The GP and menopause expert who plugs products, sometimes without disclosure of interest

  1. In Allison Pearson’s new novel, “How Hard Can It Be?”, Kate Reddy is back, now dealing with the menopause. The bestselling author devotes a paragraph in the acknowledgements to Dr Louise Newson, “an expert in hormone replacement therapy” (HRT). HRT is the main treatment for menopause. On 17 September 2017, Dr Newson gushed on Twitter: “This book [“How Hard Can It Be?”] is so enlightening and truthful about the menopause – I have so enjoyed helping @allisonpearson with it!” Later that day the GP and menopause expert re-tweeted Ms Pearson’s response: “You were so helpful. Gave me great confidence that what I was writing was true!” Yes, but Ms Pearson and her readers should be aware: Dr Newson is paid to promote HRT and other menopause-related products and services – but doesn’t always disclose her commercial relationships with the relevant companies.
  2. Ms Pearson and Dr Newson‘s mutual admiration continued in The Daily Telegraph newspaper, where the novelist is a columnist. On 2 October 2017, Dr Newson published an article again banging the drum for HRT, “Women need HRT, not antidepressants.” Again, the menopause expert was full of praise for “How Hard Can It Be?” and its author. There was even a plug at the end, proclaiming the book is available via The Telegraph website.
  3. Theres no suggestion Ms Pearson has been paid or received other material benefit to promote menopause-related products and services in her new book, which was published on 21 September 2017.
  4. True, Dr Newson declares her financial interests in a file on her website. But she only published the file after I contacted her to query the absence of the information on her site in relation to a particular company (see below). Also, the disclosures there are inadequate. Particularly concerning, though, is her non-disclosure when quoted as a seemingly independent expert in editorial articles in newspapers and on websites – or as author herself of such pieces. Here I discuss two examples. In the first, Dr Newson‘s promotional activities around menopause-related vaginal dryness and a new laser treatment, MonaLisa Touch (MLT). Then her work with US drug company Mylan, a major HRT manufacturer. In quotes for a recent national Sunday newspaper article, for instance, Dr Newson praised a new supposedly independent menopause website for the public – but failed to say Mylan was responsible for it. She didn’t reveal her commercial relationship with the drug firm, either.
  5. On 4 July 2017, Dr Newson published on her website, menopausedoctor.co.uk, an article by Jane Lewis on vaginal dryness. There Ms Lewis enthuses about treatment MLT. There’s two paragraphs about the laser treatment, and a link to a new website, takeoutthepause.co.uk (screen shots in Figure 1a and 1b).

    Figure 1a. Jane Lewis’ article, “Vaginal dryness – The last menopause taboo,” part one at 25 July 2017

    Figure 1b. Jane Lewis’ article, “Vaginal dryness – The last menopause taboo,” part two at 25 July 2017

  6. In her introduction, though, Dr Newson didn’t declare a relevant financial interest. She simply said: “Jane Lewis has written this article to share her experience and help to empower women and break this taboo. I am so grateful to her for allowing me to share this on my website.”
  7. Yet Dr Newson was working with MLT, raising awareness of vaginal dryness and promoting the company. Website takeoutthepause.co.uk, where she appears, is part of a PR campaign for MLT organised by ROAD Communications (screen shot in Figure 2). As you can see, ROAD put Dr Newson at the heart of the campaign.

    Figure 2. ROAD Communications PR campaign for MonaLisa Touch at 26 July 2017

  8. On the same day Dr Newson published Ms Lewis’ article, MLT UK expressly thanked Ms Lewis on Twitter for sharing her “story” via the menopause expert‘s website (screen shot in Figure 3).

    Figure 3. MonaLisa Touch UK thanks Jane Lewis for sharing her “story”: tweet on 4 July 2017

  9. After I emailed Dr Newson on 26 July 2017 to ask why she hadn’t declared her role with MLT when publishing Ms Lewis’ article, the menopause expert added a two-sentence comment at the foot of the article: “This is an independent review and the opinion of Jane Lewis. I have previously been reimbursed to provide advice on general menopause issues with regards to MonaLisa Touch (takeoutthepause.co.uk).” (screen shot in Figure 4).

    Figure 4. Jane Lewis’ article, “Vaginal dryness – The last menopause taboo,” part two at 1 August 2017 (cf. Figure 1b)

  10. In the same email on 1 August 2017, Dr Newson also brought to my attention the file on her website containing her declaration of interests: link on the “About Louise” page. Yet the file creation date reveals it was only created that day – 1 August 2017 (screen shot in Figure 5). In other words, after I’d first contacted her. The full filename, too, shows it was published in August 2017 (screen shot in Figure 6).

    Figure 5. Declaration of interests: file created on 1 August 2017

    Figure 6. Declaration of interests: full filename reveals publication in August 2017

  11. Also, the disclosures there are inadequate. The menopause expert simply lists companies with whom she has/had financial relationships (Figure 5). There’s insufficient detail.
  12. Following our email correspondence, Dr Newson arranged for a statement to be added to the MLT website, takeoutthepause.co.uk (screen shot in Figure 7). It wasn’t there originally (screen shot in Figure 8).

    Figure 7. Dr Newson on takeoutthepause.co.uk at 14 August 2017

    Figure 8. Dr Newson on takeoutthepause.co.uk at 25 July 2017 (cf. Figure 7)

  13. On 28 June 2017, Dr Newson published an article, “The A-Z Of Menopause,” on the Female First website, which clearly identifies her as “ambassador” for MLT (screen shot in Figure 9). Disclosure of interest, rightly, then. Yet no disclosure in another of her articles, in dluxe Magazine dated 11 August 2017, “5 Steps to Take the Pause out of Menopause,” where author Dr Newson refers to vaginal dryness, names MLT and lists takeoutthepause.co.uk (screen shots in Figure 10a and 10b). The headline of the article, of course, echoes the MLT website, too.

    Figure 9. Dr Newson’s article, “The A-Z Of Menopause,” published on 28 June 2017

    Figure 10a. Dr Newson’s article, “5 Steps to Take the Pause out of Menopause,” published on 11 August 2017 – part one

    Figure 10b. Dr Newson’s article, “5 Steps to Take the Pause out of Menopause,” published on 11 August 2017 – part two

  14. Dr Newson is on the board of the grandly titled Primary Care Women’s Health Forum (PCWHF), an organisation that falsely claimed to be a charity (see 17 July 2017 post). She’s lead for the West Midlands. PCWHF is “dedicated to the education and support of healthcare professionals across the UK caring for female patients,” says its website. On 21 July 2017, it published document Guidance on Diagnosis and Management of Urogenital atrophy or Genitourinary Syndrome of the Menopause (GSM)”: GSM-Guideline. Dr Newson and Dr Carrie Sadler wrote the guidance on behalf of PCWHF. As the overview explains, they use GSM as a more accurate term for menopause-related vaginal dryness. Although the authors fail to declare explicitly any relevant financial interests, the document carries five – yes, five – different brand logos, including pharmaceutical company Pfizer. MLT, though, isn’t one of them. Yet here Dr Newson was again raising awareness of vaginal dryness – while the medical face of MLT‘s PR campaign to do the same. Further, the guidance describes laser treatment, which “has been shown to lead to impressive results in some studies.” While MLT isn’t named in the document, the list of references includes a single study of laser treatment – one using MLT. It’s surely remiss of Dr Newson not to disclose her link to the company. In summer 2017, I complained twice to PCWHF via email about her failure in the guidance to disclose her commercial relationship with MLT. I didn’t receive a response either time. Nor did I hear from Dr Newson when I raised the omission in an email.
  15. Now to Dr Newson‘s work with Mylan, the major HRT manufacturer. On 17 July 2017, I exclusively revealed that the manager of the HRT portfolio at Mylan UK is a trustee of The Daisy Network, a charity providing “support, information and networking opportunities” to women with premature menopause (registered charity number: 1077930). For several reasons, I was concerned the charity is a front organisation for the pharmaceutical company. The Sunday Times newspaper reported my findings on 30 July 2017.
  16. It’s clear Dr Newson works with Mylan as she sometimes declares her relevant financial interest. But sometimes she doesn’t – and that’s the problem.
  17. First, examples of disclosure. The GP publishes four leaflets on her homepage: downloading them you discover Mylandeveloped and funded” two of them. These are “Menopause and Me” (remember the title) and “Menopause and Me: In the workplace.” Here they are: 00133-22-Menopause-Booklet-Update-AW-3-HR-FINAL-JAN17-1 and 00498-02-Menopause-and-Work-Booklet-V5-FINAL.
  18. For further information, Mylan on the back of each leaflet points readers to several websites, including Dr Newson‘s. There both state: “Please note: Mylan has had no involvement in any of the websites listed above.” This is self-evidently false – because in both cases the drug firm’s list of recommended “independent” websites includes, er, The Daisy Network!
  19. On 13 September 2017, meanwhile, Dr Newson spoke at a women’s health seminar for GPs, in London, organised by Pulse Learning Seminars – title of her talk: “Early Menopause: Do we need to treat it?” She was “supported by” Mylan, according to the day’s programme (screen shot in Figure 11). Two examples, then, the leaflets and the seminar, where Dr Newson declares her commercial relationship with the drug firm.

    Figure 11. Dr Newson’s talk for Pulse Learning Seminars in London on 13 September 2017: “supported by” Mylan

  20. Yet occasionally she doesn’t. Particularly concerning are some of her promotional activities for a new menopause website for the public, Menopause and Me: www.menopauseandme.co.uk. Sound familiar? Yes, Mylan created the site.
  21. On 2 July 2017, Dr Newson was quoted in a very troubling article in national Sunday newspaper, The People, “It’s time to change the face of our final taboo.” Here’s the online version: http://www.mirror.co.uk/news/uk-news/final-female-health-taboo-set-10720595. (Trinity Mirror publishes The People.) Author Caroline Jones describes “new advice website Menopause & Me,” which is designed to help women make more informed choices when it comes to managing their symptoms.” “Dr Newson is a wholehearted supporter of all such efforts,” writes Jones about the site. Yet neither the GP in her quotes nor the author disclose the fact that Mylan is behind the site. There’s no mention of Dr Newson’s commercial relationship with the drug firm, either. Itd be laughable if it wasnt so serious.
  22. At date of publication Dr Newson hasn’t responded to requests for comment via email about The People article.
  23. On 30 August 2017, Dr Newson was quoted in an article on the NetDoctor website, “5 unexpected symptoms of the menopause every woman needs to know about” (screen shots in Figure 12a and 12b). As you can see, there’s a plug for Mylan‘s new site at the end of the article: “Dr Louise Newson has been working with Menopause & Mea new website dedicated to supporting women throughout their menopause journeys.” At least this article discloses a relationship, if ill-defined, between Dr Newson and the site. But the fact that Mylan is responsible for Menopause and Me is omitted – as is the GP’s commercial relationship with the drug firm.

    Figure 12a. NetDoctor website article, “5 unexpected symptoms of the menopause every woman needs to know about,” published on 30 August 2017 – part one

    Figure 12b. NetDoctor website article, “5 unexpected symptoms of the menopause every woman needs to know about,” published on 30 August 2017 – part two

  24. A day before the NetDoctor article, author of The People one, Caroline Jones, again quoted Dr Newson at length, this time in the Daily Mirror newspaper (“Your guide to beating perimenopause blues”): Daily Mirror 29 Aug 2017. Although not plugging Menopause and Me this occasion, the GP reassures women on the safety and effectiveness of HRT – but again fails to declare any relevant financial interests. To treat vaginal dryness, meanwhile, the article advises use of a “good” vaginal moisturiser, naming a particular brand – Sylk. Sylk‘s logo is one of the five in Dr Newson and Dr Sadler‘s GSM guidance for the PCWHF.
  25. Dr Newson undermines both her and PCWHF‘s credibility by being paid to promote menopause-related products and services. What’s worse, she doesn’t always declare relevant financial interest(s). The egregious articles in The People and on NetDoctor deserve scrutiny for another reason: Mylan is the company involved.
  26. Mylan is unusual in the UK pharmaceutical industry because it isn’t a full member of trade association The Association of the British Pharmaceutical Industry (ABPI). ABPI members, for example, submit financial data to its Disclosure UK database: http://www.disclosureuk.org.uk. Non-member Mylan’s payments to Dr Newson and other healthcare professionals, and healthcare organisations are therefore hidden.
  27. Further, Mylan has a demonstrable track record in the UK of questionable practices in both its marketing of HRT to the public and its closeness to the menopause charities (see 17 July 2017 post). To that list can be added dishonest promotion of its new Menopause and Me website via editorial articles in newspapers and on websites. Dishonest because the editorial content hides the fact that Mylan is behind Menopause and Me; and there Dr Newson endorses the site without disclosure of relevant financial interest.
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The Daisy Network exposé in The Sunday Times

  1. On 30 July 2017, Andrew Gilligan, senior correspondent, used my The Daisy Network exposé (see 17 July 2017 post) as the basis of a report in The Sunday Times newspaper.
  2. Gilligan‘s report (“Menopause charities linked to US-based HRT company”) is available on the newspaper’s website, behind a paywall: https://www.thetimes.co.uk/edition/news/menopause-charities-linked-to-usbased-hrt-company-m6lkk3nbj. Here too is a scanned copy of the page for those like me outside the paywall: The Sunday Times 30 July 2017.

Brand manager at HRT manufacturer is trustee of charity providing “support, information and networking opportunities” to women with premature menopause

  1. Hormone replacement therapy (HRT) is the main treatment for menopause. The manager of the HRT portfolio at pharmaceutical company Mylan UK is a trustee of The Daisy Network, a charity providing “support, information and networking opportunities” to women with premature menopause (registered charity number: 1077930). At date of publication the charity website fails to disclose her paid role at the drug firm, however. Her fatal conflict of interest as a trustee is hidden.
  2. The charity website is key for transparency and accountability. Daisy hasn’t been required to submit its trustees’ annual report (TAR) and accounts to the Charity Commission in each of the last five financial years because reported income each year was below the £25k threshold. Without TAR and accounts, though, there’s very little information about the charity on the public record. It’s thus easy for The Daisy Network and other small charities, as defined by income, to avoid scrutiny (see 9 September 2015 post). There’s no suggestion that the charity has done anything illegal.
  3. Daisy has five trustees, according to the commission online public register of charities. The trustee biographies on the charity website are vague and incomplete. For a start, the group isn’t explicitly identified as the trustees: it’s simply “our people” (screen shot in Figure 1). Last names are undisclosed. Katie, for example, has worked in the “healthcare industry for over 4 years… [with] experience in advertising, journalism and marketing.” She’s “editor” at the charity.

    Figure 1. Charity The Daisy Network website: “our people” page at 6 July 2017

  4. Katie is actually Katie Sewards, who manages the HRT portfolio at Mylan UK (screen shot in Figure 2). Ms Sewards told Pharmafield in a profile published on 24 April 2017 that she’s used her “[pharma] experience to volunteer my time to a women’s health charity over the past 12 months” (screen shot in Figure 3). The charity isn’t named, though.

    Figure 2. Katie Sewards: brand Manager at Mylan UK at 6 July 2017

    Figure 3. Katie Sewards: voluntary role at “a women’s health charity” at 6 July 2017

  5. Ms Sewards previously worked for Swedish drugmaker Meda, which Mylan took over in 2016: https://www.pharmafield.co.uk/Pf-Fox-News/Talent/2017/04/Mylan-Uks-Katie-Sewards-on-what-it-means-to-make-a-difference.
  6. And last year Meda funded a PR campaign to promote use of HRT in women, a campaign aimed at both primary care professionals AND patients (screen shot in Figure 4). The campaign was run by agency Events 4 Healthcare Ltd (E4H; registered company number: 06237925), whom Ms Sewards thanked for its “superb job” (screen shot in Figure 5).

    Figure 4. Funded by Meda, PR campaign to promote use of HRT in women; aimed at both primary care professionals AND patients at 6 July 2017

    Figure 5. Katie Sewards thanks Events 4 Healthcare Ltd for its “superb job” on HRT PR campaign at 6 July 2017

  7. E4H used a linked organisation, the Primary Care Women’s Health Forum (PCWHF), that it operates from the same address, to reach primary care workers. Although PCWHF says it’s a charity on its homepage (screen shot in Figure 6), it isn’t one. Rather, it’s a community interest company (CIC; registered company number: 08747435).

    Figure 6. The Primary Care Women’s Health Forum (PCWHF) “is a charity”: homepage at 6 July 2017

  8. PCWHF now no longer states it’s a charity on the website, after I questioned the claim in an email. “Thank you for bringing this to our attention, this has now been addressed,” said the single-sentence response the next day.
  9. Pharmafield, who published the profile of Ms Sewards (see paras 4-5), is part of the E4H group, too.
  10. In July 2016, PCWHF published its “HRT Myths Uncovered” document, the basis of the PR campaign: HRT-Myths-Uncovered. The two-page document states: “Funded and supported by Meda Pharmaceuticals. Developed by Primary Care Women’s Health Forum (PCWHF). Please note Meda has had no involvement in the content of this graphic, but reviewed for factual accuracy.” It finishes by telling readers: “For further information, please visit Menopause Matters [a website] & The Daisy Network.” There’s no mention that Meda is linked to Daisy (via Ms Sewards), however.
  11. The “HRT Myths Uncovered” document thus creates the impression that The Daisy Network is an independent charity. It isn’t. The link with Meda (now Mylan UK) undermines its independence and credibility. What’s worse, Daisy hides the link.
  12. Independence and credibility are critical for any charity, let alone one for women experiencing premature menopause. The problem is that The Daisy Network is only the latest menopause charity to be entangled with pharmaceutical companies. In November 2015, the National Institute for Health and Care Excellence (NICE) published its guideline on the diagnosis and management of menopause. On the back of the NICE guideline, charity the British Menopause Society (BMS; registered charity number: 1015144) organised a PR campaign to “educate women about all aspects of the menopause and post-reproductive health.” The trustees documented the objectives of the campaign in their annual report, made up to 31 December 2015. They also stated that it was funded by “three unrestricted educational grants” from “pharmaceutical companies and a healthcare company.” But they failed to disclose the names of the three firms whose grants funded the national PR campaign.
  13. I therefore asked BMS in an email to identify the companies. They were: Novo Nordisk, Mylan and Pharmacare, said Sara Moger, BMS chief executive (email). Mylan again, then.
  14. I shall return in a later post to something else Ms Moger told me in the email about BMS’s reporting of funding from companies.
  15. In the month before publication of the NICE guideline, Mylan funded a controversial PR campaign – in its own name this time – to promote use of HRT for menopause, as Sarah Boseley revealed in The Guardian newspaper: https://www.theguardian.com/society/2015/nov/07/scientists-fear-pr-campaign-underplays-hrt-cancer-risks. Here’s the relevant Mylan press release on 19 October 2015, “Women may be suffering needlessly during menopause:” http://www.mylan.co.uk/en-gb/news/2014/women-may-be-suffering-needlessly-during-menopause. I asked Ms Moger in an email whether the Mylan press release was part of the BMS national PR campaign. Why the question? For two reasons. First, the press release is entirely consistent with the objectives of the BMS national PR campaign, according to the charity TAR, made up to 31 December 2015, p.6. Second, something not mentioned by The Guardian: the two non-Mylan experts quoted in the press release are linked or have been linked to BMS/WHC: Susan Quilliam (screen shot in Figure 7) and Dr Sarah Gray (screen shot in Figure 8).

    Figure 7. Susan Quilliam joins medical advisory panel of charity Women’s Health Concern at 16 June 2017

    Figure 8. Dr Sarah Gray “sat on the British Menopause Society council for 10 years”: speaker biography for 2017 PCWHF annual conference at 5 July 2017

  16. Charity Women’s Health Concern (WHC) is the self-styled “patient arm” of BMS (registered charity number: 279651). Ms Moger is one of the three trustees, and again public contact.
  17. The Mylan press release wasn’t part of the BMS national PR campaign, replied Ms Moger (email). Nevertheless my question was reasonable for the two reasons above. Something else about BMS’s campaign deserves attention: the PR company the charity used.
  18. Disappointingly, the BMS annual report failed to identify the company. It was Edelman, I can reveal (screen shot in Figure 9). And Edelman acts for Novo Nordisk on menopause treatments, according to a 2013 press release from the drug company for a research paper (screen shot in Figure 10). But it’s cosier than that: Novo Nordisk explicitly mentioned the then BMS affiliations of two co-authors it quoted in the press release for its study, Dr Heather Currie and Dr Nick Panay. Dr Currie has just stepped down as BMS chair, while Dr Panay is a trustee.

    Figure 9. Edelman PR campaign for charity the British Menopause Society at 8 June 2017

    Figure 10. Edelman press release for Novo Nordisk at 8 June 2017

  19. And Dr Panay, who’s former BMS chair, brings us back to The Daisy Network: he’s “a longstanding patron” of the charity (screen shot in Figure 11). It’s a small world.

    Figure 11. Dr Nick Panay: “a longstanding patron” of charity The Daisy Network at 6 July 2017

  20. There’s another problem with Daisy, and it again relates to medications. On 29 June 2017, the charity tweeted a link to its interview on the website Treated.com (screen shot in Figure 12), which describes itself as “a private online health clinic based in the UK” (screen shot in Figure 13). Its services include an online pharmacy. At date of publication there’s a sentence, undated and unexplained, at the foot of each page on Treated.com: “We are reviewing our services and systems and we are unable to process orders at this time.” The same message appears prominently on the homepage. Similarly, callers to its customer service number during the advertised opening hours hear a recorded message that finishes abruptly: “We’re sorry there’s no one available to take your call right now. Please leave a message and we’ll get back to you.”

    Figure 12. Charity The Daisy Network on Twitter promoting its interview with Treated.com, online pharmacy at 7 July 2017

    Figure 13. Treated.com “about us” page at 6 July 2017

  21. Treated.com has recently been in the news – for all the wrong reasons. In March this year, regulator the Care Quality Commission (CQC) published a damning inspection report into the online provider, as Dr Faye Kirkland reported on the BBC News website: http://www.bbc.co.uk/news/health-39134061. The CQC suspended its registration “in order to protect patients.” In October 2016, Dr Kirkland exposed Treated.com in her investigation of the inappropriate sale of antibiotics by online pharmacies, for programme 5 live Investigates, on BBC Radio 5 live.
  22. In light of the CQC’s censure and suspension of registration, it’s astonishing that The Daisy Network is happy to be associated with Treated.com. That the charity is promoting its association on Twitter is equally astonishing.
  23. As BMS shows, the problem of menopause charities being too close to the pharmaceutical industry, or reasonably perceived as such, isn’t new. Yet The Daisy Network is a worrying escalation: the manager of the HRT portfolio at a leading drug company is a trustee. She thus has a fatal conflict of interest, actual, potential, or perceived, as a trustee. As a small charity by income, and so without publicly available TAR and accounts, its website is key for transparency and accountability. Of as much concern as the conflict of interest, therefore, is that the charity website hides how it arises. Further, Daisy is happy to be associated with a discredited online pharmacy – and promote its association on Twitter.
  24. At date of publication The Daisy Network hasn’t responded to requests for comment via email.