Q&A with Liz Scherer: Fighting the medicalization of menopause one post at a time
Because of all the news about the most recent findings from the Women's Health Initiative study, I asked Scherer to answer some questions about how she started writing about women's health and what tips she might have for others. I reached her by email. The first part of our conversation, which has been edited for space and clarity, is below. The second part will be posted next week.
Q: When I first saw your blog, Flashfree, I thought, "How could someone have a blog dedicated to hot flashes?" But you consistently have interesting, insightful and provocative posts that, mostly, tie back to your central theme of women going through menopause. How did you start down this path and how did you build your audience?
A: The blog is about alternative strategies for menopausal symptoms and dealing with aging. Hot flashes are something that everyone associates with menopause so Flashfree seemed like a good choice for a title. Like many women my age, night sweats hit me like a ton of bricks and curiosity set me on the research path. Because I was unhappy with what was being written about menopause and the tone with which it was written and as a longtime women's health advocate and health/medical writer and journalist, I knew that I could do a better job and offer a comfortable space for my peers to explore and find solutions. Hence, Flashfree was born. I built my audience by leveraging social tools, including Twitter and Facebook, registering the URL in the right places, requesting incoming links and focusing on SEO. I also started to guest blog and network through local, national and international channels. Eventually, I found an audience, and they found me.
Q: From early on, you have written about hormone-replacement therapy (HRT). Let me start by asking, did you ever consider calling it something else? Because of the controversy over hormone therapy, some have said that even the term HRT is a drug company marketing device, design to make women feel like they are missing something that needs to be replaced. What's your thinking on how writers can speak clearly to readers but cut out some of the marketing language?
A: Hormone replacement therapy or HRT is a commonly used term among menopause experts and clinicians. I believe that writers would do their readers a disservice by calling it anything other than what it is and what it is intended to do, i.e. replace waning estrogen levels. In fact, the terminology became part of the vernacular long before pharmaceutical companies like Wyeth got in on the action. Hormonal therapy was lauded as early as the 1930s in France, when menopause was likened to a psychological and physical crisis that could be altered solely by addressing estrogen deficiency. As author Louise Foxcroft writes in her book, Hot Flushes, Cold Science "when oestrogen deficiency was used as the sole explanation of menopausal symptoms it reduced the experiences of aging women to biologically determined problems and reinforced the traditional view of women as different and inferior." She then cites author Elizabeth Parker (The Seven Ages of Woman, 1960), as being instrumental in marketing the myth that hormone treatment would change the concept of the menopause and stabilize women's personalities. So, I don't attribute the term HRT to pharmaceutical marketing per se, but rather, to the confluence of science and societal factors that would eventually lead to the medicalization of what is really a natural transition in a woman's life.
Q: You pull no punches in your posts about hormone therapy. For example, in one of your earliest posts you say, "This may be why HRT after menopause is counterintuitive and downright dangerous." The thinking on hormone therapy has evolved, though. How do you stay ahead of hormone research and how do you decide whether to declare it "good," "bad," or "downright dangerous" at any given point?
A: I don't believe that anyone can ‘stay ahead' of hormone research. And admittedly, this is a gray area for me. You asked about HRT as a marketing device and I think that the ad nauseum re-analyses of the Women's Health Initiative data speak to that. Wyeth (Pfizer) took a huge financial hit when the hormone arm of the WHI was halted and they continue to fund research to dispute the findings about breast cancer and other health risks. But with numerous professional associations issuing warnings that HRT should only be used as a last resort and for the shortest period of time possible, my attention has been pulled away from WHI and towards the FDA, which hasn't done much towards removing HRT from the market save for a black box warning.
My personal opinion is that HRT is very dangerous. The Pro-HRT camp will disagree and will use any means possible, including a documercial of talking heads and fake gurus, to prove that contention wrong. My goal is simply to continue to report the data and encourage women to ask the hard questions and do research before placing themselves at risk for serious health conditions.
Q: Along those same lines, are there stories you have written or posts that you wish now you could go back and rework based on expertise you have developed over time?
A: I don't think so. Flashfree charts an evolution of knowledge and self-acceptance, almost mimicking a woman's growth into mid-life and acknowledgement of the changes that are occurring in her body. If anything, I am proud of how the blog has evolved along with our knowledge base. My goal is simply to provide an alternate point of view that's based in both objective and subjective knowledge. If Flashfree resonate with at least one reader every day, I've achieved that goal.
Q: People who write about pharmaceutical companies make a lot of comparisons between them and tobacco firms or oil companies. Freelance journalist Martha Rosenberg compared Wyeth to the now defunct insurance company AIG, saying that both had a denialist mentality about severe problems with their business model. What do you think is a valid comparison for companies involved in hormone treatments, particularly Wyeth?
A: I read the interview you did with Martha and she has some very valid points about WHI and how the analyses and published papers have (and continue to be) played out. However, she paints a very black and white picture of industry that I don't necessarily agree with. She, like many, fails to acknowledge that medicine is an industry in and of itself. For better or worse, researchers need pharma and pharma needs researchers. Physicians need patients and patients need physicians. Hospitals need people to get sick and sick people need hospitals. In a Utopian world, everyone behaves and does right but we don't live in Utopia, do we?
Moreover, as your own blog posts point out time and again, physicians are humans and subject to error, even in judgment. I've toed the advertising and marketing line, and I continue to do so. I wear a lot of hats. So I have a first-hand glimpse into the ‘good,' ‘bad' and ‘evil,' and what I really see is capitalism at work in all camps, errors made because of greed or the fact that we are humans, and money being thrown into places so that something or somebody can thrive. Is a company that markets hormone therapy the same as an insurer who milks its customers or a physician who practices bad medicine? I believe that the playing ground is pretty damn level. And I can assure you that this opinion isn't one that will win me many fans.