July 18, 2002
Living Through Chemistry
The ancient rabbis practiced a relatively simple form of medicine: cabbage for sustenance, beets for healing.
It was easier then to prescribe, although harder to heal.
"Woe to the house through which vegetables are always passing," sums up the Talmud. There were no guarantees then as to what would work, the red or the green. This week, amid the controversy surrounding hormone replacement therapy, I've wondered how far past cabbages we've come.
When I first began taking the tiny pink estrogen/progestin mix, my doctor at the time assured me that it was safe.
"Would you take the pills yourself?" I asked.
But she was more than 10 years my junior, and her certainty had a distant ring, a bell that won't soon toll for thee. I never confused her with God. If I continue to take the pill, it's not because I don't think yams might work as well. I trust western medicine, and I hate hysteria. I've been down this road before.
I'm a baby boomer, particularly blessed by an outpouring of biochemical industry that did indeed bring us better living through chemistry. Capsules, tablets and curatives of all kinds have graced my every life-cycle advance, should I want them. There are drugs developed for just about every condition that drove women of the past crazy -- literally. If we feminist women have, at times, felt like guinea pigs, we have also been pioneers.
As for the hormone study, it showed only that the risks were slightly higher, not that the drug is unsafe. I'm not acting until I have a better grip on what I'm doing.
But if I want a grip, I get no help from the media, which is playing "blame the victim." Both Time and Newsweek, among others, were quick to suggest that hormone replacement was a silly dream to stop aging or otherwise "preserve their youth."
How wrong can you get? The press reacted as if menopause was mere vanity, another form of Botox. But medicine's purpose has always been one part palliative, to comfort and relief of symptoms, even where there is no cure. And if there's selfishness to hormone replacement, what does this tell us about Viagra?
Aging is hardly the big news of the hormone study. Lesson No. 1 is the need for a vigilant medical community. The National Institute of Health waited years before recognizing that previous data on hormone replacement was based on faulty premises. In Tuesday's New York Times, Dr. Susan Love wrote, "We need to demand medicine based on solid evidence, not hunches or wishful thinking."
Especially in preventive medicine, it is important to take "the time to determine the safety and efficacy of a particular therapy before we embrace it." In other words, doctors, heal yourselves.
Lesson No. 2 is, if anything, equally important: that presented with difficult medical situations, patients must, against great pressure, think for themselves.
My hunch is that many of us are ready for this step. Mine is the first generation to take birth control pills. They gave us free love and arguably a better image, but also mood swings, not to mention five extra pounds. We determined that the side effects were worth it.
Once married, we took fertility drugs, which gave us yet more mood swings, not to mention teaching us more than we wanted to know about the population density of sperm. There, too, the costs were deemed worthwhile.
And then came menopause. In my own little group, there are women who take half the recommended dose of estrogen, every other day; others eat yams. Some took estrogen until halted by a family member who got breast cancer; others, who take no hormone replacement, work on their bone density with drugs like Fosamax.
Independent thinking is the key lesson for an aging population. One of the most difficult transitions I've made since receiving a diagnosis of lung cancer is that there is no right answer. There is no medical god in whom to put my faith. There are only doctors with alternative theories, and some of them make sense. The Internet guides me from step to step, defining the next level of confusion, so the right treatment can work its way.
Scientists promised better living through chemistry. What they deliver isn't perfect, but it beats cabbage and beets.