How ghostwriters sold hormone replacement

Writing in PLoS Medicine, Adriane J. Fugh-Berman, M.D., demonstrates the cynical art of “publication planning” and the use of academic journals as an avenue for unregulated drug promotion by showing, with the help of documents from a major drug manufacturer, how ghostwriting was used to sell hormone replacement therapy.

The documents in question come from the lawsuits against Wyeth over the development of breast cancer during treatment with the hormone replacer Prempro, and were brought to light, according to Fugh-Berman, “when PLoS Medicine and The New York Times intervened in the litigation. Both intervenors successfully argued that ghostwriting undermines public health and that documents proving the practice should be unsealed.”

Fugh-Berman was a paid expert witness in the trial, and thus was familiar with the documents before their release. Her conclusion?

… the pharmaceutical company Wyeth used ghostwritten articles to mitigate the perceived risks of breast cancer associated with HT (menopausal hormone therapy), to defend the unsupported cardiovascular “benefits” of HT, and to promote off-label, unproven uses of HT such as the prevention of dementia, Parkinson’s disease, vision problems, and wrinkles.

According to Fugh-Berman, the effects of this careful campaign seem to have outweighed the preponderance of evidence, at least in the minds of some doctors.

Today, despite definitive scientific data to the contrary, many gynecologists still believe that the benefits of HT 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.

Through the course of the article, Fugh-Berman lays out the entire ghostwriting/marketing process, complete with instructive details and damning examples. There’s a lot to take in, but you’ll emerge with a far better understanding of the mundane mechanics that make ghostwriting work.


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  1. Pingback: Did PLoS suffer from COI in ghostwriting article? : Covering Health

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