Dr. Bollenbacher | Biology 52

To Believe or Not to Believe
Popular Science Writing

Introduction

Below are excerpts from Sheryl Fragin's article on Gina Kolata's "objectivity" when writing on hot science topics in the New York Times. The excerpts include:

Upon reading these excerpts, we are left with questions. Who is right, Gina Kolata or Sheryl Fragin? Could Fragin be doing what she asserts: following an agenda that would lead to another "biased" report? It is difficult to answer this kind of question short of your delving into the literature to sort out the data yourself. Herein lies a problem with newspaper- and magazine-reporting on topics, including these sciences topics. In fact, the Internet is also replete with reporting of misinformation and bias, and requires vigilance before accepting what you read. Bottom line, we should be cautious about treating popular science writing as authoritative and without bias. --Dr. B

Brill's Content, October 1998: 105ff.

 Flawed Science at the Times

 by Sheryl Fragin

 Pages 105-107:

His words hit the jury like a drug. Even on videotape, Donald Bennett was a commanding witness. Four science degrees, an unflappable doctor's demeanor, a top job at the American Medical Association. He also had once been a pharmacologist for the Dow Corning Corporation, which explains why he was testifying in this breast implant case. Because until the mid-'70s he had participated in a variety of Dow research projects on silicone. Because, as he was telling these jurors in 1995, he had quit in frustration with Dow's limited curiosity about the safety of its silicone products.

 The suit had been brought against Dow Corning and its parent The Dow Chemical Company by Charlotte Mahlum, a Nevada wife and mother who had gotten breast implants ten years earlier, after a double mastectomy at age 36. Initially, Mahlum was thrilled just to look and feel normal again. But in 1990 an array of baffling symptoms began--blinding headaches, fatigue and aching joints, dry eyes and mouth. At the same time, her implants were behaving strangely. Shifting up near her shoulder one day, under her arm the next. The skin covering them would alternate between a yellowish color and black and blue.

By the time Mahlum had the implants removed in 1993, the left one was ruptured and silicone had spread through her body, embedding itself in soft tissue. Her doctor told her that he had suctioned as much of it as he could scrape off her ribs, but that some would remain inside her forever. Pieces of crystallized silicone started pushing through her pores, like slivers of glass. Still, that wasn't the worst of it. She was diagnosed with an autoimmune disorder that brought on bowel incontinence, tremors, and mental confusion. Now she is forced to wear diapers and to get around with a walker or cane. Talking to her on the phone, you'd swear she was pushing 80.

 Although Dow did dispute some of Mahlum's ailments, what was really at issue was whether they had any connection to her implants. The jurors listened to four weeks of scientific testimony. They heard about the latest epidemiological studies that had found implants don't raise the risk of connective-tissue autoimmune diseases, like rheumatoid arthritis or scleroderma. They also heard about the limitations of those studies, and the fact that implant manufacturers had helped finance all of them, for the admitted purpose of using them as a defense in these suits. They heard from doctors who had examined hundreds of implant patients with complaints similar to Mahlum's. And, most damningly, they heard about studies that Dow itself had done on silicone--and later kept secret--that showed it to be an effective insecticide, an immuno-stimulant, a cell irritant. It took the jurors only a few hours to decide unanimously against Dow.

 It took the press barely any longer to decide the jurors were too dumb to understand the evidence.

 A Detroit News editorial, "Greed Triumphs Again," argued that the Mahlum jurors had "rendered meaningless basic principles of science and law." Newsweek declared the facts "no match for Mahlum's neighborly appeal." As the Rocky Mountain News saw things, "It made no difference to the plaintiff, her attorneys, the judge, or the jury that all of the major scientific studies of the past few years have found not one iota of evidence that breast implants cause connective tissue disease..."

 The theme of much of the commentary--greedy plaintiffs, an out-of-control tort system, so-called junk science--had been playing out in the media since the summer. Ever since, in fact, The New York Times's Gina Kolata wrote a 3,300-word piece on June 13, 1995 titled "A Case of Justice, or a Total Travesty?" about what she called the "growing waves of panic whipped up by lawyers eager for huge fees" that dragged Dow Corning, "a large and thriving company," into bankruptcy.

 "I think she singlehandedly turned the tide in favor of Dow Corning," says John Byrne, a senior writer for Business Week and author of Informed Consent, a book about Dow's history with breast implants. "All those years Dow created, sold, marketed these devices and didn't have the studies to prove they were safe. And then you have Gina Kolata contending that Dow has been convicted on junk science."

 As a science reporter for what is arguably the most important science-news forum in the country, if not the world, Gina Kolata has tremendous influence. Her stories run verbatim in some of the 350 news outlets that subscribe to the Times wire service, and many more adopt her point of view in their own reports or even quote her. That's not counting the doctors and scientists who rely on her summary of a study before their medical journals arrive in the mail, and sometimes after. It's not at all unusual for a scientist to say in an interview, "I never read the study, but based on what I saw in the Times ..."

 Silicone breast implants were suspended from the market by the Food and Drug Administration in 1992, a time when thousands of women were complaining of the kinds of symptoms seen in autoimmune diseases. Two years later, the first of the epidemiological reports began coming out. In May and June 1994, there were two new studies looking at large groups of women to see whether silicone implants cause scleroderma, which can harden the skin and cripple internal organs, or other connective-tissue autoimmune diseases. Both found no evidence of a relationship.

 It was at this point that Kolata seemed to begin making up her mind. In her June 16, 1994 piece about the latest study, from the Mayo Clinic, she presented the findings as fairly conclusive, particularly when lined up next to similar results from the universities of Michigan and Maryland. The only voices of disagreement--at least included in the story--were plaintiffs lawyers who "angrily insisted that the evidence that implants cause harm was as strong as ever."

 What she also left out was that the Mayo and Maryland studies took funding from the American Society of Plastic and Reconstructive Surgeons Inc., a group that not only funneled more than $1 million from implant manufacturers into grants under its name, but consulted with those manufacturers and their lawyers about which studies to support. The lead scientist on the Maryland study even agreed to alter his research protocol "in response to the thoughtful critique provided by scientists at Dow Corning," as he himself put it in a friendly letter to the company that later came out in court. As for the Michigan study, it was financed by Dow, something Kolata did note in a previous piece but not in this one.

 It is important to say here that drug and chemical makers routinely underwrite studies of their own products or relevant issues, and scientists at universities can gratefully accept such funding without selling their souls. But the implant studies were being done in the midst of litigation, making the money trail rather pertinent. And Kolata was scrupulous about pointing out any money a scientist might have taken from the plaintiffs' side.

 These kinds of criticisms, implying that she somehow favors one side over another, both offend and irritate Kolata, who believes they come from "people with agendas" who know nothing about the subject matter. "My only concern is with whether there is a body of scientific evidence to support an assertion and, if so, what the science says," she explains in faxed answers to prepared questions, the only way she would agree to comment for this article. (See sidebar.) "Sometimes, however, groups who are convinced of a hypothesis in the absence of scientific evidence have tried to make me the issue when I have reported that evidence is lacking."

 According to her detractors--and there are many, among scientists, doctors, and fellow journalists covering the same beats--she is precisely the issue. Her opinions seem to color a lot of her stories, particularly those on highly charged topics like breast implants. "I think what happened with Miss Kolata was she began selecting sources who echoed her point of view," says Norman Anderson, an associate professor of medicine at Johns Hopkins University and chairman of two FDA panels that looked into the safety of breast implants. "It's my belief that she began reporting editorials as news. I also was really disturbed when I saw the credence she gave to the spinmakers at Dow Corning, as opposed to the FDA."

Page 107:

 Throughout Kolata's controversial decade at the Times, there has been endless speculation about her "motives" for leading readers down the particular paths she chooses. She has been accused of propping up the medical establishment and drug companies (in a recent article in The Nation), of hyping stories to promote her own book projects, of carrying out this or that political agenda. None of this really holds up against her body of work or the obvious sincerity she has for her craft. If Kolata can be accused of any allegiance at all, it is to a narrow and traditional view of scientific evidence, where nothing is real until documented by large epidemiological studies or lab experiments.

Pages 108-110:

 In fact, there were many scientists and doctors who kept pointing out the flaws in the epidemiological studies, which by 1996 also included two Harvard studies. The chief objection: All of the studies focused on classic connective-tissue diseases, like rheumatoid arthritis, lupus, or scleroderma, even though most of the women's complaints fell into a new category that didn't typify any known disease. What you don't look for, critics argued, you won't find. The other major problem was that all but the second Harvard study were too small for such rare diseases to show up anyway.

 As for that larger Harvard study, it had "so many problems," says Sander Greenland, a professor of epidemiology at UCLA who is currently working on a new silicone study funded by Dow. "The response rate was so low, something like twenty-five percent. We don't know who responded--whether women who had problems were overrepresented, or whether their lawyers advised them not to respond.... What do you make of such a study? You certainly can't say there is no effect."

 FDA scientists, including then-commissioner David Kessler, echoed those objections in a report published in the Annals of Internal Medicine in April 1996. Reviewing all of the breast-implant literature to date, they documented the flaws in each study, concluding that none was adequate to rule out a link to either classic or atypical diseases, although there probably wasn't a large risk of the classic ones.

 Kolata, on the other hand, reported on every new study as if it were unassailable, arguing today that none of them would have passed peer review if they were so troubled. When the first Harvard study came out, she caged it the most "definitive" one yet--so "compelling" and "consistent" with the others that some leading rheumatologists believe the issue "can now be considered closed." (In case there was any doubt about Kolata's influence, a Chicago Tribune columnist, Joan Beck, had this to say three days later: "The results are so definitive and consistent with earlier research that many health experts now consider the case closed.")

 By contrast, Thomas Burton's June 22, 1995 story in The Wall Street Journal pointed out the study's limitations, including a caveat written by the Harvard authors themselves: "our study cannot be considered definitively negative." Burton also saw fit to note that Dow Corning had retained one of the authors as a consultant and subsidized the tuition of a second and the salary and benefits of a third. Kolata only mentioned funding from the National Institutes of Health, even though the Dow connection was spelled out on the front page of the study. In fact, that link was even stronger: Brigham and Women's Hospital, Harvard's partner in this and the larger study, had received $9.7 million in research grants from Dow Corning in 1994 and a $1.2 million gift in 1992.

 Kolata will not address the details she left out, except to repeat that "the study was financed by the National Institutes of Health." And once again, her editor at the time isn't bothered by her reporting choices. "I didn't study [Burton's] stories carefully, so I can't comment specifically," says Wade. "But one would expect the Journal would put more emphasis on the money side of an issue, and we would focus on the science."

 Sticking strictly to the "science," there was another issue that got lost in the smoke. Didn't the opinions of doctors who actually examined these women count for anything? All of the epidemiological studies were done from records and questionnaires, and researchers often don't see patients or hear the litany of familiar complaints: joint aches and fatigue, dry mouth and eyes, thinning hair. Nor do they see the masses of silicone that harden in up to 70 percent of the women's chests over time. "Any physician who's seen a dozen of these women knows there are illnesses caused by implants," says Gary Solomon, associate director of rheumatology at New York University's Hospital for Joint Diseases Orthopaedic Institute.

 Solomon sees a lot of women with implant problems, often by referral from lawyers, which landed him in a September 1995 story by Kolata and Barry Meier about doctors and lawyers cashing in on implant suits. Ironically, Kolata had written about Solomon eight years earlier--that time as a hero who solved an AIDS medical mystery. "In the breast implant litigation, it was mandated that if you wanted to file a claim, you had to see a rheumatologist," he says. "Then anybody who has seen them in that situation is painted as biased. Some of the people they consider to be experts have never seen patients with the illness."

 Needless to say, Solomon wasn't pleased to find himself lumped in with doctors running diagnosis mills, his name juxtaposed against the "large numbers" of patients he'd seen and the "lucrative" nature of the business. "I included him because he was so well-known as a doctor whom the lawyers relied on to help make their cases," explains Kolata.

 "I want to be fair; I've read Gina Kolata's stories for years and she's been an excellent and capable reporter," Solomon says. "She's done a very good job in stories that aren't politically charged. But on the breast-implant issue I think she has an agenda, and her stories are all geared toward proving it. She has consistently failed to present any of the science behind the problems with silicones and instead has chosen to focus on abuses in the legal and medical systems."

Page 113:

 On March 19, 1996, Kolata stepped into yet another fray. A new book was creating a buzz with its frightening premise: Many common chemical products, even ones as seemingly innocuous as plastic wrap and dental sealants, were capable of mimicking our natural hormones and causing profound health problems. Until then, the press on the book--by zoologist Theo Colborn and John Peterson Myers, and science reporter Dianne Dumanoski of The Boston Globe--had been mostly favorable. Articles in Time, Business Week, The Wall Street Journal, and U.S. News and World Report treated Our Stolen Future as an important if controversial work, often comparing it to Rachel Carson's Silent Spring. The National Academy of Sciences took the subject seriously enough to devote a two-day conference to hormone mimics, also known as endocrine disrupters, just before the book was released.

 Kolata, on the other hand, saw it as more junk science. In the lead paragraphs of her first of two stories about the book that day, she framed the debate as activists and celebrities versus credible scientists, a technique she used to great effect in her breast-implant stories. Although she granted that the book was endorsed by "several" biologists and toxicologists, she never allowed any of them to speak. Instead, she handed most of the story over to critics, introduced as "leading scientists."
 
 

Pages 113-114:

 Kolata devoted a separate story on March 19 to what is by far the most contentious piece of the debate--whether sperm counts are falling, and whether it has to do with hormone-mimicking chemicals. The issue was first raised in 1992, when Danish researchers concluded that sperm counts had dropped significantly over the past half-century, based on data from 61 studies in various countries. This was followed by local studies in France, Scotland, and Belgium that came up with similar results.

 In her piece, "Sperm Counts: Some Experts See a Fall, Others Poor Data," Kolata again collected some "leaders in the field" to dispute the reports in Our Stolen Future, and again neglected to contact any scientists in defense. Her introduction was withering: "Overnight, say many male-infertility experts, and largely on the basis of one controversial paper, a conviction has been born. Just as DDT caused birds' eggs to shatter, proponents of the theory say, something in the food, or water or perhaps the plastics people use with such abandon is decimating sperm counts."

 As her experts correctly pointed out, none of the studies was ideal. Working with sperm isn't like analyzing blood; the only places to find samples are places that can bias the study. Sperm banks, for instance, don't keep many specimens from infertile men. But the new studies that Kolata countered with were also flawed, though this time there was no mention of "serious methodological problems."

Page 114:

 Among the scientists who have never appeared in any of Kolata's pieces are Skakkebaek, the authors of the other European studies, and Swan, who was asked by a National Academy of Sciences committee to make sense of all of the contradictory evidence. Swan went back to the original data from the Danish report--all 61 studies--and set out to control for every criticism ever raised. To address the biggest concern--that most of the early numbers were just from the U.S.--she mapped separate curves for the U.S., Europe, and elsewhere.

 In her preliminary report to the Academy, Swan suggested that Skakkebaek was wrong. "I thought the criticisms that were raised were reasonable, and that probably the criticism would explain the decline," she says. But what Swan found surprised her. In both the U.S. and Europe, the declines were even steeper than in Skakkebaek's report. As for other areas, there wasn't enough data to say.

 When Swan published her analysis last November, The Washington Post, Newsday, the Chicago Tribune, and other newspapers ran stories. Kolata, who has had more to say on this issue than almost any other reporter, never mentioned it.

 It is just this kind of seemingly selective reporting that convinces critics Kolata has an agenda. Because, even though she claims only to care about distinguishing between anecdotal evidence and controlled studies, she very often ignores controlled analyses like Swan's that don't support her point of view.

Page 115:

 A big part of the problem is that she keeps trying to force a conclusion onto stories that are still unfolding. In the "Week in Review" section after the Harvard study came out, Kolata wrote, "One more environmental scare bit the dust last week..."

Page 115:

 It's ironic that it was Kolata who created such a fuss in May with her excitement over Judah Folkman, the cancer researcher who came up with the ingenious idea to focus on a tumor's food supply rather than the tumor itself. (See sidebar.) For most of his career he was ridiculed, rejected by scientific journals, denied grant money. Now he's mentioned in the same breath as Charles Darwin. As big as the cancer story is, maybe Folkman's bigger contribution to science reporters like Kolata would be to persuade them to keep an open mind.