AMAG snaps up rights to new med Intrarosa to compete with Pfizer’s Premarin® vaginal cream

Tracy Staton reporting for FiercePharma.com writes as follows.

AMAG Pharmaceuticals Logo

Caslon Quote Left BlackAMAG Pharmaceuticals has big ambitions for its women’s health business, so it’s snapped up the rights to a new med, Intrarosa, to beef up that portfolio.

The company plans to tout Intrarosa’s safety profile to set it apart from established estrogen-based treatments such as Pfizer’s Premarin cream and Estring vaginal ring. The AMAG drug, which contains the hormone precursor prasterone, has a “similar efficacy profile,” CMO Julie Krop said this week. “[F]rom an efficacy standpoint, I don’t see that there is particularly differentiating advantage,” Krop said. “It’s really on the safety side”.

The company clearly sees big potential for Intrarosa. AMAG will pay Endoceutics $50 million up front, plus 600,000 shares of newly issued common stock, which closed Tuesday at $22.65. Follow-up sales milestones add up to $45 million if Intrarosa surpasses $300 million in sales over time.

AMAG says it’s adding those 150 reps to its current team of 100, who now focus on its preterm labor drug Makena and cord blood registry (CBR). For now, the new salespeople will exclusively handle Intrarosa, a non-estrogen treatment for vaginal pain during intercourse, which often affects post-menopausal women”.

"Premarin Vaginal Cream could result in more comfortable sex, uterine cancer, heart disease, heart attacks, stroke, dementia, blood clots or breast cancer."
“Premarin Vaginal Cream could result in more comfortable sex, uterine cancer, heart disease, heart attacks, stroke, dementia, blood clots or breast cancer.” Click to be taken to source article.

NASDAQ, in its press release on the licensing and introduction of Intrarosa states:

Caslon Quote Left BlackUnlike conventional pharmacological estrogen-containing medications, Intrarosa does not carry a boxed safety warning in its label.

Intrarosa enters an existing billion dollar-plus market for intravaginal prescription therapies that treat VVA symptoms. There are an estimated 64 million post-menopausal women in the U.S., and as many as 32 million women suffer from VVA symptoms.

VVA, or vulvar and vaginal atrophy, causes pain during intercourse (dyspareunia), a common symptom of menopause”.

Jane Allin, horse advocate and expert on drugs made with pregnant mare’s urine such as Premarin® cream which is also prescribed for dyspareunia, states:

“This drug is a steroid — prasterone — of which estrogen is a metabolite so carries with it the same risks as other estrogen substitutes for Premarin® (i.e. the use of exogenous estrogen is contraindicated in women with a known or suspected history of breast cancer).

“So basically it’s just another form of estrogen that isn’t derived from horse pee. Safer but still has risks associated with estrogen.

“It would be nice if the pharmaceutical companies could come up with something that isn’t a steroid/estrogen. But that’s all they seem to know — and because it’s easy”.

Is this good news for the mares and foals used and cast off by the Premarin® industry?

“Intrarosa may cut into Pfizer’s Premarin® vaginal cream profits some but I doubt it will ever be enough that Pfizer would discontinue its sale”, states Vivian Farrell of The Horse Fund, “which is the only way the success of this new drug could help the horses used by the Premarin® industry in N. America.

“The popularity of Intrarosa may spare a few mares and foals along the way but it doesn’t appear it will spare women from the potential risk of breast cancer”.

“Where the largest threat to horses used and cast off by the PMU drug industry in terms of numbers is of course China where the copycat Premarin® cream they are manufacturing themselves is being marketed to untold millions of women”.

Packaging for Premarin like vaginal cream in China.
Packaging for Premarin like vaginal cream in China.

SOURCES

• “AMAG to hire 150 new sales reps to tout newly licensed women’s health med Intrarosa”, by Tracy Staton, FiercePharma.com, Feb 15, 2017.

• “FDA approves Intrarosa for postmenopausal women experiencing pain during sex”, FDA News Release, Nov 17, 2016.

Drugs.com Prasterone page.

FDA.gov Intrarosa label (pdf, 1p).

PREMARIN® HORSES

Premstoppers campaign, The Horse Fund website »

Premarin Horses Year in Review 2016, The Horse Fund, Tuesday’s Horse »

Alternatives to drugs made with pregnant mare’s urine

BY JANE ALLIN

As part of of the The Horse Fund’s campaign against the manufacture and use of the Premarin family of drugs – Premarin, Prempro and Duavee – we have compiled a list of alternatives to drugs made with pregnant mare’s urine (conjugated equine estrogens).

We encourage you to go online to further acquaint yourself with the effectiveness and safety of these compounds. There is a wealth of information out there, but beware of false claims and err on the side of caution.

And, as always, please consult with your doctor before you use these or any other alternatives for the relief of menopausal symptoms.

LIFESTYLE CHANGES

Probably the simplest and most natural approach to the treatment of menopause is to adopt a healthy lifestyle in regard to diet, exercise and stress management. Not only will this help alleviate symptoms but the benefits will ensure that you remain healthy now and in the future.

Nutrition: It should go without saying, avoid refined and processed foods, choose more whole foods, fresh fruit, vegetables and complex carbohydrates. Avoid high fat dairy products and meats and supplement these items with healthy fats such as olive oil, nuts, seeds and lean cuts of meat or fish. Additionally, practice portion control and avoid empty calorie foods.

Exercise: Exercise is vital to keeping symptoms in check. Exercise directly affects hormonal activities in the body by raising the level of endorphins, for example, to maintain emotional stability and suppress anxiety. Moreover, the benefits are unsurpassed: maintenance of muscle and joint strength, increased metabolism, reduced weight, improved cardiovascular health, increased cognitive function, maintenance of bone integrity, and the list goes on.

Stress Management: It is a well known fact that stress induces more severe hot flashes. There are many stress-reduction techniques available to manage the burden of everyday anxiety – rest, relaxation, varied leisure activities, and most importantly self-affirming thoughts to maintain self-image and confidence.

Lifestyle Solutions: Common sense solutions that include dressing in layers, lowering room temperatures, consuming cool drinks, and avoiding alcohol and caffeine. For those women who are overweight, weight loss can also help.

DIETARY PHYTOESTROGENS

Dietary phytoestrogens are naturally occurring substances (e.g. Isoflavins) found in fruits, vegetables, and whole grains such as soybeans, alfalfa sprouts, and oilseeds (such as flaxseed).

There is some evidence that they have a weak estrogen-like effect that may reduce the intensity and frequency of hot flashes. However an authoritative review of placebo-controlled studies of plant-based estrogens found no convincing evidence that they were helpful in curbing menopausal hot flushes.

One exception was genistein, a substance in soy, which the researchers said warranted further study (http://goo.gl/mivG1p).

Eating natural foods that contain these compounds is safe but there are also non-prescription supplements on the market for which there is no long-term safety data.

PRESCRIPTION DRUGS

There is also convincing evidence that some prescription drugs such as SSRIs, SNRIs, Gabapentin, Clonadine (Catapres) and Pristiq, which are not licensed for treating menopausal symptoms do in fact alleviate hot flashes and night sweats. These are powerful drugs yet in severe cases some doctors may be willing to prescribe one of these treatments, with the patient’s consent.

Megace and Megace ES are synthetic female hormones belonging to the progesterone group used for stimulating appetite and treating breast cancer. The mechanism of appetite stimulation or suppression of cancer is not clearly understood and was FDA approved in 1993.

HERBAL MEDICINES

Herbal medicines are readily available however caution is advised since they can contain powerful ingredients that may contraindicate other prescription drugs and/or may have adverse effects on certain individuals.

Some examples include:
— Black Cohosh for hot flashes and sweating
— Kava to reduce anxiety
— Ginko to decrease the risk of onset of dementia and
— St. John’s Wort as an anti-depressant.

No substantiated medical studies are available for these medicines and most do not have to comply with the stringent safety, quality and manufacturing regulations that govern conventional medicines.

IN THE NEWS

As time progresses many women – and doctors – are looking for safer and more humane alternatives to conventional HRT.

In 2010 a non-hormonal supplement called Amberen, manufactured by Lunada Biomedical, was touted as the next cure-all for relief of menopausal symptoms. Claiming to have a double-blind, placebo-controlled clinical study to back its effectiveness, it contains 100% natural ingredients, all on the FDA’s approved Generally Recognized As Safe (GRAS) list. To date there are mixed reviews on its effectiveness – some it works for, some it doesn’t.

Osphena – touted as the new female Viagra – was FDA approved in 2013 for the treatment of painful sex due to vaginal atrophy associated with menopause.

Osphena is a SERM (selective estrogen receptor modulator) that acts as an estrogen agonist/antagonist – the same class of drugs as bazedoxifene. However it carries with it risky side effects: stimulation of the lining of the uterus that can lead to uterine cancer, increased risk of blood clots, hot flashes and drug interactions.

Moreover in early June 2013 the U.S. Food and Drug Administration approved the drug “Brisdelle” (paroxetine) for the treatment of hot flashes due to menopause.

Brisdelle contains the selective serotonin reuptake inhibitor paroxetine mesylate, making it unique from all other FDA-approved treatment for hot flashes which contain the hormones estrogen or progestin.

Brisdelle, manufactured by Noven Pharmaceuticals, is the first non-hormonal treatment to be approved by the FDA for hot flashes associated with menopause.

BUYER BEWARE

1. Bio-identical Hormones

The term Bioidentical Hormone Replacement Therapy (BHRT) or “natural hormone therapy” is poorly defined and without a precise medical definition.

Bio-identical hormones are synthesized in the lab from plant sources and as the term implies are pharmaceuticals that closely mimic natural hormones produced in the body since they possess the same molecular structure as endogenous hormones.

There are two classifications of bioidentical hormones; (1) FDA-approved and; (2) compounded in pharmacies based on hormone levels measured in saliva and blood tests (not FDA approved).

The terminology is confusing and the FDA considers “BHRT” to be a marketing term. The lack of distinction between FDA-approved bioidentical hormones (often referred to as synthetics) and compounded bioidentical hormones has resulted in considerable misunderstanding regarding exactly what BHRT is.

The vast majority of advocates of BHRT are referring to the compounded versions where hormones are custom-mixed by a pharmacist – unapproved drugs.

In addition to estrogen and progesterone, these compounded drugs may contain other hormones such as testosterone, DHEA and adrenal hormones extracted from animal glands. http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2011/September/bioidentical-hormones-help-or-hype

Often promoted as being safer than conventional HRT derived from pregnant mare’s urine, are these claims of a safer alternative justified?

This includes both FDA-approved and compounded hormones. A Harvard Women’s Health Watch article illustrates that there is much evidence to suggest they are not. http://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2011/September/bioidentical-hormones-help-or-hype

  • In contrast to mainstream thought, compounded BHRT hormones are drugs – just not approved.
  • As much as it may seem that these hormones are safer than the Premarin® family of drugs, there is no solid evidence to prove this. Some of these drugs have been approved by the FDA because data collected from trials has proven their effectiveness in relieving menopausal symptoms and reducing the risk of osteoporosis. However there have been no long-term studies like the WHI performed to assess their safety profile.
  • FDA-approved bioidenticals come with black box warnings analogous to those for conventional HRT. Because compounding pharmacies are not required to detail the risks of their bioidenticals (i.e. they are not approved) they may therefore create the illusion of being safer than commercially marketed drugs.
  • Overall, FDA-approved and compounded bioidenticals contain the same hormones. The difference between the two is the accuracy of preparation. Where FDA-approved versions are measured precisely under rigid control, compounded bioidenticals lack these specifications. Random testing has shown that the indicated potency of compounded hormones varies substantially.
  • Blood and saliva tests to measure a woman’s hormones is only a snapshot in time and are not particularly useful for setting hormone levels which can fluctuate from hour to hour. In menopausal women hormones levels are particularly unstable without a “normal” concentration. Accordingly dosage may be inappropriate for treating symptoms.

2. FDA-Approved Hormone Therapy

Contrary to popular belief the FDA has yet to approve any “true” generic as a substitute for Premarin® and its daughter products (i.e. Prempro®, Premphase®). In other words no prescription drugs used to treat menopausal symptoms, other than the Premarin family, contain pregnant mare’s urine.

Currently the vast majority of FDA-approved HRT prescription drugs are synthetic bioidenticals often referred to as “Synthetics” (i.e. hormones identical on a molecular level to endogenous hormones that are synthesized in the lab from natural plant sources) – these are not the versions produced at a compounding pharmacy which are not FDA approved.

What’s important however is that these drugs carry with them the same risks and warnings associated with drugs derived from conjugate estrogen estrogens, whether that be estrogen alone or combined with progestin.

In pre- and postmenopausal women, estrogens can increase the risk of cancer of the ovaries, stroke, dementia, and serious blood clots in the legs.

Estrogen, when used with a progestin, can increase the risk of heart disease (such as heart attacks), stroke, serious blood clots in the lungs/legs, dementia, and cancer of the breast/ovaries.

If you are concerned about these risks, there are basically three categories of FDA- approved synthetic bioidentical HRT products on the market as shown below along with their common brand names.

PRODUCT BRAND NAME
Estradiol / Norethindrone (Estrogen/Progestin Combinations): Activella, Jevantique
Synthetic Conjugated Estrogens, Estradiol, Esterified Estrogens: Estrace, Cenestin, Climara, Dinigel, Enjuvia, Estrogel, Minivelle, Ogen, Vivelle-Dot, Evamist, Menostar, Menest, Femring, Vagifem
Esterified Estrogens / Methyltestosterone (Estrogen/Androgen Combination): Menogen, Estratest, Covaryx, Essian, Syntest D.S., Syntest H.S.

CONSULT YOUR DOCTOR

In any case, it is important to separate fact from fiction and be astutely aware of the consequences of clinically unproven medications. Apart from the unmistakable benefits of lifestyle changes, before considering any of the alternatives listed please consult your doctor.

END

Reach thousands, save thousands with Premarin billboards

Updated 12 Dec 2015 to provide most recent version of our Dear Physician Letter (pdf, 4 pp). Thank you.

A MAJOR FOCUS of the Premstoppers campaign is educating doctors and women.

First of all, thank you for sending the Dear Physician letter to so many women’s health doctors.

We always know when you are busy with this because of the calls and emails we get asking for more information. See the power of a letter. Letters still work perhaps more than ever since the take over of communicating electronically.

I’ll tell you something else that seems old-fashioned and still works.

Billboards. We love billboards. They can be very powerful. And a good investment.

The “Warning! Premarin Contains Horse Urine” billboard is a real winner. We put them at medical centers near women’s hospitals if we can.

Our goal is now 25. We now have 11*** thanks to our last Premstoppers shout out. Will you help?

Reports say that 9 million women are taking Premarin.

Women taking Premarin is what puts mares on the “pee lines” and foal meat on the dinner table.

We can reach these women who are taking Premarin or using Premarin cream, and the doctors prescribing them.

Doctors must stop prescribing Premarin; women must stop taking Premarin. There are alternatives.

Support a billboard. Any amount is gratefully received and useful.

Every time you donate to Premstoppers you help finance one of these critically important billboards.

Oh, and please remember to send your local women’s health doctors our Dear Physician Letter. It’s easy!

• Find a doctor specializing in women’s health
• Address an envelope to them
• Print the letter
• Put the letter inside
• Put a stamp on it
• Mail it to them

Thank you everyone.

Learn more at our website >>

*** As of today, December 12, 2015, we have at least one Premstoppers billboard in every State except Hawaii.

Horse pee reduces breast cancer risk. Say what?

The undying pursuit of trying to find goodness in the devil incarnate

BY JANE ALLIN

Nothing has been, or ever will be, appealing or beneficial about the PMU industry and the Premarin family of drugs; they are clearly harbingers of death from both sides of the equation. - Jane Allin
Nothing has been, or ever will be, appealing or beneficial about the PMU industry and the Premarin family of drugs; they are clearly harbingers of death from both sides of the equation. – Jane Allin

Yet again another study attempting to promote the benefits of conjugated equine estrogen (CEE) derived HRT. Or should I use the “new” acronym – MHT – or menopausal hormone treatment?

No doubt more propaganda to distance the facts from the clever marketing strategies to further muddle the minds of middle-aged women.

A recent press release from Dr. Timothy Bilash of Solana Beach CA, who specializes in women’s health issues, encourages women of all ages to attend an informational talk regarding a study claiming that there is a reduced incidence of breast cancer while taking estrogen.

    “On Tuesday, June 25th at 7:00 p.m. (repeating on Saturday June 29th at 1:00 p.m.), Dr Tim Bilash, a Solana Beach OB/BYN will explain the DNA repair protein associated with BRCA-1 and its association with breast cancer. In addition, he will present the findings of a twelve-year follow-up from the 2002 Women’s Health Initiative (WHI), reporting that women who take conjugated estrogens demonstrate a twenty-three percent reduction in breast cancer risk, and an astonishing sixty-three percent death-rate reduction among those who did develop breast cancer”.[1]

Astounding! What wonderful news.

The study Dr. Bilash is referring to appeared online in the journal Lancet Oncology in March of 2012 and was authored by Garnet L. Anderson PhD., “Conjugated equine oestrogen and breast cancer incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomised placebo-controlled trial.”[2]

Essentially, this was a follow-up study of the WHI detailing the results of 7,645 women, ages 50-79 without a family history of breast cancer, who had undergone a hysterectomy and were using estrogen-only HRT for menopausal symptoms. These women were part of the 11,000 original cohort of the estrogen-only branch of the WHI study that was aborted in 2004 due to increased risks of stroke and blood clots. In this new study the researchers followed these women for about five years after the trial ended in which about half had taken estrogen-only HRT and half a placebo.

The results of the study showed that 151 women who took estrogen-only HRT developed invasive breast cancer compared to 199 women who took a placebo while 6 women on the estrogen-only HRT died from breast cancer versus 16 who took a placebo.[3] Of note however is that women in the same group who were at higher risk of developing breast cancer as a result of behavioral, genetic or family history did not receive any cancer protection benefits from the estrogen-only HRT.[4] The therapy still poses a risk of stroke, blood-clotting disorders, dementia, gall-bladder disease, etc. and a host of other cancers particularly endometrial and uterine cancer for those women who have not undergone a hysterectomy.

Clearly there are still risks to be had, yet as expected these are understated and the new results applauded. Add to this the following comment from the authors that seems to suggest that for whatever reason the tide has turned in favor of hormone replacement therapy:

    “Concepts regarding menopausal hormone therapy and breast cancer have undergone considerable change in the last decade.”[5]

Really?

If so, it is predominantly due to the premeditated manipulation and deceitful marketing strategies conceived by Wyeth, and now Pfizer, intended to quell the fears the WHI and other studies instilled in unsuspecting women. The product hasn’t changed, nor has the intent. Given the proven cause and effect relationship of conventional HRT therapy and the cornucopia of life-threatening diseases it is propaganda at its worst.

The question looms as to the validity of this study and any politics behind it if in fact any exist. There is nothing new about Big Pharma’s conspiracies and their ability to insert distorted information into so-called “scientific” medical journals and use them as marketing tools.

Simply recall the contract between Wyeth Pharmaceuticals and DesignWrite, a medical communications company, where articles were ghostwritten for top-tier medical journals with the intention of strengthening the sales of the Premarin family of HRT products.[6]

It should come as no surprise then that the funding for this research was provided by none other than Wyeth (now part of Pfizer Pharmaceuticals) and the National Heart, Lung and Blood Institute.[7]

Coincidence?

After all, the patent for Premarin, the estrogen-only HRT used in the study, expired in February 2012 and the lawsuits are still ongoing. What could be better than some encouraging news for those women who are taking or planning to take Premarin for the relief of menopausal symptoms? Remember their mission. “We dedicate ourselves to humanity’s quest for longer, healthier, happier lives through innovation in pharmaceutical, consumer, and animal health products.” 

Hogwash. It’s all about the bottom line.

Researchers who participated in study had this to say:

    “Some previous studies have suggested that estrogen-only HRT increases the risk of breast cancer, but these studies were less rigorous in design than the new one.”[8]

What studies are they referring to? Are they trying to insinuate that the landmark WHI study, or others equally as reputable, somehow was flawed compared to theirs? Even if they are not including the WHI they are clearly proclaiming that the conclusions reached by the WHI are in error.

Let’s see how robust their study was:

  • All the women had a hysterectomy before joining the study
  • Half the women took estrogen-only, the other half a placebo
  • Neither the women or the doctors knew which women were taking the HRT and which were taking the placebo

OK so far – a double-blind placebo controlled study where the “blindness” ensures that the personal beliefs and expectations of either the researchers or the study subjects do not undermine the objectivity of the results.

  • After the study started, the women could stop taking the HRT or placebo whenever they wanted
  • On average the women took the HRT or placebo for less than 6 years with all or mostly all of the prescribed medicine for about 3.5 years
  • Many women took fewer doses than prescribed
  • Some women agreed to be followed for more time – half for 12 years and half for less.[9]

These last four bullets seem to indicate a total lack of control on the researcher’s part – more of a “soft science” area of statistics rather than a rigorous study with defined formal phases. Without all the women taking either the estrogen-HRT or placebos for the full length of the study or in lower dosages, particularly the HRT group, the study seems inherently flawed. As the famous saying goes: “There are three ways to not tell the truth: lies, damned lies and statistics”.

In any case, I don’t buy it, nor do others:

    “Other experts weren’t convinced. “It’s inconsistent with the totality of evidence that finds estrogen increases breast cancer risk,” said Valerie Beral, director of the cancer epidemiology unit at Oxford University. She said the analysis was a subset of a larger trial that wasn’t designed to specifically look at breast cancer. “If you want to take hormone replacement therapy, estrogen-only has a much lesser effect on breast cancer than with progestin,” she said. “But to say it protects against breast cancer is wrong.”[10]

While the interactions of HRT derived from CEEs and the female body may be complex, time and time again estrogen has always shown to fuel the growth of breast cancer cells. Is this some breakthrough in medical science or just some poorly designed experiment used as a marketing tool to promote a known carcinogen? When research is commissioned or funded by commercial interests – Wyeth/Pfizer in this case – this introduces another element of risk as to its scientific validity.

“To be scientifically proven” has enormous brand value. Where research funding comes from a source which can gain large financial benefit from the sales of the product or the idea or the intellectual property which results from the research then the risk that the “research results” are skewed or selectively published in favour of the funder’s interests is quite significant. The research results are now just a means of tapping into the brand value of being “scientifically proven”. The so-called science becomes nothing more than part of a marketing campaign”.[11]

Greed at its worst – Big Pharma strikes again.

Sadly, in the end Pfizer continues to profit from the suffering of the innocent mares and their foals. Nothing has been, or ever will be, appealing or beneficial about the PMU industry and the Premarin family of drugs; they are clearly harbingers of death from both sides of the equation. The devil incarnate indeed.
__________
[1] http://www.pr.com/press-release/496372
[2] http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2812%2970075-X/abstract
[3] http://www.foxnews.com/health/2012/03/07/estrogen-only-hormone-replacement-therapy-may-reduce-breast-cancer-risk/#ixzz2Vq6ZrN35
[4] http://www.foxnews.com/health/2012/03/07/estrogen-only-hormone-replacement-therapy-may-reduce-breast-cancer-risk/#ixzz2Vq6Sjy7r
[5] http://articles.latimes.com/2012/mar/15/news/la-heb-hormone-therapy-20120315
[6] https://tuesdayshorse.wordpress.com/2010/07/08/busted-wyeth-used-ghostwriters-to-place-over-40-%E2%80%9Cscientific%E2%80%9D-articles-in-medical-journals/
[7] http://www.foxnews.com/health/2012/03/07/estrogen-only-hormone-replacement-therapy-may-reduce-breast-cancer-risk/#ixzz2Vq6ZrN35
[8] http://www.foxnews.com/health/2012/03/07/estrogen-only-hormone-replacement-therapy-may-reduce-breast-cancer-risk/#ixzz2Vq6ZrN35
[9] http://www.breastcancer.org/research-news/20120306
[10] http://www.news-medical.net/news/20120308/Estrogen-only-HRT-in-some-postmenopausal-women-could-lower-breast-cancer-risk-Study.aspx?page=2
[11] http://ktwop.wordpress.com/2012/12/03/when-science-becomes-a-marketing-tool/

Researched and Written by Jane Allin
© Int’l Fund for Horses

“We are not spiritually unconnected from the drugs we take, or the pain and suffering that goes into their making.”

~ Alice Walker

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Expendable Flyer Say No to Premarin

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WHAT YOU CAN DO

— Send the Int’l Fund for Horses “Dear Physician Letter” (3 pp, pdf) – with or without a personal cover letter from you – to any doctor who may prescribe this medication today.

The letter is researched, written and signed by us. All you need to do is print and mail. Thank you.

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