For those who have been mystified by the resolute defence of HRT by some specialists, for those who are interested in integrity in publishing, medicine and science, and for those who enjoy a shocking yarn – this PLoS Medicine article is a must-read.

It is by Adriane J. Fugh-Berman from the Department of Physiology and Biophysics at Georgetown University Medical Center in Washington, DC, who was an expert witness in recent litigation against Wyeth, in which more than 14,000 plaintiffs brought claims related to developing breast cancer while taking Prempro.

Some 1500 documents revealed in the litigation provide unprecedented insights into how pharmaceutical companies promote drugs, including the placement of ghostwritten manuscripts in medical journals. These documents became public when PLoS Medicine and The New York Times intervened in the litigation.

Fugh-Berman reports that Wyeth used ghostwritten articles to mitigate the perceived risks of breast cancer associated with HRT, to defend the unsupported cardiovascular “benefits” of HRT, to downplay competing therapies, and to promote off-label, unproven uses of HRT such as the prevention of dementia, Parkinson’s disease, vision problems, and wrinkles.

She notes that despite definitive scientific data to the contrary, many gynecologists still believe that HRT’s benefits outweigh the risks in asymptomatic women. “This non-evidence–based perception may be the result of decades of carefully orchestrated corporate influence on medical literature,” she writes.

Her paper ends with a call to arms:

“Medicine, as a profession, must take responsibility for this situation. Naïveté is no longer an excuse. Perhaps physician-investigators should create and uphold a standard where relationships with industry are regarded as unsavory rather than sought after. Academic institutions and medical journals should take a hard line on ghostwriting. Patient care will benefit if physicians draw together as a profession to denormalize relationships with industry and avoid the role of corporate pawns in the future.”

Meanwhile, just to show that the problems go much wider than HRT: here is an example from cardiology, describing  “how marketing studies end up in influential medical journals”.

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