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‘Spotlight’ Gets Investigative Journalism Right

 “Spotlight,” the film based on the Boston Globe’s investigation of the Catholic Church, is a remarkable achievement. — Stephen Engelberg, ProPublica editor

 

STEPHEN ENGELBERG, ProPublica
February, 2016

Rachel McAdams, Mark Ruffalo, Brian d'Arcy James, Michael Keaton and John Slattery in 'Spotlight.' Publicity Photo: Kerry Hayes, © Open Road Films

Rachel McAdams, Mark Ruffalo, Brian d’Arcy James, Michael Keaton and John Slattery in ‘Spotlight.’ Publicity Photo: Kerry Hayes, © Open Road Films Next, read Tom Regan’s column, Priest sex abuse: before Boston, there was Newfoundland

There’s a moment in almost every movie when people in the audience who really know the line of work depicted on screen cry out in frustration and say: “Oh, come on!” “Absurd.” “Never happens.”

Over the decades, Hollywood screenwriters have taken liberties with every imaginable profession and craft, from doctors to lawyers to spies to police detectives. Rocky Balboa survives punches that would decapitate an ordinary boxer. The car chases in The Bourne Identity defy physics. John McClane, the hard-boiled cop in the Die Hard series, displays a supernatural ability to evade bullets.

Journalism movies have had their share of utterly improbable moments. In the 1994 film “The Paper,” the city editor of a New York City tabloid gets into a fist fight with his female boss as he tries to stop the presses. (Not a great career move.) More recently, the first season of HBO’s television series The Newsroom showed a producer landing a series of astounding scoops in the first hours after the explosion of the Deepwater Horizon. The reporter’s information came from miraculously well-placed sources – a sister who worked at Halliburton and a close friend who happened to be a junior BP executive attending all the key crisis meetings.

All of this makes “Spotlight,” the film based on the Boston Globe’s investigation of the Catholic Church, a remarkable achievement. The movie, which has been nominated for six Academy Awards including best picture, vividly captures the mix of frustration, drudgery and excitement that goes into every great investigative story. Where liberties were taken, and there were a few, they are in line with the realities of the news business.

One of the most credible aspects of the movie is the cluelessness with which the reporters begin their quest. As is often the case, the Globe’s group of reporters, known as the “Spotlight” Team, have no idea of the size and scope of what they’re trying to examine. At first, they stumble around, lacking the most basic information about how the church bureaucracy worked.

The notion of pedophile priests was not new. Newspapers from Dallas to Portland had done deeply reported stories on individual cases. Boston itself had just witnessed the criminal trial of a particularly notorious priest, Father John J. Geoghan. Initially, senior editors at the Globe are not even persuaded there was a story worth chasing.

As the film briefly acknowledges, the Globe was behind the Boston Phoenix, a respected alternative weekly, in covering the subject for local readers. Kristen Lombardi, a reporter for the Phoenix, had already written a series of stories implicating Cardinal Bernard Law, the leader of Boston’s archdiocese, in allowing Geoghan to remain in daily contact with children for three decades.

“Spotlight” opens with the arrival of Marty Baron, a veteran journalist who took over at the Globe after a stint as editor of the Miami Herald. As investigative reporters know well, Florida is a reporters’ paradise, lousy with graft, corruption and colorful characters. The state’s public records laws are decisively tilted toward openness. When a Globe columnist covering the Geoghan trial wrote that “the truth may never be known,” Baron sat down with the head of the “Spotlight” team, Walter “Robby” Robinson, and asked him to take a fresh look at the issue.

The editor suggested filing a lawsuit to force release of records the Catholic Church had submitted under court seal. Such suits were unheard of in Massachusetts. Liev Schreiber, the actor who portrays Baron, captures the true life editor’s white-hot focus and intensity, so much so that long-time colleagues were taken aback by the resemblance.

The movie accurately depicts the team’s key early breakthrough. The reporters figured out that priests who had “acted out” with children were often listed in the diocese’s phone book as on leave. They obtained years of directories and pored through thousands of entries to create a database, using the then-remarkable new technology known as a computer spreadsheet. With artful editing and a stirring score, director Tom McCarthy made this excruciatingly boring work an inspiring event, which in a way it was.

Another turning point came when Sacha Pfeiffer, the Globe reporter played by Rachel McAdams, knocks on the door of a priest who off-handedly acknowledges that he has abused children. (He asserts, bizarrely, that his conduct was not improper because he was not sexually aroused.) The reporter is clearly flustered and unprepared for this admission and she rushes through the interview before a woman at the house can slam the door. The practice of “door stopping” is routine for investigative journalists; nearly all such encounters end in failure. But the few attempts that succeed deliver an adrenalin kick unlike anything in reporting.

Fascinatingly, one of the more compelling scenes about journalism in the movie was invented by Tom McCarthy and Josh Singer, the screenwriters who worked closely with the reporters and editors involved the story.

It comes late in the film, after the “Spotlight” team has figured out that scores of Boston-area priests had abused children. Eric MacLeish, a lawyer for the victims, angrily tells Robinson that he sent the Globe a list of 20 priests “and you buried it.” Soon after, the reporters come across a story that ran deep inside the Globe’s metro section when Robinson was in charge of local coverage.

The writers came across the buried story when they interviewed MacLeish as part of their research for the film. They seized on it as the perfect way to illustrate the Globe’s earlier failures to investigate an important local institution. The conversation between MacLeish and Robinson is fictional. But the sentiments portrayed in the movie are real. “It happened on my watch and I’ll go to confession on it,” the Robinson told Entertainment Weekly. “Like any journalist who’s been around this long, I’ve made my share of mistakes.”

In investigative reporting, of course, nearly all great stories are screamingly obvious in retrospect. The reporting and documents the Globe obtained through its lawsuit proved that Church leaders had knowingly shuffled around pedophile priests from parish to parish. Geoghan turned out to be a piece of a much, much larger story, one that has rippled across the United States and the world over the past 15 years. Baron has pointed out that the movie is not a stenographic record of how the investigation unfolded. But it gets the big things right, providing a compelling picture of how great reporters break big stories.

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ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletterStephen Engelberg was the founding managing editor of ProPublica from 2008-2012, and became editor-in-chief on January 1, 2013. He worked previously as managing editor of The Oregonian in Portland, Ore., where he supervised investigative projects and news coverage. Before that, Engelberg worked for 18 years at The New York Times as an editor and reporter, founding the paper’s investigative unit and serving as a reporter in Washington, D.C., and Warsaw. Engelberg shared in two George Polk Awards for reporting: the first, in 1989, for articles on nuclear proliferation; the second, in 1994, for articles on U.S. immigration. A group of articles he co-authored in 1995 on an airplane crash was a finalist for a Pulitzer Prize. Projects he supervised at the Times on Mexican corruption (published in 1997) and the rise of Al Qaeda (published beginning in January 2001) were awarded the Pulitzer Prize. During his years at The Oregonian, the paper won the Pulitzer for breaking news and was finalist for its investigative work on methamphetamines and charities intended to help the disabled. He is the co-author of “Germs: Biological Weapons and America’s Secret War” (2001).

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Next, read Tom Regan’s column, Priest sex abuse: before Boston, there was Newfoundland

It was a bombshell: a local paper printed an exposé on sexual abuse by Catholic religious figures. No, I’m not talking about the Boston Globe, and its 2002 series on sexual abuse that won a Pulitzer Prize and is also the subject of the much praised film released November 6, “Spotlight.” That happened almost a decade after the story I’m referring to.

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Rethinking Cancer: non-sexy, low-cost therapies

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Vikas Sukhatme, a Harvard Medical School professor, and his wife, Vidula, co-founded the nonprofit Global Cures to promote research of cost-effective cancer treatments. (Photo by Matthew Healey for ProPublica)

Increasingly, Big Pharma is betting on new blockbuster cancer drugs that cost billions to develop and can be sold for thousands of dollars a dose. In 2010, each of the top 10 cancer drugs topped more than $1 billion in sales, according to Campbell Alliance, a health-care consulting firm. A decade earlier, only two of them did. Left behind are low-cost alternatives — therapies like off-label medications, including generics — that have shown some merit but don’t have enough profit potential for drug companies to invest in researching them.

Read the free, in-depth, investigation in Think, Magazine, by ProPublica’s Jake Bernstein:

Cancer: Where Are The Low-Cost Treatments?

Excerpt:

Michael Retsky awoke from surgery to bad news. The tumor in his colon had spread to four of his lymph nodes and penetrated the bowel wall. When Retsky showed the pathology report to William Hrushesky, his treating oncologist, the doctor exclaimed, “Mamma mia.”

“Michael had a mean looking cancer,” Hrushesky remembers.

Retsky didn’t need anyone to tell him his prognosis. Although trained as a physicist, he had switched careers to cancer research in the early 1980s and spent more than a decade modeling the growth of breast cancer tumors. During his treatment, he joined the staff of one of the most prestigious cancer research labs in the country.

In the absence of chemotherapy, there was an 80 percent chance of relapse. Even with therapy, there was a 50 percent chance the cancer would return. The standard treatment was brutal. Six months of the highest dose of chemotherapy his body could withstand and, after that, nothing but hope.

 

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Cancer: Where Are The Low-Cost Treatments?

Big Pharma’s focus on blockbuster cancer drugs squeezes out research into potential treatments that are more affordable. Says one researcher: “What is scientific and sexy is driven by what can be monetized.”

JAKE BERNSTEIN, ProPublica
April 24, 2014

Michael Retsky awoke from surgery to bad news. The tumor in his colon had spread to four of his lymph nodes and penetrated the bowel wall. When Retsky showed the pathology report to William Hrushesky, his treating oncologist, the doctor exclaimed, “Mamma mia.”

“Michael had a mean looking cancer,” Hrushesky remembers.

Retsky didn’t need anyone to tell him his prognosis. Although trained as a physicist, he had switched careers to cancer research in the early 1980s and spent more than a decade modeling the growth of breast cancer tumors. During his treatment, he joined the staff of one of the most prestigious cancer research labs in the country.

In the absence of chemotherapy, there was an 80 percent chance of relapse. Even with therapy, there was a 50 percent chance the cancer would return. The standard treatment was brutal. Six months of the highest dose of chemotherapy his body could withstand and, after that, nothing but hope.

Like many cancer patients, Retsky didn’t much like the odds. Unlike most cancer patients, however, he had the knowledge to question them. His own research had sown doubts that standard chemotherapy, as used the world over to treat colon and some breast cancers, was always the best approach. In collaboration with Hrushesky, the two devised an inexpensive, low-impact chemo treatment following surgery that dripped smaller doses of the drug into his body over a longer period of time.

Seventeen years later and cancer free, Retsky cannot be entirely sure the treatment cured him, but he believes it likely did. Numerous laboratory, animal and small human studies1 suggest that low-dose, continuous chemotherapy holds promise in shrinking tumors and preventing cancer’s recurrence. But the next step — testing what Retsky did in a large-scale clinical trial — is a longshot given the way cancer treatments are developed today.

Take Michelle Holmes, an associate professor of medicine at Harvard Medical School. She’s been trying for years to raise money for trials on the effects of aspirin on breast cancer. Animal studies, in vitro experiments and analysis of patient outcomes suggest2 that aspirin might help inhibit breast cancer from spreading. Yet even her peers on scientific advisory boards appear uninterested, she says.

“For some reason a drug that could be patented would get a randomized trial, but aspirin, which has amazing properties, goes unexplored because it’s 99 cents at CVS,” says Holmes.

Increasingly, Big Pharma is betting on new blockbuster cancer drugs that cost billions to develop and can be sold for thousands of dollars a dose. In 2010, each of the top 10 cancer drugs topped more than $1 billion in sales, according to Campbell Alliance, a health-care consulting firm. A decade earlier, only two of them did. Left behind are low-cost alternatives — therapies like Retsky’s or existing off-label medications, including generics — that have shown some merit but don’t have enough profit potential for drug companies to invest in researching them.

In 2012 8.2 million people died of cancer, worldwide.  Some 65 per cent of all deaths are in developing countries. —  World Health Organization

The newer drugs have in some cases shown dramatic life-extending results for patients. Yet cancer remains the second-most-common cause of death in the U.S. after heart disease, killing about 580,000 people a year. Worldwide, 60 percent of all cancer deaths occur in developing countries, where experts say the incidence of the disease is growing rapidly,3 as is a desperate need for affordable care. That has added urgency to an active debate about whether efforts to combat cancer — and where to put scarce research dollars — need to be rethought.

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Vikas Sukhatme, a Harvard Medical School professor, and his wife, Vidula, co-founded the nonprofit Global Cures to promote research of cost-effective cancer treatments. (Photo by Matthew Healey for ProPublica)

Vikas Sukhatme, a Harvard Medical School professor, and his wife, Vidula, co-founded the nonprofit Global Cures4 to promote research of cost-effective cancer treatments. (Matthew Healey for ProPublica)

“If we are winning the war on cancer, we are not winning that fast,” says Vikas Sukhatme, Harvard faculty dean for academic programs at Beth Israel Deaconess Medical Center in Boston and the Victor J. Aresty Professor of Medicine at Harvard Medical School.

Sukhatme and his wife Vidula, an epidemiologist, are among those trying to do something about it. They have spearheaded a new nonprofit, Global Cures, to promote alternative treatments that are unlikely to attract commercial interest from drug companies.

Global Cures calls these forsaken therapies, ” financial orphans.5” To help patients and their doctors, the nonprofit is producing reports that explain the science behind promising orphan therapies — those that have shown merit in animal studies and limited human data. And Global Cures also has set itself a more challenging goal — to find the money for clinical trials.

In one example, Retsky and a team of collaborators are exploring whether an inexpensive dose of a generic painkiller before breast cancer surgery might reduce lethal recurrences of the disease. If results in a small retrospective study of 327 mastectomy patients in Europe were to bear out, the anti-inflammatory drug ketorolac could save thousands of lives a year in the United States alone, Sukhatme has estimated.

“If we are winning the war on cancer, we are not winning that fast.” – Vikas Sukhatme, Harvard Medical School professor

The data behind the treatment are only suggestive, however, and more testing is required. Retsky and his colleagues have been unable to raise the millions of dollars a large-scale trial would need to make a real determination, in part because no drug company has the incentive to fund such a study, they say.

Without the confirmation of large-scale human trials, doctors are reluctant to approve patient use of orphan therapies, even in cases where there is little else to offer. It’s a challenging conversation when a patient suggests an alternative medication to a doctor, who despite having the ability to prescribe off-label, doesn’t want to risk making the situation worse. “It borders on crossing the line between good evidence-based medicine and simply trying to deal with the desperate hopes of desperate patients,” says Allen Lichter, chief executive officer of the American Society of Clinical Oncology. Nonetheless, Lichter acknowledges that there are financial orphans that do not get the review they deserve.

The financial orphan problem points to a deeper issue with the way cancer drugs are developed. Pharmaceutical companies exist to make a profit and cannot be expected to cover many important areas of research that go unexplored, according toLarry Norton,deputy physician-in-chief for Breast Cancer Programs at New York’s Memorial Sloan Kettering Cancer Center.It’s a gap in the system.

“The biggest challenge we have today is not necessarily the science,” Norton says, “it’s creating a business model that makes sense.”

In 1993, about a year before Retsky received his colon cancer diagnosis, he attended a breast cancer conference in Europe. An Italian scientist named Romano Demicheli presented data from a decades-long study of breast cancer patients. Demicheli also had been a physicist but had switched to oncology research after his wife died of Hodgkin lymphoma in 1976. Like Retsky, Demicheli doubted the dominant view of how cancerous tumors grow.

In a landmark study from the 1960s, Anna Laird at the Argonne National Laboratory had published research6 showing that tumor growth was predictable. They started fast, grew at an almost exponential rate and then slowed, she wrote. More than 500 scientific papers cited Laird. Based in part on these studies, chemotherapy was developed to attack tumors aggressively in the early, high-growth stage when they presumably would be most vulnerable.

Retsky’s research into the data had convinced him there was nothing linear about tumor growth. Instead, he found that they developed erratically and sometimes experienced periods of dormancy before reawakening. Demicheli’s presentation offered another insight into the progression of tumors.

Data from the Istituto Nazionale dei Tumori in Milan, where Demicheli is a senior researcher, showed7 two distinct patterns of relapses in a sample of 1,173 Italian women who had undergone breast cancer surgery but no additional treatment. One grouping of relapses came around 18 months after surgery, and a second smaller one cropped up around 60 months.

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Michael Baum, former president of the British Oncological Association, believes research focus should be on low-cost and generic cancer therapies. (Photo courtesy of michaelbaum.co.uk)

At the same conference, Retsky saw a presentation by Michael Baum, a professor of surgery at the University College London who later became president of the British Oncological Association. Baum, looking at British databases, had come to a similar conclusion: There were two distinct waves of post-surgical breast cancer recurrence.

Over the next few years, the men met and began to kick around the obvious questions: What was causing that first wave of recurrence? And what did it mean for cancer treatment?

A third question hovered unspoken over the conversation: Who would pay to find out?

Creating an innovative new drug — including everything from early research to late stage trials — costs on average of $1.3 billion, according to the Tufts Center for the Study of Drug Development. The Food and Drug Administration has taken steps to speed up the process for approving cancer drugs. Nonetheless, drug development in the United States, even when it is funded in part by taxpayer dollars and encouraged by federal bureaucracies, isn’t geared toward inexpensive alternative treatments.

The bulk of funding the U.S. government dedicates to research on diseases like cancer goes to basic science and is funneled through the National Institutes of Health (NIH). It is research that might not be done but for taxpayer investment. Federal dollars helped produce such scientific breakthroughs as the human genome project.

The NIH, particularly through the National Cancer Institute, contributes to about 15 percent of all clinical trials related to cancer, but the amount it gives is in decline. In 2012, the NCI spent about $754 million on clinical trials, or nearly $100 million less than in 2008. To leverage the money, the NCI seldom funds an entire trial by itself. The agency instead partners with pharmaceutical companies or academic institutions, and the trials the NCI does support usually are for new drugs, not for repurposing existing ones. Of the 1,785 trials the agency is backing at the moment, only 134 are for the larger and costlier late-stage human trials known as phase III.

The NIH recognizes that commercial drug development has its limitations. For example, a new NIH program targets what researchers call the “Valley of Death.” This area encompasses the research that comes before key human studies, where treatments often languish for lack of funding or attention. One NIH pilot project encourages drug companies to let researchers study compounds that are under patent but are no longer being explored. In 2013, the NIH gave $12.7 million spread over nine projects. The effort does not focus on inexpensive alternatives that could be made available quickly, according to John McKew, acting scientific director for preclinical innovation at the NIH’s National Center for Advancing Translational Sciences.

Holmes, the Harvard professor, says money sets the agenda for cancer drug development. “What is scientific and sexy is driven by what can be monetized,” she says, “and that becomes the norm.”

In September 2013, the British Health Service launched a randomized aspirin trial,8 something Holmes has been struggling to do in the United States. The trial, which will run through 2025 and involve thousands of patients, looks at whether aspirin taken after standard curative treatments can improve survival and reduce the recurrence of breast, colorectal, prostate and gastro-esophageal cancers.

“What is scientific and sexy is driven by what can be monetized.” – Michelle Holmes, associate professor of medicine Harvard Medical School

A summary of the trial explains that concerns about toxicity, particularly the risk of bleeding, are among the reasons aspirin hasn’t been studied for primary prevention of cancer.For patientswho have already been treated, however, the potential benefitas a follow-up therapymay outweighthe risks. If aspirin is shown to work, “it could be implemented in both resource rich and resource poor countries and would have a huge impact, improving cancer outcomes worldwide,” the summary says.

Low-cost alternatives like aspirin must fight for consideration within a scientific community that is producing effective cancer drugs that can command $100,000 or more for a course of treatment. The escalating prices for these drugs worry many involved in the fight against cancer. Some of the new drugs will eventually be used in combination, a step that could push cost of treatment into the hundreds of thousands, says Lichter.

“There is a point at which the equation breaks down and you can’t support the whole treatment process anymore,” he says. “We need to have an environment where we can have new drugs at a price that allows us to use those drugs and still allows these companies that have invested in them to reap a profit. But how we get from here to there is not clear.”

The Pharmaceutical Research and Manufacturers of America, the major trade group representing the world’s top drug companies, declined to comment about financial orphans. A spokeswoman for the group provided a white paper9 that makes the case that there has been “substantial progress in the fight against cancer.” The impact of new drugs takes years to fully realize, and therapies being developed for single indications may eventually be useful for other cancers, the paper says.

“It is important to keep in mind that innovative medicines are what provide the next generation of generic medicines,” Sally Beatty, a spokeswoman for the drug company Pfizer, says in an emailed statement from the company.

The predominant focus of cancer drug development today is on “targeted therapies” that are both innovative and lucrative. These drugs block the growth and spread of cancer by interfering with specific molecules involved in tumor growth. Fashioning these targeted therapies involves costly molecular and genetic experimentation, but once patented the investment can translate into enormous drug company profits.

The Swiss multinational company Novartis created one of the first targeted drugs. Gleevec treats myeloid leukemia and has turned a terminal disease into a chronic one for many patients. In 2012, Novartis had $4.7 billion in global sales from Gleevec. Last year the FDA approved its use for another kind of leukemia that affects children. Novartis declined a request to comment on the issue of financial orphans.

A subset of targeted therapies involves shutting down the ability of cancer cells to evade the body’s immune response. Immunotherapy, as the treatments are called, was long seen as a failed approach until recent molecular breakthroughs. Now, the promise of immunotherapy is ratcheting up the stock prices of several companies that are developing drugs along these lines.

One of the first to get a drug in this class to market was Bristol-Meyers Squibb, with Yervoy. Even though the drug is only approved for advanced melanoma, an aggressive skin cancer, it grossed $960 million last year. A course of treatment goes for about $120,000. Bristol-Meyers also declined a request to comment on the issue of financial orphans.

‘Dirty” medicine: therapies that works without an understanding of the precise mechanism

Some of the financial orphans Global Cures identifies are believed to enhance the immune response to tumors. Without more study it is difficult to isolate exactly why they operate the way they do. Vidula Sukhatme says this is one of the chief complaints she and her husband receive from scientists who disagree with their approach. “They call them ‘dirty medicine,'” she says. “They say, ‘The whole world is going toward targeted therapies and you are going backwards.'”

Sukhatme believes that what matters more than an understanding of the precise mechanism is whether a drug works. It’s possible that these alternatives may have synergistic effects that cannot be reduced to a single molecular target, she says.

Even before his cancer diagnosis, Retsky had dug out the original Laird papers from the medical library at Penrose Hospital in Colorado Springs, where he was a professor at the University of Colorado. The initial study was based on observations of tumors in only 18 rodents and one rabbit. Earlier studies contradicted the findings.

After Retsky weighed the evidence, he decided not to risk his recovery on standard chemotherapy. In January 1995, after surgery to remove his tumor, Retsky was ready for treatment. Yet he was no doctor. An oncologist would need to supervise.

Retsky found Hrushesky, a cancer doctor who split his practice between the Department of Veterans Affairs Albany Stratton Medical Center in New York and another local hospital. Hrushesky had worked with the National Cancer Institute doing therapy evaluation and had gained attention for a theory that the ill effects of chemotherapy could be minimized based on the time of day it was administered. To accommodate patients getting chemotherapy at odd hours, Hrushesky used a pump that operated automatically. He also gave low doses of chemo to patients with late-stage cancers whose bodies couldn’t withstand conventional high-dose therapy. Six years later, the approach would be dubbed “metronomic therapy” by another researcher.

As he sat in Hrushesky’s waiting room, Retsky wondered how the oncologist would greet his unconventional proposal. Hrushesky came out in cowboy boots and proceeded to shake the hand of every patient in the room. Retsky liked him immediately.

In the therapy, Retsky received low doses of a standard chemotherapy agent called Fluorouracil (5-FU) through a pump while he slept at night. The hole in his chest through which the drug flowed required some fussing, but there was no discomfort. The therapy lasted two and a half years, a period Retsky chose based on his estimates of tumor growth and the amount of chemo needed. In aggregate, Retsky received a larger dose of 5-FU than the standard concentrated therapy. Other than a few blood blisters in his mouth and slight skin cracking on his hands, Retsky experienced none of the worst chemo side effects, like nausea, fatigue and hair loss, he and Hrushesky say.

During his therapy, Retsky took a job with the research team of Dr. Judah Folkman, a renowned cancer researcher whose Boston laboratory ushered in new understandings of the way tumors grow. Retsky says he and Folkman, who has since died, went to a meeting with a top scientist at the Dana Farber Cancer Center in Boston, one of the foremost cancer treatment centres in the United States to pitch an exploration of metronomic therapy.

 No one was interested. Retsky says they were told it was most likely the surgery rather than the follow-up treatment had stopped his cancer. It’s not an unreasonable response, he says. Without more research, there is no way to know for sure.

Metronomic therapy is a quintessential financial orphan, Vikas Sukhatme says. It has some promising data behind it, but why it appears to function is not well understood. Retsky used a relatively cheap generic.

Independent researchers in Canada, Europe and India are exploring similar inexpensive agents with metronomic therapy. The low cost provides little incentive to pharmaceutical companies to investigate but makes it a source of great interest to the developing world.

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Robert Kerbel

In 2000, Folkman’s researchers published an animal study of metronomic therapy and found that it seemed to limit tumor growth. Around the same time, a cancer researcher in the department of medical biophysics at the University of Toronto, Robert Kerbel, did an animal study that reached similar conclusions. Randomized human studies involving hundreds of European and Japanese patients who underwent a metronomic therapy have shown improved survival rates.

The approach still faces hurdles beyond just the uncertainty about how it works. One theory, Kerbel says, is that metronomic therapy triggers an immune response in addition to chemo’s traditional toxic effect on cancer cells. But pinpointing a proper dose is challenging, as are the ethics of involving patients with early stage cancers, he says. A trial could needlessly endanger patients either by exposing them to a toxic drug they didn’t need or causing them to forgo a better-established treatment.

Nonetheless, a French pediatric oncologist, Nicolas André, is trying to promote metronomic therapy in the developing world and has organized a foundation to pay for studies. “Will we ever be able to treat cancer for US$1 a day?” he asks in a recent paper.10 “The answer might be an absolute yes, provided we encourage scientific research and clinical studies on metronomic treatments.”

Retsky is less confident that metronomic therapy using 5-FU on early stage colon cancer will ever receive trials in the United States. “The drug was less expensive than sterile water,” he says, “so no pharmaceutical company would spend millions of dollars testing it if there was no financial reward.”

The data that led Retsky and his colleagues to recognize the two waves of relapses and the erratic growth of tumors also carried them into the fiercest dispute over breast cancer of the past 20 years: When should women have mammograms?

One of his collaborators, Baum, had helped establish the mammography program for England’s National Health Service in the 1980s. The thinking behind it was self-evident. Catch the tumor early. Save a life. But the reasoning only made sense if the tumor grew in a linear, predictable way.

Michael Baum, former president of the British Oncological Association, believes research focus should be on low-cost and generic cancer therapies. (Photo courtesy of michaelbaum.co.uk)

It was also possible, Baum theorized, that the tumors might never progress; they might remain dormant for long periods of time or, less likely, could even shrink. By the 1990s, studies had begun to suggest that mammograms, for younger women, were not helpful and possibly were harmful. Women in their 40s who received mammograms had a slightly higher mortality rate than women who did not. Called the “mammography paradox,” the phenomenon remains controversial. Baum concluded money would be better spent on treatment rather than mammography.

The toolkit for treating aggressive breast cancer once it migrates to another part of the body remains limited. The majority of the approximately 40,000 U.S. women who die from breast cancer annually do so when the cancer reappears in another part of the body after surgery. There is no cure once the disease has gone metastatic, according to a report by the Department of Defense Breast Cancer Research Program. The median survival term for metastatic breast cancer is about three years, a number that hasn’t statistically changed in two decades.

In 1997, Retsky and Demicheli published a paper suggesting that it might be the breast cancer surgery itself that was causing the first wave of relapses they had identified. A computer simulation based on the data of Italian women Demicheli had studied suggested that removal of a primary breast tumor from premenopausal women with cancer in a lymph node triggered a cancer growth elsewhere in about 20 percent of cases. A few years later, Baum posited that the math behind tumor growth looked more like chaos theory than anything else. He, too, suggested that surgery might play a role in breast cancer recurrences. The trio, as well as Folkman and other researchers in their group, published several more papers along the same lines, but it wasn’t until 2005 that their theories entered the mainstream.

“We weren’t running to newspapers and issuing press releases,” says Retsky. “We were just looking at the data and presenting it to our colleagues in the scientific community.”

In 2005, Retsky, Demicheli and Hrushesky published a report in the International Journal of Surgery that offered surgery as a theory to explain both the mammography paradox and the first relapse wave. The paper did not propose that women forgo surgery — only that the data suggested a need for more research. But this time, an article about their report in The Wall Street Journal brought the idea to the wider public, where it was pilloried as dangerous because it might scare women from a vital treatment option.

What exactly connected surgery and the cancer recurrence remained a mystery to Retsky and his collaborators, who proposed and discarded various hypotheses. By this time, Retsky was a lecturer at Boston’s Children’s Hospital and Harvard Medical School and the author of multiple scientific papers. He was asked to review a case study out of Lebanon that had cited his work. It described a patient with advanced cancer who had bumped his head. Tumors had grown at the site of the bruise. Retsky couldn’t explain why, but a colleague at the Folkman lab suggested he look at inflammation. Animal studies showed a correlation between inflammation and cancer growth. And surgery also caused inflammation.

Researchers had the idea that inflammation itself could be a facilitator of metastatic growth

From there grew the idea that inflammation itself could be a facilitator of metastatic growth. Retsky and his colleagues theorized that the act of creating wounds in surgery spurred the body to growth as part of the healing process. This in turn might spread the cancer cells. If this was true, intervention to save breast cancer patients had to begin prior to surgery, the researchers concluded.

In 2010, Retsky and his collaborators came upon a paper published in the journal of the International Anesthesia Research Society by a Belgium-based anesthesiologist named Patrice Forget. He had looked at retrospective data from a Belgian surgeon whose breast cancer patients had received nonsteroidal anti-inflammatory drugs (NSAIDs) prior to surgery in the hope that they would lessen post-operative pain. Among the NSAIDs used was ketorolac.

After surgery, the patients all received the standard therapy of chemo, radiotherapy and endocrine therapy. The study size was small — 327 patients who had undergone mastectomies between February 2003 and September 2008. Of those 175 had received ketorolac.

Forget found that cancer recurred in 17 percent of patients who did not receive ketorolac and only 6 percent of those who did. The association was statistically significant and held up even when adjusted for age and other characteristics. There was no effect for the other NSAIDs although that may have been a function of not enough patients trying them, says Forget.

Clinical evidence from studies in animals and retrospectively in humans already existed suggesting that NSAIDs might help limit tumor growth. At least one other large retrospective study published in the peer-reviewed journal Cancer Causes & Control reported that NSAIDs might limit breast cancer recurrences. Forget didn’t know why ketorolac might work better than other NSAIDs, although he postulated various theories.

Ketorolac, a generic, is considered a relatively nontoxic drug. No single company owns it. The drug can cost as little as $5 a dose and might only be needed once before breast surgery. Retsky says a large-scale clinical trial in India could provide a better patient population for study and be done for as little as a few million dollars. But because it’s so cheap, ketorolac offers little in the way of profit incentive.

Retsky met with Brandy Heckman-Stoddard, program director for the Breast and Gynecologic Cancer Research Group for the National Cancer Institute. She had seen one of his presentations at a scientific conference and had been intrigued. “Retsky’s work is very provocative, but it is difficult to believe that such a short course of NSAIDs during surgery could have such a dramatic effect on recurrence,” she says.

Sloan-Kettering’s Norton is also aware of Forget’s paper on ketorolac, but he cautions that there are too many potential variables to draw definitive conclusions from a single retrospective study. Although it would not be his first choice for investigation, Norton believes the effects of ketorolac and other NSAIDs on breast cancer are worth exploring and are the types of research for which there is no business model. “Is it a meritorious hypothesis to test?” he says. “Yes, I think it is.”

Giving patients ketorolac before surgery is not without risk. In some cases it can lead to bleeding. It’s a legitimate issue, says Vikas Sukhatme, and one that surgeons would have to understand. Forget notes that an American Society of Anesthesiologists report approves of ketorolac use for pain prior to surgery.

The National Cancer Institute estimates the current annual cost of breast cancer treatment in the United States at approximately $19 billion. If a single injection of a low-cost drug could save lives and put a dent in those costs, Vikas Sukhatme contends it’s worth investing in definitive research about its effectiveness and safety.

“Personally, should I have to choose an analgesic drug [to take before] breast cancer surgery, I would choose ketorolac,” Demicheli says. “But it is still a reasonable choice, not a scientifically based choice. To solve the question, at least one high-quality randomized clinical trial is needed.”

Widespread acceptance won’t come without trials that give doctors confidence. Guari Bhide, a community oncologist in the Boston area who has consulted with Global Cures and believes in its mission, says she would not prescribe ketorolac. “The surgeons would kill me,” she says. “Until someone tells them it is safe to take right before surgery, they are not going to do it.”

Forget is trying. After multiple rejections, he cobbled together enough money for a limited double-blind trial that began last year. One of the donors is a small Belgian-based foundation called The Anticancer Fund. Like Global Cures, the group has a dual mission of providing information on alternative cures and encouraging their study. It was started by a wealthy European real estate mogul, Luc Verelst, born from his experience trying to help his sister, who was suffering from uterine cancer.

Still, Forget’s study is not large enough to be dispositive. “It’s a pilot study,” says Retsky. “It’s not designed to confirm or deny [if the drug works].”

Money for trials won’t come easy. Retsky and his collaborators received a $600,000 multiyear research grant in 2009 from the Susan G. Komen breast cancer foundation. The group turned them down for money for a clinical trial of ketorolac a few years later. Only about 3 percent of Komen’s clinical trial investments go to large, final-phase studies, according to a foundation spokeswoman. Retsky’s group made it past the first round for funding from the Department of Defense, which has poured almost $3 billion into breast cancer research since 1992. Then money for the DOD program was sidelined by the sequestration budget cuts mandated by Congress, Retsky was told.

PamelaGoodwin

Pamela Goodwin

One of the drugs Global Cures highlights has found backing for a large-scale trial — though it took Pamela Goodwin, a Canadian oncologist, more than a dozen years of grant writing, meetings and clinical breakthroughs from other researchers to cobble together what will eventually be close to a $30 million study.

The widely used Type 2 diabetes drug metformin, a generic that has been associated with reduced breast cancer risk, is now the subject of a 3,500-patient trial involving 300 medical centers that Goodwin characterizes as bare-bones. The NCI is providing about half the funding, primarily for the U.S.-based centres, with contributions also coming from Canadian nonprofits and the British and Swiss governments.

Given recent cutbacks in U.S. government funding, both Goodwin and Dr. Lois Shepherd, senior investigator with the National Cancer Institute of Canada Clinical Trials Group, believe that what they’ve done probably can’t be replicated.

Shepherd_Lois

Lois Shepherd

“If this trial had come forward for approval today, I’m not sure it would be approved — and it has nothing to do with the science,” says Shepherd.

The Sukhatmes hope that Global Cures can serve as a matchmaker between researchers who want to conduct trials on promising alternatives and family foundations or other donors that might fund them. The group also plans to use crowdsourcing to raise money from patients and others who may want to donate to trials.

 Patient groups have become much more active in the way they approach the funding of trials, says Kenneth Kaitin, director of the Tufts Center for the Study of Drug Development, who believes that the research gap identified by Global Cures exists across multiple diseases.

“[Patients] have a vested interest in seeing the product developed,” he says. “Their goal is not to make a lot of money but to get [the drugs] out.”

The Sukhatmes hope to create a way for patients to document online the treatments they undergo. Harnessing the experience of cancer patients is also a goal of the American Society of Clinical Oncology, says Lichter, the group’s CEO. The society wants to compile and analyze patient experiences nationwide to give better guidance to patients and doctors. “There is a lot of knowledge out there, but it is locked up in individual files and records,” Lichter says.

Vikas Sukhatme says Retsky’s experience with his own cancer exemplifies what Global Cures hopes to do. Retsky was a patient who, after careful research, adopted a financial orphan treatment and documented the result. The toxicity of the treatment was not bad. Retsky went into it with eyes open and understood the tradeoffs. Although his case is far from conclusive, if there were 50 people like Retsky whose collective data showed strong results, it would build a foundation for further study, Sukhatme believes.

Although Retsky and his collaborators are frustrated about the lack of progress on ketorolac, they are optimistic that scientific advances under way, including the new targeted therapies, will eventually have a real impact. Still, they worry that these new therapies will only be available for the wealthy.

“It is so expensive it makes me weep,” says Baum, the British oncologist. “I weep for all the poor people in the world who will never have access to such treatment.”

Creative Commons

Further reading:
Five Low-Cost Drugs That Might Combat Cancer, ProPublica

References:

  1. http://www.ncbi.nlm.nih.gov/pubmed/?term=metronomic+and+cancer
  2. http://www.propublica.org/documents/item/1094921-aspirin-jco
  3. http://www.propublica.org/documents/item/1109107-acs-facts-and-figures-2013#document/p51
  4. http://www.global-cures.org/
  5. http://healthaffairs.org/blog/2014/03/06/financial-orphan-therapies-looking-for-adoption/
  6. http://www.propublica.org/documents/item/1146889-laird-1965-brjcancer00487-0067
  7. http://www.propublica.org/documents/item/1102779-demicheli-1996-study
  8. http://www.cancerresearchuk.org/science/research/who-and-what-we-fund/browse-by-location/london/medical-research-council-clinical-trials-unit/grants/ruth-langley-15015-cruk-12-033-add-aspirin-trial–a-phase
  9. http://www.propublica.org/documents/item/1109114-phrma-innovation-oncology.html
  10. http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2813%2970056-1/abstract

 

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Racial resegregation in the American south

 

Sixty years after the United States Supreme Court outlawed “separate but equal” schools, Nikole Hannah-Jones of  journalism organization ProPublica went to Tuscaloosa, Ala., to investigate the resegregation of Southern schools. Her series begins today, April 17.

 

Segregation Now: 60 Years After Brown v. Board from ProPublica on Vimeo.

 

A short documentary film by the award-winning Maisie Crow:

 

Independent, non-partisan and employee-owned, FactsandOpinions serves, and is funded by, readers. We do not carry advertising or solicit donations from foundations or causes. Our original work in Dispatches, Think and Photo-Essays is available for a $1 site day pass or at a modest subscription price. Use the SUBSCRIBE  form to the right, on our free Frontlines blog, to receive notices of all new work on site.

 

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Golden Age of American Journalism?

 

Paul Steiger, founder and executive chairman of ProPublica, and  chairman of the Committee to Protect Journalists amongst several other roles, gave this speech today as he accepted an honour, the William Allen White Foundation National Citation, from the University of Kansas’s White School of Journalism and Mass Communications in Lawrence.

By PAUL STEIGER, ProPublica
Published February 7, 2014

I’m honored to be here in Lawrence for the second time in 48 years. In the summer of 1966, having spent nearly all my life within 75 miles of New York City, I was driving across our great country on my way to California. In the late afternoon, one of those explosive thunderstorms you Kansans are familiar with poured rain in such sheets as to force me to pull over for 15 or 30 minutes till it passed. Then came one of those gorgeous, sun-dappled, cool and peaceful evenings that I suspect you also know well. A half century later I still remember it.

In the intervening years I confess to having thought about this place for two things: your great basketball teams, and your great journalists. It has been my privilege to work with some of those journalists: Jerry Seib and Barbara Rosewicz. Kevin Helliker. Danforth Austin. Steve Frasier. To name a few.  And then of course there is William Allen White, whose name adorns this great school and the citation that I am overwhelmed to receive today.

No, I didn’t work with him, although some of my 20-something colleagues at ProPublica think I go back that far. He died when I was two, in 1944. But like many journalists, I’ve long known of and admired Mr. White, and why not?  Multiple Pulitzer winner. The voice of Middle America who lived here all his life yet made time to travel east and write pathbreaking pieces for the cutting-edge, New York-based national magazine, McClure’s.  Mr. White without question was one of the leaders of a great revolution in journalism, which parallels in some ways the revolution taking place today.

In fact, in her latest marvelous book, The Bully Pulpit: Theodore Roosevelt, William Howard Taft, and the Golden Age of Journalism, historian Doris Kearns Goodwin applies that gleaming, golden label to the early decades of Mr. White’s era. [See her ProPublica podcast on the subject here.]

It was certainly a golden age. Whether it was the golden age is something we could argue about. Indeed, some Internet writers and publishers have taken to contending recently that our current era is the best ever for American journalism — this only a brief time after others  took to declaring that the loss of billions of dollars of advertising revenue and tens of thousands of jobs at metro newspapers was driving us into a journalistic wasteland.

That leads me to what I’d like to talk with you about today. My interest isn’t so much to determine what was the golden age of journalism, although I have a candidate, which I will make a case for in a moment.

My real interest, sitting where we do in a period of incredibly rapid change, is what should we want in a new golden age? I confess to having more questions than answers, so I look forward to hearing from you in the comment period.

Let’s start by taking a close look at the period that Doris Goodwin, with her historian’s perspective, describes as American journalism’s finest hour.  It began, she tells us, in the 1880s and 1890s, a time in some ways like our own, with major changes in the economy involving first rapid growth and industrialization, and then, in 1893, a crash that produced huge unemployment and hardship. Through it all, there was a major surge in inequality.

The urban poor lived in squalid tenements. Factory workers endured crushingly low wages, six-day work weeks, dangerous conditions on the job, and the ability of owners to fire them at will. The giant trusts and the all-powerful railroads manipulated freight rates and other prices to squeeze growers and small entrepreneurs, in the end driving many into bankruptcy and seizing their businesses or lands.

Meanwhile, the rich lived in mansions with servants and took their children on grand tours of Europe. America, the land of the citizen farmer, the industrious  merchant, and the emancipated slave, increasingly took on notions of class. A brilliant and gregarious student at Harvard, New York mansion-dweller Teddy Roosevelt worried that some of the classmates he thought to befriend might be from families of insufficient standing.


Teddy Roosevelt, unlike many political and business leaders,  didn’t fear being criticized or misquoted by reporters. He boldly assumed he could make common cause with them.

At the same time, Roosevelt had a passion for public service and a liking for journalists. Unlike many political and business leaders, then and now, he didn’t fear being criticized or misquoted by reporters. Rather, he boldly assumed he could make common cause with them. So when the assassination of William McKinley in 1901 made the 42-year-old Roosevelt our nation’s youngest president, he had already built a network of reporters and writers to whom he gave extraordinary access, whose advice he sought and sometimes followed, and who often helped explain his positions favorably to the public.

A key to TR’s journalistic network was a group of extraordinary writers assembled by a once penniless Irish immigrant, S.S. McClure, to work on the magazine he called, simply, McClure’s. 

Then as now, technology aided change.  The newly perfected process of photoengraving was both cheaper and faster than traditional woodcuts, and Sam McClure made good use of it.

He also used his powerful talent as an editor to inspire the great writers he had collected. In particular, he sent them on missions to dig deep into the secrets of the powerful, and to reveal them in enthralling narratives. The approach was rare in American journalism. It caught on soon with the public — who made McClure’s a financial success — and with competitors, who sought to imitate the approach.

All came together in the January 1903 McClure’s, a truly extraordinary issue containing three powerful exposes: Lincoln Steffens on the corrupt mayor of Minneapolis, Ray Stannard Baker on misbehavior in the nascent labor movement,  and the first installment of what is justly revered as one of the greatest feats of investigative reporting ever, Ida Tarbell’s mammoth inquisition into rapacious business practices by John D. Rockefeller and the Standard Oil Trust.

It took eight long years, but Tarbell’s chapter-and-verse reporting served as a guide for a federal government lawsuit to break up the trust. The suit finally broke through Rockefeller’s legions of lawyers and political supporters to win at the Supreme Court.


McClure’s collapsed, Roosevelt assaulted  “sensational, lurid and untruthful” articles … and an era of broad public support for expose journalism ended.

By that time, however, the magazine had collapsed, in part because of McClure’s moods and unpredictable rages at the staff, and his insistence that the poetry editor publish submissions by a young woman with whom he had had an affair.

The public was also tiring of the expose form. Some of McClure’s competitors were not so scrupulous about their reporting and relied on bombastic rhetoric and name calling when the facts were insufficiently at hand. In 1906, that great friend of journalists, President Roosevelt, diluted his support by giving a speech, first off the record at the annual Gridiron Club dinner in Washington, and then in public, a month later.

Roosevelt used the image of the muckraker to describe writers who focused only on the negative. While he expressed backing for those who carefully documented what they wrote, his assault on what he termed “sensational, lurid and untruthful” articles overwhelmed the positive words, Goodwin concluded. TR’s view took hold, and an era of broad public support for expose journalism came to an end.

The terms muckraking and muckraker, of course, were actually embraced, not shunned, by the McClure’s writers and are used today as terms of approbation by investigative reporters.  At ProPublica we label “Muckreads” a section of our website in which we highlight interesting investigative reporting by journalists other than our own. Even so, for much of the first half of the 20th Century, this kind of work faded from prominence. Its practitioners had made a strong record and established reporting and writing models that influenced how journalists work today. But I can think of at least one period in which the accomplishments of journalists surpassed these.

The period that I would anoint as the golden era in American journalism was from the mid 1950s to the mid 1970s. It had three separate major strands: the Civil Rights struggle over integration of schools and public facilities in the South; the Vietnam War; and Watergate.

Once again, there was interaction with technology. In this period, the ability to take television outdoors and get footage on the air rose progressively, and in all three cases — Civil Rights, Vietnam, and Watergate — TV combined with print to multiply the power of each form of reporting.

In addition, during this period there was a much greater role for aggressive spot-news reporting of dramatic and sometimes violent events, often at considerable personal risk to reporters and photographers. It brought home to the public appalling behavior by people in authority, including sheriffs in the American South and soldiers in Vietnam.

The trigger for major print and TV coverage of the Civil Rights movement was the unanimous 1954 Supreme Court decision outlawing school segregation, reversing the “separate but equal” decision of 58 years earlier, and generating  outrage among many white Southerners. Then, rather than go forward with plans to implement the ruling, Arkansas Governor OrvalFaubus in September 1957 suddenly ordered out National Guard troops to block the planned entrance of nine black students into the city’s all-white Central High School.

A month later, President Dwight Eisenhower federalized the Guard troops, who swiftly enforced the enrollment of the black children. This set off a decade of struggle all across the South between segregationist whites and determined blacks, who  demanded their rights not only to integrated schooling but also to vote and to use the same bus seats, restaurants and lunch counters, restrooms, and other public facilities as whites did.

In little more than a decade, they won most of their objectives, by a combination of their own efforts and by the actions of a horde of journalists, some from the black press but many Southern-born-and-raised whites who rejected the white-supremacist views of their parents and cousins.

The Race Beat, a 2006 book by two journalist sons of the South, Gene Roberts and Hank Klibanoff, is a fine guide to this history and many of the brave and colorful characters who lived it. Among them, besides Roberts himself, were Claude Sitton of the New York Times, Karl Fleming of Newsweek, Haynes Johnson of the Washington Star, and three Pulitzer Prize winners at the Atlanta Journal & Constitution — Gene Patterson, Ralph McGill and Jack Nelson.

On the television side were John Chancellor and Richard Valeriani at NBC, Dan Rather and Nelson Benton at CBS, and many others.  Their network status didn’t spare them. Valeriani had his head bashed in by an Alabama state trooper; a nearby cameraman watching blood spurt from his head couldn’t believe he’d survive. Rather had a shotgun poked into his ribs.A soundman pressed a pistol against the man’s head and persuade him to pull back the shotgun.

The print reporting conveyed what smoke or tear gas or the lack of equipment in the right place prevented the cameras from catching; cameras pointed in the right position captured action that neither reporters nor cameraman could spot. And then, at times,  there was the perfect — and perfectly horrific — moment.

March 7, 1965. Bloody Sunday. Some 500 demonstrators start to cross the Edmund Pettusbridge near Selma, Alabama. They are opposed by an equal number of riot-equipped state troopers plus a sheriff’s posse, some on them on horseback. The police commander orders the marchers to disperse. The lead marchers kneel to pray. The police charge, running over and through the marchers, hammering them with clubs, chasing the ones who run and hammering them some more. And all this in full view of the cameras of all three networks, which air the footage Sunday evening. ABC interrupts the prime time showing of “Judgment at Nuremberg,” the Oscar-winning film about German war crimes, to air detailed coverage of the beatings.

All across America, the public is aroused and outraged. President Lyndon Johnson asks both houses of Congress to approve a massive civil rights bill, one considered a long shot a few days earlier. They can’t wait to vote.

The coverage of the Vietnam War wasn’t as comprehensively and consistently a success as that of the Civil Rights struggle in the South, but television and print media took on significant new challenges and for the most part met them. 

The war was increasingly controversial as the manpower and expenditure demands grew. The public wanted more information faster, and they wanted it to be more definitive. Were we winning or losing? Did it make any difference?  Both print and TV reporters recognized that they were sometimes being spun by government briefers, and they became appropriately more skeptical.

In some cases the skepticism was overblown, most notably in the coverage of the Tet offensive early in 1968. North Vietnamese and Vietcong forces briefly captured some cities and other strategically important places, but they were quickly retaken, and the casualty cost to enemy forces was high. The reporting that treated Tet as a major defeat for the Americans was probably wrong. Whether better coverage would have changed the outcome of the war or of the 1968 election, I cannot say.

In any case, success returned by 1971, with the Pentagon Papers case. The New York Times and the Washington Post reconfirmed the right of the press to publish most national security-related information without prior restraint.

And the coverage of the Watergate break-in, dominated by Bob Woodward and Carl Bernstein of the Washington Post, was an even greater success. President Richard Nixon was shown unequivocally to have abused his office for personal political gain and ultimately was forced to resign.

This brings us back to where we started, which is the following question: What changes can we reasonably look for in the current state of American journalism for it to qualify as a new Golden Age, one that matches or even exceeds the two eras I’ve been talking about?

What seems clear to me is that we are not there yet.

Some people, to be sure, think we are already there.

Digital tools are thrilling, but not enough for a new Golden Age of American journalism. It needs lots of reporters, editors, data journalists, a lawyer. And they need to get paid.

Henry Blodget of Business Insider last summer famously said “Journalism has entered a Golden Age.” And then he helpfully posted backup for his case, and quite a few people agreed with him. His argument basically is that the combination of the web, social media, and the smart hand-held makes it possible for anyone with the talent to just start producing journalism. He says that while some newspapers have closed or contracted, others are “hanging in there” and more native digital news platforms are starting and growing. I encourage you to read his entire argument. I agree with some of it but not all.

On the plus side, I too am thrilled with what the new digital tools can do, in capturing data, drawing knowledge it, and in displaying and distributing that knowledge.  I’m also delighted that the barriers to entry have shrunk so dramatically. Instead of spending millions on a printing press, you need only spend a few thousand on a laptop and a website and, boom, you’re a publisher.

But creating millions of lone-wolf, single-person bloggers doesn’t get us to a golden age. It can give us cat photos that make us giggle, news scoops involving an original fact or two, a trenchant analysis of finance or politics or sculpture, video of Miley Cyrus or Taylor Swift nuzzling their latest boyfriends, or possibly some movie and book reviews worth trusting. All nice to have but not game-changing.

If you’re going to reliably produce journalism that improves the world, maybe you don’t need a village, but you need some collaborators. You need lots of reporters. You need editors, data journalists, a lawyer.

If it sounds like I’m trying to restore the primacy of the print newspaper, I’m not. That train has left the station. Instead, it’s time that we embrace the dominance of the web, not just say “Digital First,” but mean it. News platforms are rising frequently on the Internet; some, like BuzzFeed, are amassing huge traffic and edging toward profitability. If I were the young journalists and journalism students here, that’s the kind of team I’d want to join.

Finally, unless you have a hefty trust fund, like the billion-dollar one the Guardian just got, you need to find a way to get paid. In the brief time I’ve been able to spend with you here, I’ve seen a lot of talent, a lot of energy, a lot of determination.

Whatever enterprise you lend those talents to, don’t be afraid or ashamed to ask how you’re going to get paid. It’s no great mystery. The sources have to be advertising, subscription fees, donations, or some combination of them.

Woodward and Bernstein got paid. So did Sy Hersh. And Dan Rather and Richard Valeriani. Ida Tarbell got paid. Sam McClure got paid. And so did William Allen White. They all made a difference. It is your time. I look forward to seeing what you do.

Published with permission under Creative Commons licence

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