Tough Love

Last week, editors at The New Republic found out they had dodged a bullet: Rolling Stone is getting sued by D.A.R.E., but they're not. In the complaint against Rolling Stone, lawyers for the drug education program explain why: in California, where the suit was filed, there is a one-year statute of limitations on libel suits, "or else The New Republic would also be a defendant in this lawsuit."

First The New Republic, and then Rolling Stone, ran critical stories about D.A.R.E. by Stephen Glass, the lovable rascal who turned out to be a total fabricator. But by the time he confessed last May, The New Republic story was a year old— which means the mag was saved by the bell.

Or was it? Sources familiar with the case say it didn't hurt that The New Republic's editor, Charles Lane, published humble retractions in the June 1 and June 29 issues. "We are not proud of the fact that Glass's falsehoods ever made it into our pages," he wrote, and later itemized Glass's fabrications about D.A.R.E. and repudiated the substance of his work.

Meanwhile, Rolling Stone stood by the story, repeating the claim that D.A.R.E. and its supporters used intimidation tactics to silence their critics, even though most of these allegations were based on fictitious sources. In the July 9­23 issue, the editors wrote, "To date . . . we have found nothing to contradict the essence of this piece." By then, D.A.R.E. had sued Glass, who later tattled to D.A.R.E. lawyers about both magazines' editorial processes, and wrote a craven apology letter of his own.

The only one who has yet to eat humble pie is Rolling Stone managing editor Robert Love, who released a defiant statement in response to the D.A.R.E. suit filed February 2, calling it "little more than an attempt to intimidate and discourage legitimate debate."

Rolling Stone is expected to fight the suit on First Amendment grounds.


Smart Pills

Obsessive readers of The New Yorker may have noticed a new genre lately. This hybrid is not quite fact or fiction, but rather a "dispatch" delivered from the cutting edge of science and industry.

Whether these stories appear under the label Medical Dispatch or Annals of Medicine or A Critic at Large, and whether the byline is Dr. Jerome Groopman, Dr. Atul Gawande, or Malcolm Gladwell (all-around spin doctor), one could argue the dispatches share a distinct narrative style.

Rather than cite authorities, the narrator is the authority, a priestlike figure addressing the reader from a vantage point so lofty and removed there is no room left for ambiguity or debate. (As if anyone would dare to question a soft-spoken gentleman who hurries by in a white coat.)

Indeed, dispatch writers are considered omniscient. And why not? With their elite education and inside connections at Harvard Medical School, they are uniquely qualified to schmooze the best experts and to vacuum up a vast library of scientific literature at a moment's notice.

A study of the dispatch genre reveals certain hypnotic techniques, such as delivering information without revealing its precise source. For example, see the February 8 dispatch by Gawande, titled "The Cancer- Cluster Myth." Gawande's obvious aim was to debunk the myth, that is, the notion that environmental agents might be the cause for cancer outbreaks in a residential community. (One such "myth," he implies, is the basis of the movie A Civil Action.)

It's true that few of these investigations have panned out. But in a sweeping generalization, Gawande writes that given the "exceedingly poor success rate of such investigations, epidemiologists tend to be skeptical of their worth." Thus, he claims the existence of a consensus on the proposition that cluster investigations have no value— while naming only a single epidemiologist as his source. The claim makes more sense if you know that Gawande works at the Harvard School of Public Health, where epidemiologists— and cluster skeptics— abound.

Gladwell pulled a similar move in a January 11 Comment, blaming A Civil Action for feeding the public's appetite for simplistic narratives. Moving to other popular misconceptions, he wrote, "There is little or no reason to believe that breast implants cause disease of any kind." But he obscured the source of this conclusion, referring first to some specific studies and then to an unnamed "independent scientific panel, appointed by a federal court," which reached the consensus.

Another piece in the anti-tort series is Gawande's February 1 "Medical Mistakes," which combined high-stakes emergency-room scenes with the argument that malpractice litigation doesn't prevent doctors from screwing up.

Taken together, these pieces seem designed to send a subliminal message to plaintiffs who want to sue over anything from chemical spills to incompetent doctors: the courts demand rigorous proof, and it usually isn't there, so don't bother.

The dispatch writers have every right to align themselves with defendants in civil actions. But they may have lost some objectivity in their zeal to pursue this agenda. In the January 11 Comment, Gladwell criticized the book A Civil Action for labeling trichloroethylene as a known carcinogen. In fact, the book called the cancer link inconclusive. Gladwell was forced to acknowledge this error in the January 25 letters section.

Another job for the dispatch writer is that of pharmaceutical cheerleader. Consider "Superaspirin," which appeared in the June 15, 1998, issue. The subject was Celebra, a promising drug being developed by Monsanto to treat inflammatory ailments such as arthritis. The author, Jerome Groopman, is a professor of immunology at Harvard Medical School, which may help to explain why he found a place in The New Yorker to puff Dr. Lee Simon, a Harvard colleague who helped design Monsanto's clinical trials for Celebra.

Simon appears late in the piece, injecting cortisone into Groopman's elbow (dispatch writers often make a cameo appearance). "Celebra is incredible," Simon tells his patient, pointing out that more than 10,000 people have received the drug— with no observed side effects. At the end of this narrative infomercial, Groopman works in a disclaimer. "It seems too good to be true," the patient-narrator tells the doctor, whereupon the doctor concedes that before it can be deemed safe, Celebra must be studied over several decades.

No such hesitation for Malcolm Gladwell, who displayed his knack for writing ad copy in "More Ritalin!," a story that received top billing on the February 15 cover flap. Ritalin is used to treat attention-deficit hyperactivity disorder, or A.D.H.D., in children; 30 years ago it replaced amphetamines as the preferred medication for A.D.H.D.

The piece appears to be a review of three recent books about Ritalin. But by the end of the first page, Gladwell makes mincemeat of the books, because their authors do not subscribe to that school which believes psychiatric disorders are rooted in biological causes and best treated by psychopharmacology alone.

The review quickly segues into an essay on the cutting edge of A.D.H.D. treatment. "My role in this," Gladwell said in an interview, "is I am interpreting the views of the leading experts of the day on this drug and this disorder."

To be sure, Gladwell is a brilliant writer. But in "More Ritalin!" his facility gets the best of him. He glibly endorses Ritalin, while glossing over long-standing concerns about prescribing psychoactive drugs to children. Specifically, Gladwell calls Ritalin "remarkably safe" and "not addictive," but does not mention its known potential to become addictive and to stunt a child's growth.

Gladwell brushes aside the risks. "When we say something is safe, we don't mean there are no side effects," he said. "When we say something is not addictive, we don't mean it's impossible to get addicted to it." Asked if he believes children experience withdrawal when they stop taking Ritalin, he said, "I know there would be changes in the child's behavior. Does that qualify as withdrawal?" (Once, a 14-year-old boy withdrawing from Ritalin killed a classmate with a baseball bat. Total fluke!)

Gladwell also left out this factoid: there have been no conclusive studies on the safety of long-term Ritalin use. This absence of evidence bothered some people at a recent "consensus conference" on A.D.H.D., sponsored by the National Institutes of Health, enough that the conference panel recommended studying "the benefits and risks of long-term use" of Ritalin. The panel also noted conflicting evidence as to whether Ritalin kids are likely to become teen drug abusers, contrary to Gladwell's story, which quoted a Harvard professor whose study showed a very low risk. Gladwell dismissed such nitpicky concerns, saying, "It is the consensus of many of those who attended that the NIH consensus panel was way too conservative."

Remember, this is the same man who warned against making science conform to a simplistic narrative. Could there be a double standard at work here? It's true that a layperson can be so willing to believe something that she treats inconclusive evidence as if it were proof of her cherished beliefs. But sometimes a dispatch writer gets so infatuated with an idea, he errs in the other direction, by treating inconclusive evidence as no evidence at all. Just because dosing kids with Ritalin has not been proved to be dangerous does not mean it is safe.

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