Our Bodies, Ourselves (142 page)

SOME GOOD SOURCES OF INFORMATION ON WOMEN'S HEALTH

Many government organizations, women's health organizations, and individuals have websites that provide accurate and reliable information on women's reproductive and sexual health. Below are some good places to begin looking; for a complete list of recommended resources, see ourbodies ourselves.org/book/library.asp.

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National Women's Health information Center:
womenshealth.gov; 1-800-994-9662

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girlshealth. Gov:
girlshealth.gov

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MedlinePlus:
nlm.nih.gov/medlineplus, a resource from the national library of Medicine that provides basic overviews of and links to additional reliable information on a wide variety of topics

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Centers for Disease Control and Prevention, Women's Health:

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National Women's Health Network:
nwhn.org/health-information-womens -health-voice; 202-682-2646

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Canadian Women's Health Network:
cwhn.ca

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Women's Health Matters:
womens healthmatters.ca

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NOAH (New York Online Access to Health), Women's Health:
noah-health.org/en/healthy/women

Recommended Reading:
Interested in learning more about how to read and understand research studies? Check out
Know Your Chances: Understanding Health Statistics
and
How to Read a Paper: The Basics of Evidence-Based Medicine
(see Recommended Resources).

DO THESE RESULTS APPLY TO ME?

One of the most important questions to ask yourself when you are looking at a research paper is, “Do these results apply to me?” To answer this question, you actually have to ask two related questions, “Am I similar to the women in the study?” and “Will the test or treatment be the same for me as it was in the study?”

You are most likely to experience the same benefits and harms of an intervention that are reported in a study if you share characteristics with the people who participated in the study. You may (or may not) be similar to the study participants in terms of your sex, age, diagnosis, previous health history, current health, pregnancy status, and other characteristics. For instance, a study of the safety of labor induction conducted among women who had given birth already cannot be applied to women who are giving birth for the first time. Similarly, a new STI prevention strategy may be more or less effective depending on whether the study is conducted on college students in the United States or women visiting a family planning clinic in Africa. The study participants will usually be described in the methods section of the paper, although some information about the participants may also be listed in the results section.

Even if the women studied are similar to you, the context in which the care was provided might be different. The dose of the drug, the timing of the test or treatment, the skill of the practitioner, and the other care given along with the intervention may influence how effective or safe a procedure is. If your situation is different, you may not be able to expect the same results. A good research paper will describe these issues in detail, usually in the methods section of the paper.

CAN WE BELIEVE THE EVIDENCE IN EVIDENCE-BASED MEDICINE?
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When we and our providers seek solutions to our health problems, we depend on medical research to explain which treatments work best, the likelihood that a particular treatment will help, and the risks involved. We expect this evidence-based medicine, as it is called, to identify the best possible care.

Sources that health professionals turn to include research published in respected medical journals, continuing education courses presented by experts, and clinical practice guidelines established by expert review committees that evaluate medical research to define standards of good care.

What few people realize is that medical research has undergone a quiet but radical transformation. Before 1970, the vast majority of clinical research was funded by government sources.
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By 2009, 85 percent of clinical trials were commercially funded.
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In 1991, 70 percent of clinical research was commercially funded, but about 80 percent of this research was still being done in universities, where academic checks and balances supported the independence of researchers. By 2004, however, only 26 percent of this research was conducted in academic medical centers. The rest was conducted by for-profit research companies, a trend that continues today.
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When drug and medical device companies fund research directly through private contracts, they are able to influence the study design and the published results. For starters, drug companies can select the characteristics of the people included in a study to highlight the benefits of the drug and minimize the risks—including studying the product on healthy, younger people who take few other medications and are therefore less likely to have adverse effects, even though the drug is more likely to be taken by older people taking multiple medications. The drug companies are not required to compare their products with other known treatments, and they can end studies if the results don't appear favorable. Though they still must report results of most studies to the FDA, drug companies don't have to publish studies that don't come out the way they had hoped. And many of the authors of the research articles published in even the most respected medical journals have access only to data the drug companies choose to make available to them.

Because of these limitations, medical literature often gives an unbalanced picture of drug risks, benefits, and alternatives. Two studies published in 2003, one in the
Journal of the American Medical Association
(
JAMA
) and the other in the
British Medical Journal
, found that commercially funded studies were 3.6 to 4 times more likely than noncommercially funded studies to show positive results for the sponsor's product.
7
another
JAMA
study that looked only at highest-quality studies found even stronger bias: The odds that commercially funded research found the sponsor's product the treatment of choice were 5.3 times greater than for studies funded by nonprofits.
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And yet another study found that when clinical studies are commercially
funded and authors have financial ties to the sponsor (sometimes as paid speakers or consultants), the odds are 8.4 times higher that the results of the study will support use of the sponsor's drug.
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Another problem with commercially funded studies is that the articles published are sometimes “ghostwritten” by companies hired by pharmaceutical companies. In 2010, thousands of court documents stemming from a civil lawsuit over the safety of hormone therapy (HT) were made public. Analysis of these documents revealed that Wyeth pharmaceutical company, maker of the popular hormone drugs Premarin and Prempro, paid ghostwriters to produce twenty-six scientific papers promoting the benefits and downplaying the risks of HT and then found academic physicians willing to put their names on them and submit them to peer-reviewed journals.
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In addition to downplaying the perceived risks of breast cancer and promoting cardiovascular benefits of hormone therapy, the articles promoted off-label, unproven uses, such as the prevention of dementia and Parkinson's disease—both of which were later debunked by the Women's Health Initiative study.

Unfortunately, the agencies we count on to protect the interests of health consumers are increasingly compromised. More than half of the funding for the Center for Drug Evaluation and Research, the division of the U.S. food and drug Administration that approves new drugs and oversees drug safety, comes from user fees paid by drug companies. Medical journals, trusted to evaluate articles independently, themselves depend on money from pharmaceutical advertising and from selling reprints of commercially favorable published articles to corporate sponsors, whose drug reps then distribute them to physicians. So-called expert committees that produce the clinical practice guidelines that inform and direct health care professionals are often dominated by researchers with active financial ties to one or more companies that make the drugs under consideration. And about 70 percent of continuing medical education courses for doctors are paid for by drug companies and other medical industries. Since doctors must participate in continuing medical education to maintain their medical licenses, it becomes increasingly difficult to avoid exposure to industry-sponsored messages.

The fundamental reason that companies create and distribute this information is to fulfill their primary fiduciary responsibilities to their shareholders and investors. Increasing product sales increases corporate bottom lines. Our health is relegated, at best, to a secondary consideration.

We need to demand complete transparency so we'll know when medical experts quoted by the media are receiving research funding or advising/consulting/speaking fees from drug and biomedical companies. We need to advocate for stricter standards in both the regulatory agencies and the medical journals that evaluate and publish research results. And we must insist that clinical guidelines that inform our doctors' decisions be free of commercial interest. The commercial takeover of our medical
knowledge is, at its core, not a scientific problem but a political one. Reorienting our health care system to the service of public rather than private interests will occur only when an engaged and active citizenry creates a political force that stands at least equal to the political power of the drug industry.

Some change is already under way. Harvard Medical School instituted new rules in 2010 prohibiting professors from getting paid by drug companies to deliver educational talks and from accepting personal gifts, travel, or meals from drug companies. The new rules also restrict the amount of money professors can earn from consulting to drug companies or serving as board members. Some medical journal editors are requiring drug companies to register studies in advance, before rather than after the results are known, so that negative results are easier to track. And following the lead of Minnesota, more states are requiring drug companies to disclose payments to doctors. Some drug companies have begun posting doctors' names and compensation online. ProPublica compiled these disclosures into one database—projects.propublica.org/docdollars—that allows patients to search for their doctor. As ProPublica notes, “Receiving payments isn't necessarily wrong, but it does raise ethical issues.”