HEALTH CARE/Joan Retsinas

The 1099 Health Award

This month the 1099s are streaming in. The listed value of a stock will wax and wane, driven, by the zeitgeist of the market; the dividend is the measure of performance. And the 1099s sum up that performance.

In the spirit of performance-evaluation, I propose evaluating health care spending -- what investment has performed superbly, measured by tangible measures? Call it a 1099 Health Award.

This year's award goes to the Women's Heath Initiative, funded by the National Institutes of Health (NIH). The NIH funds the tests that rarely rate headlines. Will drug X work? Will treatment Y have side effects? The answer generally lies in lengthy, expensive clinical trials, where patients are randomly assigned into either an "experimental" or "control" group. The Women's Health Initiative was one such trial. It put the magic of hormone replacement therapy under a clinical spotlight.

For 15 very profitable years, drug manufacturers have touted hormone replacements as an elixir to keep women looking and feeling young even as they age. One hallmark of aging is a descent into brittleness: bones, teeth, even hair grows brittle. The diseases of senescence show up on medical charts: women who ran marathons in their 40s find themselves with osteoporosis, heart disease, memory loss in their 60s and 70s. Many women entering menopause (the stage, not the musical) suffer from hot flashes and mood swings.

Women can stave off the manifestations of aging. Hair dyes, dental implants, cosmetic surgery, as well as healthy diets and exercise, have kept women looking and feeling middle-aged even as the birthdays roll by. But how much better it would be to retard the impact of aging -- to arrest the hormonal losses! That was the premise of hormone replacement therapy. Rationally, it seemed a valid premise. And for millions of women it worked. At least women thought it worked. Not surprisingly, women were elated, pleased to hold the diseases of aging at bay. Physicians were pleased to help patients stay healthy.

And the drug manufacturers were elated. Even if they hadn't found the key to youth, they had found the key to profits. The customer base for replacement hormones included almost every woman over age 45, who could take this therapy for 10, 15, even 20 years.

The Initiative, launched in 1991, spent millions of dollars following thousands of women, typically for eight to 12 years. Some took hormone replacement drugs; some didn't. Scientists compared the results.

Early results suggested that the data did not support the much-touted claims of protection. Women on the therapy, as well as women off it, still got heart disease. Later results found that the therapy may have increased the risk of breast cancer. In July 2002 the Women's Health Initiative ended, when the women taking estrogen showed a higher incidence of breast cancers and heart maladies. The conclusion was clear: this Ponce-de-Leon pill had some serious risks.

Women, and their physicians, re-considered the merits of hormone replacements.

Recently statisticians reported a 7% drop in breast cancers. Every cancer registry that reports to the federal government noted the drop. Cancers fueled by estrogen decreased the most,

At the December San Antonio Breast Cancer Symposium (Associate Press, Dec. 15, 2006), researchers translated the statistics into lives. The 7% drop in new cases meant that 14,000 fewer women were diagnosed.

Without federal dollars, researchers would never have amassed the data to de-mystify this profitable elixir. And without a multi-year, multi-million dollar clinical trial, scientists would not have pinpointed flaws in the supposition that women should artificially replace the hormones lost through normal aging.

We taxpayers are investors in the apparatus of government. We often question the merits of that investment: what return are we getting? The 1099s (and the W2s) are not so much a harbinger of spring, but a reminder that we are paying for Uncle Sam's upkeep.

With the Women's Health Initiative, we got a great return on investment.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email


From The Progressive Populist, February 15, 2007

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