Women’s health: Are we taking a risk by dumping the Democrats?


The MJA this month also brings us Mary Lander’s story: “The fight for a life-saving drug: a personal perspective”.

Mary Lander has a relentlessly-growing meningioma adjacent to her brainstem. This is a non-cancerous tumour of the lining of the brain. She has already suffered a hearing loss, and the tumour involves three facial nerves and her carotid artery. The usual treatments – surgery and radiotherapy – carry dramatic risks. There is another treatment option, a hormone antagonist medication. But her access to this treatment has been hampered by people claiming to be “pro-life” activists.

Lander writes:

While doing some research on the subject, I came across references indicating that a high percentage of meningiomas contained progesterone receptors, and there was mention of a drug that could halt the growth of the tumour. The drug was RU486 (mifepristone), the most effective progesterone antagonist available. In overseas clinical studies, it had been successful in some meningioma patients. In my view, a trial of the drug was a better option than the 50% risk of irreparable damage to my vision through surgery. The uncertainty of the long-term prognosis after stereotactic radiotherapy was also unappealing.

Mifepristone has a number of medical uses, including its utility in non-surgical termination of pregnancy. Access to the drug in Australia has been hampered by the now-deposed theocon government who were afraid of women’s access to reproductive medicine. Lander contacted Senator Lyn Allison about her problem, and Allison informed her that the medication could be obtained through a little-known importation loophole scheme, the Special Access Scheme of the Therapeutic Goods Association. Lander’s general practitioner initially obtained a permit to import mifepristone – but then withdrew from being involved in the prescription, citing “medical indemnity insurance issues”:

My GP gave me a copy of the letter which accompanied the permit. It was signed by a “delegate of the Secretary” and dated 8 September 2005. It stated “All parties involved need to recognise the practice may carry medico-legal risk, and there may be implications regarding indemnity”. Why did the TGA wait until they issued a permit before providing that advice? Clearly, no consideration was given to the impact on the patient who had the rug pulled out from under her feet in an instant.

Lander didn’t quit. She became involved in parliamentary and media lobbying and two 2005 Senate Inquiries. From her submission to the Senate Inquiry into services and treatment options for persons with cancer

It is of concern that although TGA approved the use of RU 486 years ago, the Commonwealth Government has not, to date, supported its use as a treatment for the conditions noted above, conducted clinical trials, encouraged or funded any research into this area or established a program whereby people with these medical conditions can obtain access to this medication. I note that only recently a spokesperson for the Minister for Health Tony Abbott “declined to comment any further on the subject of RU 486 (Mifepristone).”

Declined to comment? I would like to whether the Minister for Health, Mr Tony Abbot has any moral or philosophical reasons for denying people with these debilitating, and in some instances life-threatening medical conditions, their ‘Right to Life’?:

Lander also worked with the Feminist Majority Foundation of the USA, who placed a further submission to the Senate Inquiry into the repeal of Ministerial responsibility for approval of RU486. You can read that submission [PDF] and others here at the APH site.


Senators Lyn Allison, Judith Troeth, Fiona Nash and Claire Moore: co-sponsors for mifepristone availability [image source: SMH]

After a cross-party private Member’s Bill (including National Fiona Nash and Liberal Judith Troeth who defied their party lines), and a conscience vote, special Ministerial responsibility for mifepristone was finally removed in 2006. Responsibility was handed over to the Therapeutic Goods Association. In August 2007, approval was granted [PDF] for the use of mifepristone in medical abortion. Tony Abbott resisted all the way, claiming that he was more “accountable” than the TGA – which regulates all other drugs in Australia.

This is what we risk losing by no longer having any Democrats in the Federal parliament. The Dems, particularly Lynn Allison and Natasha Stott-Despoja, have been eloquent, tireless feminist voices. I hope the ALP will step up. Gillard has spoken out for reproductive justice in the past, but without a “minor” party constantly putting the pressure on, can the ALP keep it up?

It took a year and nine months, and an oncologist prepared to take a risk, before Mary Lander could obtain treatment for the tumour slowly growing at the base of her brain. The drug remains unsubsidised; she pays out of pocket for this essential treatment. What are we going to do about it?

Categories: gender & feminism, medicine, Politics

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7 replies

  1. While the demise of the Democrats is a sad loss, you’re completely ignoring the presence of the Greens as the third political force in Australian politics. I predict they will be the voice of reason that is sorely needed in Parliament. Not to denegrate the ALP, but sometimes their judgement can be a little off.

  2. I’d love to see the Greens step up for feminism and reproductive justice, Barry. I haven’t seen as much evidence for their vocal support yet as there was for the Democrats, but am looking forward to there being more of it, if that’s in the offing.

  3. I have no idea how long it will take for the new federal government to undo the horrible ‘moral high-ground’ erosion of our rights to adequate healthcare.
    Mary Lander has been unrelenting in her determination to obtain this treatment and for someone who’s health has suffered from the meningioms that is all the more amazing.
    I think she would in fact make an excellent federal health minister and wish – once she’s recovered – that she would join one of the parties and run for election – we’d certainly all be better off with her common-sense approach and can-do-ism.
    The cost should be rebated retrospectively at the very least – the government has a moral obligation to do that not only for Mary Lander, but for all those who have this type of meningioma.
    TheDailyMagnet’s last blog post..Like blamonge through the hour glass

  4. Thanks to everyone for their interest. In fact the loss of Senator Allison is a great loss for women’s rights and health matters and she was the only one prepared to run with this issue. Kerry Nettle from the Greens came on board first but unfortunately she has lost her seat as well (she was the one to introduce social issues into the Greens Agenda so I expect they will no longer have that focus). Julia Gillard, the then Opposition Health Minister refused my request to her to tackle this issue and I still have her letter stating just that in response so the initiative came about no thanks to the ALP. However, after Senator Allison ran with it, Julia Gillard then eventually came on board and so did the majority of ALP MP’s voting 74 for and 11 against the amendment to overturn the legal status of the drug. The Liberal National Party Coalition voted predominantly AGAINST changing the legislation.
    How Did your MP’s Vote on Conscience:
    While not outlined in my article in the MJA (due to word count limits), the issue also has implications for senior public sector managers in the Department of Health who think nothing of misrepresenting medical opinions. In this case and in the first instance, by the Chief Medical Officer noting the (then) Minister was also considering the appointment of his wife as the new CEO of a new government organsisation. Nepotism over women’s rights and health issues – see:
    Abortion drug anger
    It’s not over yet but I can’t do this alone so thankyou everyone for your support.
    Mary Lander

  5. Dear Good People,
    I have been in long distance email contact with Mary Lander for a few years. I have faced a similar year long battle with institutional red tape and personal expense starting in March 2004 to take the drug in the USA again for my own similar condition.
    Please read my webpage resources about my personal medical experiences with meningioma and mifeprex the past twenty years using Ru-486 (mifepristone) brand name Mifeprex to control and stop or stall the progesterone related regrowth of recurrent meningioma instead of brain radiation which has been recommended by many neurosurgeons for me since 1992. I am on it again now since Feb 2005, my recent Nov 07 head MRI shows no significant change and no side effects in the almost three years I have been on a small daily dose 200 mg of the “early option pill” this time. THANK GOD
    Unfortunately, the same political/religious ideology opposition to the drug in the United States has prevented thousands of other meningioma patients from being told by their doctors of this possible alternative to brain surgery or brain radiation for their condition. I believe if I had been offered this drug after its discovery and successful use in France and Germany in the mid 1980’s for meningiomas after my first craniotomy in 1986, I might never have had a recurrence of this brain tumor in 1992 or the other benign uterine fibroids removed by total hysterectomy in 1992 or needed the second craniotomy in 2000.

  6. Mary and Anne: many thanks for dropping in, and thankyou also for being such amazing advocates for other women in similarly untenable positions. I wish you both the best of health and smooth sailing.
    Lauredhel’s last blog post..Tagged! A Roar for Powerful Words

  7. Thanks Laurel,
    I thought it interesting to note that the Department of Health “could see no reason to change the status of this drug” (as per their own advice to the Minister), yet if you look at breast cancer as another example noting that women with progesterone receptor positive (PR+) breast cancers have an increased risk of mortality of 1.5 – 2.1 fold as per recent findings below. Alas, mifepristone (also called RU486), the most effective progesterone antagonist and one that would be suitable to use for PR+ breast cancers is not readily available. The patient would need to pay the full cost of the drug mifepristone themselves and obtain it via the Special Access Scheme if they wanted to access it and not only that, but they would have to wait until they have exhausted other treatments first and could die within a matter of months to be eligible via the Special Access Scheme at which time the cancer has spread so extensively it’s a moot point as to whether anything can save them at that stage.
    Question: Why would Australian women need to wait that long to access the drug mifepristone?
    Answer: Because the Australian governmement has not done clinical trials using the drug here?
    Question: How many women die of breast cancer every year?
    By way of a comparison, through which I can demonstrate the disparity that exists, depending on the hormone status of a cancer, those women with ER+ breast cancers can get tamoxifen (an oestrogen antagonist) via a prescription for ER+ breast cancers and that drug is subsidised and available to them at any time (it’s not necessary for those women to wait until they are on their death bed to get it). Quite a different story for those women with PR+ breast cancers (they have a 1.5 – 2.1 fold increased risk of mortality). The drugs work in similar ways just on different hormones. Is it fair that women with PR+ breast cancers should be disadvantaged simply because the drug that could help them is caught up in controversy due to another of the drug’s uses?
    Also might be worth noting that recent studies have shown promise using mifepristone for familial types of breast cancer such as that which result from the BRCA-1 gene as well as those breast cancers that are ER+/PR+ and for use on a subset of this combination of hormone receptors that are antiestrogen resistant.
    Hormone Receptor Status, Tumor Characteristics, and Prognosis: A Prospective
    Cohort of Breast Cancer Patients
    10 April 07
    Results: Compared to ER+/PR+ cases, elevations in risk of mortality were observed across all subcategories of age at diagnosis, ranging from 1.2- to 1.5-fold differences for ER+/PR- cases, 1.5- to 2.1-fold differences for ER-/PR+ cases, and 2.1- to 2.6-fold differences for ER-/PR- cases. Greater differences were observed in analyses stratified by grade; among women with low-grade lesions, ER-/PR- patients had a 2.6-fold (95% confidence interval [CI] 1.7 to 3.9) to 3.1-fold (95% CI 2.8 to 3.4) increased risk of mortality compared to ER+/PR+ patients, but among women with high-grade lesions, they had a 2.1-fold (95% CI 1.9 to 2.2) to 2.3-fold
    (95% CI 1.8 to 2.8) increased risk.
    1998 – Additive effect of mifepristone and tamoxifen on apoptotic pathways
    in MCF-7 human breast cancer cells:
    “Our data further suggest that a combination of an antiprogestin with tamoxifen may be more effective than tamoxifen monotherapy in the management of human breast cancer.”
    2006: Prevention of Brca1-mediated mammary tumorigenesis in mice by a
    progesterone antagonist.
    Women with mutations in the breast cancer susceptibility gene BRCA1 are predisposed to breast and ovarian cancers. Why the BRCA1 protein suppresses tumor development specifically in ovarian hormone-sensitive tissues remains unclear. We demonstrate that mammary glands of nulliparous Brca1/p53-deficient mice accumulate lateral branches and undergo extensive alveologenesis, a phenotype that occurs only during pregnancy in wild-type mice. Progesterone receptors, but not estrogen receptors, are overexpressed in the mutant mammary epithelial cells because of a defect in their degradation by the proteasome pathway. Treatment of Brca1/p53-deficient mice with the progesterone antagonist mifepristone (RU 486) prevented mammary tumorigenesis. These findings reveal a tissue-specific function for the BRCA1 protein and raise the possibility that antiprogesterone treatment may be useful for breast cancer prevention in individuals with BRCA1 mutations.
    2004: Mifepristone Induces Growth Arrest, Caspase Activation, and Apoptosis
    of Estrogen Receptor-Expressing, Antiestrogen-Resistant Breast Cancer Cells
    “We demonstrate that: (a) estrogen receptor+progesterone receptor+, 4-OHT-resistant clonal variants can be isolated from an MCF-7 cell line in the absence of antiestrogen selection; and (b) MIF and MIF plus 4-OHT combination therapy induces growth arrest and active cell death of the antiestrogen-resistant breast cancer cells. These preclinical findings show potential for a combined hormonal regimen of an antiestrogen and an antiprogestin to combat the emergence of antiestrogen-resistant breast cancer cells and, ultimately, improve the therapeutic index of antiestrogen therapy.”
    Also note: The research shows that the mild antiglucocorticoid effect of
    mifepristone could also help to stop metastatis in some breast cancers
    (effects are dose dependant). Previous studies have demonstrated that 58% of
    all and 85% of invasive breast carcinomas expressed CSF-1R and this study
    shows that RU486 (mifepristone) therefore has the potential to prevent
    invasiveness (metastatis) by acting on CSF-1R:
    1985: [Glucocorticoid receptors and the histological structure of breast cancer]
    Glucocorticoid receptors (GR) were studied in tumor cytosols from 140 breast cancer patients. The level of GR depended upon tumor histology. The highest GR level was found in medullary cancer, while the lowest–in a mucinous one. The GR level in ductal-invasive cancer was significantly higher than in the lobular infiltrative type. The frequency of GR in tumors of the 1st grade of malignancy was significantly lower than in those of the 2nd and 3rd grade of malignancy. The 1st grade of malignancy tumors which contained GR had estrogen and progesterone receptors, too. The increasing malignancy was matched by the rising percentage of such tumors which was as high as 47% among 3rd grade of malignancy tumors.
    2003: Glucocorticoid Cotreatment Induces Apoptosis Resistance toward Cancer Therapy in Carcinomas1
    a.. ….In this study, we have shown that application of GCs renders
    certain tumors resistant or less susceptible to apoptosis after cancer
    therapy. This finding urges to carefully reconsider the widespread use of
    GCs in almost all treatment protocols for patients with solid cancers. In
    the clinical setting of cancer therapy, e.g., in antiemetic regimens,
    corticosteroids are usually given transiently to suppress acute side effects
    of cancer therapy. Although our experiments did not mimic precisely the
    clinical situation because we administered DEX daily to achieve steady-state
    levels, short-term exposure to DEX may nevertheless be sufficient to
    abrogate or diminish the efficacy of concomitant chemotherapy in cancer
    patients in vivo. This is suggested by our experiments where DEX was found
    to down-regulate basal and cisplatin-induced expression of apoptosis
    effectors within 24 h in vitro. Also, endogenous levels of GCs and those
    existing as a consequence of administered hormones may render solid tumors
    less susceptible to apoptosis after cancer therapy. The administration of
    steroid/receptor agonists such as RU486 might be beneficial before
    chemotherapy and radiotherapy to enhance cell death of solid tumor cells.

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