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Women Behaving Badly?

Female Troubles

Cash or Compassion? continued...

"4. Retain a physician to give each woman you hire a special physical examination -- one covering female conditions. This step not only protects the property against the possibilities of lawsuit, but also reveals whether the employee-to-be has any female weaknesses, which would make her mentally or physically unfit for the job."

Allyne Rosenthal, DC, a Chicago-based chiropractor and practitioner of functional medicine, has studied and written about the creation of PMDD as a distinct medical entity. She tells WebMD that new attention being paid by the medical and pharmaceutical industries to PMDD, female sexual dysfunction, and menopause may be motivated as much by cash as by compassion.

"The hallmark of adolescence is hormonal imbalance. Therefore, the numbers of young girls who will deemed to be candidates for this medication are astronomical if they go ahead with this, and that is one of the major problems," she says.

Rosenthal also expresses concern that fluoxetine was not tested for long-term use prior to FDA approval, yet giving it to combat the hormonal effects of menstruation is, in effect, writing a reproductive-length prescription.

"The tests on it were 6-8 weeks, but PMS is not a short-term syndrome," she says. She points to evidence suggesting that long-term use of Prozac and similar drugs could cause serious side effects, such as those seen with the older generation of powerful antidepressants that were prescribed in the 1950s, '60s, and '70s.

Lilly Responds

Asked by WebMD to comment on the concerns of critics, Lilly spokeswoman Laura Miller drew attention to an FDA "talk paper" issued in July 2000 to coincide with the agency's approval of Sarafem for PMDD. The document states that "on November 3, 1999, FDA's Psychopharmacologic Advisory Committee unanimously recommended approval for fluoxetine to treat women with PMDD. The committee concluded that fluoxetine was effective for the condition and that PMDD has well defined, accepted diagnostic criteria."

The very next sentence, however, offers this caveat: "The committee also advised that the drug should be used only to treat women whose symptoms are severe enough to interfere with functioning at work or school, or with social activities and relationships."

Miller also forwarded a "roundtable discussion" published in the Journal of Women's Health and Gender-Based Medicine, in which panelists from highly respected research centers in the U.S. and Canada conclude that "PMDD is a distinct entity with clinical biologic profiles dissimilar to those seen in other disorders. Thus, the relative safety and efficacy of potential treatments for PMDD can be evaluated, and, indeed many of those present thought that sufficient evidence is now available to support the use of [Prozac and similar antidepressants] in this disorder."

Natural Alternatives Also Work

"The vision of millions of women being put on this drug for a condition that can be so effectively treated in other ways is just stunning," Rosenthal says. "PMS is something that bothers a lot of women. There's no question about that, but it responds incredibly well -- and quickly -- to a combination of things, like vitamin B-6, magnesium, zinc, and the correct balance of proteins and carbohydrates in the diet."

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