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Partisan Perspectives in the Medical Literature: A Study of High Frequency Editorialists Favoring Hormone Replacement Therapy

Journal of General Internal Medicine volume 25, pages 914–919 (2010)Cite this article

ABSTRACT

Background

Unfavorable results of major studies have led to a large shrinkage of the market for hormone replacement therapy (HRT) in the last 6 years. Some scientists continue to strongly support the use of HRT.

Objectives

We analyzed a sample of partisan editorializing articles on HRT to examine their arguments, the reporting of competing interests, the journal venues and their sponsoring societies.

Data Sources

Through Thomson ISI database, we selected articles without primary data written by the five most prolific editorialists that addressed clinical topics pertaining to HRT and that were published in regular journal issues in 2002–2008.

Main Measures

We recorded the number of articles with a partisan stance and their arguments, the number of partisan articles that reported conflicting interests, and the journal venues and their sponsoring societies publishing the partisan editorials.

Key Results

We analyzed 114 eligible articles (58 editorials, 16 guidelines, 37 reviews, 3 letters), of which 110 (96%) had a partisan stance favoring HRT. Typical arguments were benefits for menopausal and related symptoms (64.9%), criticism of unfavorable studies (78.9%), preclinical data that showed favorable effects of HRT (50%), and benefits for major outcomes such as osteoporosis and fractures (49.1%), cardiovascular disease (31.6%), dementia (24.6%) or colorectal cancer (20.2%), but also even breast cancer (4.4%). All 5 prolific editorialists had financial relationships with hormone manufacturers, but these were reported in only 6 of the 110 partisan articles. Four journals published 15–37 partisan articles each. The medical societies of these journals reported on their websites that several pharmaceutical companies sponsored them or their conferences.

Conclusions

There is a considerable body of editorializing articles favoring HRT use and very few of these articles report conflicts of interest. Full disclosure of conflicts of interest is needed, especially for articles without primary data.

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REFERENCES

  1. Wilson D. Wyeth’s Use of Medical Ghostwriters Questioned. New York Times. December 13, 2008:B1 (Accessed on March 2010 at http://www.nytimes.com/2008/12/13/business/13wyeth.html?_r=1&ref=business)

  2. Rossouw JE, Anderson GL, Prentice RL, et al. Writing Group for the Women’s Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288:321–33.

    Article  PubMed  CAS  Google Scholar 

  3. Million Women Study Collaborators. Breast cancer and hormone-replacement therapy in the Million Women Study. Lancet. 2003;362:419–27.

    Article  CAS  Google Scholar 

  4. Hersh AL, Stefanick ML, Stafford RS. National use of postmenopausal hormone therapy: annual trends and response to recent evidence. JAMA. 2004;291:47–53.

    Article  PubMed  CAS  Google Scholar 

  5. Watson J, Wise L, Green J. Prescribing of hormone therapy for menopause, tibolone, and bisphosphonates in women in the UK between 1991 and 2005. Eur J Clin Pharmacol. 2007;63:843–9.

    Article  PubMed  Google Scholar 

  6. ACOG Task Force for Hormone Therapy American College of Obstetricians and Gynecologists Women’s Health Care Physicians. Summary of balancing risks and benefits. Obstet Gynecol. 2004;104:128S–129S.

    Article  Google Scholar 

  7. Mosca L, Appel LJ, Benjamin EJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women. Circulation. 2004;109:672–93.

    Article  PubMed  Google Scholar 

  8. Recommendations for estrogen and progestogen use in peri-and postmenopausal women: October 2004 position statement of The North American Menopause Society. Menopause. 2004;11:589–600.

    Google Scholar 

  9. Wathen CN, Feig DS, Feightner JW, Abramson BL, Cheung AM. Hormone replacement therapy for the primary prevention of chronic diseases: recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ. 2004;170:1535–7.

    PubMed  Google Scholar 

  10. Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of contradicted claims in the literature. JAMA. 2007;298:2517–26.

    Article  PubMed  CAS  Google Scholar 

  11. Siontis GC, Tatsioni A, Katritsis DG, Ioannidis JP. Persistent reservations against contradicted percutaneous coronary intervention indications: citation content analysis. Am Heart J. 2009;157:695–701.

    Article  PubMed  Google Scholar 

  12. Angell M. Drug companies. New York: Oxford University Press; 2004:251.

    Google Scholar 

  13. Rothman DJ, McDonald WJ, Berkowitz CD, et al. Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest. JAMA. 2009;301:1367–72.

    Article  PubMed  CAS  Google Scholar 

  14. Sniderman AD, Furberg CD. Why guidelinemaking requires reform. JAMA. 2009;301:429–31.

    Article  PubMed  CAS  Google Scholar 

  15. Steinbrook R. Financial support of continuing medical education. JAMA. 2008;299:1060–2.

    Article  PubMed  CAS  Google Scholar 

  16. Rothman DJ. Academic medical centers and financial conflicts of interest. JAMA. 2008;299:695–7.

    Article  PubMed  CAS  Google Scholar 

  17. Ehringhaus SH, Weissman JS, Sears JL, Goold SD, Feibelmann S, Campbell EG. Responses of medical schools to institutional conflicts of interest. JAMA. 2008;299:665–71.

    Article  PubMed  CAS  Google Scholar 

  18. Podolsky SH, Greene JA. A historical perspective of pharmaceutical promotion and physician education. JAMA. 2008;300:831–3.

    Article  PubMed  CAS  Google Scholar 

  19. Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. A national survey of physician-industry relationships. N Engl J Med. 2007;356:1742–50.

    Article  PubMed  CAS  Google Scholar 

  20. Relman AS. Medical professionalism in a commercialized health care market. JAMA. 2007;298:2668–70.

    Article  PubMed  CAS  Google Scholar 

  21. Brennan TA, Rothman DJ, Blank L, et al. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA. 2006;295:429–33.

    Article  PubMed  CAS  Google Scholar 

  22. Peppercorn J, Blood E, Winer E, Partridge A. Association between pharmaceutical involvement and outcomes in breast cancer clinical trials. Cancer. 2007;109:1239–46.

    Article  PubMed  Google Scholar 

  23. Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ? Arthritis Rheum. 2007;56:2267–77.

    Article  PubMed  CAS  Google Scholar 

  24. Ioannidis JP. Why most published research findings are false. PLoS Med. 2005;2:e124.

    Article  PubMed  Google Scholar 

  25. Ioannidis JP. Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials? Philos Ethics Humanit Med. 2008;3:14.

    Article  PubMed  Google Scholar 

  26. Stelfox HT, Chua G, O’Rourke K, Detsky AS. Conflict of interest in the debate over calcium-channel antagonists. N Engl J Med. 1998;338:101–6.

    Article  PubMed  CAS  Google Scholar 

  27. Choudhry NK, Stelfox HT, Detsky AS. Relationships between authors of clinical practice guidelines and the pharmaceutical industry. JAMA. 2002;287:612–7.

    Article  PubMed  Google Scholar 

  28. Angell M, Kassirer JP. Editorials and conflicts of interest. N Engl J Med. 1996;335:1055–6.

    Article  PubMed  CAS  Google Scholar 

  29. Kassirer JP, Angell M. Financial conflicts of interest in biomedical research. N Engl J Med. 1993;329:570–1.

    Article  PubMed  CAS  Google Scholar 

  30. Steinman MA, Bero LA, Chren MM, Landefeld CS. Narrative review: the promotion of gabapentin: an analysis of internal industry documents. Ann Intern Med. 2006;145:284–93.

    PubMed  Google Scholar 

  31. Healy D, Cattell D. Interface between authorship, industry and science in the domain of therapeutics. Br J Psychiatry. 2003;183:22–7.

    Article  PubMed  Google Scholar 

  32. Ross JS, Hill KP, Egilman DS, Krumholz HM. Guest authorship and ghostwriting in publications related to rofecoxib: a case study of industry documents from rofecoxib litigation. JAMA. 2008;299:1800–12.

    Article  PubMed  CAS  Google Scholar 

  33. Gøtzsche PC, Hróbjartsson A, Johansen HK, Haahr MT, Altman DG, Chan AW. Ghost authorship in industry-initiated randomised trials. PLoS Med. 2007;4:e19.

    Article  PubMed  Google Scholar 

  34. Conflict of Interest in Medical Research, Education and Practice. Bernard Lo and Marilyn J. Eds. Report prepared by the Committee on Conflict of Interest in Medical Research, Education, and Practice. Washington, DC: Institute of Medicine. National Academy Press; April 28, 2009.

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Author Contributions

Dr. Ioannidis had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Funding/Support

None

Conflict of Interest

None disclosed.

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Authors and Affiliations

  1. Clinical Trials and Evidence-Based Medicine Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, 45110, Greece

    Athina Tatsioni MD, George C. M. Siontis MD & John P. A. Ioannidis MD

  2. Biomedical Research Institute, Foundation for Research and Technology-Hellas, Ioannina, Greece

    John P. A. Ioannidis MD

  3. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA

    Athina Tatsioni MD & John P. A. Ioannidis MD

Authors
  1. Athina Tatsioni MD
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  2. George C. M. Siontis MD
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  3. John P. A. Ioannidis MD
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Corresponding author

Correspondence to John P. A. Ioannidis MD.

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Tatsioni, A., Siontis, G.C.M. & Ioannidis, J.P.A. Partisan Perspectives in the Medical Literature: A Study of High Frequency Editorialists Favoring Hormone Replacement Therapy. J GEN INTERN MED 25, 914–919 (2010). https://doi.org/10.1007/s11606-010-1360-7

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  • DOI: https://doi.org/10.1007/s11606-010-1360-7

KEY WORDS

  • hormone replacement therapy
  • menopause
  • postmenopausal women