Premarin A Bitter Pill

By Marc Paulhus
(Reprinted courtesy of The Humane Society of the United States)

One of the most commonly prescribed drugs in America is Premarin, used for estrogen replacement therapy by an estimated 9 million American women. Manufactured by the pharmaceutical giant Wyeth-Ayerst Laboratories, Premarin has been on the market for more than five decades and reportedly has a 75 percent worldwide market share among all estrogen replacement therapy drugs. It is prescribed to alleviate hot flashes and other menopausal symptoms, and it is also taken by women who have had a hysterectomy. Post-menopausal women may take the drug for the remainder of their lives in order to prevent heart disease, decrease bone loss, maintain skin elasticity, and improve sexual function.

Much has been written in the medical journals and in the popular press about the benefits and risks associated with Premarin and other estrogen replacement drugs. What is less well known is the devastating impact that Premarin has on the lives of many thousands of horses. As its name indicates, Premarin is produced from pregnant mares’ urine. It is the only estrogen replacement drug that is derived from animals. Newer and equally effective estrogen substitutes are extracted from plant materials, notably soybeans and Mexican yams, or are synthesized artificially in the laboratory. Plant-derived and synthetic estrogens have been tested on laboratory animals, but they differ from Premarin in one important way: they do not require the continuing exploitation of animals.

To obtain the raw material for Premarin, Wyeth-Ayerst has exclusive contracts with some five hundred managers of pregnant mare urine (PMU) farms. Most of these facilities are located in the Canadian provinces of Alberta, Manitoba, and Saskatchewan, but about thirty can be found in North Dakota.

As millions of women from the baby boom generation enter menopause, the demand for estrogen replacement drugs is expected to increase dramatically and the number of PMU farms will grow in proportion.

A spokesperson for a PMU industry group euphemistically known as the North American Equine Ranching Information Council admits that some 50,000 mares are used in the production of Premarin. Animal-protection groups challenge this figure, asserting that the actual number may exceed 75,000. What is undisputed is that each PMU farm keeps from several dozen to a few hundred mares “on line,” and many also maintain a substantial number of replacement mares and breeding stallions. The mares must be kept pregnant in order to produce estrogen-rich urine, and approximately 90 percent of them deliver live foals each year. The total number of mares, replacement mares, stallions, and foals affected by the PMU industry is greater than 100,000 per year.

The care that horses receive on PMU farms is not controlled by specific laws or government regulations. Instead, under the terms of their contract with Wyeth-Ayerst, the farm managers are subject to a corporate code of practices developed in consultation with a committee of agricultural officials. The HSUS has carefully reviewed the code and found it insufficient to protect the well-being of the mares and the thousands of foals they produce. We have learned that even this inadequate code has not been stringently followed. According to independent reports, the pharmaceutical company employs its own inspectors who allow farm managers considerable leeway regarding some of the recommended practices.

The annual estrogen-production cycle begins when the pregnant mares enter the PMU collection barns in late September or October. By then the mares are three or four months into their el even-month-long pregnancies. They are placed in narrow, individual stalls, tethered by short ropes or chains, and fitted with flexible harnesses suspended from above. A rubber collection cup is held in position beneath each mare’s tail to catch the urine flow. Because the tether and collection apparatus greatly restrict the mare’s movement, she cannot turn around within the stall nor take more than a small step or two in any direction. If the restraining rope or chain is too short, as has been observed, she may even be unable to lie down comfortably. During the several months of near total immobility, most mares are rarely, if ever, taken off line and out of the harnesses for even a few brief hours of exercise. PMU farm managers argue that Canadian winters can be exceptionally frigid and that mares would rather be indoors. However, managers could easily provide partially sheltered paddocks where the mares could occasionally walk, kick up their heels, and socialize with each other. At the very least, mares could be given regular access to an interior enclosure that would allow them to stretch their muscles and tendons and flex their joints. Mares are denied exercise probably because providing it would be inconvenient and time consuming — the facilities have too few laborers and many of the horses are unaccustomed to handling.

PMU mares typically are not provided with adequate bedding to cushion and insulate them from the cold, hard floor. Observers report that farmers consider bedding to be a needless expense, since mares tend to kick it into the open aisles behind the stalls. Most likely, bedding is also limited because it is bothersome to clean up and dispose of. Inadequate bedding, however, discourages mares from lying down to rest.

Another concern is the common practice of restricting the amount of water available to the mares. The majority of barns have automatic watering systems that dispense water only at timed intervals and in small, measured amounts. An inspection report by a veterinarian with the U.S. Department of Agriculture criticized the drug company’s water restriction policy and cited evidence that it may be the cause of an apparent increase in liver and kidney disorders among PMU mares. According to the World Society for the Protection of Animals, which sent a representative to more than thirty PMU farms during the winter of 1995, “mares sometimes fight and injure themselves as they struggle at water distribution times. If horses were allowed to drink water whenever they were thirsty, that would result in greater shipping cost [of the urine to the processing plants], because the horses would urinate more and the hormone would be more diluted.”

PMU farm managers are compensated, on a sliding scale, depending on the grade of urine produced, which is determined by the concentration of estrogen in it. The grading system seems to provide an economic incentive to restrict water. Although the drug company flatly denies that water is withheld in order to concentrate the urine, it offers no alternative explanation for the practice.

PMU mares exhibit an abnormally high frequency of hoof and leg injuries. Sores and lacerations on the lower legs seem to be caused by the narrowness of the stalls and the frequent use of tubular steel rails to separate horses. If a mare lies down, she can have great difficulty getting up again without catching her legs in the open spaces between rails. Aggressive mares may injure themselves when trying to kick adjacent horses. Such injuries could be prevented if the stalls were wider and had solid partitions. Other problems, such as swollen joints and edema, may be related to the lack of exercise or bedding or may be indicative of dehydration.

A PMU mare remains in the collection barn for approximately six months. By late March or April when she is finally allowed outside to graze, she is swollen and heavy with the weight of her unborn foal. Within a few weeks, she gives birth and is almost immediately reimpregnated. Common sense alone dictates that a mare be permitted at least a month or two to recuperate from foaling, but the rigid timetable of the industry outweighs sensible and humane considerations. If a mare does not become pregnant within a very short time, she cannot be returned to the collection barns. She probably will be sent instead to the slaughterhouse.

Foals are allowed to remain with their mothers only until they are three or four months old. At that time the mares must resume their place in the production line. The foals are merely by-products of the business. Perhaps a few of the female foals will be raised on the farm as future PMU mares, but most of the females, and virtually all of the males, are disposed of by mid-September.

Because of the careless overbreeding of horses throughout North America, the prospect of PMU foals finding good homes is bleak. In recent years some PMU farm managers have tried to improve the marketability of the foals by using registered breeding stock. A few have succeeded. Nevertheless, many foals are sent to open feedlots to be fattened and eventually slaughtered. The meat is exported to Asian and European markets for human consumption. Some of the feedlot-raised foals are even shipped live to Japan at great expense. The HSUS obtained documents under the U.S. Freedom of Information Act showing that hundreds of PMU foals, classified as “feeder horses,” are shipped from feedlots in Canada to an export quarantine station near Seattle. A number of independent sources confirm the horses are then flown to specialty meat markets in Japan.

PMU mares are back in the barns by the fall, and the cycle of deprivation begins all over again. They are unable to run, they are isolated from their young and from their herd mates, they are denied the opportunity to express the very nature of their highly social, very athletic species. Instead, these beautiful and noble creatures are forced to become drug factories.

PMU horses and foals can be spared lives of misery if women choose plant-derived or synthetic estrogen products instead of Premarin. All of us can share information about PMU farms and estrogen alternatives with the women in our lives — husbands with wives, children with mothers, friends with friends. Women can discuss their ethical concerns and explore treatment options with their physicians. Many women forego estrogen replacement therapy entirely in favor of dietary changes and exercise programs. Others prefer to use synthetic estrogen creams or transdermal patches. Women do not have to choose between their health and their consciences when faced with the issue of hormone replacement.

What Women Should Know

Choosing whether to begin estrogen replacement therapy after menopause or hysterectomy is one of the most important decisions a woman will make in her life. It is a complicated health-care issue, one in which the benefits — the reduced chance of heart disease and osteoporosis — must be weighed against the risks — the possibly increased potential for developing breast and/or endometrial cancer. It is vital that women be informed and participate in making this decision. Here are a few questions that women should discuss with their doctors when considering estrogen replacement therapy:

* Why am I considering taking estrogen? Am I trying to ease the unpleasant symptoms of hormone deficiency, or am I trying to minimize my risk of developing heart disease or osteoporosis?

* If I am considering estrogen to mitigate symptoms, what are these symptoms? If my problem is limited to vaginal atrophy, can I use an estrogen cream instead of oral or transdermal estrogen so that lower levels of estrogen enter my bloodstream?

* Would I prefer to take estrogen orally or through a patch I wear on my skin?

* If I am considering estrogen replacement therapy to decrease my risk of developing heart disease, can I consider instead other lifestyle changes, such as diet and exercise, to decrease my risk?

* If I am at risk for osteoporosis, can I decrease my rate of bone loss through proper nutrition and exercise? Are there alternative therapies for reducing the effects of osteoporosis?

* If I decide to take estrogen, what kind of estrogen do I want to take? Do I want to take animal-derived estrogens, such as those found in Premarin, or do I want to take plant-derived or synthetic estrogens that are more similar to human estrogens?

To protect your health, discuss your concerns and treatment options with your physician. If you determine that estrogen replacement therapy is appropriate, a plant-derived or synthetic drug offers an ethical alternative to Premarin. For a detailed chart comparing all FDA-approved estrogens, contact The HSUS, 2100 L St., NW, Washington, DC 20037. [Or see “Facts About Hormone Replacement Therapy.”]–

This checklist was prepared in consultation with David O. Wiebers, M.D., Jennifer Leaning, M.D., S.M.H., Ruth Barron, M.D., and Mary Helen Niemeyer, M.D., M.P.H., F.A.A.P.P., physician members of and consultants to the HSUS Scientific Advisory Council.
Editors note: Women should look into using Natural Progesterone cream which helps balance women’s hormones. Many women report good results by using this cream transdermally. Available in most health food stores and some better drug stores