Customer Reviews

The Estrogen Elixir: A History of Hormone Replacement Therapy in America

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I came across this book while preparing to write my own book on the topic. I read it hoping to find shoddy work that I might improve upon, or huge unanswered questions that I might address. Too bad for me, Elizabeth Watkins has excellently covered most of the topics I intended: a social history of hormone discovery and medical replacement, the role of interest groups (medical, pharmaceutical, media, women's movement) in shaping cultural notions of menopause and its "treatment," the scientific evidence for estrogen's effects, and the promotion of estrogen replacement. The big issue, of course, is how Medicine (and its surrounding institutions) reversed itself so completely from widespread promotion of routine long-term estrogen replacement for nearly all menopausal women, to only short-term treatment for the relatively few women with severe menopausal symptoms. The highly-publicized pivot point was the cessation in 2002 of the Women's Health Initiation (WHI), a large experimental study that showed increased heart disease and breast cancer among estrogen users. This led to an abrupt decrease of prescription and use. (Though not covered in the book, there followed a drop in the U.S. breast cancer rate, possibly a consequence of the drop in estrogen users.)
If the book has a weakness, it is Watkins's regard of the WHI as the "gold standard" of research, as if it has definitively put to rest the major questions about estrogen therapy. Perhaps if she were writing ten years later, she would give more relevance to the scientific limitations of the study. Possibly, too, the publicity rush of 2002 produced an overweighting of risk factors compared to the benefits of estrogen replacement -- an issue not yet fully resolved.

Any library seeking a comprehensive coverage of hormone replacement therapy needs THE ESTROGEN ELIXIR: A HISTORY OF HORMONE REPLACEMENT THERAPY IN AMERICA. It describes both the medical and sociological spread of HRT theory and practices in this country, exploring how science and society shaped the idea and distribution of HRT and how medical discoveries on women's health and aging changed initial ideas. From pharmaceutical manufacturers and government regulators to feminist health activists and the media, chapters offer wide-ranging surveys of influences and changes which are key to understanding the science, history and promotion of HRT in this country.

As the other reviewers describe, this book has sociological aspects of HRT. This book really tells us that HRT is the most important agent involving major social and medical issues:
- FDA's approval without scientific rigidity during 1930s and 1940s
- heavy involvement of pharmaceutical industry in medicine
- ethics of human studies involving elderly subjects or prisoners without informed consents.
- bias in belief-based advocacy by medical doctors
- conflict of interest in relation to chemical and drug industries
- social psychology of fear against aging after population had achieved average longevity longer than 60 years.
- epidemiologic approach to study relatively-rare cancers such as endometrial cancer
- difficulty in dealing with a single agent related to multiple diseases; cancer, heart diseases, bone diseases
- difference between randomized controlled trial and observational studies

This book presets that these public health controversies have literally grown with HRT. In other words, HRT history can provide very important implications for public health in US. With respect to this, anyone who is interested in social aspects of medicine, not necessarily in HRT or menopause, will love this book.