the audit

Doctor’s potential conflict of interest goes unmentioned in Newsday piece*

February 15, 2006

Newsday reported yesterday on the results of a recent government study investigating the link between hormone replacement therapy and heart disease in middle-aged women.

Like most other news organizations focusing on the report, Newsday highlighted the study’s major findings — specifically, that the use of estrogen for the relief of menopausal symptoms does not increase, and may actually decrease, the risk of heart disease in certain groups of women.

“Postmenopausal estrogen therapy does not appear to protect women in their 60s and older from heart disease,” wrote Newsday staff writer Delthia Ricks, “but researchers say it may have some protective effect for women in their 50s.”

Unlike most other news organizations, Newsday also reported what might seem to be a merely tangential implication of the study–that its findings could affect the warning label on the estrogen replacement drug Premarin.

“Given the new findings, some experts said Food and Drug Administration warnings in package inserts of estrogen pills might be too stringent,” reported Newsday. “The inserts summarize problems such as the higher propensity for blood clots and strokes.”

So who were these “experts” calling for a revised FDA warning on the estrogen drug Premarin?

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The story cites only one. That would be Dr. Lila Nachtigall, who told Newsday, “One of the things that’s frightening to doctors is to have this package insert. And, of course, for the patient it is frightening to read that warning.”

We’re can’t say for certain whether the FDA’s Premarin warning is appropriate or not, but we’d definitely attach a strongly worded warning to any story containing a quote from Dr. Nachtigall. It would be something subtle, like:

WARNING!!! DR. NACHTIGALL HAS BEEN PAID BY A PHARMACEUTICAL COMPANY THAT MAKES BILLIONS OF DOLLARS SELLING ESTROGEN PILLS. TAKE WITH GLASS OF WATER, AND GRAIN OF SALT.

Newsday identified Dr. Nachtigall as “a professor of obstetrics and gynecology at New York University Medical Center.” The reporter neglected to mention that (a) Dr. Nachtigall co-authored Estrogen: The Facts Can Change Your Life, a book of unrivalled estrogen-replacement-therapy boosterism, and (b) according to the disclosures section on the Web Site for the Council on Hormone Education, she receives a honoraria from Wyeth Pharmaceuticals. That would be the same Wyeth Pharmaceuticals that manufactures Premarin.

Not that Dr. Nachtigall’s conflict of interest should come as much of a surprise.

Back in 2002, CBS News ran an investigative piece called “Hormone Hype” in which correspondent Sharyl Attkisson honed in on the unsavory relationship between doctors who advocate for hormone replacement therapy (HRT) and the pharmaceutical companies that profit from it.

“The selling of HRT was a coup by any standard, generating $3 billion a year,” reported Attkisson. “One news magazine even called it the closest thing to putting youth in a tablet. But a lot of the claims weren’t backed by serious science. And women never knew the same doctors promoting the wonders of HRT often had financial ties to the drugmakers.”

Enter Dr. Nachtigall.

“For years, much of that [grossly exaggerated] information got into print, bolstered by quotes from respected experts on the cutting edge of hormone research, like Dr. Lila Nachtigall,” noted Attkisson. “She questioned the breast cancer link and touted bonuses, like the supposed heart benefit, good looks and great sex. Readers weren’t told Nachtigall also gets paid to speak for at least 11 drug companies, including Wyeth, the biggest maker of HRT drugs.”

Four years later, Newsday still isn’t telling its readers about Dr. Nachtigall’s potential conflict of interest, which is too bad. After all, newspaper readers, like pill poppers, should know what they are digesting.

*A previous version of this piece appeared under an inaccurate headline. Delthia Ricks responds: Mr. Gillette’s article unfairly assesses my multi-sourced Newsday piece, which was also published in other major newspapers. He did not interview me or, apparently, the physician he accuses of wrongdoing. Instead, he acknowledges that he obtained his information about the doctor from a TV news report. The link in the CJR story takes readers to an article about the TV report, but not to the report itself, leaving us with no way to evaluate it fully. Was the CBS report a hit piece or an example of measured, thoughtful journalism? As readers of Gillette’s story, we have no idea. Relying solely on the work of another reporter to support an accusation of this kind is sloppy. Readers benefit when reporters seek comment from all sides and do their due diligence to gather information themselves, not from secondhand sources.

Felix Gillette writes about the media for The New York Observer.