publish & be damned?

In this particular case – yes. What else would be an apt outcome for a pharmaceutical company that had ghost-writers producing review papers for publication that promoted their own drugs as examples of best practice? This is actually an example of how science shouldn’t be done – & also of the self-correcting nature of science, because it was subsequent research that showed that some of the claims being made didn’t stack up.

The story centres on the promotion of Hormone Replacement Therapy for menopausal & post-menopausal women – not just to relieve hot flushes (which can be a downright pain, believe me!), but also to reduce the appearance of skin aging & also to reduce the risks of developing heart disease & dementia. (I could go off on a tangent here, because this medicalisation of a normal aging process is something that concerns me. This is not intended to trivialise the impact of dementia – I’ve seen it in members of my own family & it’s not good. But aging happens to us all, so why in the last century or so has society as a whole become so obsessed with minimising or hiding its more cosmetic impacts?… no, no, I won’t go there right now! Back to the story!)

Essentially, it seems that ghostwriters paid by a pharmaceutical company played a major role in producing 26 scientific papers backing the use of hormone replacement therapy in women. What’s worse, at least one scientist working in the area was happy to have their name associated with the paper (thus boosting its credibility), despite apparently having had very little to do with writing it. Houston, we have a problem – this is a serious conflict of interest, and it’s not how science should be done! And to anyone reading the papers, the drug company’s input would not be obvious; you’d assume it was a piece of independent work. But it wasn’t – & it seems that these papers also over-emphasised the benefits of the company’s drugs, & underplayed any harmful effects. 

However, from 2002 a series of independent studies found that in fact, while HRT was helpful in reducing the impact of hot flushes, the drugs were also linked to an increased risk of breast cancer, cardiovascular disease (including strokes) – and of older patients developing dementia. I remember when these data hit the headlines, & the very rapid change in medical advice to menopausal women. As Orac says: The triumph of science-based medicine is that this result showed that previous practice was subjecting women to a higher risk than had been thought and publication of these data resulted in a near-instantaneous change in practice in which routine recommendation of HRT for cardiovascular benefit as well as relief of menopausal symptoms. Again, as I’ve said time and time again, it may be messy and it may take more time than we like (not to mention encounter more resistance than is always desirable), but eventually science-based medicine, like science, is self-correcting.

Small comfort to anyone prescribing or taking the medications in good faith, & now hearing this news. And the whole unfortunate saga is grist to the mill of those who believe that science, & scientists, just can’t be trusted (missing the point that it was science, and scientists, who got to the bottom of it all).

Orac has an extremely thorough review of the case here.


Update: and see Ben Goldacre on How myths are made.

Leave a Reply

Your email address will not be published. Required fields are marked *