The fact that this kind of scurrilous trash is being considered for a big journalism prize is really shocking to me.

Edward A. Clark, Ph.D.
Professor of Microbiology
and Immunology
University of Washington
Seattle

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I've worked on clinical trials for more than 22 years, which including stints in both cancer institutions cited by Ms. Landro. I also have a keen interest in how health-care issues are reported.

Sensational reporting on only parts of a story from 20 years ago is obviously absurd. Unfortunately, many people who read these articles in the Seattle Times translated the reports to mean that many of the cited problems with trials are problems at the Hutch today. This is far from the truth. Subsequently, as Ms. Landro reported, reputations were damaged and people were hurt.

There is no doubt that there is a role for the media to bring problems concerning clinical trials to the nation's attention. However, it needs to be done in a more professional manner than the Seattle Times's series. The Hutchinson center is by far the most ethical health-care institution I have worked in.

Stephanie Mehl
Seattle

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As someone whose mother died in 1993 while participating in one of the experiments at the Hutch that was the subject of the Seattle Times's article, I disagree strongly with Ms. Landro's accusations, and believe the articles to be fundamentally true and courageous.

In support of her arguments, Ms. Landro notes that she had a positive experience at the Hutch when she received a bone marrow transplant in 1992. While this may be true, it does nothing to undermine the legitimacy of the Times story about many patients, including my mother, who were misled or not given critical information when deciding to participate in the clinical trials in which they died. In my mother's case, she was promised a rescue drug that, it was hoped, would allow her to tolerate what was otherwise a lethal dose of chemotherapy. But she was not told that the drug was not available in intravenous form -- the only form she could tolerate.

Ms. Landro also argues that because other research institutions were conducting studies in the 1980s that were similar to the T-cell depletion experiments at the Hutch, the Hutch must have done nothing wrong. She does not discuss how those other institutions carried out their studies, but if they, like the Hutch, were failing to inform patients of the risks of those studies, and of less risky alternative treatments, hopefully they will come under similar scrutiny. She also notes that prior investigations of certain of these experiments found no wrongdoing, but the more detailed analysis in the Times articles shows these investigations to be superficial, at best.

The numerous articles that have been published in the last few years documenting the problems with and dangers of clinical research have indeed caused some skepticism. Ms. Landro worries that this will have a chilling effect on clinical research. Perhaps. But the fact remains that studies have shown that most people participating in Phase 1 drug studies -- which are designed for sole the purpose of determining the toxicity of the drug being studied -- participate with the hope that the "treatment" will make them better.

Clinical research is, of course, vital to medical advancement, but noble goals do not justify careless means. The Times articles exhaustively documented that in certain clinical cancer trials at the Hutch, patients were not fully informed of known risks of the experiments in which they died, and were not given full information about alternative therapies.

Chris Addicott
Seattle
(Mr. Addicott is a business and real estate attorney, and is the author of "Regulating Research on the Terminally Ill, a Proposal for Heightened Safeguards.")

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As a recent transplant patient treated at the Hutchinson last year, I can tell you I have the utmost respect for the oncologists and support personnel. I was part of a new clinical trial for multiple myloma that uses a new protocol to try to reduce not only the return of the cancer but also the mortality from graft vs. host disease. It is an ongoing battle to find better ways to treat cancer and reduce the toxic side effects that still kill many patients even today.

William N. Stokes, D.D.S.
Roanoke, Va.

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As a cancer survivor and someone whose interest in medicine takes several forms -- such as establishing philanthropic ties to institutions -- I applaud Ms. Landro's article. The media has long been known to favor the sensational over the factual. But when it comes to reporting on medical research trials, journalists must be careful to think about the second and third order of consequences. If patients become too frightened by irresponsible journalism, all of us suffer without the valuable information those trials afford the medical field. The more we are able to learn, the more lives will be saved in the future.

Amy Perella
New York
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Credit goes to Ms. Landro for setting the record straight on what is best described as shoddy reporting by the Seattle Times in relationship to the Fred Hutchinson Cancer Research Center.

Over the past 20 years, I have had the honor to work with many physicians and scientists at the Hutch. To a person, they are impeccable individuals who are devoted to their research and dedicated to the patients they treat. Their clinical innovations have saved countless lives in a field that has historically had dismal results.

Unlike the investigators at the Hutch, the Seattle Times reporters appear to have started with a conclusion, generated a hypothesis, misrepresented the data and concluded what they had always assumed. This is not the scientific method, nor should it be considered journalistically acceptable behavior.

Roger W. Evans, Ph.D.
Rochester, Minn.

REVIEW & OUTLOOK (Editorial)

Tort-Lawyer Journalism

Any significant challenge to the accuracy or fairness of an entry, such as published letters, corrections, retractions, as well as responses by the newspaper, should be included in the submission.

-- from Pulitzer Prizes, How to Submit an Entry

The other day we devoted nearly a complete letters column to a lecture on our journalistic responsibilities from Michael R. Fancher, executive editor of the Seattle Times. He rambled on about this and that "irony" in an attack by our Laura Landro on his newspaper's series "Uninformed Consent," which is reportedly a finalist for a Pulitzer Prize.

The biggest irony, it seems to us, is that we published Mr. Fancher's Letter to the Editor. The Landro piece to which he objects is an elaboration of a Letter to the Editor she submitted to the Seattle Times a year ago; the Times refused to publish her views in its letters column. If it had, according to the rules quoted above, it would have had to include her letter with its Pulitzer submission. That the spirit of this rule can be evaded by not publishing a strong challenge is an irony the Pulitzer Board might want to ponder.

The burden of "Uninformed Consent" is an allegation of improper paperwork in medical studies done nearly two decades ago at Seattle's Fred Hutchinson Cancer Research Center. The "informed consent" forms did not describe the risks of the experimental procedures, it argues, and 80 of 82 leukemia patients died. The dead patients are not in a position to explain what their doctors told them or what was in their minds in consenting. The forms are written for lawyers, and contingency-fee lawyers are now suing the center on behalf of the patients' heirs.

The suits were not filed, Mr. Fancher pathetically explained, until after the expose was published. Yes, the ambulance went by back in 1985, and was pretty much forgotten until the Times dug up the tracks, along the way applying to the older trials today's medical knowledge and informed-consent standards. Even accepting at face value Mr. Fancher's explanation of his reporter's role as an intermediary between heirs and lawyers, what we have here is an example of tort-lawyer journalism.

Journalists often find themselves in alliance with the plaintiff's bar because both are propelled by the evidence of dramatic anecdotes. It scarcely matters that carefully conceived experiments find that, say, the morning-sickness drug Bendectin does not cause birth defects, or that silicone breast implants do not produce auto-immune disease. Wave a deformed child or suffering implant patient before a reader and you have a headline-grabbing story. To the plaintiff's bar, you also have a potential class-action jackpot.

In medical research this is a heavily tilted game. You can find anecdotes about the patient who was injured by an experimental drug. You cannot collect anecdotes from patients who would have been helped by the same drug but were denied access to it because of safety fears. The Seattle Times series largely concerned a failed medical experiment. Doctors had reason to hope that removing T- cells from bone-marrow transplants would stop graft-versus-host reactions; instead they found that such transplants usually did not help (though they are still used in certain applications).

So we now have heirs and their lawyers to speak for leukemia patients who were not helped during one medical dead end. But we typically would have no one to speak for leukemia patients who benefited from the larger thrust of the same research. This is where Laura Landro comes in.

In 1991 she was diagnosed with chronic myelogenous leukemia, a dread form of the disease. She researched the disease and its treatment, including the T-cell depletion experiments of which the Times wrote years later. Though a resident of New York with several excellent cancer centers, she chose to travel to Seattle to be treated at Hutchinson. The marrow transplant worked, and she went on to write a book, "Survivor: Taking Control of Your Fight Against Cancer."

According to Mr. Fancher's idea of journalistic ethics, this makes her unfit to write about the issues raised by his series. She not only succeeded in her fight with cancer but established herself as an assistant managing editor of this newspaper. But since she owes her life to the center, she is biased in its favor. She replies, "This is insulting, patronizing and also, frankly, sexist -- as if I am some bubbleheaded woman who can't separate emotions from professionalism."

Mr. Fancher finds no bias, however, among heirs with a potential financial interest in speculative lawsuits about deaths back in 1985. But for the record: The Seattle T-cell depletion experiments were part of a national and international trial; Hutchinson was the first center to discontinue its part of the trial. The disgruntled former employee who was the principal source of the Times series also complained to medical authorities, but a two-year investigation by the National Institutes of Health found no material ethical violations. A letter from the Institute's Office of Protection from Research Risks can be found on the center's Web site.

We are concerned with this issue on two levels. One is journalistic professionalism; it is not a credit to our craft that "Uninformed Consent" has already won several journalistic awards. But even more seriously, we have long felt that medical research needs to be liberated, not inhibited. Some experiments will fail, but more patients will suffer if medical advances are tied up in lawsuits or medical bureaucracies.

We are on the side of patients who need and want advanced, if speculative, technologies -- that is, of the patients for whom Laura Landro speaks so eloquently

REVIEW & OUTLOOK (Editorial)

Righteous in Seattle

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.

Readers who want to see Ms. Landro's letters in their entirety, as well as Mr. Fancher's note to us and an independent scientific review of the Times' cancer series, can find them on our Web site, OpinionJournal.com

Some thoughts on the Uniformed Consent articles

The authors of these articles do not appear to really understand BMTs, or how clinical trials works. They take items out of context and use them to support their views. It certainly seemed to be the case that there was the appearance of conflicts of interest between Hutch doctors' financial interests and the interests of their patients, but it did not seem to me that there was a "smoking gun" polant