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How The Sun got the story on Factor VII

Last Sunday, The Sun began a three-part series about a drug used by American military doctors in Iraq that could be killing some of the very soldiers it was intended to save. The drug, Factor VII, helps doctors stop blood flow from devastating wounds, but there is abundant evidence that the drug may later cause blood clots that result in heart attacks and strokes.

The series, "Dangerous Remedy," was reported and written by Robert Little and photographed by Monica Lopossay. It represents exceptional enterprise reporting. The work stands out for a number of reasons. Little spent months researching the effects of Factor VII. He examined scores of medical reports and interviewed dozens of experts in hematology - discovering that civilian doctors believe Factor VII is potentially dangerous. The drug has been approved for use in treating hemophilia - a blood-clotting disorder. It is being used "off-label" in Iraq.At a time when newspapers face growing economic challenges, editors find it more difficult to devote resources to such in-depth enterprise reporting. The Sun's decision to send Little and Lopossay overseas and to give them the time and resources to produce such a powerful and important series is a credit to the newspaper - and is a model for papers to follow despite the financial pressures to restrain spending on journalism.

Little, a Sun national reporter who has been covering combat medicine for more than a year, was told first about this new battlefield medicine while working on another story at the Army's surgical research center in Texas. After months of further reporting on Factor VII, Little traveled to military hospitals in Iraq and later to Germany to try to assess Factor VII's value for military trauma care.

"I knew how devoted the Army's doctors are to saving soldiers in Iraq and know how desperate they are for new solutions," Little said last week. "But I truly had no idea what to expect or what I would find once I got there."

What he found in Iraq shaped the course of the story and his research for months to come. Little noticed immediately that the Army was using Factor VII frequently and liberally. (The series reported that more than 1,000 wounded troops have been injected with Factor VII). American doctors working in Baghdad, who received assurances from military officials that Factor VII was safe, were not aware of the potential complications of using the drug. And the Army had no recordkeeping system to track the condition of soldiers who had received Factor VII.

But most important, Little and Lopossay witnessed three wounded soldiers being treated with the drug at the Army's combat hospital in Baghdad in one 24-hour period in May. Little followed their cases for months and reported that two of the soldiers later suffered blood clots that contributed to their deaths.

"I came home from Iraq knowing I needed to explore the potential complications further," Little said later. Because of the military's poor recordkeeping and the Pentagon's refusal to provide autopsy information, Little himself began to identify soldiers who had been given Factor VII to determine what happened to them. He traveled to the homes of soldiers and surviving families around the country as well as military hospitals.

A number of readers were impressed with the results.

Jo-Ann Dwyer said: "Mr. Little has done a masterpiece of writing and a masterful service to the military."

Barbara Zalesky said: "A very proud moment for The Sun."

From Bradford Kirkman-Liff: "Your articles on use of Factor VII by the U.S. military in Iraq and the accompanying photojournalism of Monica Lopossay are both outstanding and deserve recognition. You have presented to the public balanced views on complex issues."

Several readers, however, found the front-page photo of a soldier's badly injured arm getting an injection of Factor VII too graphic. "I simply couldn't read the story because I was so upset about the picture," one reader said.

This and other similar reactions are understandable given the nature of this and several other photos published by The Sun. But in my view, the photos showed the real nature of the conflict and were absolutely relevant to telling this story.

In the end, Little's ability to balance the imperative of military doctors' efforts to save lives under chaotic conditions with the longer-term concerns for the soldiers' health is remarkable.

What remains to be seen is what effect these articles will have. Will Congress or military leaders examine the use of Factor VII as they ponder the larger question of the United States' involvement in Iraq? Given that the number of American wounded will continue to climb in the months ahead, one hopes that the important questions raised by this series will receive the attention they deserve.

Copyright © 2014, The Baltimore Sun
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