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Hot flash, cold cash: how a once-respected women's group went through the change—with the help of drug industry money

Hot flash, cold cash: how a once-respected women's group went through the change—with the help of drug industry moneyLAST APRIL, SEVERAL HUNDRED BLACK-TIE and couture-clad worthies crowded into the ornate ballroom of the Washington Ritz-Carlton for one more dinner on the spring charity circuit. This one seemed especially well-suited for the usual crowd of congressmen's wives and old-school hostesses. Themed "Coming of Age," the entire evening was a salute to the vibrancy of middle-aged women--from the appearance by Cheryl Ladd of "Charlie's Angels" fame, glittering and trim at 51; through a special photography exhibit tided "A Celebration of Women in Midlife and Beyond"; to a performance by 38-year-old country singer Trisha Yearwood.

Ostensibly, "Coming of Age" was thrown for the benefit of a group that enjoys, or enjoyed, a sterling reputation and pursued an unexceptionable purpose: the Society for Women's Health Research, a 12-year-old Beltway nonprofit whose "sole mission is to improve the health of women through research," according to its brochure. But there was something different about this evening's charity ball. The whole event had been underwritten by the pharmaceutical company Wyeth, which also happens to manufacture Prempro, the drug most widely used in hormone-replacement therapy (HRT) for post-menopausal women. That evening, after a brief speech by Wyeth's CEO Robert Essner, the celebrities joined menopause maven Gail Sheehy to. read literary selections celebrating what the society called "advances in the quality and duration of a woman's life." Sheehy read from her own book The Silent Passage, noting how women were enjoying better lives because of "lifesaving preventative measures" including "hormone-replacement therapy."

Some participants were taken aback. "Without mentioning Wyeth," says one, "It was like they were doing an ad for Wyeth." The whole evening was, she recalls, "a perfect way to ensure you'll keep one of your biggest benefactors happy: a dinner theme tied to one of their biggest selling products." A week later, Wyeth presented the society with a $250,000 check at a special event celebrating the 60th anniversary of Premarin, the company's other HRT drug.

All nonprofits, of course, must occasionally confront the tension between what's good for their stated mission and what's good for their funders. But the Society for Women's Health Research has clearly decided to bend to the latter. For decades, middle-aged women in America had been encouraged to take medications to replace the estrogen which the body ceases to produce adequately after menopause; last year, doctors wrote a total of 67 million prescriptions for such drugs, including 22 million for Prempro (which contains estrogen compounded with progestin). The medications were once considered post-menopausal wonder drugs--relieving hot flashes and insomnia, preserving mental acuity and bone strength, and, most importantly, staving off heart disease.

But as researchers examined the drugs more closely in the 1990s, they began to have second thoughts. Women on such drugs as Prempro were suffering fewer bone fractures and developing illnesses like colon cancer less often, but they were showing an increased susceptibility to strokes and blood clots. Indeed, during the two years before the society's gala, women taking Prempro had received two well-publicized letters from the directors of a major National Institutes of Health study of HRT warning them of possible heart problems connected to the drug. Months before the gala, several respected medical journals published studies suggesting links between breast cancer and the use of some types of estrogen.

These problems were to some extent well known within the women's health community the night of the gala. But the biggest bombshell burst three months later, when NIH officials halted the HRT study, and concluded, five years into the planned eight-year trial, that the verdict was clear: Although Prempro did some good when taken for shorter periods of time (i.e. during menopause), long-term use of the drug--as advocated by its makers--significantly increased the risk of heart attacks, stroke, blood clots, and last, but not least, breast cancer. Sales of Prempro plummeted about 50 percent.

In the weeks following the announcement, many nonprofit women's advocacy groups warned women about the dangers of overusing hormone-replacement therapy. The Society for Women's Health Research, however, did the opposite, attacking the study, its authors, and its conclusions on chat shows and in newspaper articles. Instead of taking the side of its constituents, the society seemingly took the side of its donors--and of Wyeth, in particular, which manufactures 70 percent of the HRT drugs on the world market.

The society's curious behavior represents the latest innovation in the art of Washington influence peddling. For years, business interests have created and bankrolled think tanks and "Astroturf" advocacy groups to generate pro-business policy thinking and political momentum in Washington. But these institutions' effectiveness is usually limited by their obvious agenda: Reporters, Hill staffers, and consumer advocacy groups can soon enough tell a front from a philanthropy, and treat them accordingly. In their dealings with the society, however, the pharmaceutical industry has figured out a new tactic. Why start a new group when generosity no more expensive than an ordinary public relations campaign can enable corporations to all but take over an already existing and respected nonprofit, and use its credibility to advance their own interests? The tactic is so clever, it's a wonder other industries didn't think of it--though many will surely copy it.

No Ladies' Room

The Society for Women's Health Research was launched in 1990 by Florence Hazeltine and Susan Blumenthal, who in the previous decade were almost the only two tenured physicians at the NIH. Like other women there, Hazeltine and Blumenthal had become increasingly concerned with the way the institutes' studies of such conditions as heart disease and various cancers used male subjects almost exclusively. (Legend has it that an NIH study on aging held in one hospital ward was limited to male patients because there were no women's restrooms on that floor.) Hazeltine and Blumenthal began pushing NIH to expand their studies among women; it was important, they would point out, that the nation's top medical institute track heart attacks, cancers, diabetes, mental illness, and glaucoma in both halves of the population.

But officials resisted. So Hazeltine and Blumenthal, along with a few feminist groups and sympathetic congresswomen, began making their case to reporters and on the Hill. In 1990, Congress' General Accounting Office issued a study strongly critical of the NIH's lack of research on female patients. Soon after, Hazeltine and Blumenthal launched the society. Hazeltine became its president and Blumenthal the vice-president and scientific director. They quickly linked up with publisher Mary Ann Liebert, jointly sponsoring a new publication, the Journal of Women's Health, and started the Congress on Women's Health, an annual event attracting politicians, scientists, and consumer advocates. Operating on a tiny budget and with no staff, Hazeltine and Blumenthal recruited P.R. mavens Marie Bass and Joanne Howes, who worked for peanuts to put the issue on the map. Their efforts had an effect: In 1991, the Bush administration ordered NIH to begin funding several medical studies using women. The society's conferences became a major draw on the Hill, its galas picking up sponsorship from the well-connected wives of Reps. Henry Waxman, John Dingell, and Dan Glickman.

In 1993, Blumenthal brought Phyllis Greenberger, then a lobbyist for the American Psychiatric Association, to the society. Greenberger, as executive director, was a hard worker and tireless promoter of the organization. When Blumenthal left in 1994 to take the newly created position of deputy assistant secretary for women's health at the Department of Health and Human Services, Greenberger took over completely, Hazeltine falling into the background. By this time, Blumenthal and Hazeltine had been wondering whether the society had finally achieved most of what it set out to do; Congress had heard them and acted, and funding for women-focused medicine was growing by leaps and bounds. U.S. health agencies were spending $100 million on relevant research (a figure up to about $4 billion per year today). They could have declared victory and gone home.