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Linda is 53, and suffering from menopausal symptoms of hot flashes, night sweats, insomnia and mood disturbance. While at the hair salon, a friend told her she needed hormone therapy, so she went on the internet to read up on it. Linda learned about the Womens's Health Initiative Study that showed synthetic hormones are unsafe, causing breast cancer and heart disease. Next, she cheerfully made an appointment to see her OB Gyne doctor thinking he would gladly prescribe bioidentical hormones. To her dismay, Linda's doctor was not at all pleased when she raised the topic. Her doctor scowled and said,"those aren't any good", and besides, "there is no evidence that bioidentical hormones are any safer than synthetics". Linda ran out the door crying all the way home. A few days later, Linda was sitting in my office asking, "Why is my doctor opposed to bioidentical hormones?"
The Doctor Reads Ghost Written Articles
I explained to Linda that her doctor reads medical journals containing ghost written articles from the synthetic hormone industry, Wyeth and Pfizer. Ghost written means the real author is hidden, without a disclosure that the real author is a ghost writer hired by the pharmaceutical company. DesignWrite and PharmaWrite provide the medical writers for hire, instructed to downplay the adverse effects of synthetic hormones, and raise doubts about bioidenticals. Medical ghostwriting is marketing, rather than science. As such, it is a form of plagiarism, scientific misconduct and fraud. The invited "author" is usually an academic professor in a university medical center serving as opinion leader who lends his name to the article.
Shocking Revelations from Drug Litigation, Medical Ghostwriting
8,000 women have filed court claims against Wyeth-Pfizer, claiming that their synthetic hormone pill, Prempro, caused breast cancer. During the discovery process, internal company documents were made public revealing the extent of the medical ghost writing. About 44 articles in the women's health medical literature are ghost written by Wyeth in a marketing program to convince doctors to prescribe their synthetic hormones, and not to prescribe bioidenticals. These documents are publicly available in a document database.
An Example of Medical Ghost Writing in the Women's Hormone Literature
Here is an example of biased pro-industry medical ghostwriting. The article is entitled, Bioidentical Hormone Therapy: A Review of the Evidence. by Michael Cirigliano, an Internist at the University of Pennsylvania School of Medicine, published in the Journal of Womens Health. (2007 Jun;16(5):600-31.) Michael Cirigliano is Associate Professor of Medicine at the U Penn Medical center.
At the very end of the article (page 625), you will find this notice:
ACKNOWLEDGMENTS - I received editorial assistance from Eugene R.Tombler, Ph.D., Florencia Schapiro, Ph.D., and Monica Ramchandani, Ph.D., of PharmaWrite,LLC..
Pharmawrite/Designwrite is the medical ghostwriting company paid by Wyeth to write the 44 articles on women's hormones. They are currently under investigation by Grassley's Senate Committee. Dr Cirigliano acknowledges three PHD medical ghost writers from Pharmawrite paid by an (unnamed) drug company to write a pro-synthetic hormone article biased against bioidentical hormones. The article is a review of the literature to determine if sufficient scientific evidence supports claims of greater efficacy and safety for bioidentical hormones compared to synthetic hormones. And the conclusion, you guessed it, "No scientific evidence to support this".
In case you were thinking this is OK, the University of Pennsylvania School of Medicine (Penn Medicine) has policies against plagiarism and it considers ghostwriting to be the equivalent of plagiarism. Plagiarism is a serious academic infraction, and a deviation from academic norms.
Lefrt Image :Ghost Stories 1931 courtesy of wikimedia commons.
Comparison with Non-Biased Review
The Bioidentical Hormone Debate: Are Bioidentical Hormones Safer or More Efficacious than Synthetic Hormone Replacement Therapy? by Kent Holtorf, MD. Postgraduate Medicine: Volume 121: No.1 January 2009.
The doctor's conclusion after reviewing the medical literature is: YES, they are. "Bioidentical hormones have lower risk of breast cancer and heart disease, and are more efficacious than synthetic counterparts. Until evidence is found to the contrary, bioidentical hormones remain the preferred method of HRT." Dr Holtorf cites 196 medical studies to support his conclusion.