>> thank you so much and thank you everyone for attending. have a wonderful day. god bless. >> his work appears regularly and hundreds of newspapers including the "washington post," the guardian, usa today and "the new york times" and he's been nominated by the associated press for the pulitzer prize and as a representative with michigan news at the university

of michigan he joined in last march after 30 years working as a reporter. they can't hear you but they can sense it through the power of the internet so please join me in welcoming jason and jeff into your living room. >> hello john and jason. >> it's going great. i am talking to you from dearborn michigan and it will be great to be in person but this is the next best thing and i'm glad you've asked me to talk to you. i'm not here in the capacity of the university of michigan and you are not on the capacity of the associated press but both do i think play a roll in our

conversation. we will bring up each of those entities in time because they do play a roll in the story or the back story. i wanted i know you spent three and a half years working on this book which is amazing. i have a little connection to the story. i wrote a couple stories for the associated press from michigan which some folks may know and some will know when they read the book does play a significant roll in the story that you wrote and you spent a lot of time reporting from here. i remember i went to howl michigan and i saw on the front lawn a gentle man whose wife, lillian was infected with meningitis and she died. he held a press conference with his family on their front lawn.

i thought looking back on this quote from 2012, he said our loss and that of others should be a wake-up call to the country. the apparent lack of suitable inspections should not have happened. that was very early in the story and i just thought that is a message that resonates throughout the book, people talking about all the failures throughout the process. i thought a good place to start would be how did you come to this story and how did it become a book? >> as an investigative reporter that is interested in doing accountability journalism, one of the first questions i asked when i was interested in the topic and for me it came in 2017 after the federal criminal trials of the two main compounding pharmacists who were

involved in and tried for second-degree murder in federal court. i got interested after that and an editor of mine i was casting about for a new project to work on and she mentioned the trial. there's probably a lot of information like the trial exhibits and things like that to start looking through so that was my initial entrée into this. i started looking, and the more i read and the more i learned about what happened in 2012 and 2013, i saw it as this great american tragedy with multiple systemic breakdowns along the way like you were eluding to in terms of inspections of compounding pharmacies. but then the big question i had to ask myself is why do this now. we've gone through the outbreak. there was a law that was passed in the year following called the

drug quality and secure act so i thought maybe they fixed the problem. maybe this will never happen again. the deeper i got into it, not only did the story unfold in a dramatic way as i learned about the science and the epidemiology and the microbiology involved in figuring out this disease, but then also the regulatory side of this, the accountability side. i thought there were still gaps that allowed this to occur and exist so i thought not only is it a great uniquely american tragedy but also there's still work that needs to be done and as a journalist that's why i exist to shine light on problems that need more discussion and more thought so that may be the policy and enforcement actions can come from it.

>> and you do what we call in journalism a tick-tock, not of that which has become popular with the kids, but meaning it's basically telling the story through time and it does go in a very compelling way and as you and i have talked about before, sometimes you go back and sometimes you go forward but the story does drive forward from 2012 to the epilogue which is 2020. it's a story that is still being told, as you say, from a criminal justice standpoint and it remains to be seen if we get curious about the law to regulate this kind of thing. let's talk about the michigan connection that i eluded to before. i know you spent some time on the ground traveling around and michigan was one of if not the most affected the state in terms

of cases and deaths. it's right up there and if not at the top as i recall. you write in the book, and i quote, the hospital quickly became ground zero in the national emergency. there are so many stories here and you tell many of them. i wondered what stands out of your time reporting from michigan? >> what stands out the most is the way the community responded to this unfolding mystery, because that is what it was when it was unfolding. people were dying and getting sick. they didn't know initially for a couple of weeks exactly what was happening. there were people suspected that it was contaminated but there were multiple products used so that epidemiologists had to trace the supply chains and as

that is happening, folks are showing up at saint joe's, as you mentioned at ann arbor in the hospital, showing up in droves. the hospital happened to complete a completely new system to deal with this and so that's one thing that really snubbed me was spending time with all the doctors, surgeons, radiologists, lab scientists and hearing the stories and from my perspective, i'm taking all the stories and thinking where can i put them together. one of the main things i would say you have to leave so many on the cutting room floor or it is just too much. but there were so many stories of heroism and drama by the staff of the hospital that it came under immense pressure and are operating without a

playbook. there was no playbook for this. there was no kind of scientific literature for dozens of cases of fungal meningitis with a fungus that had never been seen before in a human being's nervous system. not only that, there were surgeries that needed to be done and different decisions that needed to be made on the fly with consultation with the cdc, but that was happening in real time and tell saint joe's was the epicenter because there were so many there that i immediately thought i needed to go and spend time because it is a huge part of the story and so i met with multiple patients who were treated and from there i put it all together in a chronological narrative and it helped me

pieced together the sweeping drama of what happened in a way that would instruct people how difficult the situation was at the time, and it was incredibly complex for the doctors and the hospital. among those people that you wrote about or talked to who were the love perry [inaudible] there is a passage in the book that struck me in many ways as a sort of microcosm of the frustrations and the anguish and the pain and confusion. would you mind reading that passage on page 113 talking about their story? >> i don't mind at all. thanks. this takes place in ann arbor, and at this time, patients are

just starting to show up to the hospital and doctors still don't have a full grasp of what's going on so they are reacting to what they are saying and this is where the passage takes place. three days passed since the happy retirement was curtailed. they were in lynn's hospital room when penny saw the news come across the television in the corner. it went by quickly as she noted the words, meningitis outbreak. her doctors were huddled just outside of the room. he developed bleeding around his brain stem. penny broke into the conversation and told them what she had just seen. he gave a skeptical look and the doctor noted the information without reaction. she took out her phone and looked up meningitis outbreak and they came out with the

investigation, the possible ties to any steroid objections in the cases. she thrust the phone into the nurses face but the medical team remained focused on the immediate deterioration and waved her off. she left the room and found a quiet note in the hallway. she texted tip line at a channel for that had run the news ticker and was sent to a reporter. my husband has all these symptoms zoomed nobody's listening to me. next, she dialed the michigan pain specialist where lynn had gotten his steroid shot and was connected to the doctor who knew about the recall. they received a voice message from the department of health and human services and the cdc guidelines for contacting patients. he told penny that lynn was injected with a drug that might have been contaminated and had his doctors look.

>> this is just not the kind of thing that anybody wants to go through. the fact that i think you write in the book about how it isn't so much there is a good treatment for fungal meningitis that is just the least bad treatment. they all come with serious side effects up to and including death. >> because fungal meningitis is pretty rare especially in healthy people, but it isn't such a common disease that there's been a development of lots of drugs to treated over the years and so when the doctors were faced with this particular meningitis, they only had a few options and all of them, like you said, come with a very powerful side effects, hallucinations, kidney failure

and other types of terrible debilitating effects. so, a lot of the patients who survived that had gone through that treatment described real horror. seeing very real hallucinations and just feeling terrible that it was a thing saving their lives. early on in the outbreak before they discovered that it was a fungus even or had at least confirmed that, the mortality rate was 50%. people were dying. once they started to people on the fungal medications, that started declining precipitously and when they found out what particular microbe it was, later in october, a full month or so after it had started and thousands were already dying or were seriously ill, they finally targeted it and once they were able to do that, that's when you

saw the death curve go way down. >> people that have reviewed the book said that it's a spine tingling mystery. it's a true crime, but the emphasis ought to be untrue. that's the thing that's really happened. and it was a race against time involving multiple medical detectives. i hadn't come across that phrase before but the doctors, researchers, scientists at the local, state and federal levels were working on this as fast as they possibly could. >> right. when i first started reporting this, one of the drawls to the story was the public health pubh epidemiologists who are detectives. that's what they do. they investigate weird diseases in communities that don't have any solution or answer.

they are puzzles and that's what they are trained to do. what this book delves into, and i immerse myself in this before and learned a lot about how the public-health system works is that the state public health departments, so this started the first patient to be known was in tennessee, showed up at nashville so it was a state epidemiologist named marianne kaner who had a training with the cdc, a former epidemic intelligence officer which is an elite detective core that is trained in a two-year program and they learn all high level epidemiology. she had been through that program and immediately was concerned even though it was only one patient because then as soon she looked in the clinic where the patient had been

treated she realized a couple others had similar types of symptoms and had been reporting it. she reported that immediately to the cdc and asked for help and that is when you see the states and the cdc start working together and that relationship was key to solving the mystery and tracking the contamination all the way to this small time custom drug maker in massachusetts that was shipping it's drugs all over the country. it was the epidemiologists that figured that out so they were unwinding their story. i came into this after the fact. i had to interview everybody and put their actions, thankfully much of it is documented whether

it be health records for patients or detailed investigative reports by the investigators themselves so i was able to piece it together and see how it unfolded and it is quite remarkable what they were able to do in the time they were able to do it because this quickly unfolded into a natural scale disaster and they didn't know how many people were going to die at the time. all the new is dozens were falling ill and by the end they would be some 800 infected people. and another thing is this story, while most of the people affected by it were hurt in 2012 and 2013, those who survived as you said earlier eluded to this story that continues on for them and then if you look at the compounding industry and its effect in the united states it's expanded from this one event and

another reason i wanted to do the book is first of all it isn't well tracked like there's a database i can go to to say how many people have been hurt so you have to do it through anecdotal evidence. since this event it has happened again on a smaller scale through overdoses and other drug errors made at the compounding pharmacies that just are not being inspected regularly or don't have the kind of oversight that you would expect of a drug maker that is making sterile injectable drugs in the united states of america. so i knew that there was a bigger story here and an ongoing story that continues past the timeline of the book. >> you spoke with a woman who solve the problems with compounding pharmacy industry years before. i don't want to give too much away. but you do spend a lot of time

and the clean rooms of the nec see. people do see what happens or what happened there and what didn't happen there, more importantly. there is still mysteries involved just because people have been brought to justice, it isn't entirely clear just how this happened. there are some good ideas but i don't think that there is a slamdunk that can pinpoint precisely. >> that's right. it's an example of when there's no inspection regimen of whether it's a food maker or a drug maker the type of things that can happen and in terms of knowing exactly what happened, i was able to get pretty close

because while it was a slapdash operation that sent some 17,000 vials of contaminated lots to the clinics in the united states, they did some environmental monitoring required under the so they had a staffer that would go around with little sponges and take samples from shelves and the floor and the work areas and then put those into a dish and see if something would grow. that's how she figured out if there was a contaminant. from those records i was able to find numerous examples of mold contamination in that facility throughout the year while they were making these drugs including on the very shelf so there was mold on that shelf. while it doesn't completely

solve the mystery of how it gets into the vials themselves, it does show there was mold very close by and if somebody touched it without their gloves, there you go. and that is exactly why oversight is needed for dangerous drugs like this. if you are injecting something into your body, one of the things when i started reporting, i went to a bunch of doctors, first thing. and doctors i interviewed for the book. when you get somebody a drug, injection or something do you know if it's a compounded drug or not or fda approved. compounded drugs are not fda approved most of the time. they didn't, they just suspected like most of us do if you are getting a drug at a doctor's office or hospital in the united states that it is fda approved

and that just is not always the case. one of the big takeaways from this is that compounding is clearly in important part of the pharmaceutical supply chain. when you allow it to occur like it did in this case and others since then you're going to have these type of problems occur so it's important that people are aware that these products are out there in the system. and if they are concerned about it, they ask about it. >> your book talks about the law such as they are, the regulations such as they are what is required to be purported i mentioned this to you early

earlierbefore our talk today. michigan watchers will also know the appearance of the late great john dingell and of course i should practice this question with a little knowledge for people. this book as i said stands several years of time and it did take quite a while for this to reach capitol hill. i forget how many years but may maybe three to four years from when this started. >> it went straight to capitol hill and passed a law for next year. the federal trial didn't start for a few years after that. >> so, john dingell is no longer with us but was the longest serving u.s. congressman and well known in michigan, a legend around these parts and was my first vip interview as a

reporter, it's sort of a rite ot of passage among detroit journalists to interview john dingell at some point. unfortunately you can't now. there was a line that you shared in the book from john dingell, and if you don't mind i will read it. it's pretty quick. i won't do the impression but it appears new england compounding center and other rascals engaged in the practice of picturing a fine loophole to engage in practices that imposed substantial dangers on the american people. and there's a little ellipses in there. i shortened the line, but it's very to the point. i would say for a congressman those are strong words, but as you've said, strong action didn't follow. can we talk about what does exist in terms of the law?

>> the question here is right now, compounding is overseen by the states. some states do a better job than others. but the problem is compounding pharmacies can still especially now during covid because any of the kind of rules about this have been relaxed again because the emergency need for drugs so they can shift from state to state. while you may have michigan, tennessee since the tougher laws and better oversight in massachusetts where it certainly improved the law there the system is only as strong as the weakest link because if you run a compounding pharmacy and want to crank out drugs quickly to increase profit like mississippi

or alabama or florida where the regulations are not as strict and there's a lot of other states like that i don't mean to pick on those although they do have fraud cases and others that have come out since then because they are a little bit weaker. but if you want oversight to ensure safety, many of the people that are smarter than me that i talked to for the book are drug safety advocates and have been their entire career say that some level of federal oversight is needed so after this event in 2012, the senate put forth a bill that both the fda in charge and they had been trying to gain the purchase over the combating industry for years and the industry successfully fought them off and i go into great detail in the book it's very interesting the example of

good lobbying by the compounding industry. they are really good at beating back the attempts to regulate and it was no different even in the face of 70 to 80 dead people, now it is over 100. one of the greatest disasters for pharmaceuticals in american history and fda still even with that still couldn't get the bill through congress that gave them the oversight powers like they have over the big pharma manufacturers with exact standards like the vaccine for example, those undergo so much scrutiny every step of the process is measured in the redundant processes in place for safety. those are some of the safest things you can put on your body.

the opposite, there are none of these inspectors that can pop in from the fda, do a surprise inspection and ensure that they are following the rules properly so that is the problem. even the law that ends up passing in 2013 and being voluntary because the lobby was very effective at arguing that patients would suffer if compounding came under the fda they wouldn't be able to produce as many drugs as they do and so it is a voluntary standard and that's why we've continued to see adverse effects and recalls, overdoses, drugs for infants used in hospitals. there's an example in the book of overdoses from a morphine that was 2700% too potent that was used because of compounding error and there are a lot more of these type of examples.

so, the laws are still what they were before this happened essentially. there were a few advances, but nothing that radically changed anything. >> and i know that there are people in the book that are survivors or family members of those that died that don't understand why this of all things wouldn't have led to something more substantial. i know we met in person a few years ago. it was the associated press. my former employer, your current employer who gathered reporters in new york city for some data training to learn about the data and how to work with it and incorporate it into our stories. i thought of that as i was reading your book. and i wondered if it informed

your research and reporting this data knowledge which you have more than i do. >> the short answer is i wish there were more data and that is one of the gaps and oversight even the basic information about how many compounding pharmacies there are, that data would be very helpful. you can look at medicare data. it's hard to get and expensive. there is some of that in terms of claims but overall data of the industry and how much it's making for the supply chain it doesn't exist. but in terms of investigative

reporting, the treasure trove were documents they conducted a multiyear investigation that turned up through the discovery tens of thousands of documents related and that was a big reason why i was able to reconstruct what happened inside of the in the ecc. i had a treasure trove of e-mails stated, time stamped from boom to whom so i was able to see what the reactions were at the time and then augment that with the people that were there at the time. so it was working with the documents as an investigative reporter was key and crucial to the book. a few stories that were built, everything in the book is

documented and comes in large part because of those federal investigations. once the trials were over the documents became public and i was able to spend a couple of years with them. the other thing in terms of working with the data that was helpful is spreadsheets. i'm not going to bore the audience talking spreadsheets more than 30 seconds but it's helpful to me. spreadsheets and creating a timeline and organizing that including data work over the years and building a complex timeline that is a visual aid to the stories you can see in chronological order where things over lab for intersect that

level of working with spreadsheets and documents was absolutely fundamental to this process and i couldn't have done it without it. i was imagining like you see in the procedurals i was imagining a board with the arrows and the strings and the wire and the duct tape. a. >> i do want to do that sometime. the strings tied making the connections. in this case i did the same thing but digitally and instead of strings, i used color coding so if there was a specific story i could see in the timeline where it pops back up. >> i think it makes sense and even those that are not journalists can appreciate that there is a good upside.

they do organize things. i'm probably the most boring person in the world right now but i do love spreadsheets. >> i know we have some questions but i have one more question for you. it might take us right to the time we will share with folks watching. you've eluted to a couple of these people already but in the story is like this it's pretty easy to find and you found a lot of heroes and we talked about some of them, the medical detectives, the doctors, people right here in michigan and tennessee. but i wondered if you could maybe think about somebody that stood out for you, particularly somebody unexpected or surprising as far as a hero of

the story. >> like you said there were so many people that did such great work and in choosing who to include in the book was difficult. one of the most incredible stories that i uncovered while reporting this that didn't get recorded at the time was a woman named beverly jones who is a fungal expert that works in the state lab in virginia and as the investigation is unfolding, people are dying. it was attacking the nervous systems of these people and sometimes it would go from all the way through their spine all

the way up into their brain. that question was important for lots of reasons. mold acts differently in the body with different ways they operate or that interact with the immune system so that knowledge is key for targeting treatments and beverly jones working by herself in a lab was the first to recognize this and she had a really unique way of getting a sample because they have to put them in a dish and grow so it gets big enough to pull apart under a microscope. they are trying different foods and she wasn't having luck with those so she tried plain water.

she learned in a class in her training and sometimes the water she said makes it angry so she said she used water and it worked and not only that but when she got the usable sample, and she put it under her microscope, she was able to identify it by eyes. the fungus that infected all these people that was in the drugs, there were a couple the main one is an environmental fungus you breathe it in all the time or you can come in contact with it but it doesn't get into your body, your immune system and that armor that you have doesn't let it into your body so it needed that injection. she had seen it in someone's

sinus infection before. she recognized it and was able to send it to the cdc and get the dna identified very quickly and that was a huge break in this investigation and really helped save a lot of lives because after that you see a lot more confidence in the types of targeted treatments with these antifungals and ones that kind of work better with that type of yes, so it was stories like that. it's crucial to our safety net and all of the defunding of the safety nets across the country and how that hurt us and this book is a testament to how important their work is.

we talk about the medical health catastrophes and the lessons do crossover significantly and how we treat these kind of things. >> it's all connected in these type of disasters. >> we have some questions, do we not. >> my internet has been frustrating tonight so if i start breaking up, feel free to open up the queuing day and pick up where i left off. sorry in advance. thank you for this incredible book in the course of your reporting you and the chance to

visit several compounding clean rooms to see how, quote, things get done properly. can you speak to how much work and diligence that takes from testing to robust cleaning and disinfecting, all the things that any cc didn't do? >> that is a great question and there's a lot of people that do this right. unfortunately, like i said, to ensure what he's talking about each of these facilities that makes injectable drugs isn't happening right now. but one thing is true. the usp that he referred to as the pharmacy has been around since 1820 when pharmacists back in the 19th century made a vast majority of drugs in the pharmacies, there wasn't pfizer and johnson & johnson of 1820.

you went to your local druggist with ailments and got a prescription and most of the time they made it there. unfortunately, they didn't keep information safe. it was a hodgepodge system. you are only as safe as your local druggist's capabilities. and they were there to standardize everything. so, pharmacies that follow it to the letter have a system in place that is of checks and balances of stability, cleanliness, monitoring and just a plethora of cleanliness standards that ensure when the drugs come out of that pharmacy that they are safe. that's one of the things that lied to the hospitals and clinics that it was selling drugs to.

the literature over and over saying they followed these standards. but unfortunately like i said before, there was nobody in massachusetts at that time making sure that what they were saying was true. they were not matching the advertising reality and in a lot of states that is still a problem. the state pharmacy boards don't have enough inspectors to go from place to place so that they are well-meaning and sometimes they will be operating kind of in the shadows kind of off the grid. so you know, if they do where they are going there so many of them they couldn't possibly do the type of detailed inspections they need to do. so something needs to be done with some investment in bolstering up states or getting the fda involved in regular inspections.

>> there's a question from someone. jason, you can hear me, right? >> yes it looks like john froze up. >> there's someone identifying herself as the seed planter. this would be pauline, who you and i both know. first, congratulations. i'm beyond thrilled to see this come true and come to fruition and now a question. what advice would you give to working journalists who also dream of publishing a nonfiction book? i know you worked on this as a part of the fellowship not juggling a full time day job. how would others make it happen, and that is from a former colleague of ours. >> one thing i want to say about pauline our former colleague is when you asked me before where the seed came from and we were

talking about how an editor said look into those documents and see i think there's something here that may have been someone named pauline. i was lucky to be at a point in my career where i could apply for a fellowship and leave my day job and go do research and i'm also likely to have a union and a contract that allows me to have a leave policy so i took unpaid leave for a year after i got my contract and i was able to finish the book after the fellowship so i was able to take two years away and not lose my job the union contract that i have, first i want to give that a shout out. a lot of people don't have that especially these days and it

makes it really hard to get into a project like this and be able to complete it. my advice would be you have to be committed. i have tried numerous times to get projects off the ground working a full-time job. this is my first book. i've had a few and turned them into other types of projects. you just have to stick to it. you cannot give yourself a timeline. you have to give a realistic timeline and that means you have to work on weekends and at night after the kids go to bed. if a book is what you want to do with it. there are many different ways to tell a story journalistically. i love nonfiction narrative books. i thought this was a huge

complicated story that warranted a book. i still would have done it anyway if i didn't have that time off it would have taken me five years, not three. so my advice is try not to get frustrated because it's not a very lucrative and ever writing a book most of the time it is a labor of love. it's something that is a passion of the session i would say at some point you have to become obsessed with it and cut yourself a break and realize you have to make a living. i took a nonfiction book writing class in grad school in 2001 and 2002 and the professor of the class, samuel friedman recommended it to all the students do not get a job at a newspaper if you want to write a book. get a job as a bartender or something like that where you

can make money and focus your brain energy on your book. that is not what i did. i took that class and became a newspaper reporter and was lucky enough to take a break midcareer but if you don't want to wait 20 years like i did, then maybe it's about getting a job that has a more flexible if it. but you do have to make some concessions for sure. do we have time for one more box. >> we have time for one more. carla writes in given your experience and covering a very complicated health story, do you have any thoughts on how the media has covered the covid-19 pandemic? >> the term the media, i'm not

sure what that means. we are a vast diverse landscape of media. i can speak about myself and the associated press and i can tell you that i have been so impressed with many news organizations when this happened last year i was coming up finishing the book and coming into daily reporting. we have reporters all over the world and it became the main story for many months and that required a massive reorganization of resources from editors to reporters, and i know a lot of other news organizations have done the same thing. from that standpoint i think

it's been the media has done a great public service. the media that i'm involved in and some of the others that i'm familiar with, "the new york times" and other big newspapers have done a wonderful public service by exposing inaction and mistakes by the trump administration and others who have risked lives through policy that didn't factor in science. i know that's what i wrote about how the administration was ignoring or suppressing science from the cdc and other agencies and that was my goal. i am very proud of that and i think that my profession has done a wonderful job this past year making sure that we are all informed about the actions of the government and how to keep

safe. >> i think we have time for one more question before we sign off. maybe you can discuss some of these. the main challenge was that geographically it's very spread out and it's all happening at the same time. and there were multiple layers. then there's the whole why did this happen. why did these exist without inspectors, regular inspections. how is that possible. that is a longer story that was a political story that spanned over multiple decades and then you also had the true crime criminal justice story of the investigation and the trial and at the end of it, weaving all of

the stories together in a way that makes sense but also is compelling to read because at the end of the day you don't want to write a book nobody wants to read. i want it to be entertaining. it's a terrible tragic story but it's also a story we were speaking about on heroism and science and those types of themes while there's a lot of darkness and tragedy and in light of how science can help us through these dark times and if we trust it and follow its lead and listen to the experts and people who know what they are talking about you can greatly reduce harm. this is a good example of that and it was a terrible tragedy that hurt a lot of people, but it could have been a lot worse.

>> thank you. i think that is a wonderful place to end. thank you for such a wonderful conversation and for joining us tonight and for putting up with us this evening. we hope to have you in the bookstore when it is safe to do so but until then we hope we will continue to be safe and well and to the viewers thank you for joining us as well. you can buy with of the links in the chat or below if you are watching we will see you at the next event. good evening everybody. good night.

professor rosa brooks details her experiences in the leasing after becoming an armed reserve police officer in washington, d.c. she's interviewed by houston police chief and major city chiefs association