It's rare to get a glimpse behind the curtain of pharmaceutical marketing.

And it raises questions about when particular symptoms need to be treated with prescription drugs.

It started when CBC learned about a stealth marketing campaign involving a drug company, a well-known Canadian comedian, a doctor and a public relations firm.

"Cathy Jones of This Hour Has 22 Minutes is on a mission to get women to start talking about female sexual health after menopause — and particularly, their vaginas," wrote PR company GCI Group in a press release, offering to arrange an interview.

But nowhere did it say this "mission" was initiated and sponsored by Novo Nordisk Canada Inc., which makes a vaginal hormone pill. Nor did GCI's release specify that Jones was paid to give media interviews about vaginal atrophy.

'My focus is that I agreed to be part of a campaign where I promote that women should talk to their doctors and doctors should talk to their patients because I feel passionate about vaginal health,' actress Cathy Jones says. (CBC)

When CBC asked if there was a drug company involved, the PR firm said yes, Novo Nordisk, but that was to be kept secret.

"No parties including GCI want any mention of the drug or drug company," CBC was told. "It's an unbranded campaign."

In other words, it's marketing that looks like any other lifestyle article in news. This is what it looks like on the Globe and Mail's website. There was originally no mention of Novo Nordisk sponsoring the campaign.

When CBC contacted the Globe's reporter, she said she wasn't aware that Jones was being paid. The paper later published an article acknowledging that the connection to the drug company was mentioned during their interview.

We were intrigued by what the campaign revealed about pharmaceutical marketing and the questions it raised.

'Highly misleading'

For instance, is it OK for a drug company, behind a curtain, to generate news about a condition and then encourage women to see their doctor?

"No, it is not OK," says Dr. Jerilynn Prior, who runs the University of British Columbia's Centre for Menstrual Cycle and Ovulation Research.

"It is misrepresenting the marketing purpose behind it. It's misrepresenting as helping women, but its purpose is making money."





"And then there are the issues of what are these people to do? Are they going to see their doctors about something they might not have chosen to see them about before? Or whether they think they have a larger problem than they thought they had before?" 'It's highly misleading and that's an ethical implication in and of itself,' Sergio Sismondo, a Queen's University philosophy professor, says of the 'stealth marketing' campaign. (CBC) Sergio Sismondo, a philosophy professor at Queen's University, says it's "highly misleading and that's an ethical implication in and of itself.""And then there are the issues of what are these people to do? Are they going to see their doctors about something they might not have chosen to see them about before? Or whether they think they have a larger problem than they thought they had before?"

Novo Nordisk also hired Dr. Vivien Brown, assistant professor of family and community medicine at the University of Toronto, to accompany Jones on the media interviews. Brown has published research sponsored by Novo Nordisk. CBC's request to interview Brown was declined.

The headline in the Globe and Mail upset Cathy Jones because it read: "What it's like to have vaginal atrophy." She says she doesn't actually have the condition.

"I've never been diagnosed with vaginal atrophy myself," she said, although she uses Nova Nordisk's Vagifem medication.

After she complained about the headline, the Globe changed the online version to read: "What it's like to talk about vaginal atrophy."

"That's my focus," Jones said. "My focus is that I agreed to be part of a campaign where I promote that women should talk to their doctors and doctors should talk to their patients because I feel passionate about vaginal health."

Power to shape information

Sismondo studies the way the pharmaceutical industry shapes medical opinion and says this is a rare public example of something that happens all the time.

"The companies have a lot of power to shape the sorts of medical information that doctors see, and then meanwhile, when Cathy Jones and Dr. Vivien Brown are talking to the media, they can shape the way patients can see their symptoms too," he said.

"And if they can bring these two things together neatly, seamlessly, using the same terms, then that will really increase prescriptions."

Health Canada has rules about how drug companies are allowed to advertise to consumers.

Novo Nordisk told CBC News in a statement: "In Canada, pharmaceutical companies are permitted to provide factual, fair, balanced and non-promotional information to the public on health and diseases."

Under the rules, it's considered a help seeking announcement and the drug company is not allowed to mention its name or the name of a drug.

'Igniting the VA Dialogue'

It's not the first time GCI Group has worked with Novo Nordisk to get "vaginal atrophy" in the news.

It ran a campaign in 2012 that tried to get people to call the condition by the initials "VA." It declared the effort a success on its website because it was "the first time in Canadian media history, the acronym "VA" was mentioned in mainstream news channels."

The campaign, called "Igniting the VA Dialogue," even won a Silver Leaf Award of Merit from the International Association of Business Communicators.

It is misrepresenting the marketing purpose behind it. It's misrepresenting as helping women, but its purpose is making money. - Dr. Jerilynn Prior

For Sismondo, unbranded campaigns can be one piece of a drug company's larger effort to control what scientific data is generated about a condition, what information is given to doctors and then how consumers think about their health.

"A lot of the medical literature is ghostwritten," Sismondo said. "The company does the research, does the analysis, does the statistics and then hands it over, perhaps a pre-written article, to a medical researcher to serve as the author."

Doctors for hire

He also studies the way doctors are used to influence the medical opinions of their peers.



"Pharmaceutical companies will hire researchers, prominent doctors, to go and give talks to other doctors," he said. "In a sense, giving talks about the science, but at the same time, giving talks the way the company wants the science to be understood."

In the case of vaginal atrophy, what's the evidence that post-menopausal women need to worry about their vaginal health? A close look at the scientific literature fails to produce a clear answer.

Dr. Jerilynn Prior of the University of British Columbia says vaginal atrophy isn't a disease and the PR campaign makes 'a pathological diagnosis out of something that's normal and that women can usually deal with.' (CBC) Most of the data have been generated through online surveys and questionnaires, by researchers who work for, or are funded by, drug companies making vaginal hormone products.

Dr. Jerilynn Prior says most women don't experience vaginal dryness.

"It's usually attributed to a drop in estrogen, but that's a misunderstanding about how the vagina works," she said. "If you're sexually active, and you're interested, the vagina secretes kind of a film that makes the sex painless and smooth."



"It is certainly not a disease."

Expect to hear more about vaginal health in the coming months. A series of new vaginal atrophy drugs are in the pipeline, and industry analysts believe it's a big untapped market.