Judges’ comments:
Amy Harmon spins out a rich tale of medical science and how it gropes its way forward to develop drugs that might add weeks, then months and then years to life. At its heart, though, this is a story about ambitious, passionate researchers who cry when a patient relapses; about terribly ill people who manage to joke through their fears when told their illness has returned; and about the altruistic force that compels a dying patient to drive hundreds of miles so a researcher can take a sample of tumor tissue.
A gem of a series. Ms. Harmon expertly reduced complex science into a compelling and moving narrative of resolve and suffering.
1. Provide the title of your story or series and the names of the journalists involved.
“Target Cancer” by Amy Harmon
2. List date(s) this work was published or aired.
Feb. 22-24, Sept. 19, Dec. 27, 2010
3. Provide a brief synopsis of the story or stories, including any significant findings.
“Target Cancer” is a close-up look at the testing of a melanoma drug whose targeted approach to cancer treatment is widely seen as holding promise. Told through the eyes of the doctors and the dying patients involved in the drug’s clinical testing, it illuminates the scientific and ethical challenges of drug development in the dawning era of personalized medicine. And is shows just how much dedication and loss it takes to make even a little headway against cancer. The series ran in five parts over the course of 2010. The first three parts, structured as a serial, portray the roller-coaster of progress and setbacks that marked the drug’s first human trial. Under pressure from the pharmaceutical company that owns the drug to move ahead even with lackluster results, the doctor leading the trial jockeys for a way to test the drug’s full potential. When it finally does begin to melt his patients’ tumors, he must decide whether to bend the trial’s rules for someone he knows he can help. And when patients who have miraculously recovered begin to relapse, both he and they must grapple with the drug’s limitations. In part four, the drug has advanced to the final, randomized trial required before regulators will consider approving it for sale. Two cousins enter this trial, both almost certain to respond to the drug because of the particular genetic mutation in their tumors. One is assigned to get it, the other to a control group that means he never can. The story raises the curtain on a debate raging among oncologists and regulators: has the science behind the new drugs rendered the old framework for testing them unethical? The series’ final installment takes place in a laboratory where scientists are racing to build on the qualified success of the new drug with tumor donations from the very patients who have relapsed. After his death, a patient whose cancer diagnosis had provoked deep regrets about having accomplished so little in his life, provides a key breakthrough in the research. Here again, there is a glimmer of progress, but after a Herculean effort, it seems we are at only the very beginning.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I researched over a dozen clinical trials before I settled on the trial of this drug, owned code-named PLX4032. In that process, I used an online database called clinicaltrials.gov, which lists all ongoing trials, their
sponsors, where they are open and what sorts of patients they are enrolling. Since I knew virtually nothing about cancer when I started, I read lots of scientific journal articles to grasp how molecularly targeted drugs work, how they depart from chemotherapy, why they are considered promising and what are their flaws. In reporting on the results of the drug’s first human trial, I learned how to parse the charts and statistics oncologists use to measure a drug’s safety and effectiveness. I did not need to request any documents through FOIA or public records acts.
5. Explain types of human sources used.
I spent nearly a year interviewing and observing close to 100 people involved in the trial of this drug, including the six oncologists who led it, several of the drug company executives who sponsored it, more than 20 patients who enrolled in it and their family members, and the scientists who sought to build on it. I also interviewed about a dozen cancer researchers who had nothing to do with this trial, but who helped me understand the science and significance of this particular approach to cancer therapy. One of the hardest parts was getting the initial access. I had to persuade the lead investigator that I could be trusted to wait until the trial’s results were reported publicly to write my fly-on-the-wall version of the story. And I had to persuade all six of the oncologists, at high-profile cancer centers like MD Anderson, Sloan Kettering, etc., where sensitivity to federal privacy regulations runs high, to put me in touch with patients. Then, about two months into my reporting, the pharmaceutical company that was sponsoring the trial ordered the doctors not to cooperate with me. Some of them stopped. But the drug company had no control over the patients — they wanted to do anything they could to help others in a similar situation, and they felt telling this story just might.
6. Results (if any).
After part 4 of the series was published in September, Food and Drug Administration officials met with leading melanoma oncologists and patient advocates to discuss the ethical issues it raised about the trial’s design. In consultation with regulators, the company agreed in November to give patients on the control arm the drug after their cancer advanced. (Previously, they had been prohibited from receiving the drug, so as accentuate the potential difference between how long the patients in the control arm lived compared to those who received the drug). Since the drug arrests the advance of the disease for six months on average in the patients it is designed for, it is likely that this change has lengthened the lives of several dozen. Hundreds more who are currently on the control arm will likely follow in the coming months.
7. Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No.
8. Advice to other journalists planning a similar story or project.
In order to dispense any advice, I first need to say that this series was not conceived as an investigative project. Although part 4, the story of the two cousins, did provoke a policy shift from the FDA, I was able to do that story only because I was so immersed in the world of melanoma oncologists from the earlier parts of the series: I knew what they were talking about with each other, I attended their meetings, I was intimately familiar with the drug’s capabilities and limitations. This started out as an effort to explore, in a narrative format, the promise of a new kind of approach to treating cancer. And that is really all I’d say to other journalists — consider “immersion reporting” as a vehicle. Consider reporting important news trends through stories that include suspense and characters that you come to care about, who start with a conflict and achieve some sort of resolution over time. It’s hard to persuade editors to let you do it. It’s incredibly time-consuming. It often doesn’t yield the kind of tangible results that a traditional investigative project might. It’s stressful, because your colleagues are churning out bylines while you’re, say, sitting in someone’s clinic, hoping for a scrap of dialogue or a scene that will advance your story. But if you can find the right tale to illuminate a broader trend, I think this kind of story can be used to convey complex issues in medicine and health policy in a way that stays with readers, because it engages them on an emotional level.