Many thanks to Adriane J. Fugh-Berman for this timely piece. It is distressing to find that the medical literature, an extremely important resource for the practice of rational medicine, is contaminated. Most problematic, the degree and directions in which it is contaminated are for the most part unknown.

Physicians who strive to provide the best care for their patients rely on this literature - there is nothing else, aside from anecdotal data and personal experience - both of which can easily mislead one. Some of my own patients may have suffered as a result of the specific skewed HRT literature described here; I am aware of others who have definitely suffered injury as a result.

Preventing further destruction of the utility of the medical literature will likely require the cooperative efforts of academic physicians, medical journals, and editors. Because of the public health implications of a tainted literature, government regulation to prevent or criminalize the types of manipulation described seems reasonable.