Michael felt the story would illustrate why the battle against AIDS
was going so slowly. But he began to fret that the story was falling apart
when one scientist after another backed away from admitting a lack of progress.
Curious as to why the researchers had lost the pessimism they had freely
expressed only a few months before, Michael began to push for an explanation.
Then, as part of the Journal's required coverage of a mundane Wall Street security analysts meeting, Michael got the answer.
Such was the trail that led to the 1996 Pulitzer Prize for national reporting going to Michael for breaking the news last year about the dramatic turnaround in the treatment of AIDS, and to six of his colleagues on the Journal for follow-up stories.
The award proves once again the value of a publication having reporters specializing in science and medicine. The stories that Michael broke last year would have been missed by most reporters--and, indeed, were missed by reporters specializing in business and finance even though the evidence was lying under their collective noses.
But Michael's journey to the Pulitzer also underscores the increasing importance of industry and of Wall Street as sources for science and medical news. This is a trend that many science and medical reporters tend to overlook, sometimes to their regret. Far too often the science reporters dismiss an industry-based or Wall Street-sourced story as the province of the business section while the business section discards the same story as the province of the science desk.
Having sat next to Michael for more than 15 years, I had the privilege--and the fun--of watching a dedicated reporter uncover one of the biggest medical stories since the beginning of the AIDS pandemic 15 years ago.
Michael should have gotten the Pulitzer for persistence, if nothing else. He began pursuing the story of the protease inhibitors, as the new AIDS drugs are called, as far back as 1988, long before any other reporter in the field. That was when Roy Vagelos, the chief executive of Merck & Co., was invited to lunch with the Journal's top editors. Such luncheons give executives of leading corporations a chance to update Journal editors on industry trends and developments in their companies--and they help weaken the resistance of corporate executives to dealing directly with the Journal reporters who cover that particular company. Because Merck was on Michael's drug industry beat he sat in on the luncheon.
Inevitably the talk turned to AIDS and why the drug industry wasn't able to come up with an effective treatment. In what seemed an uncharacteristic moment of rashness, Dr. Vagelos predicted that the industry would come up with a powerful new treatment for AIDS within five years. When pressed by Michael, the executive said his confidence was based on a discovery at Merck that would be announced sometime in the next few months. He refused to describe the discovery other than saying it was at a basic research level.
Anyone who knows Michael is aware that he's hardly a laid-back reporter, especially when his editors have been alerted that important news may be breaking on his beat. So he proceeded to make a nuisance of himself at Merck, pestering the PR staff and Dr. Vagelos whenever he could for some tip about the new development. Finally, in February 1989, sources inside Merck advised Michael that company researchers would have a report in Nature providing the three-dimensional structure of the protease enzyme that is critical to the virus's copying process. It was clear that deactivating this enzyme with a drug would block the virus already inside cells from infecting additional cells.
Armed with this tip, Michael persuaded the company to let him talk to the Merck researchers on the record before the paper was published. The 3-D structure, he learned, revealed molecular cavities into which a synthetic drug might fit, thereby blocking the protease from carrying out its job. If the molecule's toxicity was low enough, it might be used as a drug to stop the spread of HIV through a person's immune system. Michael soon learned that Merck and several other drug makers were rushing to develop their own protease inhibitors, and a furious industrial research race was on, the kind of story that the Journal thrives on but few other newspapers attempt.
Thus, when the Nature news embargo lifted, Michael had a definitive piece on page one of the Journal detailing the discovery and its significance. The Journal's competitors either missed the story or downplayed its significance.
As he followed up on the story, Michael uncovered unpublicized but promising research inside Merck and elsewhere to develop drugs to block another enzyme also vital to the HIV, reverse transcriptase, the same enzyme inhibited by AZT. But in the spring of 1992, under a page-one story carrying the flashline, "Stymied Science," he reported that the new reverse transcriptase inhibitor had first produced stunning results but then failed dramatically in its initial clinical trials. Thus, the industry's dwindling hopes of conquering AIDS relied solely on the protease inhibitors.
But barely two years later, Michael told Journal's readers that "Months of high hopes and excitement have suddenly turned to disappointment for Merck & Co. scientists developing a promising new type of drug against the AIDS virus." The first few patients to take the Merck protease inhibitor had seen their HIV levels drop sharply only to return to pre-treatment levels within six months. He reported that the researchers planned to try higher doses of the drug to see if that would help, but he wrote that it looked like protease inhibitors may follow the fate of the reverse transcriptase inhibitors.
Then the roller-coaster life of the protease inhibitors suddenly took a turn up.
In early 1995, Michael reported that the higher doses of several protease inhibitors, combined with AZT-like drugs, had produced the most dramatic response yet seen in AIDS, patients: levels of CD4 cells in some patients had stopped falling, and in others the cells were increasing.
Nevertheless, he quoted researchers, resistance had developed in some patients and the drugs were 'far from a cure.' With Merck, Hoffmann LaRoche and Abbott Laboratories applying for and expecting to get Food and Drug Administration approval to market their various protease inhibitors, Michael decided to make sure that 'hype' about the drugs didn't raise false hopes among the Journal's readers.
Although the drugs were being described as the 'best yet' seen in AIDS, Michael was convinced that disappointment was just around the corner. In the midst of the expected excitement over FDA approval of the protease inhibitors, Michael planned to write a sobering story explaining why the effort to develop a cure for AIDS was going to be long and frustrating.
To this end, he turned first to the industrial researchers, personally visiting several drug company research labs over a three-week period to find out what kind of problems they were running into in trying to develop AIDS drugs. As he interviewed the industry scientists, he pressed for names of the clinicians running the trials of the various protease inhibitors. One reason was that he didn't want to rely wholly on the industry for the story. But he also needed to talk to patients who were using the new drugs to get the kind of color that makes a good science story even better.
After weeks of calling, he was finally able to set up personal interviews with clinicians in Harlem, Newark, Philadelphia, New York and Baltimore, and by phone, at Stanford University, in San Francisco and Los Angeles. Each of these doctors passed along their own surprising, but limited, anecdotal reports of deathly ill test subjects experiencing unprecedented rebounds in their health. Several researchers also were persuaded to introduce him to some of their trial participants, who, in turn, introduced him to others.
Michael knew from experience that in any clinical trial there would always be a few patients who seemed to be helped even by an experimental therapy, even an ineffective one. The anecdotal reports, he assumed, likely were flukes and not indicative of the drugs' true effect--or lack of effect. Each time he heard of another two or three patients being helped by the drugs, he pressed even harder to get the skepticism that would salvage his story on the difficulties of AIDS war.
At this early stage of the trials, the researchers themselves knew only of their own experiences and most were unaware of what was taking place in other labs and in other test groups. Thus, few of them had a sense of how widespread the impact the new drugs might be. Only the company sponsoring each trial had an overall view.
By early May, following three months of reporting, Michael had accumulated impressive clinical data on more than two dozen test subjects, and anecdotal descriptions of still another 20. He still had no way of knowing for sure whether he was hearing only about temporary successes, and he didn't know how many other patients in the trials had failed to respond to the drugs or had relapsed after a response. But he began to suspect that the dramatic results weren't flukes confined to just a few isolated cases. In addition, he learned that several drug makers were now beginning to pull together the same data he had accumulated.
His original story idea, he realized, had gone by the boards. He now faced a difficult decision: Should he go out on a limb and say that a breakthrough in the AIDS war was in the making or should he play it safe and wait until the clinicians and the companies analyzed their data and either presented it at a formal meeting or published it in a peer-reviewed journal?
That's when he picked up hints that the most impressive evidence supporting the new therapy's power was contained in a study sponsored by Merck & Co. But despite weeks of calling and visiting Merck officials and their outside researchers, no one would reveal the data that, he was sure, was hidden in Merck's files awaiting peer review and publication.
One day, the Merck study literally fell into his lap. On most newspapers, one of the more mundane duties reporters have to perform is occasionally filling in on writing obituaries. The Journal doesn't carry obituaries but it does have an equivalent: covering meetings every week where corporate executives tell security analysts what's going on in their companies. Few reporters enjoy sitting through two hours of executives bragging about their earnings per share, their return on equity and what a great job they expect to do for the shareholders next year. But it's one of those chores almost every Journal reporter has to do a few times a year.
Thus, on one fine spring day last year, Merck scheduled such a meeting and one of Michael's science-writing colleagues, Elyse Tanouye, was assigned to cover it. After the financial executives droned through their slide presentation, the company's research executives began their presentation with the usual slides. During the talk on the company's new AIDS drugs, the company momentarily displayed a series of slides whose significance few, if any, in the audience appreciated.
Indeed, when Elyse returned from the meeting and gave Michael paper copies of the slides she mentioned that they contained a brief but seemingly unimportant reference to the new drugs. Michael took the documents home, but it was a few days later that he sat down to examine the presentation to the analysts.
Suddenly, he discovered the data he needed to confirm his reporting. Merck's officials had inadvertently included in their slide presentation a graph of the year-long clinical data for each of 26 patients in the most important study yet undertaken of the new protease drug cocktail. It showed that 90% of the patients who were taking the cocktail had dramatic reductions in their HIV level, many to the point where the virus was undetectable.
One slide, also included inadvertently, showed that one test subject, code-named "142," had gone almost two years on the protease drug alone without any virus detectable in his blood. Michael launched a search for patient 142 and finally tracked him down. He discovered that that 142's surprising success early in the development of the protease inhibitors was the sole reason that Merck hadn't abandoned the drugs back in 1994 when other patients had experienced a resurgence of the virus after only six months of treatment.
Michael was no longer hesitant about what the story was. His immediate editor and the editors on the page-one desk agreed that if the story was as big as it sounded he could have whatever space he needed to tell it.
Under the flashline, "Strong Medicine," Michael's page-one story of June 14 began, "Fifteen years into the global AIDS epidemic, researchers are seeing the first glimmerings of a cure." He proceeded to describe case after case of AIDS patients destined to die in a matter of months suddenly recovering their health. He delved into the history of the new protease inhibitors, taking the reader into the drug company laboratories where they had been developed and into the academic labs where the drugs helped scientists uncover new evidence that made it clear that only a cocktail of medicines could thwart HIV.
And he emphasized the researchers' worries that at any moment the deadly HIV might suddenly begin circumventing the drugs' action.
The story apparently was a little too astonishing for the competition. It got only a minimal 'pickup' the day after it appeared. But over the next few days, as other medical and science reporters made their own inquiries, it began to pop up on other front pages and in evening newscasts. Within two weeks. Michael followed up his initial report with another page-one story about how the drugs' cost and complicated dosing schedule was going to deny the use of the drugs to the poor. In July Michael had the satisfaction of covering the international AIDS conference in Seattle and hearing the data he had included in his story being formally presented. By then, every major publication and network had confirmed it.
The Journal editors, realizing they were well ahead of any competition on the story, mobilized additional reporters to cover stories identified by Michael. (The Journal editors apparently weren't contemplating a Pulitzer since it's well known that the Pulitzer committee prefers to give prizes to individual reporters.) Michael was told to keep reporting the impact of the new treatment. He ended the year with a profile of researcher David Ho and his efforts to produce a cure, just weeks before Time Magazine named Ho its "Man of the Year."
Ironically, there was one editor at the Journal who thought Michael's story was too good to be true. In November 1995, a few weeks before Michael started working on his story about the slow progress of AIDS drug research, David Sanford, a senior rewrite editor on the page-one desk, had sent a note to the managing editor, Paul Steiger. Sanford revealed that he was gay and that he was dying of AIDS, the consequence of a promiscuous homosexual encounter years earlier. He said that he preferred to be open about his illness and impending death rather than letting it become the subject of gossip and speculation on the Journal's grapevine. Steiger not only asked Sanford to work as long as he felt like it, but he complied with Sanford's wishes, distributing his note to the Journal staff worldwide, accompanied with his own praise of Sanford's courage in making the revelation.
While Michael was well aware that Sanford was dying of AIDS, he didn't know that in January 1996, Sanford's physician had put him on one of the new protease inhibitors. Sanford was beginning to feel his health rebound but until he read Michael's story as it was being edited by another page-one editor, he thought it was only a temporary improvement. In November, five months after Michael's first story appeared, the Journal carried Sanford's poignant 5,000-word account of his personal battle with AIDS and the rebound of his health. Now, he wrote, "Thanks to the arrival of the new drugs called protease inhibitors, I am probably more likely to be hit by a truck than to die of AIDS."
Although the Pulitzer went to a Journal team of seven reporters and editors, the Journal itself made clear in its own story of the award that it was the stories by Michael and David Sanford that carried the day.
Jerry Bishop recently retired as deputy news editor of The Wall Street Journal, after covering medical research for the Journal since 1958.
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