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.
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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.