Cheap Tricks

One of the obvious first steps in remaking the scientific enterprise is to get the corruption out of it. This is not new news but we do get some juicy specifics from the class action lawsuit against Wyeth regarding Hormone Replacement Therapy (HRT). The story is well-known: hormones were widely prescribed for many years to women undergoing or past menopause on the theory that they would protect against heart disease and generally be a fountain of youth. But then it turned out that HRT raised the risk of cancer, heart disease, stroke and dementia. Oh well.

For most of the researchers involved in this field and the physicians who prescribed HRT, this was an honest mistake. Retrospective epidemiological studies, which was all we had for a while, can be misleading because of confounding: the people who meet condition A -- such as taking HRT -- are bound to be dissimilar in other respects from people in condition B -- not taking HRT -- and you can't be sure you've accounted for all the differences, or done so appropriately, in your analysis. It took a randomized controlled trial to demonstrate the risks. (For any female readers who may be of a certain age, subsequent analysis is relatively reassuring about taking HRT for a short time to control symptoms of menopause, so discuss this with your doctor if you are interested. But that's a far cry from prescribing these drugs for years on end, supposedly as a magic elixir, which is how Wyeth made the big bucks.)

The corruption comes in at the stage where the complex, uncertain and sometimes conflicting results of epidemiological studies get processed into digestible form for the medical profession. This happens largely through what are called review articles in medical journals, which as we learned a few days ago can be strongly influential in shaping the general interpretation of evidence.

The documents released by the court show that Wyeth was writing review articles, and paying big shot medical professors to slap their names on them. It doesn't take a cynic to conclude that Wyeth presumably shaped the reviews to make long-term HRT maintenance therapy seem like the greatest thing since oxygen.

While it is no surprise that a corporation, an entity with the moral sensibility of a tapeworm, would act remorselessly in pursuing its bloodsucking purpose, it may be disturbing to some people that prominent academic physicians would conspire with them. The motive is more than just whatever money Wyeth slipped into their thongs; publishing review articles in major medical journals is one of those big fat plums on your CV that gets you promotions, speaking engagements, and yet more consulting fees. As far as I'm concerned, any faculty member who engaged in this practice ought to be fired and permanently barred from any academic position, forever. That won't happen of course -- these guys will just get bigger and fatter and richer, they won't pay any price. That's how it works. It has to change.