How The Chicago Tribune used ‘rock-solid science’ to shake up pharmacies

The day before President Donald Trump’s chief strategist advised the media to shut up, Chicago’s leading daily newspaper reminded its audience exactly why good journalism must keep talking.

The Chicago Tribune detailed Illinois Governor Bruce Rauner’s proposal for broad regulatory changes to how pharmacies alert their customers to dangerous drug combinations—the most recent result of the Tribune’s “Dangerous Doses” series. The Tribune’s top investigations editor said the project, which culminated in December with a sweeping indictment of the pharmaceutical industry, was one of the largest and most extensive undertaken by the paper in the past two decades. Rauner credited the Tribune with revealing “deficiencies in the state’s current pharmacy system that put patients at risk.”

At a time when many scientists and journalists believe the reception to their work to be unfairly politicized, the Tribune’s investigation is an unequivocal success. “Dangerous Doses”—a finalist for the annual Goldsmith Prize for Investigative Reporting—hinged on a unique collaboration between journalists and scientists that enabled the Tribune essentially to conduct its own scientific investigation. The impact of that investigation is a credit to the Tribune’s reporting as well as to the science that supported it.

The three-part investigative project focuses on hidden interactions between prescription medicines that could have life-threatening consequences if taken together. The first of the “Dangerous Doses” series, published a year ago, identified four potentially unsafe drug combinations; one pairing, according to the report, “blocked an electrical channel crucial to the heart.” The second story focused on a woman whose drug combination of Lamictal and Depakote left her legally blind and fighting for her life. Neither the doctor who dispensed her medications nor the pharmacist who filled her two prescriptions warned her of the potential risk.

For the final story in the series, a Chicago physician wrote prescriptions for drugs with dangerous interactions and gave them to the Tribune. Led by reporters Sam Roe, Ray Long, and Karisa King (who has since left the paper for a position as investigations editor at the Las Vegas Review-Journal), the Tribune dispersed those prescriptions among 15 staff reporters. At each of the pharmacies that reporters visited—in Chicago, downstate Illinois, and neighboring Indiana, Wisconsin, and Michigan—reporters presented prescriptions and noted whether pharmacists warned them of potential drug interactions. Although they did not identify themselves as journalists, the reporters used their real names and answered questions truthfully. The filled prescriptions were collected and stored in a secure location.

In all, the Tribune tested 255 pharmacies; of that number, 52 percent failed to provide reporters with adequate warnings.

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“We set out to do this as scientifically as possible. In order for this to work, to impact the country, it had to be extremely scientific and solid in every way,” Roe says. “We felt that, if we hadn’t done this, there was good reason to believe that people would be harmed unnecessarily. That pushed us forward. It was a public service.”

The impact of the pharmacy investigation was quick. CVS, Walgreens, and Wal-Mart, whose pharmacies were tested as part of the project, “vowed to take significant steps to improve patient safety” at their stores nationwide, according to the Tribune. “Combined, the actions affect 22,000 drugstores and involve additional training for 123,000 pharmacists and technicians.”

In the days following publication, the National Association of Boards of Pharmacy, the nation’s top association for pharmacy regulators, called on states to enact laws requiring pharmacists to counsel those patients who pick up medications that could be dangerous if taken together. (State laws vary as to whether pharmacists are required to offer counseling or simply ask patients if they have questions, the Tribune reported.)  In Illinois, Rauner, a pro-business Republican, ordered state agencies to figure out how to hold pharmacies accountable. Lawmakers have begun drafting legislation that would set minimum requirements for staffing at pharmacies.

“There’s no way Walgreens or Wal-Mart [were] going to make substantial changes to the way they do business unless this piece was…not just rock-solid journalism, but rock-solid science,” Roe told me during an interview at Columbia College Chicago, where Roe and I are co-teaching a graduate course this spring on legislative and investigative reporting. “This is why it took so long.”

Often, when a news organization reports on a scientific finding, it will seek out qualified scientists in the relevant field to explain the finding’s significance. The Tribune distinguished itself by performing its own independent testing and analysis, says Deborah Blum, director of the Knight Science Journalism Program at MIT. She notes that Consumer Reports accomplished something similar in 2012, when it analyzed arsenic in apple and grape juice and found that children were being exposed to unhealthy levels of the poison.

When journalists produce their own science, “my feeling about it is that it’s really unusual and it’s really a powerful tool,” Blum says. “In the right circumstances, I’d love to see us do it more often.”

George Papajohn, the Tribune’s assistant managing editor of investigations, says that, in the past, the Tribune typically outsourced its scientific work—for instance, sending toys to a lab to be tested for lead or fish samples to be tested for mercury. “Then you’d await the results,” he says.

For “Dangerous Doses,” the Tribune worked with data scientists, pharmacologists and cellular researchers and “used novel data-mining techniques to identify four drug combinations associated with a heart condition that can lead to a potentially fatal arrhythmia,” Roe explained in a first-person account for CJR last year. “In the process, the team created an innovative scientific model with the potential to flag hundreds of additional drug interactions, offering a new way to protect patients and save lives.”

Papajohn says that approach distinguishes “Dangerous Doses” from previous investigations. The Tribune journalists, he says, were “actually helping to think about how the scientists should approach the work and in some cases looking over their shoulder. It was much more of a collaboration.”

Jeff Lyon, a 34-year veteran reporter at the Chicago Tribune who won a Pulitzer Prize in 1987 for a medical series on gene therapy, says the Tribune has a long history of consumer-based science reporting. That work is particularly important now, when so much of the public is questioning science and the media, he says.

Our job is to try to educate people and, between the smaller budgets and the increasing resistance by a large segment of the public to understand the realities of science, it’s making it very hard,” he says. The more that news organizations report on global warming and species becoming extinct, “the more people turn a deaf ear because they think we are lying or don’t know what we are talking about.” That frustration is likely shared by journalists and scientists, says Lyon.

Such resistance makes journalism—and science journalism, in particular—more urgent than ever, says Lyon.

“I think we have to pile on,” he says. “We have to keep going and get the message out there and work with scientists.”

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Jackie Spinner is CJR’s correspondent for Illinois, Indiana, Ohio, and Wisconsin. She is an associate journalism professor at Columbia College Chicago and a former staff writer for The Washington Post. Follow her on Twitter @jackiespinner.