203-550-5220

| bissell.jennifer@gmail.com 321 E 108th St. Apt. 4E | New York, NY 10029

Jennifer Bissell

Copied below are clips featuring computer-assisted reporting techniques: Metro Transit riding on overtime (pg. 1) Minnesota high-school students taking Adderall to boost academic performance (pg. 5) Motives for doctor payments examined (pg. 9)

Metro Transit riding on overtime

Agency leaning on fewer drivers to save money, but is there a threat to safety? Publication: St. Paul Pioneer Press Placement: 1A Date: Jan. 1, 2012 *For this article I independently analyzed a city payroll database that should bus drivers were putting in large amounts of overtime. BY JENNIFER BISSELL Metro Transit bus driver overtime jumped 52 percent from 2008 to 2010, largely because staffing was reduced to save money. In 2010, the agency spent more than $8.5 million on overtime. About 5 percent of the drivers averaged 50 to 70 hours of work per week, according to a Pioneer Press analysis of recent compensation data. One boosted his pay to $120,000. Were grateful to have a workforce that is willing to come in, whatever the situation is, said John Levine, director of service development. Metro Transit had 100 fewer drivers by the end of 2010 than it had in 2008.
Print edition:

As the struggle to make ends meet will probably continue in future budgets, Metro Transit has found overtime a cheaper way to keep buses on schedule. But one union leader says some drivers are giving up their lives to increase their pay and fill the open routes. And two Twin Cities personnel experts say a better balance could be found, perhaps by hiring a few drivers. The 12 percent of total wages paid to drivers as overtime is more than twice the rate for police officers in Minneapolis and St. Paul, a group that typically accrues significant overtime.

Even with the increase in overtime, Metro Transit has saved $790,000 through employee attrition. The paychecks may be bigger, but hiring drivers would mean more training expenses and added benefits packages to fund, the agency says. With state funding for 2012- 13 being reduced $50 million, Metro Transit officials say overtime remains a cost-effective tool to continue the same level of service. The agency was able to find other transit sources to fill the gap for its 2012 $277 million budget. BOOSTING PAY AND PENSIONS Lance Wallace is happy to drive a few extra hours if it means his wife can stay home with their four children all younger than 5. The New Hope man is among the top 5 percent of overtime earners at Metro Transit. Picking up extra shifts and working nearly every day, he averages 60 to 70 hours a week. The $37,700 in overtime he earned last year pushed his total earnings to $86,400. I dont really want to work overtime, Wallace said. But I do it to make up the income. The extra work doesnt make him overly tired, Wallace said. In fact, after working two jobs before, he feels good to now work where he can dictate his own hours. Some overtime is normal in the bus industry, said George Gmach, director of compensation and benefits at the consulting agency Trusight. The vast majority of Metro Transit drivers worked fewer than 50 hours a week. But the top 5 percent of overtime earners like Wallace are living to work, he said. With a base pay of about $50,000, drivers are working the extra hours to boost their incomes; 16 earned more than $90,000. Bus driver Glenn Vierling, an employee since 1975, is Metro Transits top overtime earner. The $120,000 he made last year averages out to 74 hours a week. To work 1,804 hours (of overtime), you really have to put yourself out, Gmach said. Vierling could not be reached for comment. The top earners should be supported for their hard work and service to the community, said Michelle Sommers, Local 1005 Amalgamated Transit Union president. They are giving up their lives, she added. Drivers will use overtime to put their kids through college, buy extra Christmas gifts or save for retirement, Sommers said. Bus driver Charles Pierce of South Haven, Minn., made $32,300 in overtime in 2010 to increase his pension and Social Security benefits, which are based on wages.

Thats damn hard work to put in that many hours, said Pierce, who is now retired. But the extra hours helped considerably. I didnt appreciate it then, he said. But I sure do now. SAVING BY NOT HIRING By paying workers extra, Metro Transit is actually saving money. A driver on overtime paid at time and a half saves Metro Transit $4 an hour on average, spokesman John Siqveland said. If another driver were hired for the work, the agency would have to pay for training, additional benefits and pension. In 2010, Metro Transit saved $790,000 in payroll and benefits using overtime, Siqveland said. Through attrition, the agency has reduced its staff by 100 employees since 2008. With 1,500 bus drivers, overtime is an effective way to fill hourly fluctuations in service demands, as well as fill open routes when drivers call in sick, Siqveland said. Scheduling is made difficult because demand is focused on rush hours, both morning and evenings, he said. The number of drivers needed can drop by as much as 363 just after the morning rush hours, only to pick up later for the evening rush. Shocked that Metro Transits overtime has increased $3 million in two years, Gmach the compensation expert from Trusight questioned whether the agency is really being cost-effective with its overtime. Theres no reason to pay someone $120,000, Gmach said. The wiser thing would be to push overtime more equally across the workforce. Gmach said that when employees work as much overtime as the top Metro Transit overtime earners, that overtime can stop being cost effective. If workers are being paid more in overtime than their health benefits are worth, its no longer cheaper. Metro Transit officials say they must rely on part-timers and overtime to fit their route demand needs more buses during rush hours, for example and prevent significant downtime for hundreds of employees after those rush hours. But a union agreement says that no more than 24 percent of Metro Transits workforce can be part time prompting the agency to turn to overtime, Siqveland said. In October, 89 percent of weekday overtime assignments were during rush hour and lasted less than three hours.

If more drivers were to be hired, Metro Transit would be paying people to sit around during lulls, said Brian Funk, assistant director of field operations. Hiring more drivers to fill overtime wouldnt work, Funk said. They wont be in the right place at the right time. SAFETY STUDIED The driver of a semi heading down the highway is limited to 11 hours of work per day and 60 hours a week. A driver of a Metro Transit bus carrying dozens of passengers on a city street, though, can drive 16 hours a day and is limited to 98 hours a week. This is apples and oranges even though, on the surface, it may not seem like it, said Metro Transit General Manager Brian Lamb, who praised the agencys safety record. While federal laws limit interstate bus and truck drivers for safety reasons, no national standard exists for inner-city bus drivers. Local transportation services set their own standards, allowing for significant amounts of overtime to accrue. Bus drivers do not face the same driving conditions that interstate commercial drivers face, Lamb said. During the course of a shift, bus drivers have more stimuli. They interact with customers, have frequent stops and have more breaks to rest and stretch than truck drivers, he said. The Twin Cities ranked as the second-safest bus system among peer regions in 2009, with three incidents per 1 million miles, according to Minnesotas most recent legislative auditors report. Safety is influenced much more by other factors than by overtime, Lamb said. In fact, accidents are more likely to happen with inexperienced drivers than with operators on long shifts, Lamb said. With bids for overtime based on seniority, those earning the most overtime tend to be the safest drivers. Operators learn how much overtime works for them, Levine said. People know what theyre capable of. Working 60 to 70 hours per week isnt as hard as it looks, Wallace says. When you put in a lot of hours, you kind of live there, he said. Not in a tired way, but in a everyday-I- getdressed-for-work way. We need the money, he said. #

Minnesota high-school students taking Adderall to boost academic performance Online version:
Publication: Minnpost.com Placement: Featured headline, online only publication Date: Feb. 15, 2012 *I heard a rumor high school students were taking Adderall to study, so a partner and I went straight to the source. We designed a questionnaire for students to fill out and collected the data to determine Adderalls prevalence in local high schools. BY JENNIFER BISSELL AND MEGAN NICOLAI

In the same way that some athletes have taken steroids to become stronger, some Minnesota high- school students are taking unprescribed Adderall to perform better in the classroom and on exams. This illegal use of the drug is prevalent enough that many students seem to take it for granted. Selling it or giving it away is common practice, they say. Prescribed for attention deficit hyperactivity disorder (ADHD), the medication increases concentration, and many students have come to believe it's a necessary element to compete with peers for grades and test scores. Some who don't take it say its use creates an unfair advantage. In an informal survey of 256 recent high-school graduates by MinnPost, 22 percent of respondents said they had taken Adderall or Ritalin without a prescription during high school. Roughly 54 percent knew of at least one person who had, and 89 percent said a portion of students were using the drugs unprescribed. Katie Matthews remembers walking out of the ACT as a junior in high school two years ago with her boyfriend. A group of his friends were bothering him about not taking any Adderall before the test, as they had. "They just always did it, especially for ACT tests," the 2011 Eastview High School graduate said. Out of a class of 500 students, Matthews estimated roughly 40 students at her school were regularly taking the drug for homework and tests. The scope of such Adderall use in high schools is hard to gauge. With more students diagnosed with ADHD each year, the medication is easy to get, students say, and with minimal short-term effects besides "improved" focus, many schools and parents don't know and can't tell if students are using it. STUDENTS HOPE FOR BIG PAYOFFS, SEE FEW RISKS

Whether it's a C-average student looking for ways to keep up or a high achiever looking for a competitive edge, Adderall can be enticing; abuse of the drug increases dramatically before big tests and standardized exams, students said. Of those who have used Adderall, most say they took it to study. "I technically 'abuse' Adderall and Vyvanse, but I view it as a necessary component to stay competitive in today's environment," one questionnaire respondent wrote. "If everyone took Adderall the world would work at 120 percent efficiency," another respondent said. MinnPost offered respondents anonymity when filling out the questionnaire, though many students spoke on the record about the extent of Adderall use in their schools. Hal Pickett, adolescent chemical health specialist and director of the Twin Cities' Headway Emotional Health Services, said he wouldn't doubt students would use the drug if they thought it would help them. "Adderall is a prescription that enhances concentration, so a lot of kids could take it and you won't notice it at all," Pickett said. "In fact, it could help them." DIFFICULT TO TELL IF SOMEONE HAS TAKEN IT Though Pickett said taking any drug without a prescription could be dangerous, Adderall is one of the safest comparatively, if used in moderation. Although side effects can include appetite suppression, increased irritability, or feeling jittery and anxious, Pickett said it would be difficult to tell if a student had taken it. And it is uncommon for Adderall to cause long-term side effects in users, said Joel Oberstar, chief medical officer of PrairieCare. Less than 1 percent of the patients seen at Headway have abused Adderall, Pickett said. Medications such as Adderall and Ritalin keep neurotransmitters like dopamine or adrenaline in the brain for a longer period of time, increasing concentration, said Pete Jensen, a child psychiatrist and co- chair of the Division of Child Psychiatry and Psychology at Mayo Clinic. ADHD sufferers are less able to absorb those neurotransmitters, resulting in symptoms like impulsivity and lack of concentration. Though use of ADHD medication can be detected with drug testing, a student's use of the pills doesn't typically emerge unless there is additional drug use, usually marijuana or cocaine, Jensen said. Compared to other drugs, there's not a significant danger that a user will become addicted, Jensen said. Meth, cocaine and marijuana are bigger problem drugs in high school, along with alcohol use. NORMAL WAYS OF DETECTING DON'T WORK Schools detect student drug use with failing grades and bad behavior. But if students aren't abusing other drugs and they're actually doing better in school, the normal ways to detect use don't work. If counselors see students about Adderall use, it's because they're using it negatively to get high or lose weight.

"This could be one of those silent things that the larger community doesn't know about," Pickett said. "The kids are getting better grades rather than worse grades." And the race for better grades and test scores has created pressure on kids to use Adderall whether they've been diagnosed with ADHD or not. The rate of ADHD diagnosis increased each year by an average of 5.5 percent from 2003 to 2007, according to a survey by the Centers for Disease Control and Prevention. In the Midwest, 10 percent of kids have an ADHD diagnosis, according to a 2009 U.S. Department of Health report. MOST PRESCRIPTIONS WRITTEN BY PRIMARY-CARE DOCTORS The majority of prescriptions for psychiatric medications are prescribed by primary-care doctors instead of psychiatrists, who are more experienced with the medication, Oberstar said. As a result, he said, more psychiatric medications could be available to students who don't need them. According to a study by Michigan State University economic researcher Todd Elder, 900,000 children in the U.S. could have received an ADHD diagnosis in error. But many physicians are becoming more wary of the medication and their lack of knowledge about an ADHD diagnosis, and are less likely to prescribe it, Mayo's Jensen said. "It's being passed around and it shouldn't be," Jensen said. "What all doctors are trying to do, is say, 'Look, I'm prescribing this for this reason and this reason only, and I need to trust you.' " With more of their peers diagnosed with ADHD, students say it's easy to get pills from friends or family members. "People do whatever they can to get it," Hopkins High School student Sarah Ungerman said. "People want it bad. I take it for my ADD and people ask me all the time if they can buy it." SOME QUESTION ITS ABILITY TO HELP MUCH While students agree Adderall is easy to get, their opinions on actually using it differ. Among students interviewed who didn't use it, some thought using it gave students an unfair advantage while others doubted it would help that much. While waiting for a physics quiz to begin last year as a senior at Wayzata High School, Marissa Berglund said, she overheard a girl talking about how her Adderall dealer hadn't come through for her that morning. The girl said she was nervous about taking the test without Adderall, saying she couldn't focus without it. "If you aren't prepared for the test, just being able to focus isn't going to help you that much," Berglund said looking back at the moment. "You need to have studied in order to do well." But not everyone agrees.

"It's totally unfair," Haley DeParde, a student at South High School in Minneapolis, said. "It's a boost they don't deserve." NOT AWARE OF SCHOOLS DOING MUCH ABOUT IT Berglund estimated roughly 10 percent of her class of 900 students were using Adderall. She assumes the school doesn't know. "It's kept pretty quiet if they do," she said. Berglund said a wellness class she took briefly mentioned Adderall use, but that the most she knew about it came out of a year-in-review current-events page added to her yearbook by the publisher. Only 15 of the 256 respondents to the MinnPost questionnaire said they had heard of a program to address unprescribed Adderall or Ritalin use in their high schools. In a dozen calls to high-school officials in the Twin Cities area, none had heard of students using unprescribed Adderall for tests in their school. "Most of our students make healthy choices when it comes to drug and alcohol use," Minnetonka High School Chemical Health Counselor Nancy Olson-Engebreth said. "I wouldn't have any idea," said Richard Cash, Bloomington Gifted and Talented Programs director, adding that he doesn't deal with student health issues. "I don't know if I'd want to know." With no students coming forward about the problem or students getting caught, Bloomington Jefferson Chemical Health Counselor Kristin Wetzel said the achieving side of unperscribed Adderall use isn't an issue she's thought to look for. In the two years she's worked at the high school, she said she's only heard of students using the drug to get high. When those students get caught, it's usually because of behavioral issues. After reflecting on national trends and statistics about prescription drug abuse however, Wetzel said it might be something she needs to be educating parents about. PRESCRIPTION DRUG USE IS A NATIONAL ISSUE Prescription drug use has become a huge issue nationwide, according to the U.S. Drug Enforcement Agency. While ADHD medications aren't as much of a concern as drugs like the painkiller Oxycodone for the agency, Adderall is still one of the top five diverted prescription drugs or drugs that are abused or sold illegally. "They might be off the radar because they're kids who are high achievers," Wetzel said. "They're not kids with behavior issues, so it's hard to get to." Yet with a larger supply of prescription drugs at home, Wetzel said she wouldn't be surprised if more students were using it unprescribed.

"Even from last year it seems like a more accessible drug," she added. "And it's not just here. It's the result of a community and society where there is a bigger supply of prescription drugs out there." This article was produced in partnership with students at the University of Minnesota School of Journalism and Mass Communication, and funded in part with a grant from the Ethics and Excellence in Journalism Foundation. #

Motives for doctor payments examined

Publication: Fairfield County Business Journal Placement: 1A Date: April 25, 2013 *The following article is a look into pharmaceutical company payments to physicians in Connecticut. I wrote the story after ProPublica, a nonprofit news source, published a database of payments online. I scraped the data off of ProPublicas website and analyzed it in Microsoft Access and Excel. BY JENNIFER BISSELL As more light is shed on drug company payments to physicians, national trends show payments decreasing. But in Connecticut, its more of a mixed bag. From 2009 to 2012, pharmaceutical companies paid Connecticut doctors at least $28 million for conducting clinical trials, speaking at promotional lectures or attending dinners, according to an analysis by the Fairfield County Business Journal of publicly reported payments. Payments to Connecticut doctors were on an upward trajectory contrary to national trends until 2012, when they decreased 28 percent, primarily because of a drop in research funding to Yale University. More than 50 doctors in the state grossed at least $100,000 in payments from pharmaceutical firms from 2009 to 2012, with some earning as much as $1 million for research. In Fairfield County alone, nearly 500 doctors have been paid at least $250. To report these findings, the Business Journal used data compiled by ProPublica, a nonprofit news organization. But the data have its limitations. The 15 drug companies included in the data represent only 47 percent of the U.S. pharmaceutical market. Among the companies that disclosed payments, not all of them reported the same kinds of payments or reported payments for all four years. For instance, most companies reported how much they paid in speaker and consultant fees, but not every company reported how much they gave doctors for research, travel reimbursements, meals and educational gifts. As a result, the total amount of money 9
Print edition:

paid to physicians nationwide is likely much higher than the $2 billion publicly reported over the last four years. The payments are designed to compensate doctors for their time, whether its for research or speaking at promotional events. Drug manufacturers say the two are vital to the progression of medicine and educating physicians about both the pros and cons of their drugs and how to safely prescribe them. Critics question the ethicality of the payments and whether they are influencing doctors to prescribe certain brands and medications over other treatments. Dr. Joseph Ross, an assistant professor at Yale University School of Medicine, said he believes research and clinical trials are good examples of academic and industry cooperation. Multimillion-dollar research projects have to happen, he said. But what does worry him are the smaller payments, such as speaker fees, meals and travel reimbursements. What I care about is how these payments can influence the care for patients, Ross said. Theres no reason a physician needs to be paid to hear about a promotion. Ross was a part of one of the first successful efforts to bring to light the issue of pharmaceutical company payments to doctors. In 2007, he was the lead author of a study covering the subject in the Journal of the American Medical Association. Now, under the Physician Payment Sunshine Act a provision of the Patient Protection and Affordable Care Act all drug companies will be required to collect payment data for public disclosure in 2014. A few states already require payment disclosure; however, Connecticut isnt among them. Its going to have a tremendous impact, Ross said of the new regulations. No more loopholes or considerations about what we dont know. Theres just so much missing from the data. Well finally have a comprehensive understanding. With more public disclosures and scrutiny over the data, Ross said he hopes more doctors will be dissuaded to accept payments for fear of the possible negative publicity. In advance of the new legislation, payments to doctors have already begun decreasing nationwide, though its difficult to say by how much, with more companies starting to report nationwide. In Connecticut, its also difficult to say with certainty why payment levels have seemed to both increase and decrease. In 2009, $2.8 million in payments were publically disclosed, but fewer companies were reporting then. By 2011, disclosed payments were as high $11.2 million, but in 2012, payments fell to $8 million, primarily because large research grants to Yale University appeared to have decreased. Yale officials declined to comment, noting they do not track payments, but require employees to disclose conflicts of interest. Representatives at Pfizer Inc. say a nationwide decrease in its payments to physicians is primarily due to the companys changing drug portfolio that includes fewer patented drugs, which in turn dont require the same level of funding. Additionally, the company says it is using more cost-effective tools to educate physicians, such as web conferences instead of dinners and events.

10

We are utilizing more efficient and strategic ways to deliver educational material, and are evolving our approaches to meet physician information needs, said Steve Danehy, a Pfizer spokesman, in an email. To suggest anything otherwise would be an oversimplification of the data. Pfizer has publically disclosed its payments since the second half of 2009 as a reflection of its unwavering belief that its collaboration with doctors led to meaningful and productive dialogue, scientific insights and improved medicines for patients. In Connecticut, Pfizers payments made up 20 percent to 40 percent of disclosed payments every year from 2009 to 2012. The company is also a key reason why funding decreased dramatically in 2012, when it decreased its research funding to Yale. Dr. Ghazi Asaad, a psychologist in Danbury, has made at least $222,100 in the past four years as a promotional speaker, according to the Business Journals analysis. Assad said hes been speaking at events since the 1990s, sometimes speaking as often as every week for four or five companies in a year. He doesnt keep track of how much money hes earned. Asaad said he was aware of criticisms that drug companies were choosing doctors to be speakers based on how many patients they had, instead of their ability to speak well. But Asaad said he considers himself to be an excellent speaker who is not persuaded to prescribe the drugs he speaks about. He has about 2,000 patients. Looking from the corporate point of view, Asaad said he thinks the companies are trying to influence speakers and those in attendance to prescribe their drugs. They want promotion, they want to sell drugs, he said. Its obvious. Its an open agenda. If they can manipulate the speaker to be biased, they will do it. But from the doctors perspective, a simple event is not going to manipulate them. A free meal isnt either, he said. The drug companies try to be pushy, and to some degree, try to be unethical with some speakers, but I think its all about the integrity of the speaker, Asaad said. Now I might be one of the top paid people but nobody can influence my prescribing habits. In fact, many times they become frustrated with me. They say, Why are you prescribing this drug instead of this? And I say, Because thats what the patient needed. It works. Its more affordable. Why not? Dr. Joseph F. Goldberg, a psychiatrist in New Canaan, wasnt as liberal with his words. Goldberg, who has received at least $321,000 in four years, emphasized how the events help doctors learn about the proper use of the medications. All the materials and the events themselves are approved by the U.S. Food and Drug Administration. I do not personally feel pressure to prescribe certain brands over others when multiple FDA-approved treatments exist for a particular ailment, he said. Such programs are meant to make attendees more familiar with the appropriate use of a treatment as they hopefully make their own independent decisions. Goldberg has conducted clinical research in psychopharmacology for more than 20 years and questioned why he shouldnt be paid for his time and expertise.

11

Asaad contends no doctors would speak if they werent paid, but that if it was the money he was after, he could make much more by taking on additional patients. Asaad said he is a speaker primarily because its a social activity and because he wants to help educate physicians about the drugs. The events are often the best way to learn about the side effects, safety precautions or how to prescribe certain drugs. Plus, the companies create a positive atmosphere thats very pleasant, he said. This is business in America, this is how business goes, Asaad said, noting that other industries might take clients to Las Vegas or give them private jets. Our judges are our patients. I think they see if people are good or not good. And I can assure you they have not said a word. #

12