In late September, Jeff Gerth and T. Christian Miller of the non-profit investigative news site ProPublica wrote a 10,000-word story, "Use Only as Directed," on the risks of liver damage and death from acetaminophen, the active ingredient in Tylenol. The story also reported that the FDA has been slow to take action that could have prevented some of these illnesses and deaths.
A 6,000-word sidebar, "Dose of Confusion," told a heartbreaking tale of the damage that an overdose of Tylenol can do to children. Miller and Gerth also followed up with a Sept. 23 story reporting the results of a nationwide poll ProPublica commissioned on the public's understanding of Tylenol's risks. The headline read, "Tylenol's Risks Not Fully Understood, Poll Shows." The project included other assorted sidebars and graphics.
The public radio show This American Life did an hour-long show on the ProPublica series the day it came out, relying on many of the same sources, but with some new reporting. And Salon published the results of the investigation for several days after the main story appeared.
This is the kind of massive, industrial-strength investigative reporting that we want to see, and which many journalists and critics fear will decline and perhaps even disappear with the gradual withering of the mainstream media. Peter Osnos, a former reporter at The Washington Post and the founder of Public Affairs Books blogged in The Atlantic that ProPublica's "major–and scathing–investigative series…shows yet again the essential role of investigative journalism in providing public information that can literally save lives." He asked Richard Tofel, ProPublica's president, what the Tylenol investigation cost. This was Tofel's response:
We conservatively estimate the cost of this coverage at $750,000; it could be more. This covers the reporters, news applications and web developers, editors, video production, social media and PR, travel, legal review, half of the public opinion poll etc. It does NOT include any costs of the work at This American Life.
That's mind-numbing figure. Who, Osnos asked, is going to pay non-profits such as ProPublica to do this kind of work?
It's a fair question, but the only answer is: We'll see. Foundations and wealthy individuals might continue to support the many non-profit news sites that have bloomed in the past few years. Osnos, quotes a Pew study that counted 172 nonprofit news sites as of last June.
If such new sites are to continue to attract support, they must do first-rate work. ProPublica is universally admired, and its output is impressive. "Trying to keep up with all of the investigations published by ProPublica," I've written, "is like trying to drink water out of a fire hose."
I'm a great admirer of ProPublica, but it should not be immune from criticism. So it's reasonable to ask: Was its Tylenol story worth the $750,000 it said it spent?
Here are the story's "major takeaways," which appear in a graphic near the top of the mainbar:
1. About 150 Americans die a year by accidentally taking too much acetaminophen, the active ingredient in Tylenol, federal data from the CDC shows.
2. Acetaminophen has a narrow safety margin: the dose that helps is close to the dose that can cause serious harm, according to the FDA.
3. The FDA has long been aware of studies showing the risks of acetaminophen. So has the maker of Tylenol, McNeil Consumer Healthcare, a division of Johnson & Johnson.
4. Over more than 30 years, the FDA has delayed or failed to adopt measures designed to reduce deaths and injuries from acetaminophen. The agency began a comprehensive review to set safety rules for acetaminophen in the 1970s, but still has not finished.
5. McNeil, the maker of Tylenol, has taken steps to protect consumers. But over more than three decades, the company has repeatedly opposed safety warnings, dosage restrictions and other measures meant to safeguard users of the drug.
None of these conclusions is new, as the story itself makes clear. Many of these things have been known for decades. They are surely news to somebody, but they are not news in the narrower sense of new revelations. Indeed, ProPublica's poll revealed that of those who were polled, "80 percent said that overdosing on the medicine could result in serious side effects." Considering the many studies on how poorly many Americans understand science and medicine, 80 percent is probably as close to "everybody knows" as we ever will get. And the 20 percent who don't know might not be among the readership of ProPublica or the listeners of This American Life.
But the most powerful criticism of the story I could find, by far, was this:
All we can say is that only a tiny fraction of people who take acetaminophen appear to suffer injuries or fatalities as a result. Adding up the highest estimates of injuries and deaths linked to acetaminophen would result in a total of a little over 110,000 incidents annually. About 27 billion doses were sold in 2009, the most recent year for which figures are publicly available. If all the pills were consumed, that would mean about one injury for every quarter million doses. In actuality, that almost certainly lowballs the rate of injuries, but by how much, nobody knows.
And who was responsible for this takedown of the ProPublica project? It comes from the ProPublica reporters themselves. It's the startling final paragraph in a sidebar called "Behind the Numbers." You have to read through thousands of words of reporting indicting Tylenol and its manufacturer to get to this graf, which seems to support the argument that ProPublica has made far too much of this story.
I was prompted to question the story's claims by an Oct. 3 blog post by Kevin Anderson on his blog Strange Attractor. In the post "ProPublica, This American Life and acetaminophen: $750,000 to state the obvious," he finds other, freely available public sources for ProPublica's very expensive conclusions. Osnos, he writes, "seems to be equating cost with impact."
Anderson, a journalist who has worked for the BBC and others and who now works for The Media Development Investment Fund, also has problems with the crafting of the story. He concedes that the ProPublica reporters "meticulously documented their points," but writes that they did so "to the point where I think they completely diluted the impact of the piece." He says he loves ProPublica and This American Life, but he worries that "stating the obvious in thousands of words" carries with it an opportunity cost: That is, what other stories might have been written with that money? "In this era of scarce resources, it is even more important to ask what opportunities are foregone because resources are deploying elsewhere," he writes.
The story goes into great detail into the history of Tylenol marketing and FDA regulatory decisions, reaching back more than 50 years. The writers clearly want to show a pattern of behavior by Tylenol's maker, but they could have greatly condensed the history and still made the point.
And the study's "takeaways" are disappointing. The death toll and the narrow safety margin are not a surprise, nor is the idea that the FDA and Tylenol's maker knew of the risks. And we're hardly shocked to learn that the FDA has fallen short of what it might have done, and that McNeil has opposed safety warnings. What is more surprising, perhaps, is that McNeil has "taken steps to protect consumers."
T. Christian Miller, one of the story's authors, posted a sarcastic response to Anderson in the comments in which he highlighted only two of the story's five takeaways–that the FDA has delayed actions that could have reduced the number of deaths, and that Tylenol has opposed safety warnings, which he says were not known "until we unearthed them." Most journalists, Miller wrote in a swipe at Anderson, "realize that going to the 3rd page of Google search results does not constitute shoe-leather reporting." Does Miller mean to suggest that the other three takeaways were available with a Google search?
In his rebuttal, Anderson then argues that some of ProPublica's statistics were incomplete and misleading, and, ignoring Miller's sarcasm, he analyzes the story further, to support his argument. (Miller has not responded as of this writing.)
This story will certainly save lives. All of this is news to some people, and those people might be more careful with Tylenol after reading ProPublica's stories. It's absolutely a story worth doing.
I found the story on the use of Tylenol in children to be far more important and surprising than the main story. Among other things, Gerth and Miller report the following:
The two types of pediatric Tylenol had a counterintuitive difference. Drop for drop, the strength of Infants’ Tylenol far exceeded that of Children’s Tylenol.
Parents who might reasonably think the reverse is true could deliberately or accidentally use the wrong medicine could put their children at risk. I will be checking the labels with my kids, but we don't use Tylenol much–because we know about the safety concerns. We give them ibuprofen.
ProPublica is revered among journalists as a model for journalism in the 21st century, and it deserves to be. Its reporting on the aftermath of Hurricane Katrina, which won a Pulitzer, will be studied in journalism schools for years to come, and so will many of its other projects. The Tylenol investigation was a misstep; the same message could have been conveyed in a 1,500-word, $10,000 story. But it was a rare misstep.
-Paul Raeburn
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