Madison Avenue Science

Viagra. Vioxx. Bextra. Prozac. These are the Chers and Madonnas of the pharmaceutical world, and they got there on the pharmaceutical casting couch: Madison Avenue. They are the pinups of scientific advertising. Madison Avenue, long a bastion of Big Chem like DuPont, Ciba-Geigy, Novartis and Big Oil, like Exxon, had, in the last ten years, noticeably turned its sights on the possibilities afforded by Big Pharma. But now something strange is happening: The three largest advertising companies in the country—Omnicon, Interpublic and WPP—have begun performing clinical trials of experimental drugs because the pace of university research, even when funded by the pharmaceutical companies themselves, is “too slow”.

Pharmaceutical companies have shifted their advertising focus from slick prime time commercials—remember the bouncing Prozac pebble?—to the courting of doctors. The pharmaceutical industry spends approximately two billion dollars a year on this practice. While pharmaceutical executives say that interaction with doctors is crucial for companies to determine how well their products are working, critics counter that the practice increases the use of expensive prescription drugs—how many patients have refused to take a doctor’s advice on a prescription drug?—which is a major factor in the astronomical cost of health insurance.

In 2002, pharmaceutical giant Warner-Lambert (since acquired by Pfizer) wanted to increase visibility and sales of its epilepsy drug Neurontin. To accomplish this—as well as to promote uses for the drug that had not yet been approved –the company began a “shadowing program.” Essentially, physicians—in exchange for cash—allowed drug reps into their examining rooms to question patients, review medical histories and charts, and to pitch their drugs. Most often, the physicians swung open their exam room doors for $350 or less.

One doctor who is particularly interesting is retired Manhattan psychiatrist Richard J. Brown, who has been a vocal opponent of the way pharmaceutical companies court doctors with consulting fees, expensive dinners and merchandise, even standing outside the Four Seasons and picketing in protest while Forest Labs, the company that makes the antidepressant Lexapro, wined and dined hundreds of doctors, offering them dinner, a free Four Seasons suite, breakfast in the morning, and a five hundred dollar check. And yet even Brown had financial ties to Forest Labs (makers of Lexapro), GlaxoSmithKline (makers of Paxil) and Pfizer (makers of Zoloft.)
“They paid for a weekend at this resort,” Brown said of an event he attended at the Ritz-Carlton, a “summit” sponsored by Wyeth. “plus air transportation—the whole schmeer. They spared nothing. It was just outrageous. They also have me two thousand dollars to attend.” I am particularly interested in the wooing of medical students—while still in school, hundreds of med students enjoy the spoils of having future prescribing power by long weekends in Manhattan paid for by pharmaceutical companies.

Then there is the scandalous strategies of pharmaceutical sales reps. The New York Times published an article in 2005 about the industry’s use of attractive young women, many of them former cheerleaders right out of college, as sales reps. (the overwhelming majority of physicians in the United States is still male.) Florida cardiologist Stanley Moles says he routinely turns down the almost daily invitations he receives from pharmaceutical companies for “informational dinners”, though he admits having gone to one in particular, sponsored by Merck.
“They bugged me and bugged me, and in a weak moment with a pretty sales rep, I told her: ‘I’ll only go if you send a limo with a bottle of champagne.’ Merck sent a limo with a bottle of champagne.” I plan to interview several sales reps—former and current—for pharmaceutical companies.

These kinds of cozy relationships between prescribing doctors and pharmaceutical companies too often result in biased medical reviews, over-prescribing of drugs, the prescribing of drugs that are not approved for the ailment in question (this is, in fact, what happened in the case of Warner-Lambert), and a general lack of transparency in medical treatment.

The Unbearable Fogginess of Going "Green"

Until now, this blog has focused on documented though little known acts of "scientific" sleight of hand and misinformation campaigns that affect the products we consume, that we build with, that we wrap ourselves in, and that we depend upon to cure or ameliorate disease. This sort of journalistic inquiry will continue. However, I am about to step into the arena myself. I am eight and a half months pregnant and preparing to move into a 100-year-old house in Hopkins, Minnesota. Although I have always despised the phrase "going green", and the term "green" itself--most especially because it has recently been coopted by companies that are decidedly un-green but who want to cash in on the fad--my husband and I are about to embark upon a massive effort to create a nontoxic environment for both the new baby and for ourselves, while doing minimal damage to the surrounding environment. As many people who have done this before us, it is not easy. The entire industry--remodeling, chemical companies, textile manufacturers, etc--are against you when you try to find alternatives to their surprisingly toxic products.

People who do this, however, do have a tendency to become very militant. It's understandable. I've seldom been so full of rage as when I was researching my book Science for Sale. (Of course, the journalistic rule is to write with even more detachment than usual the more rage you feel, and let the facts speak for themselves.) But this militancy really turns would-be converts off, because it can be so self-congratulatory, so judgmental of those who can't or who choose not to follow the same path. The "greening" effect has also been prohibitively expensive, so it has been seen as the exclusive domain of those who have the luxury of spending $50 on a gallon on no-VOC paint--read: people with a lot of money. With indoor air three times more polluted than outdoor air (according to the notoriously conservative and industry-entangled EPA), it is probably no wonder that babies in Harlem, New York have such ridiculously high rates of asthma and other respiratory disorders.

My goal in documenting this journey alongside my journalistic work about the manipulation of science by corporation and industry is to REMAIN CALM. Then, I will attempt to find ways to create a safe home that are not out of reach for regular people like myself. Look for this blog to provide information about products, techniques, and companies that make such a thing possible. I'll document here my trials and my errors and, I'm hopeful, will become a source of reliable information for anyone seeking to do the same thing. Because nontoxic products should be available to and within reach of everyone, regardless of income. For the short-term, I will be focusing on light remodeling products, such as paints, paint removers, etc., and baby and mother products, such as diapers, baby wipes, crib mattresses, crib linens, nursing pads, baby laundry detergent, and sanitary aids. I welcome any comments or tips.

Lastly, I will document a perhaps less technical and more personal--though, I believe it to be universal--experience: the reaction of family and friends to this effort. The other day, over lunch, I mentioned to my mother that I wanted an organic crib mattress for Hudson, our baby boy due in April, but was complaining about how expensive it was: $249.00 compared to the typical crib mattress found at Target for $69.00. My mother didn't understand why I would opt for something so expensive. I told her that the vast majority of crib mattresses manufactured today were loaded with chemicals like PVCs, phthalates, PBDEs, polyurethane foam, etc., as well as chemicals that make them fire retardant. Crib mattresses, I told her, can be made without such chemicals, and when a baby is spending 14 hours a day with its little face no more than a couple inches from these kind of daunting acronyms, it might be worth it to consider spending a little more.
"I find it very difficult to believe the federal government would allow dangerous products onto the market, especially when little babies use them." I almost choked on my sandwich. I gave her the brief rundown of the "success" of federal regulatory agencies when it came to combatting big business and its "science". Her face fell. She became very upset. She put her head in her hands, and, I could tell, began to feel a crushing guilt over the crib mattresses, plastic crib sheets, etc, etc, she had used for her three daughters.

Poor Mom. This is not the goal. However, when confronted with information like this, one is going to face a lot of resistance from other consumers, mostly because we have all been lulled into this false sense of security, believing that the federal government is watching out for us. The good news is the more we demand products that are free from harmful chemicals, the more we'll get. The key is to make sure our claims are backed by real science, verifiable facts, and are not hysterical.

Dupont University and the College of GlaxoSmithKline

Dr. Charles B. Nemeroff has a shock of salt-and-pepper hair with a moustache to match, and an easy, almost boyish smile. Dr. Nemeroff’s visage alone would not provoke suspicions. His research, on the other hand, has. He is one of the country’s most accomplished psychiatric researchers, having won accolades from the Society of Biological Psychiatry, the National Alliance for the Mentally Ill, the American Psychiatric Association, and the American College of Psychiatrists, among others. Professor and Chairman of Emory University School of Medicine’s Department of Psychiatry & Behavioral Sciences, Nemeroff was, for most of his career, considered one of the finest minds working in medicine.

Until 2002. In November of that year, medical journal Nature Neuroscience published an article by Dr. Nemeroff that praised three pharmaceutical products—to which Nemeroff had financial ties—and called other competing products “disappointing.” In the article, Dr. Nemeroff favorably highlighted one treatment that delivered lithium through a patch affixed to the skin. He did not mention that he held a patent on that patch. Nemeroff has been a consultant to twenty pharmaceutical companies—including Lilly, Merck, GlaxoSmithKline, and Pfizer. All while serving as a top-ranking researcher at one of America’s top research university.

UPDATE: Read the New York Times article from October 3, 2008 about Nemeroff, and his ties to the industry, which has prompted a legislative overhaul of such ties.

The revered University Research Department has come under scrutiny in the last few years due to some highly publicized partnerships—and attendant scandals—with large corporations, mainly from Big Pharma and Big Chemicals. Long lionized as the haunts of the objective scientist, universities are now simply commodities that can be bought and sold to the highest bidder. One of the reasons for this, according to the late Dr. Robert van den Bosch, is because industries like the agri-chemical/pesticide industry sensed a major threat in the early activities of seventies environmentalists. A battle plan was drawn, and it included “a strategy for deep penetration of the scientific societies and the land-grant universities, and utilization of those agencies to help tell the ‘truth’” about products like pesticides and other chemicals.

The history of university and academic research--in terms of its funding and its ethos--is fascinating. During World War II, Senator Harley Kilgore proposed legislation that would allow, he argued, greater public control over science. Indeed, “public control” translated into governmental control, and this was something against which the academic world howled in protest. But Kilgore’s proposals included the participation of labor, small businesses and individual consumers, as well as corporations. Regardless, chief of the Office of Scientific Research and Development and director of AT&T, Merck, and Raytheon, Vannevar Bush led the fight against the Kilgore proposal. He, and his allies, were enthusiastic participants in the partnership between corporations and university research departments, and the Kilgore proposal threatened that partnership. Their argument: the automatic beneficence of the market will take care of everything, and the Kilgore proposal will turn scientists into “slaves of the state.”

Then there is the development of the university/corporate/industrial nexus, in which many argue that scientists have become slaves, or at least indentured servants, of Corporate America. In addition, there has been a blurring of the lines between a corporation and a university research department and the tension, in David Noble’s terms, “between propriety and proprietary interest.” The corporate-university relationship also makes accountability next-to-impossible, and shields activities from the public eye. A relationship with a university also protects a corporation from scrutiny, in the name of proprietary privilege.

Drycleaners, Mobile Homes, and Weeds

One day, in the late seventies, a young environmental health professor named Peter Bressye received a phone call about a couple drugstore clerks who had fallen ill at the pharmacy where they worked. They had terrible headaches, were fatigued, suffered rashes, and were having problems concentrating. Bressye immediately assumed the employees had been exposed to a medicine spill. But when he arrived, the smell of formaldehyde hit Bressye square in the face, causing tears to spring from his eyes. The smell, the sick clerks told Breysse, had been present since the store had been remodeled with particleboard. (The wood grain in particleboard is bonded with formaldehyde.) A few months later, he was called to a mobile home. The same unmistakable odor hit him full on again. Formaldehyde. The chemical was, he discovered, pervasive in offices and homes. Concerned that thousands of people were working and living in environments that were poisoning them, Bressye made formaldehyde his life.

Over the course of the next ten years, Bressye attacked the problem of formaldehyde in building materials, going head to head with giants like Georgia-Pacific and the infamous front group the Formaldehyde Institute. When, after years of research, Bressye published research that suggested a cap on the level of formaldehyde in the air of a home, “arrangements were made to monitor” (according to meeting minutes from the Formaldehyde Institute, obtained by the Center for Public Integrity) Bressye’s work and to meet with John Wilson, Breysse’s superior at the University of Washington. (The school had received more money from particleboard manufacturers any other school in the country.)

What goes on in these strange worlds of formaldehyde (found in several building materials, most notably mobile homes), perchloroethylene, or “perc” (the chemical our dry-cleaned clothes are soaked in), and other potent and possibly carcinogenic chemicals that are widely used, including herbicides and pesticides? The science of carcinogens is one of the most contentious areas of medical research and fierce battles are fought on Capitol Hill and in courtrooms and research labs across the country to keep products that have been shown to be carcinogenic on the market. This chapter will examine one of the aforementioned avenues industry uses to manipulate science to its benefit: by steering research in directions that play down the product’s risks, often focusing on what is called mechanistic research, or the study of how a disease actually manifests itself. An example comes from an asbestos trial in the early nineties. In testimony, a Boston University scientist outlined the way the asbestos industry had defended itself, over the years, against charges of toxicity.

“Asbestos doesn’t hurt your health.
OK, it does hurt your health, but it doesn’t cause cancer.
OK, asbestos can cause cancer, but not our kind of asbestos.
OK, our kind of asbestos can cause cancer, but not the kind this person got.
OK, our kind of asbestos can cause cancer, but not at the doses to which this
person was exposed.
OK, asbestos does cause cancer, and at this dosage, but this person got his disease from something else, like smoking.
OK, he was exposed to our asbestos and it did cause his cancer, but we did not know about the danger when we exposed him.
OK, we knew about the danger when we exposed him, but the statute of limitations has run out.
OK, the statute of limitations hasn’t run out, but if we’re guilty we’ll go out of business and everyone will be worse off.
OK, we’ll agree to go out of business, but only if you let us keep part of our company intact, and only if you limit our liability for the harms we have caused.

One of the most interesting pharmaceutical examples is the case of breast cancer research. Until quite recently, research focus has been limited to what are called “lifestyle” factors thought to lead to the disease: obesity, alcohol use, fat intake, and early detection. In fact, Breast Cancer Awareness month focuses entirely on early detection, and is funded by one of the world’s largest manufacturers of pesticides, pharmaceuticals, and plastics: Zeneca Pharmaceuticals. Zeneca earns more than $300 million a year in sales of acetochlor, a carcinogenic herbicide. It earns nearly $500 million a year from its bestselling cancer therapy drug, tamoxifen citrate. It operates eleven cancer treatment centers. When, in 2001, researchers with Cornell University suggested that environmental estrogens such as the chlorine compounds found in herbicides might cause breast cancer, the Chemical Manufacturers Association launched a million dollar P.R. campaign to discredit the research, calling it “a rejection of accepted scientific method.” While it’s rarely talked about, early detection is, ultimately, a stopgap method for managing breast cancer. However, research into causes of cancer that have to do with chemicals in the air and in the ground, as well as herbicides, is limited due to the vigorous attempts of those industries to squelch such inquiries.

A note: if you'd like to avoid wearing clothing that has been soaked in a carcinogenic chemical against your skin, seek out "green" dry cleaners--also called "wet cleaners". They have been popping up all over the country and a quick Google search should yield the names of local wet cleaners in your area. My husband and I use green cleaners exclusively and we have never had a problem. The science of wet cleaning is actually quite fascinating, as is the strangehold the dry cleaning community has on clothing companies in terms of tagging items of clothing with care instructions. The vast majority of clothing marked as "dry clean only" can safely be wet cleaned.