The ongoing debate over hormone replacement therapy continues in Mother Jones as Dr. Susan Love, one of HRT's most outspoken critics, attacks Michael Castleman's endorsement of the treatment for some women in his July/August column. Plus: Gambling is good for you; why the Better Business Bureau is out to get us; and hosannas to hemp.
Unfortunately, Michael Castleman has fallen prey to the media hype on the use of hormone therapy for long-term disease prevention ("Hormonious Heart," WellBeing, July/August). The significant data on the use of hormones for the prevention of heart disease, colon cancer, and Alzheimer's disease are all observational. It is not clear whether hormones make women healthy or healthy women take hormones.
Castleman's point is that the risk/benefit balance was shifted by a new study demonstrating a decrease in deaths from breast cancer in women who have taken hormone replacement therapy. In fact, the study is not really helpful for women facing the HRT decision. It is well known that women who take HRT are healthier than the general population. In addition, they are more likely to undergo screening and therefore have their cancers found earlier. These biases alone, which were pointed out in the paper to which Castleman refers, could easily explain the decrease in breast cancer deaths.
In addition, this study only looks at women who have ever used hormones. That means the women could have taken hormones for one month or 10 years. There is agreement that it is both current use and duration of use that increase breast cancer incidence and deaths. The most recent report from the Nurses' Health Study showed that the mortality advantage from taking HRT was partially counteracted after 10 years of use because of the increase in deaths from breast cancer. What will happen after 20 or 30 years?
Castleman does women a disservice by oversimplifying the issues. The fundamental problem with using HRT for prevention is the notion that a drug with any potential risk should be used to prevent a future disease that may or may not occur. As the most recent Nurses' Health Study pointed out, women who live a healthy lifestyle -- nonsmoking, not obese, normal cholesterol, normal blood pressure -- have no significant advantage from taking HRT. Lifestyle changes are an option that should not be so easily dismissed.
SUSAN M. LOVE, M.D.
ADJUNCT PROFESSOR OF SURGERY, UCLA
LOS ANGELES, CALIF.
Scant hours before reading about Michael Castleman's newly found support for HRT, I read Ms. magazine's July/August interview with Dr. Susan Love. Both experts are, much to their credit, interested in individual solutions for individual women, rather than in wholesale prescriptions.
Yet Love in addition does what MoJo usually does so well: She questions the reliability of the heart disease studies under discussion; she places HRT in its capitalistic context, wherein selling more drugs to women as "preventive" health care is big business for drug companies; and she explores options such as using HRT temporarily or starting it later in life.
I have long been an admirer of MoJo's reporting on health topics, but in this case I think you've overlooked key issues. Women need to be told when the information available is partial, under debate, potentially skewed, or still in the early stages of confirmation. Castleman's article implies that the HRT story is solid and complete. Whether Love is correct or not, her contrasting voice belies this implication.
Michael Castleman responds: I have admired Dr. Love for many years, and have recommended her Breast Book to dozens of women. I agree with her that lifestyle changes are preferable to drugs. My column did not urge women to embrace HRT as some godsend, only to consider it a personal option in consultation with their physicians and in light of their own individual risk for heart disease, breast cancer, colon cancer, osteoporosis, and Alzheimer's disease.
The HRT studies are open to interpretation, and reasonable people may disagree. My beef with Dr. Love is that she has become unreasonable. She argued in an op-ed piece in the New York Times in March that breast cancer was a greater risk to postmenopausal women than heart disease. This is an imaginative interpretation of the data, and she caught hell for it in the New Yorker in June.
Now she argues that no "drug with any potential risk should be used to prevent a future disease that may or may not occur." Using that logic, no one should ever be vaccinated. Preventive medicine requires perspective, living with small risks to prevent major health hazards. I fear that Dr. Love has lost her perspective.
Lifestyle changes are, indeed, preferable to drugs. But only about 20 percent of Americans live a healthy lifestyle: near-vegetarian diet, regular exercise, and little, if any, alcohol. Should public health advocates write off the rest of the population as hopeless? Or should they offer drugs that, while not perfect, partially substitute for lifestyle changes?
I share some of Dr. Love's concerns about the HRT studies, but by citing them very selectively, she obscures the weight of the evidence: HRT reduces the risk of heart disease, osteoporosis, colon cancer, and Alzheimer's disease. And though it increases breast cancer incidence, it appears to reduce the risk of breast cancer death.
Clearly, some women should not take HRT, including my wife, who has a personal history of breast cancer. But Dr. Love's blanket condemnation of the treatment takes healthy skepticism to an unhealthy extreme.
The gaming entertainment industry is a business, and like any other business, the premise is to provide our customers with an entertainment experience and derive a profit for our shareholders ("Easy Money," July/August). The industry employs more than 1 million Americans with good-paying jobs (the average wage is $26,000), many of them in economically distressed areas, offering opportunity to people who have had little hope in many years. The tax revenues to state and local governments refurbish communities and provide for hospitals, housing, schools, and daycare centers. Georgia earmarks lottery proceeds for the Hope Scholarship Program, which provides college scholarships to all students who graduate from high school with a B average.
Your use of Joliet, Illinois, as an example of a community negatively affected by gaming is a poor choice. In fact, a recent economic impact study of new gaming jurisdictions conducted by the accounting firm Arthur Andersen found that Joliet has experienced significant positive economic impacts as a direct result of gaming. The study found the creation of thousands of new jobs that employ a larger proportion of minorities and women than other employers. Tax revenues have gone to pay for community services and played an extremely important part in the city's budget, and the number of people on public assistance programs has dropped dramatically.
Your claim that every $1 in tax revenue from the gaming industry creates $3 in social costs is totally false. The Arthur Andersen study revealed that social costs have fallen in Shreveport, Louisiana, and Gulfport, Mississippi, as well as in Joliet, after the introduction of gaming.
You are clearly entitled to your own opinion as to whether gaming is good or bad. It is, however, unfortunate that you rely on half-truths, lies, and a total failure to seek balanced information. Gaming may not be right for every community -- it is not a magic economic silver bullet. However, if made part of a carefully crafted economic development plan, gaming can help revitalize communities and allow them to prosper.
FRANK FAHRENKOPF JR.
PRESIDENT AND CEO, AMERICAN GAMING ASSOCIATION
Editor's note: The American Gaming Association bought and paid for the Arthur Andersen study that Fahrenkopf cites in his letter.
Your exposé on gambling filled a void in the national media. During the 1990s, gambling lobbyists have thwarted the public's right to vote on gambling issues, using vast financial resources to legalize casinos and other organized gambling activities in many states. When gambling proponents could not avoid a vote on these issues, they often outspent their opponents by a ratio of 50-to-l.
Federal campaign contributions made by gambling interests during the 1995-96 election cycle amounted to at least $5.4 million, including $3.6 million in soft money. These donations helped make gambling advocates the dominant influence on the National Gambling Impact Study Commission recently formed by Congress. Fortunately, Mother Jones and other national icons of the fourth estate have remembered the lessons of Watergate and are beginning to "follow the money."
JOHN WARREN KINDT
PROFESSOR OF COMMERCE AND LEGAL POLICY
UNIVERSITY OF ILLINOIS
Given that I am, by Jeffrey Klein's own testimony, his "most rational, economically informed friend," I feel obliged to make a rational, economically informed point or two in response to his Editor's Note on gambling ("Bad Odds," July/August). First, the Super Bowl wager Jeffrey and I indulged in suggests not only that I am vulnerable to gambling's wiles, but that Mother Jones' editor is equally susceptible. Jeffrey writes that my enthusiasm for my home team, the New England Patriots, was a sign of mania and that, spotting the opportunity to "make a smart friend look like a sucker," he took it. Let me explain the fallacy here.
I bet Jeffrey that my New England Patriots would win the game. The football cognoscenti deemed this highly unlikely. So unlikely, indeed, that the odds against the Patriots winning were 4 1/2-to-1.
How did the odds get that way? By thousands, perhaps millions, of football enthusiasts putting their money where their mouths were. In economic terms, Super Bowl gambling is a market -- an "efficient" one, in that no one exercises undue influence or tilts the final price one way or the other.
Now, I thought the Patriots were not that much weaker than the Packers. Rashly, I shared my reasoning with Jeffrey. He suggested we bet. By backing Green Bay, Jeffrey was, in gambling parlance, "betting on the favorite," which I've always considered an unduly conservative way to wager. But -- and here's the key point -- his risk was still no less than mine.
Consider, by way of analogy, the stock market. At any given moment, the price of a stock, say, IBM, is the best guess, among all investors, as to what IBM is worth. Should I buy, I would be gambling that IBM is worth more than the consensus believes. If Jeffrey were to sell, he would be betting that IBM is worth less than the collective best guess. And, just so, the tides of collective optimism and pessimism about IBM raise and lower its price, moment by moment.
In exactly the same way, the collective betting public determined the Super Bowl odds, which fluctuated within about 10 percent in the two weeks leading up to the game. Finally, just as much money was bet on the Patriots at 4 1/2-to-1 as was wagered on the Packers at 1-to-4 1/2.
Jeffrey thought he was taking advantage of my partisan bias in favor of New England. But in fact, he was taking as much of a chance as I was, simply in the opposite direction. I was betting that New England was somehow superior to the collective best estimate of gamblers everywhere; he was betting the same with regard to Green Bay. In the end, of course, Jeffrey was motivated more by an effort to show up a friend than to win a piddling sum. This motivation drove him to a bet no less (or more) irrational than mine.
So what? you may well ask. My response is that gambling can be, and often is, a source of far more than the desire for money. It can be a way of humbling one's friends. It can be a way, in one's mind, of beating the gods (what it feels like when you hit an exacta at the racetrack). It can be a source of companionship (the weekly poker game), amusement (Wayne Newton at Las Vegas), distraction (the slot machine). And often -- oh so often -- it is exciting, causing the heart to pound, the muscles to tense, etc.
It is gambling's multiple attractions that make it especially insidious, and especially addictive. Which is why, in the end, I so heartily agree with Jeffrey, despite his crowing about our wager.
One last point: If such rational specimens as Jeffrey and myself can squander this much of our time (and yours) on one lousy, arguably illicit telephone Super Bowl bet, imagine what might happen if California, Massachusetts, and/or the U.S. government were to run -- and advertise -- football betting operations. You'd never hear the end of it.
"THE NEWSHOUR WITH JIM LEHRER"
The EPA is taking innovative steps to address the concerns about the effectiveness of hospital disinfectants raised in "Unsanitary Behavior" (July/August). In the 1980s, the EPA's review of disinfectants was not very thorough. The General Accounting Office evaluated the program in 1990 and made a number of recommendations aimed to ensure public health pesticides are effective. Since then, the EPA has taken many ineffective public health pesticides off the market.
New techniques are allowing us to evaluate more products against more stringent standards than we could in the past. We are using tough new screening tests to help us determine which of the 800 registered hospital disinfectants in use should be tested more fully. These and other efforts will ensure that new disinfectant products are effective at controlling harmful microorganisms, and that ineffective or mislabeled products lose their registration.
LYNN R. GOLDMAN, M.D.
ENVIRONMENTAL PROTECTION AGENCY
"Unsanitary Behavior" charges that Sani-Cloth is ineffective. In view of your failure to verify with us the accuracy of specific statements in the article, we can only conclude that Mother Jones published the false statements on Sani-Cloth with knowledge of their falsity or with reckless disregard of the truth. These false statements have seriously damaged our outstanding business reputation and will cause us serious financial harm. The article contains the following false statements:
(1) Sani-Cloth does not kill the three bacterial pathogens necessary for EPA registration. This statement is false. Sani-Cloth's effectiveness against these organisms has been verified by Hill Top Research Ltd., a highly regarded independent laboratory that performed the tests on the target organisms in accordance with proper EPA protocols.
(2) An 8 percent alcohol level is "generally considered insufficient for effective disinfectant use." This statement is false. The enclosed test report confirms that an 8 percent isopropyl alcohol level in combination with Sani-Cloth's other active ingredients is an effective disinfectant.
(3) The Sani-Cloth polio virus claim was removed as a result of Mother Jones' contacting Nice-Pak Products. This statement is false. The polio claim has been removed from our label since July 24, 1996, when we launched Super Sani-Cloth. Super Sani-Cloth has a broader spectrum of disinfectant activity and the polio claim was not required by either the market or the EPA. Accordingly, we removed the claim from both products at the time.
Professional Disposables Inc. is a responsible company that sells only properly registered products that are proved effective under the most exacting laboratory tests. PDI has established a strong market leadership position through excellent quality, efficacy, and service.
ROBERT P. JULIUS, PRESIDENT
NICE-PAK PRODUCTS INC.
The editors respond: Mother Jones reported a respected lab's findings that clearly showed that Sani-Cloth hard-surface wipes did not kill the three bacterial pathogens necessary for EPA registration.
According to experts interviewed by Mother Jones, 8 percent isopropyl alcohol content is a level generally considered insufficient for effective disinfectant use. We stand by our original reporting.
We believe that Nice-Pak did remove its polio claim from its label in July 1996. We did not assert, and did not intend to imply, that Sani-Cloth took the polio claim off its product label because of our reporter's inquiries. We understand that the EPA does not require hospital disinfectants to kill the polio virus, but it is important to note that several infection control specialists told Mother Jones that a product's effectiveness against the polio virus is a major selling point.
I'd like to point out some inaccuracies in Leora Broydo's "Clothing Arguments" (HomePlanet, July/August). Her assertion that hemp companies greenwash and that hemp is not an ecofriendly alternative crop is just not true.
As a hemp importer and wholesaler, I've traveled to Hungary and Romania and have visited with hemp farmers, researchers, and processors. I can assure you that pesticides and other harsh chemicals are not used on the fiber hemp crops grown there.
Many consumers prefer hemp to cotton because it is grown without the use of toxic pesticides, herbicides, or defoliants. The damage caused by pesticides sprayed on cotton crops has been well documented. In 1994, 39 million pounds of pesticides were sprayed on cotton crops in the U.S. This is in stark contrast to hemp crops, which were not sprayed with any of these toxic chemicals.
ERIC STEENSTRA,VICE PRESIDENT
HEMP INDUSTRIES ASSOCIATION
Leora Broydo responds: Mr. Steenstra is correct when he says that hemp can be an ecofriendly alternative to conventional crops such as cotton. But it was the Hemp Industries Association that enlightened me about hemp greenwashing to begin with.
My point in "Clothing Arguments" was to provide consumers with an answer to the following question: Does an ecofriendly clothing label necessarily guarantee ecofriendliness? When I posed this question to HIA board member Christie Bohling, she told me that greenwashing is why the HIA is vigorously pursuing a testing program to ensure the integrity of hemp products, and why the HIA was founded in the first place.
Surely if all hemp products were problem-free, if no growers ever used strong chemicals that decrease the quality of the garment, or if no one were selling cotton products and passing them off as hemp, then the HIA wouldn't feel the need to police its own industry or establish quality controls.
Any clothing option, given enough scrutiny, will have a downside, and every industry has bad seeds. This should not deter consumers from buying hemp or any other ecofriendly fashions. Instead, consumers who care should ask manufacturers to provide them with information to back up green claims. In other words, as Bohling put it, "know your supplier."
Corrections: In "Big Game Hunter" (May/June), we noted that Terence McAuliffe and Tony Coelho were accused of influence peddling in two 1995 lawsuits that were later settled. In one case, the plaintiff withdrew the charges, citing unreliable information.
McAuliffe became finance chairman of the Democratic Congressional Campaign Committee in 1982.
Marvin Rosen became finance chairman of the Democratic National Committee in September 1995, shortly before McAuliffe officially left the Clinton/Gore campaign in November 1995.