ABSTRACT
In January 2003, the US Food and Drug Administration published new guidelines and labels regarding preparations used for hormone replacement therapy (HRT) during the menopause. These guidelines followed the early termination of the Women's Health Initiative, a very large cohort study that demonstrated a higher risk of cancer and cardiovascular disorders among women taking HRT. In the United States, the end of the trial opened a public debate whose quick and radical consequence was the fact that women opted out, with a major drop in sales and the filing of court cases against the companies producing HRT, which were regularly accused of biased expertise and problematic promotional activities. Conflict of interest (COI) thus became central in the media coverage of the crisis. Focusing on the activities of Wyeth, the main producer of HRT in the country, as revealed by court documents, this chapter analyzes the nature of industrial influence and the uses of COI. It shows that Wyeth's main communications partner, DesignWrite, was much more than a simple ghostwriting agency. In analogy with the now-famous “contract research organizations”, it was a scientific marketing organization (SMO), a contractor organizing a whole series of activities at the interface of marketing and research. The collaboration between Wyeth and DesignWrite thus illustrates the importance and the externalization of a system linking clinical research and marketing that emerged in large pharmaceutical companies in the 1960s. COI is a category that makes it difficult to apprehend the systemic nature of the problems originating in the industrial/corporate production of knowledge and expertise. The chapter, therefore, concludes that we need to supplement COI with other notions; for instance with hegemony, which reminds us that the accumulation of capital critically depends upon social and political regulations.
