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The cruel irony of trying to be ‘feminine forever’

The recent data on breast cancer rates suggest that millions of women could have developed and even died from the disease because of excessive use of hormone replacement therapy. NBC's Robert Bazell reports.
/ Source: NBC News

The recent data on breast cancer rates suggest that millions of women could have developed and even died from the disease because of excessive use of hormone replacement therapy (HRT). 

How did this happen?

A good place to look is a book called “Feminine Forever,” by Dr. Robert A. Wilson. A best seller when it was published 40 years ago, the book helped persuade millions of physicians and their female patients that HRT was not just helpful, but necessary. It also offers a sobering and occasionally comical look at the misogyny that pervaded medicine in those days and has certainly not disappeared. You can still find the book on eBay, and similar sites.

Wilson, a British-born gynecologist who practiced in Brooklyn and — as his fame expanded — on Park Avenue in Manhattan, helped pioneer what would become a major goal of large segments of the pharmaceutical industry. He defined a natural human condition as a disease and the cure as the “off-label” or unapproved use of a drug that healthy people would take every day for the rest of their lives.

“Many physicians,” Wilson wrote, “simply refuse to recognize menopause for what it is — a serious, painful and often crippling disease.” In 1942, 25 years before Wilson’s book appeared, the Food and Drug Administration had approved HRT to treat the hot flashes, difficulty sleeping, mood swings and other symptoms that can accompany menopause.

But Wilson proselytized that HRT could accomplish far more than symptom relief.

“Every woman alive today has the option of remaining feminine forever,” he wrote. “No longer need she fret about the cruel irony of women aging faster than men. It is simply no longer true that the sexuality of a woman past forty necessarily declines more rapidly than that of her husband.” 

If a woman refused HRT, the consequences would be unthinkable. “All post-menopausal women are castrates," Wilson wrote. But, with HRT, a woman’s “breasts and genital organs will not shrivel. She will be much more pleasant to live with and will not become dull and unattractive.”

Where did Wilson get these notions? 

His principal research was an uncontrolled study of 304 women, ages 40 to 70, taking HRT, published in the Journal of the American Medical Association in 1962.

Reporters from The New Republic and the Washington Post discovered documents revealing that Wilson, who died in 1981, received payment for the book and for speaking tours on its behalf from companies making HRT. His son confirmed the payments to the New York Times. The drug companies said too much time had passed to check the records. If they did pay, however, they certainly got their money’s worth. Sales of HRT quadrupled in the years surrounding the book’s release.

'She's driving me nuts'
To help sell the idea of HRT, Wilson discussed his own views of sexuality. For a husband, having an affair is perfectly normal, he asserted, “a fact which most non-European civilizations have always calmly and openly recognized. A great deal of human misery stems from the failure of our culture to do likewise.”

But wait! Should a man worry that his wife of a certain age sexually recharged with HRT might go astray? Wilson assures us that “on the contrary, an estrogen-rich woman capable of being physically and emotionally fulfilled by her husband … is least likely to go afield in search of  casual encounters.”

The most amusing section of the book describes a visit to Wilson’s office from “a prominent member of the Brooklyn underworld.” The mobster is sick himself, but he has come for the doctor’s help for his wife.

“She’s driving me nuts,” the tough guy says. “She won’t fix meals. She lets me get no sleep.  She picks on me all the time." 

The visitor then displays a .32 automatic and tells Wilson, “If you don’t cure her, I’ll kill her.”

Wilson calmed the mobster. He accepted the wife as his patient and reported that she responded well to twice-a-week estrogen treatments. "Her disposition improved noticeably after three weeks and soon she was very busy taking care of her sick husband.”

There is no doubt that many women suffer terribly from the symptoms of menopause and that HRT is by far the best treatment. But, as the label now says, it should be given in the smallest doses and for the shortest duration possible.

Unlike the mobster’s wife, women need not risk death to get relief from the natural consequences of aging.