Loyalties in clinical research on drugs: The case of hormone replacement therapy

Abstract

In this study, physicians’ loyalties toward patients and pharmaceutical companies in clinical drug research are explored, using Bourdieu's conceptual tools. The utilization of estrogen supplements in so-called hormone replacement therapy (HRT) for healthy menopausal and postmenopausal women is used as a case. For over 60 years a multitude of reports in medical journals have praised the benefits of HRT, even though some studies indicated hazards. Clinical studies and promotional campaigns resulted in prescriptions of HRT for millions of women. A large randomized controlled clinical trial known as the Women's Health Initiative (WHI) in 2002 demonstrated that many of the claims of benefits of HRT had been misguiding; the risks of cancer and heart disease had been proven higher than most purported benefits. I draw on Bourdieu's theories to emphasize that a more distinct demarcation line between those who dispose their economic capital in the interests of producing and promoting products for profit, and those who exchange their cultural capital for economic benefits, is needed to ensure trust in physicians’ loyalty to patients is not eroded.