Righteous in Seattle
An editor says we were "misleading and fundamentally unfair." You be the judge.

Monday, April 1, 2002 12:01 A.M. EST

The Seattle Times' executive editor, Michael Fancher, has responded to our editorial last Wednesday criticizing his newspaper's cancer journalism by demanding a correction.

He says we were wrong to report that the Times didn't submit as part of its Pulitzer Prize entry a critical letter from our Laura Landro. While the Times didn't publish or submit her letter, he says, it did submit a letter she wrote to the Columbia Journalism Review. They ask us to believe that other submissions were just more compelling than one from a top-flight journalist who'd published a book on surviving cancer. Other Times editors have peppered the media gossip site of Poynter.org with similiar claims.

We're happy to share with readers this insight into Mr. Fancher's standards of accuracy. Ms. Landro's original letter to the Times, the one it refused to publish, ran to about two-and-a-half pages. The letter that CJR ultimately published was slashed from roughly the same length to two paragraphs. This is the letter Mr. Fancher brags that the Times submitted to the Pulitzer judges. By the way, Columbia University administers the Pulitzers, so any editor with a room temperature IQ knows you'd better submit anything critical from its Journalism Review.

All of this only reinforces our view that what really needs correcting is reporting standards in Seattle. The rest of the press corps seems to be treating this as little more than intra-media spat, as if it's rude to challenge a fellow journalist's work. But they aren't addressing the substance of Ms. Landro's critique.

Below are Mr. Fancher's complaint, Ms. Landro's letter to the CJR, in both edited and unedited versions, and her unpublished letter to the Seattle Times. In addition, the Association of Independent Research Institutes, a nationwide group of nonprofit institutions that conduct peer-reviewed biomedical research, prepared a report on "major factual errors" in the Seattle Times series, which is available in PDF format here.

Your editorial today is misleading and fundamentally unfair.

When "Uninformed Consent" was published, we received hundreds of letters and e-mails from readers, both positive and negative. There was no way we could publish all of them. Ms. Landro's letter was not one of those published, although many negative letters were.

Ms. Landro later submitted a similar critical letter to Columbia Journalism Review, after CJR praised our series. CJR printed her letter, which made reference to her earlier letter to us and its availability on the cancer center's web site.

Ms. Landro's letter published in CJR was submitted as part of our Pulitzer entry.

SATISFIED PATIENT
In awarding a Laurel to The Seattle Times for its series "Informed Consent" on the Fred Hutchinson Cancer Research Center (July/August), CJR has conferred its highest praise on a most undeserving journalistic effort. To the casual reader the stories about the Hutch's conduct in clinical trials and patient care may seem credible. But to anyone who knows the facts, these stories are fundamentally flawed, biased, and reckless. I investigated the facts behind those stories a decade ago when I was diagnosed with leukemia. I subsequently had a bone marrow transplant at the Hutch, and am convinced now, as I was then, that it is the world's finest cancer institution, and has always acted ethically, responsibly, and with the highest regard for the safety of its patients.

Readers who want to get the real story will find a thorough and forthright response to The Seattle Times series on the Hutch Web site, www.FHCRC.org. The Web site also includes a letter I wrote disputing The Seattle Times stories, which the newspaper neither acknowledged nor published.

Laura Landro
New York, New York

August 28, 2001

To:

Gloria Cooper

Brent Cunningham

Michael Hoyt

David Laventhol

Columbia Journalism Review

Re:

A "Laurel" for the Seattle Times?

I am dismayed that journalism's best known "watchdog," CJR, apparently took the conclusions of the Seattle Times at face value. Readers who want to get the real story will find a thorough and forthright response to the Seattle Times series on the Hutch website, www.FHCRC.org. The website includes many documents and letters that lay out the facts and evidence. The website also includes a letter I wrote disputing the Seattle Times stories, which the newspaper neither acknowledged nor published.

Tackling the complex world of bone marrow transplantation and cancer research, the Seattle Times apparently decided that the most dramatic, attention-getting approach would be an expose of wrongdoing, rather than a fair, balanced story about the intricacies and risks of pioneering cancer treatments. So it selectively reported some facts, distorted others, and left out whatever didn't fit its thesis. It relied on a disgruntled former employee as its primary source, without ever adequately disclosing his own history at the center.

The stories you single out for praise in the series accuse The Hutch of conducting dangerous clinical trials on unsuspecting patients. To quote CJR's laurel, the hospital bypassed "other treatments with a higher likelihood of success in favor of those using certain drugs--without fully informing patients that those drugs had never been tested on animals, had caused the deaths of humans on whom they'd been tried, and were owned by companies in which the doctors themselves (including a 1990 winner of the Nobel Prize in medicine) had stock, advisory positions, and/or jobs. In short, the interests of patients were in literal mortal conflict with the interests of the center and its doctors."

Nothing could be further from the truth. While CJR lauds Times reporters Duff Wilson and David Heath for conducting more than 100 interviews and analyzing some 10,000 pages of records, all that reporting and effort led them to erroneous conclusions. In particular the first story in that series, "The Blood Cancer Experiment, " completely misrepresents the efforts by Hutch cancer researchers starting 20 years ago to make bone marrow transplants more effective by removing T-cells from donor marrow, a treatment that proved ineffective in many cases. The Times' asserts that the story of this trial "has never been told." In fact, it was well documented in the medical literature and I described the history of problems with T-cell removal in a 1996 article for the Wall Street Journal and in my 1998 book "Survivor: Taking Control of Your Fight against Cancer."

Until the Hutch and others pioneered bone marrow transplants in the 1960s, a diagnosis of leukemia used to be a death sentence. Transplants, though still risky, now provide a cure for thousands of people. But in the early days, it was a difficult and often fatal procedure; even if patients survived the transplant process, they often could not survive the side effects known as graft-versus-host-disease. In an effort to prevent it, the Hutch and every other transplant center in the world began experimenting with the removal of T-cells, known as the soldiers of the immune system, from donor marrow. It seemed like a promising solution, but it turned out to have a problem they had not anticipated: when the T-cells are removed from donor marrow, the transplant is not as effective, and so patients were relapsing and dying of their leukemia after all.

The Hutch, recognizing this, was the first major transplant center to end T-cell removal in transplants for certain leukemias, focusing instead on using new drugs to prevent and treat graft-versus-host-disease. By contrast, some of the most prestigious U.S. cancer centers, including Memorial Sloan Kettering in New York, continued to experiment with T-cell removal in transplants for certain leukemias in an attempt to make it work. The Seattle Times completely ignored this crucial fact, and did not ever place the Hutch's experience with T-cell removal in the context of what was going on at its peer institutions in the field. The Hutch, rather than the irresponsible player it is portrayed to be in the Seattle Times, was in fact was the first to acknowledge that the experiment with T-cell removal was not working, and end it. It was for that reason that I withdrew from treatment at Memorial , which was still performing T-cell depleted transplants on patients with my disease, and had my transplant at the Hutch in 1992.

Did people die after T-cell depleted transplants during the early phase of clinical trials? Yes, at the Hutch, and every center that used the procedure, all over the world. Leukemia patients who were in mortal danger with slim chances of survival participated in an experiment of a new treatment that gave them hope, but no guarantees, of a cure. This is the way cancer research progresses, and to suggest that the Hutch in some way acted unethically by continuing to try to make bone marrow transplants more effective, is simply unfair. The patients were clearly informed of their risk as it related to their individual situations, including the risk of death. The main result of the Seattle Times' story has been predictable enough: a class action suit by some family members of deceased patients, aided of course, by a plaintiff's attorney and the former employee. The suit is completely without merit, and a contemptible response on the part of the plaintiffs to a hospital that did everything humanly possible to save their loved ones. Legal responses to the suit can also be found on the Hutch website.

There is no question that the issue of protections for human subjects in clinical trials is one of the most important issues in science today. There are many ways to tell that story, and to investigate situations where the protections were not adequate. But the Hutch's effort with bone marrow transplantation simply is not one of those stories. Its only motive was to try to improve a radical and potentially fatal therapy, bone marrow transplantation that was its patients' only hope of a cure. Trials of new drugs and procedures continue to this day to try to make transplants more effective, and researchers continue to investigate different strategies for T-cells.

There are also important questions to be asked about doctors with conflicts of interest involving personal financial stakes in drug or biotech companies. But even though it may be legitimate to question whether some doctors at the Hutch should have had any business relationships with a drug company, it is a pretty big leap to go from there to the accusation that they stood to benefit from letting patients die. The Seattle Times, for all its flood of documents and supporting materials, has absolutely nothing to support this contention.

The Seattle Times has continued to flog its series in an attempt to gain publicity for itself, and continues to report that the Surgeon General has called for a federal investigation of its stories. The Surgeon General has never called for a federal investigation of the Seattle Times stories.

The Hutch saved my life, so perhaps it might appear that my gratitude would distort my views. In fact, if I thought the hospital had done anything wrong or unethical, I would not be supporting them, nor would I be writing this letter. The Seattle Times committed the sin journalists are often accused of, and must always be on our guard against: disregard for the truth in the interest of a dramatic story. No doubt the newspaper is already preparing to nominate itself for the big prize. That would be a real travesty. But it would be a real tragedy if patients were dissuaded from seeking care at the Hutch because of bad journalism.

Sincerely,
Laura Landro

To:

The Editors, Seattle Times

Re:

"Uninformed Consent"

As a survivor of a bone marrow transplant at the Hutch, I found your article "The Blood-Cancer Experiment," to be particularly disturbing. You fail to make clear that the protocol for T-cell removal that the Hutch was using on leukemia patients was the same treatment every other bone marrow transplant center was pursuing at the time, all over the world. Back then, no one had any idea what the outcome would be, but it seemed like a promising way to deal with the terrible mortality of many transplant patients. It turned out to be wrong, and patients died. The Hutch was the first to acknowledge that T-cell removal was a failed strategy, and to stop using it. Others continued to pursue it long after the Hutch stopped , and in fact some centers still continue to use it for certain diseases in which their data has shown it to be effective.

You assert in your article that the story of this trial "has never been told." In fact, by the time I was diagnosed with chronic myelogenous leukemia in 1991, the data about the problems with T-cell depletion had already been published in medical journals, and as a patient I was able to find data that suggested only 25% of the patients transplanted with T-cell depleted marrow were alive and disease free. Memorial Sloan-Kettering in New York, where I initially planned to have my transplant, was continuing to pursue T-cell removal for patients with my disease even then. When I came to Seattle and met with Dr. Rainer Storb, we had a frank discussion and he was candid, telling me that T-cell removal had been dropped at the Hutch because of the terrible outcomes. I described these events and laid out the problems with T-cell removal in my 1998 book about my experience at the Hutch, "Survivor: Taking Control of Your Fight Against Cancer."

You correctly portray Dr. Storb in the article as a dedicated and forthright scientist who has never had any financial gain from association with private industry. But all that exhaustive reporting in the end did nothing to support the contention that the Hutch pursued this protocol because other doctors had a financial interest in it, or that there was a nefarious plot to keep using it because someone stood to profit. Every center conducting transplants was pursuing T-cell removal in some form because they thought it would save patients and improve their centers' outcomes.

Finally, your entire series makes all patients seem like helpless victims, misled by greedy doctors, and unable to understand what is happening to them. In fact, any patient who enters a clinical trial today has the ability to fully find out about the risks, and to use the Internet and other sources to research the options and become active, informed participants intheir own care. But while cures sometimes result from research, not every cancer patient is going to make it, and not every trial is going to work. That is why they are called trials. Every great advance in cancer therapy has come at a price.

You have in your own backyard one of the premier cancer research centers in the world. My husband and I are proud to be supporters of the Hutch. Our faith in its ethics and its science are unshaken, and I only hope that others in Seattle will respond to this slur on its reputation by increasing their support of Dr. Storb and others at the Hutch who continue to dedicate their lives to finding ways to save others. As for any patient considering treatment at the Hutch, I can only hope your series won't deter them in any way.

Sincerely,
Laura Landro