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Grapefruit article sets off PR shootout

A university news release about drug interactions with the juice starts a public relations struggle with the citrus Truth Squad.

By WILLIAM R. LEVESQUE
Published February 21, 2005

The news release contained two facts that made the members of the Truth Squad, protectors of the lovable grapefruit, hopping mad.

Neither fact, they said, was true.

The January news release touting an article by a University of Rochester Medical Center nurse said a man was the victim of a deadly interaction between grapefruit juice and a cholesterol-lowering medicine.

The release also said a woman taking birth-control pills and grapefruit juice "might find herself pregnant" because the juice, interacting with the pills, could render them useless.

"It doesn't mean it's a bad fruit," said Tom Rickey, who wrote the grapefruit release.

What followed Rickey's news release was an odd collision of public relations specialists trying to educate the world. This PR mano a mano provides a glimpse at how information is sometimes shaped for public consumption and just how slippery a concept like the truth can be.

On one side is the agency hired by the Florida Department of Citrus to protect the reputation of grapefruit, the juice of which is widely known by doctors to interact with some medications.

The agency has set up their Truth Squad, named somewhat tongue in cheek, to monitor the media for inaccurate news about those interactions.

"We're chasing misinformation everywhere," said Denise Paleothodoros, an account group supervisor with the Chicago public relations firm Golin Harris.

On the other side is Rickey, whose job it is to publicize the interesting and important work that goes on at the University of Rochester Medical Center. He said he has never seen such anger over one of his releases.

"I'm writing something about cranberry juice preventing cavities," Rickey said in an interview. "So I anticipate the cranberry juice people will love me."

Nobody, though, says cranberries cause pregnancy.

The controversy started with a 59-year-old part-time Florida resident who liked to pick grapefruit from a backyard tree to make juice.

Amy Karch, a registered nurse and assistant professor at the University of Rochester, detailed the man's medical history in a column published in the December issue of the American Journal of Nursing, a respected, peer-reviewed publication.

Headlined "The Grapefruit Challenge," her article said the man was taking Lipitor without any problems until he visited his home in Florida. Then, after he began drinking grapefruit juice, he began having muscle pain, fatigue and fever.

The article was published as a column about unusual clinical problems, and wasn't written with the intent to offer original research linking juice to the man's illness, Rickey said. The article made no mention of the man dying, and said not a word about birth-control pills.

It's known that grapefruit juice is metabolized by the same liver enzyme that also affects some drugs. That may cause problems because the juice can prevent the liver from properly breaking down a small number of drugs.

When Rickey heard about Karch's article, he spoke with her before writing his news release touting her observations about the troublesome grapefruit. Karch told him two new things. First, she said the Florida man had died since she wrote her column, and then, Rickey said, she mentioned grapefruit juice's interaction with birth-control pills.

"I said, "Wow, that sounds interesting,' " Rickey recalled.

He put his release out to reporters and was disappointed few seemed interested. His release noted the man's death, and flatly said he was the "victim of a deadly interaction" between grapefruit juice and his medication.

The next day, the head of the Truth Squad called.

"Our goal is to try to keep those kind of stories out of the news as much as we can influence that," Paleothodoros said.

The Truth Squad monitors news mentioning grapefruit juice's interaction with drugs. The citrus department is combating inaccurate information about those limited interactions.

The Squad, she said, doesn't go after accurate stories, however bad the news might be. In fact, the group had no quarrel with Karch's original column.

"We want coverage that is balanced," she said.

Rickey said Paleothodoros was frantic to reach him, calling several times. One message said, "Urgent." A second said, "Very urgent."

When they finally connected, Paleothodoros was fuming, Rickey said. She said the news release was inaccurate. A lawsuit was threatened, he said. They wanted another news release with corrections.

"I'd definitely say they were trying to bully me to get their way," Rickey said.

Paleothodoros said no threats were made, no lawsuit mentioned, no bullying displayed. She just wanted to see the science to back his claims.

"It's probably just the PR guy's style to be defensive," she said.

The citrus people sent out their own news release saying Rickey's news release was inaccurate.

In it, Dr. Hartmut Derendorf, a distinguished professor of the University of Florida's College of Pharmacy, said he knew of no fatalities from grapefruit juice. Also, he said that while grapefruit juice does change the levels of some birth-control components, that doesn't reduce their effectiveness.

A citrus department spokesman sent an e-mail to Rickey's boss asking if a medical examiner's report or other research linked the death to grapefruit juice. A department lawyer e-mailed Rickey. University officials consulted with their own attorneys. Karch, who did not return calls for comment for this report, called Paleothodoros.

Karch later sent Rickey an e-mail about her conversation with Paleothodoros: "She doesn't know a lot about medicine, as you suggested, but she is really concerned about getting people hysterical." Karch admitted she could find no specific case of birth-control pill failure due to grapefruit juice.

"It is theoretical," she said in the e-mail. "So that statement might do well to be rephrased."

Rickey's boss, Teri D'Agostino, e-mailed the department, saying the school stood by the accuracy of the news release but said it was willing to make changes. "It is clearly not the university's intent to discourage grapefruit juice consumption altogether," D'Agostino wrote.

The news release was redone with no reference to birth-control pills. The link between the man's death and the juice was watered down.

But the new release still said the man became "critically ill" as a result of an interaction between the drug and grapefruit juice.

Rickey had a simple explanation for the retreat: "We decided to make a few changes to the press release just to get the citrus people off our back."

On Wednesday, Paleothodoros hailed the victory of truth over misinformation to citrus commissioners in Lakeland, saying the Truth Squad averted a damaging story that could have gone national.

Rickey thinks his news release was mostly accurate, though he says the birth-control stuff may be wrong. What angered citrus folks, he said, was linking the juice to the death, something he still stands by.

Rickey compares the situation to a man crossing the street and dying of a broken neck after being hit by a car.

"To me," he said, "it would seem that saying simply the man died of a broken neck, or that he got a broken neck because of a collision with the pavement with no mention of a car, would be a disservice to the world of public information."

Lipitor, he said, is known to react with grapefruit juice, something even the citrus department acknowledges. What is disputed is the severity of the interaction.

Paleothodoros, saying no science linked the death to the juice, said Rickey may not have fully understood how one inaccurate announcement can undo an industry.

"It appeared to us they were just trying to make a sensational announcement," she said.

Rickey, meanwhile, said all the squawking by citrus folks brought Karch's article more attention than it otherwise would have received.

"One of the first rules of public relations is to collect your thoughts and just wait to see what the damage is," he said. "If you respond in a big way, you propagate the damage and magnify it."

For more information about drug interaction with grapefruit juice, the Florida Department of Citrus recommends people visit the web site druginteractioncenter.org. This site lists drugs that interact with the juice.

[Last modified February 19, 2005, 17:23:02]