Journal articles on HRT found mostly honest on risks, but subtly promotional

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A review of journal articles about menopausal hormone therapy found most to be factual, if promotional in tone.

The study, performed by three Georgetown Medical Center grad students under the supervision of Georgetown's Dr. Adriane Fugh-Berman, looked at 50 articles by ten authors who had published multiple articles on hormone replacement therapy (HRT) in the four years after the Women's Health Initiative's bombshell findings on its side effects. The

In 2002, the Women's Health Initiative shut down its estrogen-plus-progesterin study early due to increased risk of breast cancer and cardiovascular events, and an estrogen-only trial soon followed suit. Studies have nonetheless found in recent years that many gynecologists continue to believe in the benefits of hormone replacement therapy.  

The reviewers found 86% of the articles to be scientifically accurate, meaning that they did not downplay the risk of breast cancer associated with HRT or play up its theoretical heart benefits, which have yet to be proven conclusively. However, they also found 64% to be “promotional in tone,” with common themes including “attacks on the methodology of the Women's Health Initiative, arguments that clinical trial results should not guide treatment for individuals and arguments that observational studies are as good or better than randomized clinical trials for guiding clinical decisions.” In addition, the articles that the Georgetown team identified as promotional “implied that the risks associated with hormone therapy have been exaggerated and that the benefits of hormone therapy have been or will be proven.”

“Facts don't need to be twisted in order to leave a false impression in the reader's mind,” said Dr. Fugh-Berman. “Persuasive writing or the framing of factual information can affect how information is perceived.”

Fugh-Berman founded Georgetown-based pharma watchdog group PharmedOut and is a frequent critic of the “ghostwriting” of journal articles – ones ostensibly written by doctors -- by medical communications firms working on behalf of drug companies. She said she wasn't implying that the HRT articles reviewed were ghostwritten, but noted that in her past research on articles that had been demonstrably ghostwritten, Fugh-Berman found that “marketing messages are inserted in a very subtle way.”

“There were marketing messages in there,” she said of the HRT articles. “How they got there, we don't know.”

Of the ten authors studied, Fugh-Berman's team found that eight had declared payment for speaking or consulting on behalf of HRT drug manufacturers or for research support. Thirty of the 32 articles deemed promotional were authored by docs with potential conflicts of interest. Thus, articles promoting hormone therapy for menopausal women were nearly two-and-a-half times more likely to have been authored by doctors with conflicts of interest, and in articles by several of those authors with conflicts, text was repeated word-for-word in different articles.
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