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.