’s Health Politics” (Temple University Press, 2009).