When Drugs Stop Working: Q&A with the AP's Martha Mendoza
I wrote earlier this week about "When Drugs Stop Working," a new series of articles on drug resistance around the world based on a six-month investigation by Associated Press reporters Margie Mason and Martha Mendoza. You can see a list of the stories, published in the Washington Post and many other media outlets, here. An AP website features the multimedia version of the series and you can find an AP Television piece related to the series here.
Mendoza, who is based in Mexico City, made time to talk with me by telephone Thursday about how she and Mason reported the series – an effort that took them around the globe.
Our conversation has been edited for length and clarity.
Q: How did you decide to focus on this topic?
A: I worked on a series of stories of 2007 about pharmaceuticals in the environment. We were documenting antibiotics in drinking water. A key consequence of that is antibiotic resistance, but in that series we couldn't focus on it in any meaningful way. I was toying with how far we can go with that topic, and Margie, who is an AP medical writer, was on a Neiman Fellowship that offered her four months of travel. We hadn't seen the issue of drug resistance done before at a global level. We'd seen stories about MRSA or drug-resistant tuberculosis, but we thought of this as sweeping, that we had a much bigger issue going on here.
Q: How did you move from the general idea of drug resistance to specific stories?
A: We considered that a lot. We spent fair bit of time trying to figure out how to break down the reporting. Should we be microbe-specific, disease-specific or topic-specific? We did know we wanted to visit worst and best case scenarios and we wanted to include solutions. In the end, we decided to have stories that were disease-specific and cause-specific. We wrote about how lack of compliance in taking drugs can lead to resistance. We focused counterfeiting of malaria drugs and how resistance is a consequence of that. We wrote about antibiotic use in livestock as (a cause of) the drug-resistant infections that are popping up. We looked at cost as a cause, how lack of funding for HIV/AIDS drugs can be a cause of drug resistance.
Q: What background or training in health journalism did you have when you started reporting on this issue?
A: I have been a reporter for more than 20 years and a fair bit of that has been medical or science reporting. Like all journalists, we start out asking questions and learning. Margie is the AP medical writer and she spent a year doing the Neiman Fellowship.
Q: What led you to Norway?
A: A lot of people we talked to about this issue – we'd ask, what are the solutions? – told us to look at the Norway model. Scientific journals have written about it. We talked to the folks in Norway, and they said, you should come see how we do this. It was striking what we learned there.
Q: What was most surprising to you as you reported these stories?
A: The scope, the scale. We thought we were writing about an emerging problem that was just starting, but to everyone who was on the front lines, the problem was far worse than we'd anticipated. It surprised me in Norway to see how good things are. MRSA kills more people than AIDS each year in the United States. There were a lot of "holy shit" moments.
Q: What was your biggest challenge in reporting the series?
A: Frankly, the writing. Do you do these as hard edge investigative pieces, do you do these as narratives, or explanatory pieces? They're wonky reports when you start talking about antiretrovirals We were trying to make them compelling and understandable. We had to make each story about a person, a village, a hospital. We wrote the stories completely differently at times. The last story in the series was an American-centric news story at one point. It was lot of "back to the drawing board" with your writing.
Q: How did you find and identify the patient with extremely drug-resistant tuberculosis? His case was the first of its kind in the United States, and you were the first to report it.
A: We made list of top 10 specialty tuberculosis centers in this country and wrote their directors, asking if we could see how they handled drug-resistant cases. So one of the people we called said, "you want this case." They were very open in Lantana. They said, "We have this case – we can't figure out what going on with him." We asked, "Can we meet him?" "Sure." We spent a lot of time there. This was one of these stories where we had 50 times more material than went into the stories. I spent days at a hospital in England, and that was a paragraph. That was a writing challenge, to let go of all that.
Q: You're based in Mexico and your reporting partner, Margie Mason, is based in Vietnam. How did you divide the work with her and coordinate when you were so far apart and in different time zones?
A: We're exactly 12 hours apart. We communicated daily at 6:30 a.m., (6:30 p.m. her time). And our editor, Mary Rajkumar, in New York would check in most days. At times, Margie was in Boston and I was in California. When we traveled we'd be in touch. She'd be calling from some really remote place in Cambodia. We'd say here's what it's looking like, how do we frame this, so we could make sure we got everything we needed.
Q: Your series was just published. What kind of reaction have you gotten?
A: So far, we've seen a dozen op-ed pages. The stories were on front pages all around the country. We've had calls from members of Congress and regulatory agencies, saying, how can I see the whole (series)? We know there's legislation moving through Congress on this issue, and people are saying, (our series) is helpful.
We've had angry calls from pork producers saying we misrepresented their process. We also had people asking about creationism vs. evolution when we wrote about bacteria evolving – that was one we hadn't anticipated. I'm really proud of the way (the series) came out and the way it reads.
Q: Problems with antibiotic resistance have been known for years, but it seems like only a little progress has been made. Patients still ask for antibiotics for colds, and doctors still give them, although less than they have in the past. Why do you think that is?
A: In our reporting, one thing we found is a tremendous amount of lobbying from drug companies. That's a big counter to this. It's also a question of the greater good versus the personal good. We have a culture that sees this issue differently than other countries. In Norway, when you are sick, you get a week off paid, so that helps you not spread disease. You get paid to take care of your kids. Here, when your kids get sick, you go to work so you don't lose your house.
Q: What signs do you see that the health profession and lawmakers are taking this issue more seriously?
A: The Obama administration's CDC director said for first time antibiotics in agriculture need to be controlled. The FDA director said for first time said drug resistance needs to be (addressed). But CDC guidelines for hospitals need to be changed. They're still focusing on hand hygiene.
Q: What ideas do you have for reporters who are interested in covering this story on a more local level?
A: What's amazing to me is that when one hospital cuts way down on hospital use, their MRSA cases disappear. Hospitals (can consider) not using antibacterials when they don't need them, not using antibiotics when they're not needed, and being more aggressive in treating MRSA. If someone's on course for TB, you've got to be religious about treating it. Hospitals and counties and states track hospital infections. It can be useful to look at the trends and ask what they're doing to control hospital infections. They'll have specialist who will tell you their specific problems (in the region). Hospitals have microbiologists who study the microbes in their hospitals and they rarely get asked questions. They're great sources.
Q: What are some other under covered stories in this area that you'd like to see more coverage of?
A: One slice we didn't get to is that there's 700 products out there with antimicrobial properties, such as triclosan. It seems worth exploring.
Q: Is it worth it for reporters to check federal reports on unlawful levels of drugs in live animals?
A: Yes! You can also see what farm practices are, and county agriculture departments may be regulating that too.
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