Ghostly Prescriptions

Not so long ago, women of a certain age in the U.S. were made to believe that going on hormonal replacement therapy (HRT) was as much of a rite of passage as menarche or pregnancy. Over the past seven years, however, we have learned just how wrong that was: the science on which the prescription was based was flawed, the data were consistently misinterpreted, and the medical literature on which medical practices was based was in effect on a very shaky foundation. This whole edifice fell apart in 2002, when a large federally funded study stopped after finding that menopausal women who took certain hormones had an increased risk of invasive breast cancer, heart disease and stroke.

Now, we know that the rise of HRT cannot be attributed to well-meaning but misguided scientists but rather out-and-out fraud. Wyeth, manufacturer of Premarin and Prempro, contracted with a medical communication firm to write articles favorable to its products, and then paid (until then) reputable doctors to appear as authors. The articles were published in 18 established medical journals such as the American Journal of Obstetrics and Gynecology and the International Journal of Cardiology. These articles in effect gave the imprimatur to practices which then spread widely. And the medical literature in turn spawned a variety of more popular "chick lit" articles and books with enticing titles that touted the benefits of being "forever feminine" while avoiding dry skin and a diminished libido. The result?: millions of women being duped while Wyeth sold $2 billion worth of drugs in 2001 alone.

Medical ghost-writing is not new, and has been involved in other cases. What is new in this case is the scope of the practice, the many physicians that were willing to lend their names to the scheme, the failure of peer review to detect tainted science, the prestige of the journals involved, and the sheer magnitude of the entire enterprise. Indeed, it is likely that some medical faculty received tenure on the basis of their "literary production" when they had merely agreed to stake their names (and, by extension, the reputations of their institutions) to enhance pharmaceutical company’s profits and line their own pockets.