Canada – The Winnipeg Free Press carried an editorial on September 14, 2001 by Frances Russell about the PMU industry:

Boasting 18,267 mares harnessed six months a year to the "pee line" and the world's only pregnant mares' urine factory, Manitoba is proud to be known as the PMU capital. But the $44-million industry has once again been getting a big, black eye in the news.

Since October, 2000, Wyeth-Ayerst has recalled nearly 400 million doses of Premarin, the menopausal drug made from the urine of pregnant mares.

While the recall of 392 million pills -- nearly 20 per cent of Premarin's 1999 sales -- in three separate withdrawals was voluntary, it was done in consultation with the U.S. Food and Drug Administration (FDA).

According to The New York Times Aug. 16, the withdrawals came "after tests showed some of the tablets do not meet certain quality requirements. The drug failed to meet government quality-control standards during what is known as a 'dissolution' test."

The company and the FDA were at pains to assure Premarin consumers that the medication remains safe. If some of the recalled drug did make it to drugstore shelves, consumers might notice more discomforts like hot flashes. The FDA's dissolution test, designed in 1998, checks whether a drug can be properly absorbed in the bloodstream.

Premarin is the second-most widely prescribed drug (after the statin Lipitor) in the U.S. Each day, some 10 million American women take Premarin, earning its manufacturer $1.7 billion a year. Ayerst took out the patent on Premarin in 1942, during the Second World War. The drug has been dubbed "the Kleenex" of hormone replacement therapy (HRT). Not surprisingly, given Premarin's profitability, Ayerst fought like a tiger to keep all competitors off the U.S. market. It was successful until 1999, when the FDA licensed Cenestin, a plant-based estrogen manufactured by Duramed Pharmaceuticals.

Canada's Health Protection Branch reported "disquieting variability" in Premarin in 1992. HRT drugs based on plant and other estrogens are considered equivalent and interchangeable with Premarin in a majority of provinces.

Following the third recall, The Washington Post late last month carried an article headlined "Premarin: Straight from the Horse's What?" and stated the drug has long provoked questions.

Amy Allina, program director for the National Women's Health Network, a nonprofit education and advocacy group based in Washington, told The Post: "Unfortunately, Premarin has been promoted for many, many years for a wide variety of indications for which there isn't any evidence to prove it's effective, such as the prevention of heart disease, prevention of memory loss, making your skin look younger.

"Premarin is not simply a harmless aid for getting through menopause. It can increase other health problems and women need to know that."

Even the drug's manufacturer advises Premarin may increase the risk of uterine cancer and blood clots. And other studies suggest it may pose an increased risk of breast and ovarian cancers.

Nor are Premarin's difficulties the only problem for Manitoba's urine business. No matter how hard they try, neither Wyeth-Ayerst nor Manitoba can do much to stop the black eye the national and international media keeps giving them for the inherent cruelty of the industry and, especially, the cruelty of the fall foal auction. The biggest auction occurred here last week and TV and print journalists from Canada and the U.S. converged. The stories and pictures from Winnipeg Livestock Sales have been graphic. Most of Manitoba's PMU foals and used-up mares -- 16,200 last year alone -- are destined for the feed lot and slaughterhouse.

Last Saturday's Vancouver Sun made the Winnipeg foal auction story its Page 1 headline, accompanied by a picture of the body of a freshly-destroyed tiny foal lying beside three rotting cow carcasses on the auction grounds. Congealed blood marked the spot where one of its hooves had been torn off.

Ellen Buck, an equine veterinarian with the Humane Society of the U.S. who had come to Winnipeg, told the paper that while foals should be at least six months' old before they are taken from their mothers, most of the ones here looked to be between two and three months. The story reported that the separated mares and foals kept up a continuous plaintive whinnying for each other and also that many were sick, hardly able to walk, and only skin and bone. The writer noted that the auction ring's large iron door slammed on the head of one of the foals and a still-lactating mare's udder was painfully swollen.

In The Washington Post story, Larry D. Sasich, a pharmacist and research associate at Public Citizen, said: "We're running out of excuses for prescribing this drug."