A Bitter Pill

by Jason Black

Hailed as a wonder drug for menopausal women, Premarin has a deep dark secret: horse abuse.

February in Canada's prairie provinces is bitterly cold. The temperature can drop to 40 below zero. Locals who annually endure the season like to remind newcomers that in conditions as extreme as these, exposed flesh will freeze in one minute.

Such descriptions of cold were beginning to hit home for Joe Silva as he pulled up to a Manitoba farm one morning with several colleagues. Outfitted in his hardiest winter gear, Silva left his vehicle and thought he saw in the distance two horses lying outside the barn. As the dismayed Silva drew closer, his assumption was confirmed. Here, in the bone-chilling cold, was one mare lying motionless on the ground, another struggling to get up.

Part of a 12-member team investigating Canadian farms that sell the urine of pregnant mares to makers of the drug Premarin, Silva alerted two team veterinarians and proceeded into the barn. In a room holding urine collected from the dozens of mares cramped into nearby stalls, Silva asked about the horses outside. The producer, as owners of these farms are called, replied, "We noticed them last night, so we threw them out to see if they would come around." He had not called a veterinarian.

That night the temperature outside had been minus 27 degrees Fahrenheit, before the wind-chill factor, and the horse lying motionless was dead. When the team veterinarians came in, they reported that the struggling mare was colicky and in trouble.

A lack of veterinary care was not the only shortcoming that Silva-- director of shelters for the Massachusetts Society for the Prevention of Cruelty to Animals and the American Humane Education Society (MSPCA/AHES)--and other equine experts would come to find as they made their way through 32 pregnant-mare urine (PMU) farms in Saskatchewan, Alberta, and Manitoba.

Over the next several weeks they would see mares kept in stalls that were too small, with improper bedding and floors and inadequate sanitation; mares restrained with tethers so short that they were unable to lie down or rest their heads comfortably on the ground; and urine-collecting harnesses that overly restricted movement and caused skin abrasions. They would find a lack of water, grooming, and exercise. And they would discover that in addition to inadequate staffing at some farms, the PMU industry was troubled by too few inspectors, loose enforcement of a code of practice intended to protect horses' welfare, and farm workers who simply didn't know enough about equine care.

Correcting these problems, say Silva and others striving for PMU industry reform, won't be easy. It will require a sincere commitment by Wyeth-Ayerst Laboratories, the pharmaceutical giant based in St. David, Pennsylvania, that produces Premarin and is the sole contractor of all PMU farms. And it will require consumer pressure from some 8 million menopausal and postmenopausal women who take Premarin, the most widely prescribed drug in the country. A form of estrogen replacement therapy, Premarin has maintained a near-total monopoly for the past 50 years and generates $850 million per year for Wyeth-Ayerst.

It was just such pressure that prompted Wyeth-Ayerst, a division of American Home Products, to allow the investigation of its PMU farms earlier this year. After receiving repeated allegations of abuse to mares on PMU farms, the Canadian Farm Animal Care Trust (CANFACT) assembled 12 equine experts and arranged for the company to allow the team onto the PMU farms. Silva was representing the MSPCA/AHES's international affiliate, the World Society for the Protection of Animals (WSPA), the only U.S. animal- protection organization invited to participate in the investigation.

Wyeth-Ayerst representatives were present during the entire tour process, and the company decided which farms would be opened to the inspectors. To investigate concerns about the treatment and fate of the PMU industry "byproducts"--foals--the team also visited three feedlots and one slaughterhouse.

There are more than 450 PMU farms in the three Canadian provinces and in North Dakota. Every year more than 75,000 mares are in production from October through March, the urine-collecting season. At these farms, pregnant mares are confined for 6 of the 11 months of their pregnancies so that their estrogen-rich urine can be collected in cups harnessed beneath their tails. According to Silva, the confinement and harnessing both cause undue suffering, but some of the industry's most serious abuses result from restricting water.

On PMU farms water is given to the mares in rationed amounts, generally between 8 and 18 times per day depending on the individual producer. The less water a mare drinks, the greater the concentration of estrogen in her urine. The producers have a cap, set by Wyeth-Ayerst, on the amount of urine that they can sell, and they are paid based on the concentration of estrogen in the mare's urine they collect.

Silva recalls a scene repeated over and over as the team progressed from farm to farm. Standing by the tethered mares, the inspectors would notice the horses becoming agitated as they heard the click of the timer that releases their water. "You could hardly hear with all of the horses clanging and banging their chains," says Silva. As the water came through the pipes and poured into their bowls, some horses would bury their faces in it, drinking it as fast as it came out, licking the bowls dry. Others protected their bowls by gnashing their teeth, kicking, and braying. "But after the water stopped running, you could hear a pin drop," adds Silva. "You can't tell me those horses weren't thirsty." Often that thirst caused mares to become so excited that they hurt either themselves or others in adjacent stalls.

Indeed, veterinarian Nat Messer, a member of the inspection team and chairman of a welfare committee for the American Association of Equine Practitioners (AAEP), found "numerous lower-limb abnormalities (old wounds, edema abrasions, scar tissue, and abnormal hoof growth), most of which, excluding abnormal hoof growth, occurred on the hind legs and was presumably due to kicking and striking stall dividers."

Part of the mares' problem lies in the code fashioned to protect them. According to Silva, the code of practice for PMU producers, developed by Wyeth-Ayerst, fails to meet the horses' behavioral and physical needs. Furthermore, it is not mandatory, and the company employs only eight inspectors to monitor hundreds of PMU farms. Many of the farms Silva and others inspected did not even meet the code's minimum standards for barn and stall design.

Explains Silva, "Many producers want to do the right thing for their mares but fear it would hurt them financially or put them out of business. There is a disincentive to do the right thing."

Consider the disincentive caused just by the urine quota system. Under Wyeth-Ayerst's system, each farm sells a set amount of mares' urine. If a mare becomes sick, a new mare is moved in to take its place. The practice leaves little or no interruption in urine collection. But it also leaves little or no incentive to get an ill or injured mare proper treatment.

On a PMU farm, the value of a mare comes down to the resale value of her foals. Either she produces foals "valuable" enough to be sold to private owners, or she produces foals likely to be sold and slaughtered for human consumption in Europe or Japan. "Whether a producer decides to treat a pregnant mare depends on the resale value of the foal she's carrying," explains Silva.

At one farm, the team encountered a mare that was being kept on the production line with a serious wound. When asked how it happened, the producer said the mare got stuck in a fence but that he hoped the horse would be all right, because he wanted to keep her for his child. He added that he did not have money to spend on veterinarians: "Horses are nothing but a problem. They're not like cows, they're not very tough."

Last summer, the inspectors presented their findings to Wyeth- Ayerst executives. According to CANFACT, all of the reports "contain important recommendations for changes in the design of barns, stalls, equipment, and care given to the mares" during the time that they are on the production line.

Says Silva, "We feel strongly that Wyeth-Ayerst has a moral responsibility to these horses and to the consumer to either provide a more comfortable environment for the mares or stop producing Premarin."

When Wyeth-Ayerst received the reports, its executives indicated that they would take action. Two months later, the company's vice president for women's health care, Carrie Smith Cox, sent a letter to WSPA's international-projects director, John Walsh, indicating that watering would be studied during the 1995-96 urine-collecting season. "Our goal is to implement continuous watering for the horses in the 1996-97 season as long as it does not affect the health of the horses or the quality of our product," wrote Cox.

Considering the many improvements needed at the PMU farms, Walsh deemed the response insufficient and asked Wyeth-Ayerst to let WSPA make follow-up visits to monitor conditions at the farms. The company denied the permission. Contends Walsh, "If Wyeth-Ayerst is genuinely interested in improving conditions for the mares, they should let inspectors from WSPA or any other legitimate animal- protection agency monitor their progress."

The PMU industry also has environmental pitfalls. Once the urine is collected, it is brought to a processing plant in Brandon, Manitoba, where the equine estrogen is extracted. The process produces waste urine and ammonia, polluting the Assiniboine River.

Currently, the plant generates more than 4 million gallons of waste urine, and that figure is expected to increase to 9 million gallons in the next five years.

With another urine-collecting season under way, very few changes have been made. In fact, recent correspondence from Marc Deitch, Wyeth-Ayerst's vice president for medical affairs, to people who have expressed their concern about the conditions for the mares has contradicted and ignored many of the findings and recommendations made by the inspection team.

Deitch cites favorable findings of a 1994 study conducted for Wyeth-Ayerst by veterinarian Shauna Spurlock. Yet this study was based on inspections of farms during the summer, when the mares were not in production. Deitch states in his letters that foals born from PMU mares are "raised for a variety of purposes including show, riding, work, breeding, and overseas markets."

While it is not stated as such, the "overseas markets" for young foals include nations that import live horses or horse meat for human consumption. European nations that consume horse meat receive it chilled, after the animals have been slaughtered in Canada. But Japan imports live animals, forcing them to endure uncomfortable and sometimes dangerous transport. Many of these horses are around two years old, and they are purchased as foals from PMU farms.

Because Premarin dominates the estrogen-replacement therapy market, it might appear that women have no choice but to use a drug that causes the suffering of mares and their foals. There are signs, however, that Wyeth-Ayerst's monopoly may be coming to an end. These signs come from other pharmaceutical companies and from women who, once they learned how Premarin is produced, began to ask about alternatives. To the women's surprise, they found that synthetic and vegetable-based alternatives to Premarin are widely available, although they are less well known.

In Canada synthetic conjugated estrogens, which mimic the combined estrogens in Premarin, have been available for several years. Physician Ray Kellosalmi, who works at the Peachtree Medical Center in British Columbia, is a self-described "horse enthusiast." He has prescribed estrogen-replacement drugs for more than 20 years. But after he began to learn about conditions on PMU farms, he decided he would no longer prescribe Premarin.

"I go through the alternatives with my patients, and I tell them I would rather not prescribe Premarin," says Kellosalmi. "If a new patient comes in using Premarin, I work toward taking her off of it." Today none of Kellosalmi's hundreds of patients takes Premarin.

Eileen Oltmanns has been a patient of Kellosalmi's since 1975. She was taking Premarin for a short time at the direction of another doctor following a hysterectomy. When she learned from Kellosalmi how Premarin is produced, she immediately agreed to switch to another medication. Isabell Taylor, 70, had been taking Premarin for many years when she read an article that Kellosalmi wrote about the PMU industry. She contacted him to see if there was anything else available. "I was really shocked to learn about how this drug is made." Neither of these women, nor any other of Kellosalmi's patients, have experienced any problems without Premarin.

Sinikka Crosland, 42, knows that in the next few years she may need hormone-replacement therapy. But she has already decided that she is going to "steer clear of Premarin." She has even sent letters to more than 60 newspapers in British Columbia, urging the minister of health to use an alternative drug in a program that provides Premarin prescriptions to senior citizens.

Synthetic estrogen-replacement therapies are also available in the United States. Duramed Pharmaceuticals awaits final approval from the Food and Drug Administration for a synthetic conjugated estrogen that is expected to most closely mimic Premarin. The alternative will cost a fraction of what Premarin costs to produce and will be made entirely from a vegetable source. And Wyeth- Ayerst, while defending the PMU industry, has recently admitted that it is working on the development of a synthetic alternative to its own product.

In the long term, it may be the availability and acceptability of synthetic or vegetable-based estrogen-replacement therapies that lead to the end of the PMU industry. Until that happens, leading animal-protection groups across the country will continue to pressure the industry to make changes that protect the well-being of the thousands of horses being used.

Jason Black is a freelance writer living in Boston.

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