summer-2003-Part 2-live - Nieman Foundation - Harvard University

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Medical Reportingproject helped them as they grappledwith legislation to ban fetal tissue research.The legislature did not vote onthe measure in 2001. Still now, no banhas been passed.This was an ambitious undertakingfor a newspaper of our size—84,000circulation on Sunday. We don’t have aproject team, so we had to pull reportersoff regular beats for weeks at a timeto report and write the four-part series.Virtually everyone—editors, writers,photographer, graphic artist, even themarketing manager who promoted theproject—found this work exhilarating.We were fortunate to be able to assignto this project a medical writer whohad training in pre-med, two reporterswho were not trained in medicine butwho previously covered health andmedicine for our paper, and a reporterwhose beat is religion, values and ethics.But for several members of theteam, it was the first time they’d beeninside of medical research labs. Ourreporters spent many hours interviewingscientists, ethicists and familieswhose medical circumstances hadbrought them to these new arenas ofmedical experimentation.The time and effort we invested inthis project means our newspaper staffis better able to handle these issues asbreaking news, as topics for opinionpieces, and as material for feature stories.We haven’t done another civicjournalism project on medical ethics,but these reporters now have bettersources and a better sense of the scienceand issues. Their editors also knowmore than just a smidgen about thesetopics, so they can ask more incisivequestions and coach reporters on howto frame stories.Within six months after our seriesappeared, stem cell research was onPresident Bush’s agenda and storiesabout this and other related medicalissues were on covers of national newsmagazines. Nebraskans who had readour series or watched the televisedforum were better prepared to evaluateboth the President’s proposal andthe political, medical and ethical debatesthat have inevitably followed. ■Kathleen Rutledge is the editor of theLincoln (Nebraska) Journal Star.krutledge@journalstar.comWATCHDOGDigging Beneath What Is Said to Be the Truth‘It puts the journalist in the position of challenging the source directly, a position noreporter or editor finds comfortable.’By Philip J. HiltsIt is said that journalism is a blunttool and has trouble handling thesubtleties of issues. Maybe. Butthere are times when the hardest thingsfor journalists to handle are not subtleties,but the most blatant falsehoods,the biggest whoppers.That is because reporters daily passon what leaders say with a fair amountof trust in those who are speaking.When government officials, or the thinktanks that sometimes support them,issue reports and hold press conferences,it is assumed that some essentialacademic honesty is present in the researchand recitation of facts. Detailsor arguments might be debatable. Butreporters are handy at finding opposingviews and counterfacts for those.Challenging FalsehoodsIt is when the tales being put out arecut from whole cloth, from big as-sumptions to fine details, that the reportingbecomes much harder. Reportingthat a new study is, in essence, ablatant falsehood is actually quite hard.It puts the journalist in the position ofchallenging the source directly, a positionno reporter or editor finds comfortable.Reporters in the mainstreammedia are trained to be observers,chroniclers, not combatants. And toknock down larger falsehoods requiresnot just a day or two of calls and interviews.It requires some real digging.Some excellent examples of reporterstrying to combat larger falsehoodscome from the field of governmentregulation. In America, where conservativemarket economics is king, someof the greatest whoppers are told aboutthe dreaded “federal government regulators.”I followed the Food and DrugAdministration (FDA) as part of mybeat for 20 years, first for The WashingtonPost and then for The New YorkTimes, and I can tell you that there is agood bit of blarney spoken of the FDA.Let me cite one example first tomake the point. From late 1994 to1996, an intense “anti-regulatory” campaignwas carried out in Washington,led chiefly by Representative NewtGingrich and a number of very conservativefoundations. They put millionsof dollars into attack advertising andattack P.R. campaigns against the FDA.One example of the ads was the onerun by the Washington Legal Foundationthat read: “If a murderer kills you,it’s homicide. If the FDA kills you, it’sjust being cautious.” Use of the phrase“deadly regulation” to refer to the FDAbecame common. Gingrich called FDAcommissioner David Kessler “a thugand a bully.”As part of this campaign, bills wereproposed in Congress to strip the FDAof its regulatory powers and to end the“murder by regulation.” What the new32 Nieman Reports / Summer 2003
Medical Reportingregime proposed was to let drug companiespolice themselves by hiring theirown reviewers to check the safety andeffectiveness of their products. In aidof this “FDA reform” the pharmaceuticalmanufacturers of America staged a“fly-in”—bringing 140 “real people”who had been hurt by the FDA toWashington to testify and to visit Congress.To many reporters covering healthand science in Washington, this fly-inhad a bad smell about it, as did the wildclaims of the death and injury causedby FDA regulation. But few reportershad the nerve or time to challenge therising tide of anti-regulatory rhetoric.One who did do the work was JohnSchwartz of The Washington Post. Hedecided to take the time to interview anumber of the people flown in. Thepharmaceutical companies gave him alist, presumably their very best examples.But when Schwartz interviewedthem, it turned out that they were notdamaged by FDA policies and wouldnot be helped by the “FDA Reform”being proposed, either. Most of thepatients’ problems were, in fact, withtheir insurance. The drugs they wantedhad been approved by the FDA, but theinsurances companies wouldn’t payfor them. The whole “reform” fly-inturned out to be a whopper.The Schwartz story was unusual thenand would still be considered so today.Back then, I recall there were occasionalnews stories that got behind theveil on this issue, one in The WashingtonMonthly and one in The New YorkTimes. But, overall, the coverage wassuperficial. Many read like this: “… theconservatives say the agency is holdingup life-saving drugs and their opponentssaid the reform bills would gutthe agency and threaten safety,” all saidwithout substantive examples provided.Since most newspapers and broadcastprograms don’t have specialistsreporting on what are considered second-tieragencies, and the reporterswho cover them often aren’t given thetime to report deeply on such issues,the general weakness of the coverage isnot surprising. Most news is telegraphic,bulletin-like. Readers whowant more have to search out the morethorough stories. Of course, this soundsReporters in the mainstream media are trainedto be observers, chroniclers, not combatants.And to knock down larger falsehoods requiresnot just a day or two of calls and interviews. Itrequires some real digging.like criticism of journalistic practices ingeneral, but it is hard to imagine ajournalistic system that would be muchdifferent. For the most part, news organizationsdo provide just the alerts;magazines, books and scholarly workmust be relied on for the rest.Misinformation About theFDAIn covering various medical and scienceissues during the past three decades,I believe more such misinformedcampaigns have been mounted againstthe FDA, and perhaps the EnvironmentalProtection Agency, than any otheragencies. This is, perhaps, in some wayrelated to the level of journalistic scrutinythat I alluded to above, whichthese agencies are usually given.I have accumulated dozens of FDAexamples in my files. Here are just afew historical examples:• Ronald Reagan suggested at a pressconference that the FDA might havekilled 40,000 Americans because theagency had not approved a new tuberculosisdrug. In fact, the FDA hadapproved the drug five years beforeReagan’s press conference and hadapproved it within months of thetime the application came in. As forthe numbers: In the entire decadebetween 1968 and 1978, 28,000people died of TB, largely becausethey were diagnosed late in theirdisease.• Gingrich and the conservative WashingtonLegal Foundation said Americanswere suffering greatly whenthe FDA didn’t approve a new medicaldevice called the CardioPump. Itwas to be used instead of regularhuman CPR techniques. In nationaladvertisements, the foundation said14,000 people died because of theFDA failure to approve the device.Gingrich railed against the FDA. Butmedical studies never showed theexpensive device worked any betterthan regular CPR; early studiesshowed that it caused some damageto the chest and, in 18 percent ofcases, it slipped off and valuabletime was lost in resuscitation.• The Washington Legal Foundationalso wrote in national advertisementsabout the drug tacrine. It isnow used to give very small andtemporary memory improvementsin early Alzheimer’s cases. The foundationsaid: “During the seven yearsit took to approve tacrine, thousandsof Alzheimer’s patients graduallylost their memories. Nobodyknows how many died.” Tacrinewould not have prevented anydeaths. Nor does it halt the progressof Alzheimer’s. Worse, it was theFDA that was first in the world toapprove this marginal drug.The story of “runaway regulation”repeated in conservative political mythologyover the past 25 years has anotherside. Not only are the regulatorsbad, but also the companies that areregulated are, in fact, the chief risktakers,the ones who really bring lifesavingdrugs to Americans. The governmentis just a barrier to suchdevelopment.But history does not bear out thisargument. Two prominent examples:• The greatest drug breakthrough ofthe century, penicillin, is oftencounted as an example of a coup ofNieman Reports / Summer 2003 33
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