Premarin - The Untold Story

by Lauren RenÇ Hotchkiss

Earlier this year, a concerned friend gave me an article that had appeared in the August/September 1994 issue of the PETA Times, a bi-monthly magazine published by the People for the Ethical Treatment of Animals. The article detailed reputed incidences of animal abuse in the production of Premarin, a process with which I was largely ignorant. Upon making some calls, I subsequently obtained some further information from PETA as well as a pamphlet put out by the Animal Protection Institute (API).

Premarin (Conjugated Equine Estrogens) is the most commonly prescribed estrogen replacement drug for menopause symptoms and one of the main hormones of choice for the male-to-female members of the transgender community. It's currently being taken by more than eight million women as well as by thousands of MTFs both by prescription and on the street. Premarin is also the single most prescribed drug in the United States. In addition, it holds 80 percent of the estrogen supplement market worldwide, and is Canada's most lucrative pharmaceutical export. Premarin's revenues amount to more than $642 million a year -- more than 14 percent of manufacturer, Wyeth-Ayerst's, annual gross of $4.5 billion. Wyeth Ayerst Organics, in turn, is a division of American Home Products, which also manufactures Advil, Anacin, Black Flag, Chef Boyardee, Dristan, Easy Off, Jiffy Pop. Neet, Pam, Preparation H, Quick and Easy, Sani-Flush, and Woolite.

Apart from its well-established familiarity to physicians -- Premarin has been marketed in the United States since 1942 -- it has also, until recently been one of the cheapest estrogen drugs.

This much is common knowledge. What is less known is the fact that Premarin is distilled from the urine of pregnant mares.

Essentially it is a mixture of the seventeen estrogens which occur naturally during various stages of equine pregnancy.

The industry has grown enormously over the last 50 years or so. By 1993, there were an estimated 75,000 mares on 485 farms in North Dakota and the Canadian provinces of Saskatchewan, Alberta, and Manitoba confined for urine collection. These mares, in turn, gave birth to 70,000 foals. By 1995, the numbers had swelled to 100,000 mares on some 600 farms, with another 1,200 farms on the application list to become PMU (pregnant mare urine) producers. The financial incentives are enticing to the enterprising horse rancher, with PMU producers under contract to Wyeth-Ayerst being paid up to $17 a gallon for pregnant mare's urine.

Each September the mares are inseminated, either naturally or artificially, and then put on the production line -- each mare may spend as long as 18 years of their lives as PMU producers, PETA charges. At the end of their usefulness, PETA claims, the mares are generally auctioned off for slaughter or rewarded for their long years of service, with a one-way trip to the rendering plant.

According to PETA and API, the foals do not fare much better. Each year, in March and April, each mare will give birth to a foal. These foals are considered by-products. Some will be raised to replace worn-out mares, others will be sold as pets, but most will be fattened for a few months and then follow the older mares to slaughter house. Over the past fifty-three years this "harvest" has killed millions of foals.

The mares are kept on a "pee-line" -- ranchers' slang for the rows of stalls where the horses have their urine extracted. They are fitted with a rubber urinary collection device attached to a hose and then confined to their stalls for seven months of their eleven month pregnancies. These collection harnesses often chaff their legs, PETA charges, causing sores which remain untreated throughout the animals' lives. To concentrate the urine (for bigger profits, says PETA), the mares are poorly fed and receive less water than is normal.

Because allowing mares out to pasture would mean losing some of their precious urine, PETA charges that the mares are forced to stand on concrete floors in stalls as small as 8 feet long and 3 1/2 feet wide for more than half of their eleven month pregnancies. The mares are unable to take more than a step or two in any direction, the narrowness of their stalls preventing such simple movements as turning around or lying down. As a result, they often develop "stiff leg" from standing, heavy with pregnancy, on the hard, cold, concrete floor for months on end.

According to PETA many of the mares used at PMU facilities have never been confined before. They whinny in terror and tug frantically at their ropes. Others develop repetitive movements seen in confinement-crazed animals in zoos and on fur farms, weaving their heads from side to side and pawing rhythmically at the concrete floor. Many become panic-stricken and begin to kick and gnaw their stalls in frustration and fear. PETA claims that these inhumane conditions and the medical complications that result have led to the premature deaths of tens of thousands of horses.

On the ecological side, there are grave concerns on the part of Canadian environmentalists and legislators regarding The PMU industry's waste disposal practices. The proposed $100 million expansion of Wyeth-Ayerst's Manitoba production facilities, with aid of $20 million from the Canadian Government, threatens to overwhelm an already over-taxed sewage treatment system. In addition, according to Marianne Cerilli, member of the Legislative Assembly and Environment Critic for the Canadian New Democratic Party, the expansion has "serious consequences for the Assinboine River, a river that many Manitobans use as a drinking water source.

Fortunately, alternatives do exist. Synthetic, primarily plant-based estrogens, have been developed in recent years which have been clinically found to be equally effective as conjugated estrogens (those derived from the urine of horses, cattle, or pigs) in alleviating the menopausal symptoms in women and in enhancing feminization in MTFs.

Synthetics, at least in numbers of brands available, now dominate the market, with Premarin as the last surviving animal- derived estrogen. In many ways synthetics, formulated to be an exact chemical duplicate of human estrogen, are more natural than the conjugated estrogens.

According to Stephen Rosenman, M.D., of the Physician's Committee for Responsible Medicine (PCRP), the estrogen found in Premarin is not the same as that in humans, and like all animal- derived products, it shares the problem of dosage inconsistency. Synthetics, produced in sterile, laboratory conditions, are assured of much greater quality control. The ingredients are constant, always in the same concentration, and without the impurities contained in animal waste.

The following is a list of the leading prescription synthetic brands:

Estraderm (estradiol transdermal system) is a clear plastic patch that releases small amounts of estradiol -- the hormone produced by ovaries -- through the skin into the bloodstream. Estraderm is manufactured by CIBA Pharmaceutical Company.

Estrace (estradiol) is derived from soybeans and Mexican yams. It is manufactured by Mead Johnson Laboratories.

Estratest, manufactured by Solvay Pharmaceuticals, is a combination of esterified estrogens and methyltestosterone. It is processed from yams and soyplants and then synthesized to resemble human estrogen.

Estratab also consists of esterified estrogens. Up to fifteen percent of Estratab contains synthetic equine estrogens. It, too is manufactured by Solvay Pharmaceuticals.

Ortho-est (estropipate) is derived from soybeans or Mexican yams, and is identical to human estrone in its estrogen composition. It is made by Ortho Pharmaceuticals.

Ogen also consists of estropipate and is identical to human estrone in its estrogen composition. Until recently, it was manufactured by Abbott Labs. It is now produced by the Upjohn Company.

Other alternative brands include Theelin, Menest, and Progens.

The newest entry into the synthetic arena may be the most promising. Manufactured by Duramed Pharmaceuticals, the drug, not yet available, and still unnamed pending FDA approval, is chemically identical to Premarin with the same blend of seventeen estrogens but, being synthetic, is not derived from animal sources. Evidently the company is keeping a low profile until the drug is released, for my calls were not returned.

Non-prescription plant-based estrogens such as Fem-50, or Woman Power (both manufactured by Michael's Pharmaceuticals), are available or can be special ordered through health food stores or vitamin supply houses. Others, such as Evanesce, can be purchased by mail order through ads found in Tapestry, Ladylike and other gender community magazines. These plant-based estrogens usually contain black (or blue) Cohosh, licorice root, Don Quai, and other natural ingredients. Pro-Gest, a cream derived from yams, and containing progesterone identical to that made in the human body, is also available in many health food stores.

Though weaker in strength than conjugated or synthetic estrogens, some members of the transgendered community have reported modest results from these plant-derived products. Vegetarians should be aware, however, that some of these herbal preparations incongruously come in gelcap form (gelatine is a by-product obtained from boiled animal tissue).

Other herbal preparations can often be found at homeopathic supply houses and Chinese herbal pharmacies. For fresh ingredients, nothing can beat the Chinese herbalists. There is one catch, though. You have to be willing to take an hour to boil down the herbs and then drink, as a tea, a concoction which probably doesn't taste much better than mare's urine.

In addition to synthetic and plant-derived forms, Estrogen also occurs naturally, in trace amounts, in many soy foods such as tempeh, tofu, soy milk, etc., as well as in berries and citrus fruits.

After reading the material put out by the animal rights groups, I decided to call Wyeth-Ayerst and see how they've responded to the charges of animal cruelty. Reaching their Customer Service Dept., I was put in contact with their media representative, Audrey Ashby, a very friendly and helpful woman, who offered to Fed-Ex me a copy of their press release as well as clippings from journals and newspapers supporting their position.

In their media statement, they accuse animal-activist groups with inhibiting the important progress in the field of women's health. They also accuse PETA of factual inaccuracies, misleading photographs and often false allegations and fabrications. Interestingly, in defending themselves Wyeth-Ayerst claims that when a mare delivers, she and the foal are kept together. Foals wean, they say, as they normally would, over a period of several months and are raised for a variety of purposes including show, riding, work, breeding and "overseas markets." A little further investigation discovered these overseas markets to be the importers and exporters that cater to the European and Japanese taste for horsemeat.

In its Premarin brochure, Wyeth-Ayerst, in opposition to the contentions of PETA, API, and PCRP claims that Premarin is consistent in potency and composition from batch to batch. The brochure also claims that the harness the horses wear is a "light- weight, flexible collection pouch, loosely suspended, that allows for a full range of movement within the stall, including lying down comfortably." It does not cause chafing, they claim.

One included newspaper article, uncredited as to source, date, or author, charges that PETA's claims are unfounded and that they have no convincing evidence and have never reported any alleged mistreatment to the authorities. The article claims that the veterinarian who has spoken out on behalf of PETA only visited one farm, and so was not qualified to speak concerning the entire PMU industry. Such a generalization, they argue, is dishonest and misrepresentational. They contend that PETA's concern with the ethical treatment of animals apparently does not extend to the ethics of honest inquiry. The article also claims that the Canadian Farm Animal Care Trust (CFACT) is currently conducting a tour of Canada's PMU farms and is not finding incidences of cruelty. The article claims that unbiased evaluators say PMU production is not cruel -- it does not disclose, however, who these unbiased evaluators are.

In an article by columnist Dan Geringer which appeared August 4, 1994 in the Philadelphia Daily News, he disparagingly refers to PETA as the "Rats have rights" protest group. He also mentions equine veterinarian Dr. Shauna Spurlock's Wyeth-Ayerst sponsored "inspections" of "several" PMU farms. Not surprisingly her report to her bosses was favorable. Mr. Gerringer failed to report whether the inspections were arranged or surprise visits, however.

This same Dr. Spurlock later issued a report concerning her inspection tour entitled the "Care and Management of Horses At PMU Facilities" In addition to corroborating the high degree of care for the horses that Wyeth-Ayerst also contends, going as far as to say that the ranchers realize that the better they care for their horses, the better the horses will perform for them, Spurlock also claims that the majority of foals are intended for the race track, quarter horses for the show ring, to draft foals that may be used for "light, recreational work or cart. Some of the fillies, she says, are kept as future replacement mares. Only a small minority, she claims are ever sent to slaughter, and that she blames on the thriving market and appetite for horse meat in Europe and Asia. She concludes by saying that the entire PMU industry from the establishment of the Code of Practice for the Care and Handling of horses at PMU facilities to the way ranchers tailor the code to best serve the needs of the individual horses in their care, is a model for others in the equine industry to emulate.

Included also was a statement by Frankie L. Trull, President of The Foundation For Biomedical Research, accusing animal activist organizations of being fueled by misinformation and emotion. He accuses them of having the goal of jeopardizing the work of the medical research community, and in particular, those studies focused on advances in women's health care. He goes on to warn the public of these groups secret agenda to rid the world of meat, seafood and dairy consumption. He also warns that women would suffer because many therapeutic treatments would never exist because they could not be developed without animal testing.

Incongruously, Ms. Ashby also included PETA's compassionate living brochure, which deals with the advantages of a meatless and dairyless diet. Far from dissuading me from PETA's views, it only served to re-enforce my commitment to animal welfare and inspired me to move from vegetarian to vegan.

Also included was an article by Charles Gandee that appeared in the July 1994 issue of Vogue, blasting PETA and other animal rights organizations. This was not too surprising a view from a magazine whose major advertising revenue comes from fur manufacturers and cosmetic companies who do animal testing.

Responding to the issue of PMU facilities and treatment, Ms. Ashby included literature on the Code of Practice for the Care and Handling of horses at PMU facilities. This code calls for 5 foot wide stalls for mares over 1,700 pounds. It also calls for harnessing that does not cause chaffing and allows for a full range of movement. The code also mandates proper ventilation, lighting, disposal of wastes, and even the proper trimming of horses hooves.

Addressing the question of the amount of water given the mares is a copy of an interview with Kevin Frith, a North Dakota PMU rancher, which appeared in Ag-Week on March 6, 1995 by staffwriter Ann Bailey. In it, Mr Frith details an automated watering system for the PMU mares which regulates water to the mares 18 times a day. Each mare gets an average of 1 1/2 quarts per watering for a total of 6 3/4 gallons of water per day. He claims that regulating their water helps mares digest their food better. It is not done, says Frith, to concentrate the mare's urine for bigger profits as PETA had claimed. In checking this point with an equine veterinarian I contacted, I found that the proper water intake for a horse is 12 gallons per day.

In the same article, Frith also turns to the issue of the amount of exercise given the horses, stating that each mare is "turned out" one day per month. He seems to feel that that is enough. He disavows any knowledge of foals being sold for slaughter.

It is difficult to know where the truth lies when evaluating such divergent views as those represented by the animal rights groups and Wyeth- Ayerst. Though I'm sure humane PMU farms do exist, and may, in fact, be in the majority, it is an industry that is clearly on the wane, particularly in light of healthier synthetic and herbal alternatives now available. As these can now be manufactured inexpensively, collecting PMU, with even the possibility of cruelty to animals seems an antiquated and unnecessary method of producing estrogen.

In order to move away from relying on the PMU industry, patients and clients need to be willing to speak up and ask for alternatives. Many doctors and therapists, as well as most patients, have little or no knowledge of how Premarin is made, and upon learning the facts, the majority choose to stop using or prescribing it.

For myself, I have decided not to take a chance of contributing to animal suffering, and so have opted to stop taking Premarin. Though I realize that this is an individual decision that each person must resolve for themselves, I do feel a responsibility to present the facts as they were presented to me as an aid in helping you to make the decision that is right for you.

Copies of the PETA article plus a supplemental informational brochure are available from PETA, P.O. Box 42516, Washington, DC, 20015. Or call 301-770-PETA. You can also obtain further information from the Animal Protection Institute. P.O. Box 22505, Sacramento, CA 95822. 2831 Fruitridge Road, Sacramento, CA 95820. 916-731-5521.

For further information on the role of Premarin in the medical profession, write The Physicians Committee for Responsible Medicine; P.O. Box 6322, Washington, DC 20015; or 5100 Wisconsin Avenue NW, Suite 404, Washington, DC 20016; or call 202-686-2210.

Wyeth-Ayerst Pharmaceuticals, Robert Essner, President; Marc W. Deitch, M.D., Vice President, Medical affairs and Medical Director, can be contacted at: P.O. Box 8299, Philadelphia, PA 19101-8299. Wyeth-Ayerst's toll-free numbers are 800-999-9384 and 800-666-7248, or call 610-971-5500 or 215-971-5823.

American Home Products, Wyeth-Ayerst's parent company, can be contacted at 5 Giralda Farm, Madison, NJ 07940; or call (212) 878- 5000. The contact is John Stafford, CEO.

Duramed Pharmaceuticals can be reached at 714-952-1641. Randy Acosta, Customer Service Contact.

Those wishing further information on the environmental and ecological impact of Wyeth-Ayerst's PMU processing plants in Manitoba and on the proposed expansion of those facilities can contact, in the Canadian government: Minister Lloyd Axworthy, Department of Western Diversification, House of Commons, 418-M Center Block, Ottawa, Ontario KIA OA6. And in the Manitoban government: The Honorable Gary Filman, Premier of Manitoba, 450 Broadway, Winnipeg, Manitoba R3C OV8) protesting their funding of Ayerst's expansion.