Q&A with Martha Rosenberg: Unmasking drug industry marketing in medical journals

Freelance journalist Martha Rosenberg recently made an interesting comparison between embattled drug giant Wyeth and former insurance giant AIG. The latter famously handed out massive bonuses and planned lavish company retreats at a time when the company was receiving billions in federal bailout funds. The former has been using its financial clout to buy massive amounts of space in medical journals to combat the increasingly well-documented science that shows that its hormone replacement products, Premarin and Prempro, increase the risk of cancer and heart disease.

Rosenberg is one of the pharmaceutical industry's most relentless critics. She works as a cartoonist for the Evanston RoundTable, a community newspaper north of Chicago, and has written as a freelance columnist for publications across the country, including the Los Angeles Times, The Boston Globe, and the Providence Journal.

I reached her at her home office in Evanston. The interview has been edited for space and clarity.

Q: How did a cartoonist for a community paper start writing investigative health commentaries?

A: My background is marketing and advertising. I actually did medical copywriting for hospitals, not ghostwriting but other work. About 10 years ago I made the switch into journalism and health reporting about the same time I took the job at the Evanston RoundTable. It has always been freelance. What made me move over into it is that I got so angry about the stuff that escapes reportage. Now there are fewer and fewer reporters catching this stuff. You just want to set the record straight.

Q: When did you first start writing about Wyeth?

A: I really felt angry when the Women's Health Initiative revealed in 2002 how bad these hormone replacement therapy drugs were for women and yet Wyeth and the doctors it has selling its products didn't seem to care. I started with posts on a little blog on Op-Ed News, which carries a lot of other writers. Right away, I saw that there was this recidivism.

Q: What do you mean by that? There wasn't a crime involved.

A: There was, though. These drugs were hurting and killing women. And even with these WHI results, pharma-funded doctors were saying "yes, but." I wrote that hormones are a hard habit to give up, especially for the doctors who are getting all this money to promote them.

Q: To be fair to the companies and some of those researchers, the journal articles that came out right after the WHI study probably had been written and were in process long before the announcement that WHI was halting its study. Can you really blame them for publishing what seemed like contradictory results? That's simply the scientific process.

A: When you read something in a journal that says, "We know there are some concerns about hormones, but really they are great for all these other reasons," you should check the authors' disclosures, because they are always connected to pharma. And if it's not in their disclosure, check DIDA [the Drug Industry Document Archive]. I sometimes think, "How can we track this specious science?" It seems so complicated. One of the things I have discovered is that whenever you have many authors on a piece, it usually means pharma?

Q: Why would that be the case?

A: It just seems to be the pattern.

Q: But a lot of these review articles that are pharma-funded and ghostwritten have one or two names on them. The doctor I just wrote about, David F. Archer, often worked with just one other doctor. Dr. John Eden, who wrote about breast cancer and HRT in a review paper, was a sole author.

A: I'm sure there are exceptions. I guess what I'm saying is that when something seems outside the norm, it usually means that pharma is involved. Like you mentioned in one of your articles that someone had written more than 200 pieces. When it's sort of statistically impossible, you just wonder what is really going on. Even before WHI, you could find many examples where they were pushing non-scientific benefits of HRT for skin, hair, mood, desirability. If you were paying attention, you would start to think, "Why do all these articles have the same message?"

Q: With WHI, they had to stop the study, so part of the argument from pharma is that the researchers weren't able to generate solid results because they didn't complete the study. That's why pharma has continued to pour money into the connection between HRT and cancer or HRT and heart disease. The theory goes that there was this question that was left hanging with WHI: How bad is it? In your mind, though, the results from WHI should be reason enough for women to stop taking hormones and for the companies to stop selling them. Why?

A: I haven't really seen that argument, that the study was incomplete. They usually try to talk about the fact that progestin is the bad guy and estrogen is not the bad guy. Even though the study was stopped, it was stopped because the results were so alarming. You saw that long-term hormone therapy increases breast cancer by 26 percent, heart attacks by 29 percent, stroke by 41 percent. It doubles the risk of blood clots. Right there, you have the facts you need. Then, if you wanted more proof, within a year of quitting, four or five different reporting agencies saw the breast cancer rates falling. There was no wiggle room. I think it's the strongest case we've seen in the last 25 years of a doctor-produced calamity, much more so than Vioxx. Researchers outside of pharma have taken this up, and so the literature is continuing to confirm the problems. Yet some of these pharma-funded doctors have the audacity to continue to keep selling these drugs when they are so obviously a scourge on women. It's almost as if Americans have a short memory.

Q: When you saw the piece in Menopause that you reference in your most recent piece, did you immediately think it was purely a pharma marketing piece?

A: Yes. Here we have Michelle Warren saying, women "are reluctant to take combination hormone therapies because of the publicity after WHI." She's coming from the perspective that cancer is merely a PR problem. And what's her solution? Warren says they should take bazedoxifene, which I will never pronounce correctly and which is also a Wyeth drug. She did disclose that she was a speaker and advisory board member for Wyeth, but she didn't say anything about whether she had writing help.

Q: Did you check to see if she had worked with ghostwriters in the past?

A: I read this in the University of Illinois library and immediately became suspicious. I just thought something about it didn't ring true. She's saying, this is PR problem, not a science problem, as if it was just bad ink or a movie that scared people. Then I went to look in the DIDA database and found her name and all these references to the SERMs (selective estrogen receptor modulators) that she was pushing.

Q: So that led to your broader inquiry into SERMs.

A: That's Wyeth's big push now, because this SERM, bazedoxifene, is about to get approved by the FDA. They're spinning it as a new brand of drug that will solve everything. They're hoping it will save Wyeth. It has just merged with Pfizer and needs something to help save its pipeline after a couple of big disappointments. So  now you have all these articles coming out about bazedoxifine, there have been three just in the past few months.

Q: You have written about several SERM articles that are out there now and their authors. Let's talk about JoAnn V. Pinkerton. How did you find her?

A: She's a Wyeth advisory board member and has written at least three articles about SERMs just this year. She's also part of a Continuing Medical Education course about it. I started to see her name and wondered about her so I looked her up in DIDA. There she is as one of the authors who has worked with ghostwriters, which then starts to help explain how prolific she is. The fact that she had three articles published on SERMs on top of all the other publications she has had this year seems to defy logic.

Q: She's had eight published in 2009. Do you know if any of these were ghostwritten?

A: I can't really know. It always begs the question. If they have worked with a ghostwriting company like DesignWrite in the past, it makes you wonder.

Q: Are there any particular journals that have been friendly to running these marketing articles?

A: Menopause is not really a medical journal. It's just the voice of pharma. The second one that looks pretty bad is the Journal of Women's Health. They had a whole issue devoted to SERMs. This isn't just because of random scientists submitting papers and prompting the editors to pull them together for a special issue. It's a concerted PR attack.

Q: The Journal of Women's Health published a paper recently that talked about the cost-effectiveness of hormone therapy. You took issue with it.

A: The authors actually disclosed their Wyeth ties in that. It said, basically, this article is by Wyeth, which causes you to wonder why the Journal of Women's Health calls itself a journal. Whenever my intelligence is insulted, I suspect pharma is getting involved. Science usually isn't conclusive. It presents multiple sides of an issue. When an article is leading the witness it usually feels like pharma to me. Nobody ever said hormone therapy wasn't cost effective. They just said that it kills you. I've seen this in other pharmaceutical writings because they are kind of talking to the end payer, like the insurers, where they talk about re-hospitalizations and things like that. They are signaling to the end payer that the medicine is a good investment

Q: What can reporters do to better spot marketing messages in the medical literature?

A: I'm a little cynical because I think reporters don't spend very much time. The first and easiest thing they can do is Google the authors with the word "disclosure" and you will see right there what they have disclosed in the past. You also can use "consultant" or "speaker" or "funding." Usually that will reveal right away their conflicts. Secondly, I would say reporters should ask themselves who approached whom. I am approached a lot by people who want their messages out. The very fact that they approached me worries me. How did this idea come about in the first place? How did it get into the journal? And who is pushing the journal article now that it has been published.

Q: What can reporters do to make better use of DIDA?

A: Take 40 hours a week off to just walk through there. I have never been able to spend the kind of time I want to there. But anybody who is writing about health should look at the health stories that are coming out and then use DIDA and see what these authors' origins might be. The authors and writers in DIDA didn't go away to wait tables at Denny's, they are still doing stuff. One of my doctor sources corresponds with some of these guys who are pharma-funded. And he shares these emails that say you can't make a living as a doctor without doing it. Some of these doctors need a new business model.