Of conflicts, conspiracies, red herrings, and black swans

ABSTRACT

The impact of the findings from the Women's Health Initiative trial of estrogen plus progestin cannot be attributed to any real or imagined conflicts of interest between government, researchers, and journals. Rather, the findings overturned decades of dogma in part promoted by the pharmaceutical industry, and the reaction to these unexpected findings was in direct proportion to their importance in reversing a misguided practice of prescribing the drug for chronic disease prevention. The findings have been widely accepted, as shown by the sustained subsequent reduction in prescriptions. However, conflicts of interest may influence a minority unwilling to accept the findings. The decrease in the use of a drug with an adverse risk profile for prevention of chronic disease is a public good.

Key words::

• CONFLICT OF INTEREST
• COI
• WOMEN’S HEALTH INITIATIVE
• WHI
• INSTITUTES OF HEALTH
• NIH
• GOVERNMENT FUNDING
• INDUSTRY FUNDING

ACKNOWLEDGEMENTS

Dr Wactawski-Wende is the Chair of the WHI Steering Committee and Principal Investigator of the Northeast Regional Center of WHI. Dr Anderson is the Principal Investigator of the WHI Clinical Coordinating Center. The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN26 8201100003C, HHSN268201100004C, and HHSN27120 1100004C. Wyeth-Ayerst donated the study drugs. The authors gratefully acknowledge the assistance of Dr Jacques Rossouw, NHLBI Project Officer for the WHI, in developing this response.

Conflict of interest The authors report no conflict of interest. The authors alone are responsible for the content and writing of this paper.