The Last Word On Nothing

When my editor at Slate asked me to look into the link between statins and violent behavior, I thought the idea was crazy. But as I dug into the issue, I decided that there was an important story there. I’m still not entirely convinced that statins cause aggressive or violent behavior in some small subset of users, but after looking into the evidence, I’m convinced that the FDA system for tracking drug side effects is not equipped to tell us for sure.

The story I ended up writing ran with the headline “Lipitor Rage” and the dek, “If statins carried a rare but serious side effect, would we ever find out?” (In some contexts it was headlined “Lipitor Rage and the Problem of Rare Side Effects.”) The story wasn’t really about statins, but about whether the FDA’s current surveillance system can detect rare drug side effects, such as the purported one between statins and violence.

After the story ran last week, I received several letters from readers. As I explained previously here at LWON, I love reader mail. It can be amusing, and even ridiculous, but letters from readers provide a rare opportunity to find out how my stories are understood and interpreted, so I read each one with intent curiosity.

This time, one letter in particular caught my attention. It was from someone who identified himself as an MD. After praising the story for including the viewpoint of cardiologist Steven Nissen (who urged me not to write the story), Dr. Letterwriter went on to agree with Dr. Nissen that I should not have published the piece.

When one googles Lipitor, no doubt your article  titled “Lipitor Rage ” will be prominent. If one read only the title and the first paragraphs (very likely when surfing) one would conclude it is a dangerous drug.

I don’t agree that journalists should be targeting our writing for search engines. If it’s really true that people won’t read past the few lines of a story that turn up in a Google search, why even bother writing the rest of the story? (And for what it’s worth, I just googled Lipitor and my story did not show up on the first page.)

Maybe I’m naive, but I think that if a story is framed in a careful way, most readers will read a little further before jumping to conclusions. I’d also like to think that most Slate readers are smart enough to grasp the nuances in my story. The feedback I’ve received so far has confirmed this. I haven’t received a single letter saying that someone was quitting their statins straight away because of my story, nor have I heard of any statin-taker using the piece as a license to lash out at their spouse. As far as I can tell, none of those morning news programs has used my column as the basis for a hyped-up scare story.

But Dr. Letterwriter raises a concern I’ve encountered in other stories I’ve reported — will readers understand the nuance, or will they just read the headline and jump to conclusions? It’s  an important issue, and I agree that it’s one that journalists should consider. I have little doubt that the volume of hate letters I received about my 2010 Reader’s Digest story about multivitamins stemmed in part from the deceptive coverline, “Vitamin Scam?” I give a lot of thought to the way I frame the information in my stories, but I almost never get any say in what kind of headline my story will have. Headlines are written by editors, not the writers.

My editor at Slate is one of the best and brightest in the business, and he and I discussed this issue at length before publishing the story. We knew that if we weren’t careful, people would read the headline and think, Oh my god. Statins are making people violent murderers! So he made sure that the headline referenced the nuance and uncertainty, and we were careful that the story explained, early in the story, that the link between statins and violence was controversial and widely rejected by the medical community.

As I’ve written elsewhere, it’s not really the evidence itself that convince people, it’s the story you tell about the facts, and so it’s imperative that journalists pay close attention to the way that facts are framed in a story. But when Dr. Letterwriter tells me that I shouldn’t have written about uncertain side effects from statins he’s not asking me to acknowledge his narrative (statins save lives!) he’s asking me to censor any evidence that might dissuade people from that story. It’s one thing to explain evidence in a way that speaks to existing belief systems, it’s another to censor the facts to fit a preconceived storyline.

Dr. Letterwriter’s complaint is a common one. Often when experts grumble to me about an article, they’re not actually taking issue with what I’ve written, they’re upset that I didn’t tell the story they wanted me to tell.

My job as a journalist is to disseminate information, and my loyalty is to my readers, not my sources. Dr. Letterwriter is not the first expert to dissuade me from sharing perplexing information from my readers, and he surely won’t be the last. But I don’t buy the notion that readers can’t handle nuance. I think they’re smart enough to handle the truth, no matter how messy it may be.

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Cartoon of raging heart: Welleman

Zocor booth by Colros