Prescription for Change: Ghostwritten Articles Helped Sell Hormones
by Charlea T. Massion, M.D. & Adriane Fugh-Berman, M.D.
If you or your mother became menopausal between the 1960s and 90s, you know that most women were pressured to take hormones from their first hot flash until their death. A friend joked that all women would be clutching a vial of Premarin on their death-beds. Joking aside, all Network members should be proud to be part of the only national membership organization that consistently opposed estrogen for disease prevention.
Since the 1970’s, the Network told both women and doctors that the drug industry was producing biased articles that exaggerated hormone therapy’s (HT’s) benefits, minimized its risks, and misled physicians and patients. We pointed out the lack of data to support the claimed benefits of HT; we noted that HT increased the risk of blood clots and breast cancer. We criticized industry-biased articles that appeared in peer-reviewed medical journals, “pseudo-journals”, and women’s magazines. We decried the use of celebrities and physicians to tout hormone therapy.
While Network members were the best-informed women around, we were shouted down at medical conferences and bullied in our doctor’s offices. Doctors told women who refused HT that they were “gambling with their lives.” One woman who declined a prescription was asked, “Don’t you want to live to see your children grow up?”
Physicians sincerely believed that all women needed HT because they had been told, over and over (in medical school, in residency training, at medical meetings, in medical journals, and in clinic hallways) that HT protected women’s heart, bones, and brain, and kept women happy, sexually active, and continent. Claims were even made that hormones prevented wrinkles, tooth loss, and vision loss. While estrogen decreases the rate of bone loss and helps prevent osteoporosis, none of the other claims are true. Those who worried about breast cancer were told the risk was small. Breast cancers experienced by HT patients were deemed to be “good”, easily treated cancers. This wasn’t true either.
In 2002, the Women’s Health Initiative (WHI) found that HT provided no protection against cardiovascular disease and increased the risk of breast cancer, stroke, dementia, and incontinence. Hormone prescriptions dropped, as did the breast cancer rate, by a stunning 16,000 cases a year. The Network was proven completely right and then some.
Recently, 1,500 documents were publicly released as part of litigation involving thousands of HT patients who developed breast cancer.1 These documents provide startling evidence of a plan to swamp doctors with manufactured ‘evidence’ and convince them all menopausal women should be put on hormones. The documents also reveal that much of the pro-HT medical literature was ghostwritten by industry hacks and merely signed by academic physicians. The plan indicates that Wyeth (HT’s manufacturer) and several “medical education companies” created marketing messages supporting HT, then wrote articles promoting these messages. Plans detailed which publications the articles should be planted in and suggested physicians to list as ‘authors’. These articles convinced many physicians that menopause was a disease that required estrogen for treatment.
These documents will expose dozens of fake authors. The physicians who have been outed thus far show a shocking dearth of shame. Confronted with Wyeth documents showing that her 1999 article in Primary Care Update Ob/Gyns was ghostwritten, Dr. Lila Nachtigall told the New York Times, “If they came up with the idea or gave me an outline or something, I don’t remember that at all.” Dr. Gloria Bach-mann recalled getting assistance with her 2005 Journal of Reproductive Medicine article, but said that lending her expertise constituted a major role in the publication. She commented, “There was a need for a review article and I said ‘Yes, I will review the draft and make sure it is accurate’… This is my work, this is what I believe, this is reflective of my view.”2 Leon Speroff, author of a 2001 article in Women’s Health in Primary Care defended ghostwriting, saying, “There is nothing dishonest about it.” We wonder if other physicians agree… a frightening prospect. Perhaps we should require continuing education on the difference between readers, editors, and authors!
Pharmaceutical companies have sought to discredit the WHI, saying the participants were too old and sick to benefit from hormones — although WHI participants exactly represented the general population for whom hormones had been targeted. Unfortunately, pharma-associated physicians continue to misrepresent HT, saying that if another estrogen or progestin had been used, or if hormones were started earlier, before menopause, the results would be more favorable. Several months ago a 47-year-old friend was told it was abnormal that she hadn’t menstruated in months and that her risk of cancer would increase unless she took HT. In fact, 47 is a perfectly normal age for menopause, and menopause does not increase the risk of any cancer, or any disease. Stay strong, Network women! Get your medical information from unbiased sources, and continue the fight to ensure that ensure finance does not triumph over science. We recommend that, if you are taking HT, strongly consider stopping or tapering off. If you have osteoporosis, you can use other medications that don’t increase the risk of breast cancer.3 3 If you have severe hot flashes or vaginal dryness, take HT at the lowest dose to relieve symptoms for 6-12 months, then stop. If severe symptoms recur, try tapering; if that doesn’t work, go back on and try again in 6 months. Finally, stay tuned to the Network for women’s health news even before it breaks in the media!
1. Disclosure: Dr. Fugh-Berman has been a paid expert witness on behalf of plaintiffs in the litigation described here.
2. Singer N, “Medical Papers by Ghostwriters Pushed Therapy,” New York Times, August 4, 2009. Available on-line at: http://www.nytimes.com/2009/08/05/health/research/05ghost.html?pagewanted=2&sq=medical%20papers%20by%20ghostwriters&st=cse&scp=1; and Wilson D, “Drug Maker Said to Pay Ghostwriters for Journal Articles,” New York Times, December 12, 2008. Available at: http://www.nytimes.com/2008/12/12/business/13wyeth.html.
Charlea T. Massion, MD, is a family physician and co-founder of the American College of Women's Health Physicians; she teaches at Stanford University School of Medicine’s Center for Education in Family Medicine. Adriane Fugh-Berman, M.D., is an associate professor in the Georgetown University Medical Center, a former chair of the NWHN, and director of Pharmedout.org, which educates prescribers about pharmaceutical marketing techniques.