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AMBRIDGE, Mass. — When he tweets, stocks tumble. And biotech executives quake.

Often angry, always skeptical, Adam Feuerstein may be the most feared journalist covering the biotech industry. He digs deep into the science to take down companies that he believes overhype their drugs, distort their data, or make ridiculously grandiose promises.

And then he takes to Twitter to have a little fun. Feuerstein has called biotech CEOs “dumbass,” “douche canoe,” and “stem-cell smoothie peddler.” He has referred to financial analysts as “moron” and “dipshit.” In his telling, several companies making bold claims were peddling nothing more than “diluted bleach water.” A top public relations exec was a “human oil slick.” Another PR firm? “Idiots.” And those are just the insults we can print.

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“I have an itchy trigger finger on hypocrisy,” Feuerstein told STAT over beer at Lord Hobo, his favorite bar here, a stone’s throw from the biotech hub of Kendall Square.

His stories make waves: Galena Biopharma fired its CEO after Feuerstein reported that the company had paid outside firms to promote its stock while insiders made millions selling it. At the now-defunct BioPure, an executive landed in jail after Feuerstein reported on safety concerns about the company’s blood substitute. And long before most people had heard of Martin Shkreli, Feuerstein reported that Shkreli’s employees at the biotech firm Retrophin were controlling anonymous Twitter accounts promoting the company’s stock.

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There are dozens of examples of a stock dropping, or jumping, in apparent response to Feuerstein’s articles and tweets over the years, according to a STAT review of the archives of StreetAccount, a service that alerts investors about the latest financial market news.

“I have an itchy trigger finger on hypocrisy.”

Adam Feuerstein

A longtime senior columnist for the financial website TheStreet, Feuerstein (pronounced FOY-er-steen) does occasionally get things wrong, particularly when he tries to predict whether a drug will get approved. One company even put out a string of press releases attacking his reporting as naive and ill-informed.

But investors read him. So does the rest of the biotech world.

“Everyone is keeping an eye on what he covers — all of them,” said Dan Budwick, a media strategist at Pure Communications who works with biotech companies.

Indeed, for a guy who writes dense, insidery articles that often require a whole lot of Googling to unpack, Feuerstein has a huge following: He has 50,000 Twitter followers and on a good month can get close to a million page views for his articles, an eye-popping total for a journalist writing about a niche subject in a trade publication.

An acute bull meter

His clout inspires fear.

Budwick recalls Feuerstein’s name coming up at a long-ago meeting at Amicus Therapeutics. The investor relations team “looked at the management team dead in the face and said: ‘You’re not talking to him,’” Budwick recalled. (The Amicus CEO ignored the warning and has talked to Feuerstein periodically over the years.)

STAT requested interviews with more than three dozen current or former biopharma CEOs whose publicly traded companies Feuerstein has covered. Some of their PR managers burst into laughter at the very idea that they’d allow an executive to go on the record about a journalist who takes such delight in skewering both companies and individuals.

“You’re taking on an 800-pound gorilla,” one said.

Only four CEOs — three of whom periodically drink beer with Feuerstein at Lord Hobo — agreed to talk about him on the record.

“He has an acute bullshit meter,” said Nick Leschly, CEO of Bluebird Bio. “If he thinks you’re bullshitting him, or he thinks you’re holding back, or you’re not being balanced, he’s going to eat you alive.” (Leschly, whose company has been the target of a couple of mild Feuerstein barbs — its recent clinical trial results were cast as “worrisome” — made a point of adding that he respects Feuerstein’s reporting.)

Ron Renaud, the former CEO of Idenix, said Feuerstein aggravated him with a string of skeptical stories about the company’s business model. But he acknowledged they were fair, saying, “If I was on the outside looking in, I might have the same opinion.”

If Feuerstein thinks you’re spinning him, “he’s going to eat you alive.”

Nick Leschly, CEO of Bluebird Bio

His critics complain that Feuerstein attacks companies without first listening to what they have to say. (He does call if he has specific questions, but it’s a point of pride with him to avoid the meet-and-greet sessions that involve endless PowerPoint presentations in corporate conference rooms. “I don’t really do bullshit,” he explained. “If you’re just going to try to blow smoke up my ass, I’m not interested in hearing what you have to say.”)

Critics also whisper, without evidence, that he must be trying to drive down stocks for personal gain.

And, pointing to the voluminous record on social media, they call him mean.

He doesn’t hesitate, for instance, to embarrass the hapless PR reps who send him embargoed copies of corporate news without first asking if he’ll agree to the embargo. Unless he’s feeling charitable, he reports the information right away, as he’s entitled to do, spoiling a company’s carefully choreographed announcement.

“Sometimes I want to be an asshole,” he explained. “Sometimes you just want to teach them a lesson.”

He also publishes an annual feature on the year’s “worst biopharma CEO” — he nominates a list of candidates and then names a winner based on readers’ votes.

Feuerstein’s coverage counterbalances the at-times “delusional optimism” pervasive in the biotech sector, said Baird financial analyst Brian Skorney.

None of that wins him many friends. Feuerstein doesn’t care. (He says he’s not taking potshots, and only calls out people when they deserve it.)

His work is so closely watched that even his jokes can move the market. Last month, in response to a particularly unlikely rumor about the pharma giant Allergan’s shopping list, he sarcastically sent out a tweet announcing that Allergan was buying MannKind, a biotech company that’s been on the brink of bankruptcy in recent months. He sourced it “according to Bo.”

In the next 30 minutes, MannKind’s stock price rose nearly 3 percent to a daily peak, likely driven by trades prompted by algorithms scanning Twitter for market news.

People who actually know Feuerstein knew he was kidding. Bo is his puppy.

Feuerstein poses for a portrait with his puppy Bo at his home near Boston. Aram Boghosian for STAT

‘This isn’t summer camp’

Feuerstein, 48, grew up on Long Island, N.Y., the son of a homemaker and a businessman who manufactured plastics and sold cars. A political science major at Emory University, he got his start in professional journalism while still in college, doing a six-month internship at an Atlanta business publication. He kept showing up for work for weeks after the internship ended, until he got hired.

He moved to San Francisco as the dotcom bubble was building in the mid-1990s and began to report on technology. Feuerstein wrote a story about Google the week it launched, quizzing Larry Page on how he was going to make money off a white webpage with a search bar. (He still has Page’s original business card, which includes a fax number — but no cell.)

In 2001, Feuerstein landed at TheStreet. The investor-focused website, just five years old at the time, had a reputation for interpreting and predicting the news in a conversational tone.

It “was literally the edgiest place to be,” said Herb Greenberg, an alum of TheStreet who now runs a financial research firm.

Feuerstein had never covered biotech but when an editor asked him if he could do it, he said yes.

Other than a two-year stint as a biotech stock analyst in the mid-2000s, Feuerstein’s been doing it ever since. He’s been at TheStreet longer than any other writer except founder Jim Cramer, the former hedge fund manager and host of CNBC’s “Mad Money.”

“He represents the precise ethos that we started the company with — he’s fearless, he’s persistent, he’s not cowed, and he works harder than anyone else,” Cramer said in an email.

“Sometimes you just want to teach them a lesson.”

Adam Feuerstein

Feuerstein’s boss doesn’t object to the over-the-top insults his columnist flings around social media. “This isn’t summer camp. It can be a rough business,” said Jeffrey Kanige, editor-in-chief of TheStreet. He called Feuerstein’s work “scrupulously fair.”

For all his acerbic anger online, Feuerstein comes across as warm in person. He can be surprisingly bullish on the biotech industry, earnest even about the tremendous overall progress he believes science has made in the past decade.

And he’s not afraid to show his soft side now and again.

He tenderly chronicled on Twitter his dog Max’s months-long battle with cancer: frolicking on the beach in defiance of the diagnosis. Surgery and rounds of chemotherapy. Good news from the vet. Learning Max’s cancer had returned. Heartbreak the day Max died. And finally, a silver lining a few months later, when the family brought Bo home from a shelter.

Feuerstein also tries to keep sight of the human stories behind the news he covers. Last month, he wrote a live blog (which set a new traffic record for TheStreet) chronicling an emotional meeting of an FDA advisory panel that recommended against approval of Sarepta’s experimental drug for Duchenne muscular dystrophy. On Twitter, he expressed sympathy for the young patients and their families.

Dinging ‘the Arctic ice-cube salesman’

Feuerstein doesn’t get aggravated by the same things that outrage politicians and the public. He found the uproar over Shkreli’s decision to raise the price of an old drug for AIDS patients by 5,000 percent to be tiresome. (As Feuerstein tells it, Shkreli might have been the rudest, but he was far from the worst offender when it came to price hikes.) He’s called Gilead Sciences, another popular target for politicians, “the best biotech company on the planet” because it developed truly innovative, albeit pricey, drugs to cure hepatitis C.

Feuerstein’s targets are often lower-profile: Small and medium-sized drug companies working on science of dubious merit. CEOs, many unknown outside their local business communities, who cut corners. Analysts who pump up a stock that doesn’t deserve it.

(He doesn’t spare his fellow scribes, either — including STAT, which he’s charged with trotting out “stale retreads of stuff I know already.”)

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His stories aren’t meant for a novice: They’re packed with references to corporate history that, in many cases, only a company’s longtime investors and observers can easily interpret. But he generally steers clear of jargon.

And, as on Twitter, in his articles he calls it like he sees it.

When MannKind appointed its now-deceased founder Alfred Mann as interim CEO last fall at the age of 90, Feuerstein called it “elder abuse.” He excoriated Christoph Westphal, who founded a company developing a treatment for leg cramps made of extracts of ginger, cinnamon, and a derivative of pepper, as the industry’s “Arctic ice-cube salesman.”

And he isn’t shy about stating — without evidence — that companies are intentionally spinning data or hyping anecdotes to goose their stock.

Asked if it was possible some of those misleading corporate claims could be just an honest mistake, Feuerstein said, “It’s also possible that a pink unicorn will knock on my door tomorrow and offer to make me pancakes. Possible. Just really unlikely.”

Generex Biotechnology, a Canadian company whose stock now trades for a penny, once unsuccessfully sued Feuerstein and TheStreet for $250 million for writing that the company “plays stupid games aimed at misleading investors,” among other things. (Generex dropped the suit without any exchange of money before it reached a trial.)

Northwest Biotherapeutics, a Maryland company that Feuerstein jokingly calls “one of my nemeses,” put out six press releases in as many months in 2014 attacking Feuerstein’s dogged coverage. (One charged that his skeptical questions in one instance were “baseless and reflect a lack of understanding of clinical trial design.”)

Feuerstein has also been harangued and threatened by investors who don’t like his reporting.

Some of Feuerstein’s critics are convinced that no one could be so persistent about digging up dirt without having an ulterior motive. They circulate a conspiracy theory that he’s betting against the stocks he covers, or that he’s being paid by those who do. The unsupported accusation even made it into a column in the Washington Post until it was corrected and toned down after TheStreet’s lawyers got involved.

Feuerstein says he’s just doing his job. TheStreet’s ethics policy bars editorial employees from owning individual stocks other than TheStreet. Feuerstein says he and his family have no financial holdings other than options in the TheStreet’s (sinking) stock and a 401(k).

Feuerstein drinks a beer at Lord Hobo in Cambridge, where many of his interviews take place. Aram Boghosian for STAT

A hunt for red flags

People who know Feuerstein say he’s whip-smart, able to critique study data with a sophistication unmatched by many specialists.

“I think he’s got far more insight into clinical trial design than the vast majority of my colleagues,” said University of Chicago oncologist Dr. Mark Ratain, who once coauthored a journal editorial with Feuerstein.

Feuerstein says any investor can master the basics of what he does.

He recently wrote a column dishing out tips to his readers: Compare a company’s description of a trial with what it’s actually doing, as submitted to the federal database ClinicalTrials.gov. Watch out for red flags cloaked in jargon, like “per protocol” (a type of analysis that doesn’t reflect real-world results well) and “grade five toxicity” (code for a patient death). Be encouraged by phrases like “statistical significance” and “achieved the primary endpoint.”

“I think he’s got far more insight into clinical trial design than the vast majority of my colleagues.”

Dr. Mark Ratain, oncologist

Using those skills to call out hype is Feuerstein’s bread and butter.

Take IsoRay Medical, a small biotech company out in Washington state that makes a type of radiation therapy.

Last year, Cornell researchers published a retrospective study on 272 early-stage lung cancer patients, some of whom had received IsoRay’s treatment.

IsoRay put out a press release trumpeting the “outstanding” results: 96 percent of patients who got the company’s cancer treatment no longer had growing tumors in their lungs, and a full 100 percent of them were still alive five years after treatment. Investors were jubilant; by day’s end, the company’s stock price had doubled.

Feuerstein smelled red meat.

“100 percent — when you see something like that, you’re like, ‘Really?’ It’s like someone claiming a cure,” Feuerstein said. “The bullshit detector goes off.”

So Feuerstein read the journal article and compared it to IsoRay’s press release. There were discrepancies.

In a scathing column, Feuerstein accused IsoRay of being “lazy with the facts,” playing “rope-a-dope” with the data, and continuing a trend of “using clever, selective editing” in its communications to boost its sagging stock price. (He had been on the company about its boosterish PR even before the Cornell study appeared.)

Feuerstein walked his readers through the biggest problems:

The press release didn’t mention that the study found no statistically significant advantage to using IsoRay’s seeds in combination with surgery to control tumor growth.

It also neglected to mention that a significant number of patients could not be reached for follow-up questions in the years after the procedure. That would have cast doubt on the clinical relevance of the claim of a 100 percent survival five years out.

Feuerstein’s reporting infuriated investors, drove down the stock price — and sparked more than a dozen class action lawsuits, many of which are still pending, on behalf of investors who had purchased the company’s stock in response to the bullish press release. IsoRay denied the allegations and both its former and current CEO declined to talk to STAT.

Feuerstein calls the incident “a classic of the genre” — and really, it was classic Feuerstein, too. He summed up his appraisal of the company by tweeting out one of his favorite GIFs: SpongeBob SquarePants creating a rainbow by waving his hands. The caption: “bullshit.”

The loneliest man at J.P. Morgan

Feuerstein is at his desk just after 5 a.m. most mornings, working from a spare bedroom in his home near Boston, where he lives with his partner and their two teenagers.

You have to look carefully in his office to find signs of his ferocious persona. But they’re there. On the desktop of his computer, Feuerstein keeps a folder of several dozen of his favorite GIFs, many with profane captions, for posting on Twitter. In one, which he favors to illustrate the financial future he envisions for MannKind investors, people run mindlessly into a gaping crater.

Prints and artwork evoking his beloved San Francisco line the wall above his desk. (His distinctive Twitter avatar — a stern-looking mustachioed figurine that he snapped a photo of in a museum — is an ode to his former city, too; it caught his fancy because it was called a “San Francisco dandy.”)

Most years, Feuerstein returns to San Francisco in January for the biotech industry’s equivalent of the Super Bowl: The J.P. Morgan Healthcare Conference, which draws thousands of suited investors, executives, and journalists for a week packed with meetings and deal-making.

“The classic J.P. Morgan thing for a reporter is” — here Feuerstein put on his best haughty voice — “‘My calendar is filled from 6 a.m. til 10! I’ve got meetings with companies every 15 minutes!’”

Not Feuerstein. “I have no meetings,” he said. “Nobody calls me.”

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