Healthy Skepticism Library item: 17744

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Goozner M
Save Hormone Replacement Therapy! Five Docs on a Mission
GoozNews 2010 May 9
http://www.medcitynews.com/2010/05/wyeth-ayerst-its-docs-will-save-hormone-replacement-therapy/

Full text:

Last summer, documents uncovered in a lawsuit against Wyeth-Ayerst, the manufacturer of hormone replacement therapy, revealed that 26 journal articles touting HRT for post-menopausal women written after serious risks had become known were ghostwritten by Wyeth consultants. A new study of the five most prolific authors of HRT-related editorials, clinical practice guidelines and reviews over the same period reveals they not only were they on Wyeth’s payroll, but they failed to disclose that fact 95 percent of the time.

The study was conducted by Greek researchers led by John Ioannidis, who splits time between Tufts University in Boston and the University of Ioannina School of Medicine. They did a comprehensive search of medical opinion pieces on HRT written in the wake of the 2002 Women’s Health Initiative (WHI), which revealed that taking hormones to relieve the symptoms of menopause increased women’s risk of contracting breast cancer, heart disease and dementia. Sales slumped sharply in the wake of that study.

But over the next six years, five researchers with ties to Wyeth published 110 reviews, guidelines and editorials that continued to push HRT, often with non-scientific headlines like “The pendulum swings back; estrogen is now beneficial if started at the right time”; “Estrogens and women’s health: A scary or a fairy tale?” and “Should epidemiology, the media and quangos
determine clinical practice?”

Quangos? I’ll save you going to Wikipedia to look it up. Its a British perjorative for “quasi autonomous non-governmental organization.”

These polemics appeared largely in four journals that also had financial ties to Wyeth or other estrogen manufacturers. The leading group is the International Menopause Society (IMS), which publishes Climacteric and is based in the United Kingdom. David Sturdee of Sulihill Hospital in the UK is the current president of the IMS, which takes money from Wyeth for various functions. Sturdee was among the most prolific of the pro-HRT editorialists.

Toward the end of their article in the Journal of General Internal Medicine, Ioannidis and colleagues conclude:

Experience from other fields suggests that even when large
trials contradict previous beliefs about the benefits of various
interventions, a section of the medical literature continues to
support previous practices and raises counterarguments as to
why the large studies were wrong. This “die hard” pattern has
been demonstrated in vitamin E for cardiovascular prevention,
beta-carotene for cancer prevention, estrogen for dementia
prevention and percutaneous coronary intervention for
stable chronic coronary artery disease (in the latter case,
the source of resistance came primarily from interventional
cardiologists). . . The key vehicle of expressing doubts
about large trials has been through editorials and expert
statements.

The pro-HRT campaign came largely through journals based abroad. In the wake of the ghost-writing allegations, Sen. Charles Grassley announced an investigation. It’s too bad that foreign journals and quangos like IMS are beyond his reach. The fact that just six of the 110 articles by the five authors mentions their ties to Wyeth deserves scrutiny.