Raging Hormones, Cont'd

"Hormones Weather the Change" [Sept. 20] does a good job of describing the post-Women's Health Initiative (WHI) situation with hormone therapy -- that in spite of data showing increased health risks, many women's health experts continue to promote the use of hormones for women at and after menopause. It's too bad that the article only noted at the very end the funding that Phyllis Greenberger's organization, the Society for Women's Health Research, receives from drug companies that make the products she speaks so highly of.

Cynthia Pearson

Executive Director

National Women's Health Network

Washington

Thank you for including my personal story in Tuesday's special health section. I spoke as an individual and not as a representative of the Society for Women's Health Research, which does not provide medical advice or endorse specific treatments. Hormone therapy is a deeply personal issue for women. Decisions about its use should be individualized in consultation with doctors, as is the case with other therapies.

Phyllis Greenberger, MSW

President & CEO,

Society for Women's Health Research

Washington

I was very interested to read your article on hormone therapy this morning. I have been on Premarin for the past 10-plus years at 48 and will probably never go off it completely. I am now taking the highest dose, but am willing to lower it some.

My determination is based on my mother. When all the brouhaha broke out over taking hormone replacement therapy, her doctor took her off it. She felt so miserable that she went back and told him she wanted back on it. He tried to scare her into submission by warning about breast cancer and other risks. Her response: "I'm 91 and I am going to die of something. I am going to feel good while I do it."

Marilyn Myers

Hanover, Md.

If menopausal women reading this article remain unclear about what their best course of action is, they are not alone. Physicians, too, are trying to offer their best advice in the face of uncertain evidence.

I would like to caution your readers about home remedies. There are a slew of over-the-counter products now being sold for the relief of menopausal symptoms. Most of these are derived from plant-based estrogens. Because they are sold as food additives and not drugs, these products do not need to meet FDA approval of their claims or undergo scrutiny of their safety. These potions are largely untested in the scientific literature.

As always, please discuss all your therapies with your physician. While we may not always have the answers, at least we can help you ask the right questions.

Jeffrey M. Schulman, MD

Vienna

As a physician of internal medicine, I just can't understand how any physician can prescribe hormone replacement therapy (HRT). Yes, there may be a short-term improvement in menopausal symptoms, but the risks are too great. Proponents of HRT use the WHI study risk numbers to try to make the risk seem small, as in only eight additional cases of breast cancer per 10,000 women.

However, there is another way to look at things. Current breast cancer rates, the most common cancer for women with some 180,000 new cases per year and 2 million survivors, has an occurrence rate of 134 per 100,000 women, according to the National Cancer Institute, or 13 per 10,000. HRT adds and additional eight per 10,000.

When one makes this type of comparison, it more clearly represents the risk. And that's just for breast cancer.

Stephen K Leenay, MD

Chanhassen, Minn.

A Pox on Whom?

After reading "A Pox on My Child: Cool!" [Sept. 20], I had two reactions. One, that this is a mental affliction of stay-at-home parents with too much time on their hands and, two, that deliberately exposing a child to chickenpox when there is a perfectly good vaccine available borders on child abuse.

I had chickenpox as a child. As I recall, I spent two miserable weeks recovering from it. As a 33-year-old adult, I developed shingles. I was fortunate to make a complete recovery and avoid the debilitating pain that can result from shingles.

When the chickenpox vaccine came along in the 1990s, I made sure my young daughters received it. It was the least I could do for them as a caring parent.

David DeKok

Harrisburg, Pa.

Am I the only one confused by the massive push by the American Academy of Pediatrics (AAP) -- and, one assumes, the drug companies that manufacture the vaccine -- to vaccinate children with a vaccine that has a high probability of not working? It seems to me that attending a chickenpox party, frowned upon as it may be by the AAP and the medical establishment, is a much more effective way to develop an immunity to the relatively benign disease.

Sarah Hamaker

Fairfax

Your article implies that in the past there was a practice of intentionally exposing children to chickenpox. This is not true.

Perhaps the parents who think they remember "chickenpox parties" are confusing them with rubella parties. Unlike varicella, or chickenpox, which has the potential to cause serious complications, and rarely fatalities, rubella, commonly called German measles, is a very mild illness in childhood. However, when contracted by a pregnant woman, rubella can cause severe birth defects including blindness and deafness. It was a common practice to hold "rubella parties" so girls would be exposed at a young age and not risk contracting the disease during their childbearing years.

David H. Austein MD, FAAP

Olney

The nostalgia for something most of the interviewees never experienced -- families throwing all of their children into the bed of an infected child -- was indeed a common practice. But this was before the existence of the vaccine, which did away with the need and the practice of deliberate communal infection.

I was appalled by the complete disregard of the community at large and the potential for widespread contagion into a population that would be unaware of the hazard and would certainly not welcome having their children exposed to the virus.

Finally, if one feels the need to use the completely inappropriate term "party" for the practice, at least call them "pestilence parties."

Howard Kaplan

Chevy Chase