The NewsHour with Jim Lehrer

JIM LEHRER: Good evening. I'm Jim Lehrer. On the NewsHour tonight a Paul Solman report Part Two on the war between Microsoft and the U.S. Government; a look at a new report on the adverse effects of mixing medicines; some words and pictures from the burning rain forests of Brazil; and an interview with Katherine Graham, who won the Pulitzer Prize today for her autobiography, "A Personal History." It all follows our summary of the news this Tuesday. NEWS SUMMARY

JIM LEHRER: President Clinton said today he remained committed to a strong, stable, balanced space program. He spoke during a visit to NASA's Johnson Space Center in Houston. He was joined by Sen. John Glenn, who's training to return to space for an October mission. Mr. Clinton spoke via satellite to the space shuttle crew at the Kennedy Space Center in Florida. They're preparing for Thursday's launch of the 16-day mission. The president also delivered remarks to employees at the Johnson Space Center.

PRESIDENT CLINTON: You are the place where dreams are made real, where impossible missions are accomplished by remarkable people. We have become a great nation in no small measure because our people have always recognized the limitless possibilities of the human spirit. I have every confidence that those of you who work here at Johnson Space Center will always carry that conviction not only in your minds but in your hearts.

JIM LEHRER: The president will participate in a town meeting on race relations tonight in Houston. It'spart of his effort to encourage a national dialogue on race. That event will be aired on cable television's ESPN. The president's budget chief resigned today. Franklin Raines made the announcement on the South lawn of the White House. President Clinton hailed Raines as the first budget director in nearly 30 years to craft a balanced spending plan and Raines returned the praise.

FRANKLIN RAINES, Director, OMB: A the federal government has gotten its financial affairs in order, it has cleared the way for the America economy to deliver its best performance in more than a generation. You have not only eliminated deficit spending, which was as high as $290 billion when you took office, but even the word "deficit" seems to have disappeared from Washington's lexicon. Now, everyone focuses on the prospects of budget surpluses as far as the eye can see, surpluses you have wisely reserved until long-term solution to the problems of Social Security have been put in place.

JIM LEHRER: This ceremony occurred before the president went to Houston. Raines is leaving to become head of Fannie Mae, the Federal National Mortgage Association. He had been a Fannie Mae vice president before joining the administration. Mr. Clinton nominated Deputy Budget Director Jack Lew to succeed Raines. Inflation was kept in check again last month. The Consumer Price Index was unchanged for the second time in three months, the Labor Department reported. A steep drop in energy prices was cited. Separately, retail sales declined .1 percent in March, according to the Commerce Department. The drop was blamed on fewer sales of autos, building materials, and furniture. On Wall Street today the Dow Jones Industrial Average closed above 9100 for the first time. It rose nearly 98 points, to end the day at 9110.20. More than 100,000 Americans die every year from adverse drug reactions. Two point one million more are seriously injured from both prescribed and over-the-counter medications. That's according to an article in tomorrow's issue of the Journal of the American Medical Association. The casualties do not include drug abuse or prescription errors. The work was done by researchers at the University of Toronto. We'll have more on this story later in the program. Vice President Gore announced a plan today to create the next generation of the Internet. It will be up to a thousand times faster than the current World Wide Web. Three communications companies will provide $500 million startup money and equipment. Universities will be connected first. Researchers expect development to advance medical technologies, weather forecasting, and long distance learning. Vice President Gore spoke at the White House.

VICE PRESIDENT GORE: These 30 books here represent the entire Encyclopedia Britannica. This is one strand of fiberoptic cable. With today's announcement it will mean that this can be transmitted over this in one second. That's a startling advance. And it'll make a huge difference.

JIM LEHRER: We'll have more on the computer business right after this News Summary. The U.S. Supreme Court today considered delaying the execution of a man from Paraguay. The International Court of Justice at the Hague, Netherlands requested the action. Angel Francisco Breard was convicted of killing a Virginia woman in 1992. Secretary of State Albright has urged the governor of Virginia to stay the execution. She said it would help ensure due process for American citizens traveling abroad. She spoke today to students at Howard University in Washington.

MADELEINE ALBRIGHT, Secretary of State: What we have decided is that we have the discretion to ask for a stay from the perspective of foreign policy, which I have done, because we respect the International Court of Justice as a part of the system and because it is very important from the perspective of Secretary of State to assure ourselves that our citizens, were they to find themselves in any trouble whatsoever abroad, that they also would be accorded their rights.

JIM LEHRER: But the Virginia attorney general and the U.S. Justice Department have urged the Supreme Court not to stop the execution. It was scheduled for 9 o'clock this evening Eastern Time. In Northern Ireland today pro-British Protestant leaders urged President Clinton to hold off on a trip there. They said he should visit after the May 22nd vote on the peace agreement to avoid an appearance of interfering. Yesterday Mr. Clinton said he would go only if all the parties involved in the deal wanted him. The 1998 Pulitzer Prizes were awarded today. The Grand Forks, North Dakota Herald won the newspaper public service award for its coverage of last year's blizzards, floods, and fire. The fiction award went to Philip Ross, "American Pastoral." It was his 22nd novel, first Pulitzer. The prize for biography was awarded to "Personal History" by Katherine Graham of the Washington Post. The awards are presented annually by Columbia University. We'll have a conversation with Mrs. Graham at the end of the program tonight. Between now and then the computer war, bad medicine mixes, and the burning Brazilian rain forests. FOCUS - MICROSOFT VS. JUSTICE DEPARTMENT

JIM LEHRER: Microsoft versus the Justice Department. Last month, we reported on the computer giant's impact on new technology. Now in part two of our report the growing legal battle. Our business correspondent Paul Solman of WGBH-Boston is again the reporter.

PAUL SOLMAN: A flyover, a few years ago of the mushrooming Redmond, Washington campus of Microsoft--Microsoft the monopoly, according to most in the computer industry. That's because almost any new desktop computer was forced to use Microsoft's operating system, Windows 95, to, in the words of Mick Jagger and Microsoft's TV ad, "start me up." Microsoft, the company, was as in-your-face as its new ad's song, licensed from the Rolling Stones for at least $4 million. And when it came to its rivals, the company seemed even more aggressive. Here's marketing VP Steve Ballmer, in pep rally footage in the mid 1990's, exhorting his troops to take the competition.

STEVE BALLMER: These guys can be taken but the only way we are going to take them is to by studying them, know what they know, do what they do, watch them, watch them, watch them, look for every angle, stay on their shoulders, clone them, take every one of their good ideas and make it one of our good ideas.

PAUL SOLMAN: Ballmer was talking about business challengers. But his firm's aggressiveness had already attracted a bigger opponent: the government, in the form of the Department of Justice. In 1995, Justice formally opposed Microsoft's announced merger with rival Intuit, fearing Microsoft's monopoly would now extend to personal finance software. Facing lengthy litigation, Microsoft backed off. But the battle quickly moved to another front: emerging competitor Netscape, whose super software, Navigator, is used to navigate the Internet. In early 1996, Netscape's CEO Jim Barksdale was strutting.

JIM BARKSDALE, CEO, Netscape: Thirty-eight million copies in eighteen months and three days. Why? Because it works--just rated by an independent service at a 99out of 100--they said it was one of the highest, if not the highest, customer acceptance of a piece of consumer software they had ever tested.

PAUL SOLMAN: The problem was Netscape's breakthrough Navigator not only took the browser market by storm, it even threatened someday perhaps to bypass Microsoft's Windows monopoly. So Bill Gates used his power. He spent hundreds of millions of dollars to upgrade Microsoft's browser, Internet Explorer, and unveiled it in the summer of 1996 to nullify Netscape.

BILL GATES: Well, the product we are introducing tonight is Internet Explorer 3.0. And there's a lot of neat new things about Internet Explorer 3.0. The product is priced to sell. [laughter among audience]

PAUL SOLMAN: They're laughing for a very important reason. "Priced to sell" meant the product was apparently free: computer makers had to buy Windows from Microsoft. The new browser would automatically come with it, in which case why buy Netscape Navigator? Furthermore, computer makers weren't allowed to remove Microsoft's browser in favor of Netscape's. The results: in one year Microsoft's share of the browser market rose like a rocket, from 3 percent to 39 percent, dropping Netscape from 80 percent to 58 percent. It was at this point, in the fall of '97, that the Department of Justice really bore down on Microsoft, raising the question that's been key ever since: Was Microsoft using its monopoly power to unfairly knock off the competition? In anti-trust law parlance, was it performing bad acts? Joel Klein of the Justice Department.

JOEL KLEIN, Justice Department: I believe Microsoft is a monopoly with respect to the Windows operating system, and I don't have any doubt about that.

PAUL SOLMAN: But is it an illegal monopoly in the sense that they use that power to perform bad acts?

JOEL KLEIN: If they use that power to perform bad acts, that violates the anti-trust laws. Being a monopoly, per se, is not illegal. But if you use monopoly power in a way that is predatory or harmful to the market, that is the kind of thing we would obviously be looking into.

PAUL SOLMAN: The specific predatory act Justice looked into most deeply was "tying," Microsoft tying or bundling its browser with Windows and forcing computer makers to install them together. A federal judge agreed with Joel Klein's complaint that this was harmful to competition.

JOEL KLEIN: You've got to take our browser, and you can't un-install it. That was a forced tie. And that's what the anti-trust law is here to stop, taking that monopoly power and trying to push products that are competitive products to end up being part of your monopoly.

PAUL SOLMAN: For the moment, Justice prevailed. Computer makers can remove Microsoft's browser from the screen, while Microsoft appeals. But to Netscape attorney Christine Varney, who joined us at Computer Renaissance in Virginia, Microsoft has used other tactics to eliminate her company as competition.

CHRISTINE VARNEY: There is one way to get to the Internet on every computer in this story, and it's going to be the Internet icon, and when you click on that Internet icon, you're going to get what Microsoft considers the best way for you to get to the Internet, which is the Internet Explorer that's produced by Microsoft.

PAUL SOLMAN: In fact, the only browser pre-installed on any of the computers here was the Microsoft's Internet Explorer.

PAUL SOLMAN: There's a globe called "The Internet." And what happens if I click on this?

CHRISTINE VARNEY: You will begin the process of installing the Microsoft Internet Explorer.

PAUL SOLMAN: But it just says "Internet Connection Wizard."

CHRISTINE VARNEY: That's right. And if this computer were connected to a phone line, what you would get is a list of Internet service providers that are Microsoft-approved Internet service providers that will offer you a connection to the Internet using the Microsoft Internet Explorer browser.

PAUL SOLMAN: In fact, Microsoft is tying Explorer more and more closely to Windows. For instance, on an IBM computer we picked out at random in early April, the very first screen that popped up was this: Internet Explorer 4.0. And notice that channel bar on the right. It provides instant links to sites in cyberspace, sites Microsoft chooses, prominent among them other Microsoft businesses like MSN, Microsoft's rival to America On-Line, and MSNBC, Microsoft's news web site. What happens when you click on "travel?" You get a link for Microsoft's on-line travel agency, Expedia. Click on "business" and Microsoft's on-line stock trading system appears.

CHRISTINE VARNEY: The most precious real estate in America is right there, and Microsoft controls it completely. You want a piece of that real estate, you play by their rules, and their rules include you do not carry competing products.

PAUL SOLMAN: Now, Nathan Myhrvold, Microsoft's chief technology officer, says his firm has been acting in self defense. Netscape, he says, when it controlled the browser market, tried to make exclusive deals with computer makers to keep Microsoft's browser, Internet Explorer, off the screen.

NATHAN MYHRVOLD: Netscape tried to buy an inclusive. They tried to pay companies to kick Explorer off at a time when they had the dominant market share. So this whole thing is just ridiculous. A company that has 60, 80, 90 percent market share at various points in recent history was trying to buy exclusives to kick our things out because they wanted to integrate the whole world at one level, and we wanted to integrate the whole world at a different level.

PAUL SOLMAN: Myhrvold is clearly right, but to critics, the key is that Microsoft must not behave like other competitors because it's a monopoly.

CHRISTINE VARNEY: There's nothing wrong or illegal with exclusive deals per se. But when you're a monopolist and use your monopoly power, the first screen, the operating system, the guts of the computer, and you condition the sale of the essential element to make the computer run on an exclusion of any competitor's products in another market, that's illegal.

PAUL SOLMAN: To Silicon Valley anti-trust attorney Gary Reback, the battle is over bigger stakes than just the browser. It's over who controls the main channel on the TV of the future: the computer.

GARY REBACK, Attorney: It's one thing if a company monopolizes software; it's quite another thing if a company monopolizes access to the Internet because our lives increasingly are going to be conducted over the Internet. You're kids are going to do their homework over the Internet. You're going to deal with your bank over the Internet. You're going to buy symphony tickets over the Internet.

PAUL SOLMAN: And the fear of the Justice Department is you're going to have to do it all with Microsoft.

JOEL KLEIN: I don't want to live in a town in which there's one gas station. I don't want to live in a town in which there's one drugstore, and I don't want to have the guy who has control of the operating system decide what browser I should use.

PAUL SOLMAN: Now, however, comes the crucial question: Is what Microsoft's been doing really one of those illegal bad acts? Attorney Rick Rule says his client, Microsoft, is just being a tough competitor.

RICK RULE, Attorney: The law is pretty clear that when you're talking about unilateral behavior of companies, we allow them to engage in conduct that may be innovative, that may be different, that may even have some adverse impact on competitors if it has a legitimate business justification, if it's bringing benefits to consumers. And if it's doing that, it's not illegal even if somebody is proven to have monopoly power.

PAUL SOLMAN: Now, Microsoft says it doesn't have a monopoly since software is the fastest moving, most competitive industry on earth. But even if it did, how is it hurting consumers? When it buys up cutting edge companies, for example, and eliminates them as competition, Microsoft makes their products cheap and widely available, as when it bought Front Page, software for consumers to create their own web sites on the Internet. Mike Angiulo.

MIKE ANGIULO: We've been able to ship version after version in a really short time line, get out there and win a whole lot of industry awards, and give customers an easier and easier product, with more features in it. So we've taken something that worked and made it into something that's just the best and the easiest out there, but we're never done.

PAUL SOLMAN: As to the core charge that Microsoft is tying or bundling separate products into Windows, and thus killing competition, Nathan Myhrvold thinks government intervention would hurt consumers more than it could ever possibly help them.

NATHAN MYHRVOLD: If you want to create a principle that says if anything is ever sold separately, we can't add it in, then you're going to stop innovation in operating systems. I think that's bad for everybody.

PAUL SOLMAN: Joel Klein, of course, begs to differ.

JOEL KLEIN: The question is, if you've got a monopoly on this desktop operating system, what are the limits of what you can bundle? Can you decide all the content that goes on the desktop, which TV shows get put on the desktop, which travel agencies, which commercial operations? What are the limits, which spreadsheets? All of those things are things that certainly need to be thought about.

PAUL SOLMAN: To Joel Klein the bottom line is consumer protection. And surely if Microsoft didn't keep adding new features to Window, the price would be a lot lower than it is. But wait a second, says Microsoft, the total price would be a lot higher if the features had to be purchased as separate products; the process would be more complex. So, is Windows helping or hurting consumers? Well, it depends on how you and I look at it. And that may turn out to be the decisive issue--how we perceive what Microsoft's doing. On the walls of the Justice Department office, a reminder, almost a century old, of when the government fought the Standard Oil monopoly and other so-called "trusts" as well. Arguably, it was the court of public opinion, not legal opinion, that drove President Theodore Roosevelt and the political process to break up Standard Oil. Bob Metcalfe is a high-tech entrepreneur turned columnist, now that he's made his fortune. He thinks that these days the public is uncertain and uneasy about Microsoft, which will, in turn, prompt Bill Gates to at least listen to the Justice Department.

BOB METCALFE: I calculate he's about to have his anti- trust epiphany where he's going to go, I see, these guys have F-16's, I'm going to have to play ball; my customer--his customers, by the way, want him to behave himself. My readers, his customers, want to be served by Microsoft, and among the things they want from Microsoft is choice. They want Microsoft to allow them to have the freedom to choose other things. So to better serve their customers, they're going to have to play ball with Justice.

PAUL SOLMAN: In fact, some say Gates is already having his anti-trust epiphany and point to recent compromises by the company and an appearance before Congress.

BILL GATES: Mr. Chairman, members of the committee, thank you for this chance to present my thoughts on competition in the software industry.

ELLEN FITZPATRICK, Historian: It's sort of like the wizard has come out from behind the smoking ball to make his appearance.

PAUL SOLMAN: Historian Ellen Fitzpatrick has studied how anti- trust targets of the past have responded to government pressure. You go into PR overdrive--

ELLEN FITZPATRICK: And you put a public face, a personal, a human face, on this vast corporate wealth. And it has the effect of calming the public and soothing them about what monopoly really means.

PAUL SOLMAN: Fitzpatrick thinks a key component of public perception is size--if we think a corporation and the guy in charge, whether Rockefeller of Standard Oil or Gates of Microsoft, simply has too much power over lives. So, is Microsoft just too big? We asked Nathan Myhrvold.

NATHAN MYHRVOLD: If Microsoft makes fundamental investments in research & development, we come up with great products and people choose those products, that's okay.

PAUL SOLMAN: No matter how big you get?

NATHAN MYHRVOLD: What's wrong with that? You tell me what's wrong with us creating great innovative products and people choosing it. And if that's okay once, it's okay five times, it's okay more.

PAUL SOLMAN: But Justice says it isn't making its case on the basis of Microsoft's size. Size can mean efficiency, Joel Klein thinks. What it can't mean is what we as a people consider unfair competition.

JOEL KLEIN: You know, most Americans have a pretty good sense about competing fairly and in a way that protects consumers. And they also have a pretty good sense when you put your thumb on the scale, and I don't think anything we're doing will seek to impair Microsoft's ability to be an innovative and a true competitor. In the end, markets work best. We ought to intervene if we have an effective, meritorious claim, and then we ought to let the market get back to work.

PAUL SOLMAN: For all its caution, though, Justice thinks it does have a meritorious claim when it comes to Microsoft tying products to Windows. But to the company, that's government interference with the essence of its business. Chief Operating Officer Bob Herbold.

BOB HERBOLD: Integration is the core issue here, and it applies not just to Internet capabilities. We're talking about integrating features into products on an ongoing basis, which is the heart of this industry. And I can guarantee you that if the companies in the software business have to go through complicated guidelines or committees or whatever it is, that two things will happen: The innovation rate will slow down and the costs will go up. And that's bad for consumers.

PAUL SOLMAN: We had one last question for the standard bearer of the America software industry: Will Microsoft go to the mat against the U.S. Government?

BOB HERBOLD: Of course. This is very important, and it is something that we must fight for it for the entire industry, not only Microsoft.

PAUL SOLMAN: If that's true, Microsoft and Justice could be fighting for quite a while. FOCUS - FATAL REACTION

JIM LEHRER: Now, dangerous reactions to medical drugs and to Margaret Warner.

MARGARET WARNER: A new study in the Journal of the American Medical Association finds that adverse drug reactions are a major cause of deaths among hospital patients. The study estimates that somewhere between 76,000 and 137,000 hospital patients die each year from an adverse drug reaction. That would make it one of the leading causes of death in this country. The study also found that out of the 33 million patients admitted to hospitals each year, an additional 2.1 million experience a serious adverse reaction that doesn't result in death. For more about the study and some perspective, we're joined by Dr. Lucian Leape, Professor of Health Policy at the Harvard School of Public Health. He has co-authored several studies of patient injury from adverse drug reactions. And, welcome, Dr. Leape.First of all, for the purposes of what we're talking about here, define, what is an adverse drug reaction?

DR. LUCIAN LEAPE, Harvard School of Public Health: An adverse drug reaction is an undesired effect of a drug when it's used in the normal way. So by the definition is a side effect or injury but not related to an error in use or to drug abuse.

MARGARET WARNER: And what did this study tell us about fatal adverse drug reactions that we didn't know before?

DR. LUCIAN LEAPE: Well, I think the thing that struck me as a physician and I think most non- physicians is the magnitude. I think we all knew that there were side effects from drugs, but that number of 106,000, on average, deaths per year, wow, that seems like really a lot. And I think that's kind of scary when you look at it. In perspective, maybe it's understandable.

MARGARET WARNER: What do you mean?

DR. LUCIAN LEAPE: Well, using the figures from the study--and I have no reason to question them- -33 million admissions to the hospital in 1994, average of eight drugs per patient actually, we would think probably more than eight drugs, but let's use that number. Eight times thirty-three million means two hundred and sixty-four million drugs were given. Two point two million adverse drug reactions is less than 1 percent. I think most people, most physicians, most lay people would think that you had at least a 1 percent chance of having a reaction when you take a drug. So in that sense it's not too surprising.

MARGARET WARNER: So from the point of view of the patient, if you're one of the 33 million patients on a per person basis, it's much higher, right? I mean, you've got a 6 percent chance of having some drug have an adverse reaction for you.

DR. LUCIAN LEAPE: Exactly. Your chances of having a reaction are directly proportional to the number of drugs you get. We use more drugs now than we used to, and the more drugs you use, the more exposure, the more chances you'll have a reaction.

MARGARET WARNER: All right. So what are the ways that an adverse drug reaction are triggered? What are the causes?

DR. LUCIAN LEAPE: Well, the authors of the study talk about two different types of reactions, which are the classic way, they're considered Type A reactions, which are related to dose, and Type B reactions, which are idiosyncratic, meaning mostly allergies and that sort of thing. The dose-related ones are really, what we're really talking about here are very potent drugs that have a high risk of toxicity, drugs in which the border line between the dose that works and the possibility of having a serious effect is very, very narrow. Some of these are very important and very effective drugs but they're drugs in which the patient can have an ill effect, as well as a good effect. For example, many drugs are used to treat cancer--will have--will be effective at killing the cancer cells but will also damage normal organs. So the patient takes on the risk of having say damage to their heart or their kidneys in the hope of having their cancer cured, and yet they--these drugs, because they are so powerful, because they are so effective, can also cause damage.

MARGARET WARNER: And then what's the other? You said there were two categories or ways to trigger it.

DR. LUCIAN LEAPE: The other category are what they call idiosyncratic reactions or allergic reactions. And these are the kinds of responses that at the present time are completely impossible to predict. The patient just suddenly has an allergic reaction to a drug. The important thing there, of course, is making sure it doesn't happen twice. So if a patient has a reaction like that, you keep track of it and make sure they don't get that medication again.

MARGARET WARNER: Now, can it also include if you're--if you have two drugs that have a reaction to one another?

DR. LUCIAN LEAPE: It certainly can. We saw that recently in the Phen-Fen story in which the use of two medications for treatment of obesity resulted in some serious heart damage, and this is the kind of thing that those are particularly difficult to pick up. It took a long time for us to tumble to that. Realizing that drugs are interacting can be very tough to find out.

MARGARET WARNER: Now, you mentioned something earlier. This study did not include errors made by doctors in administering the drugs improperly to start with. Why is that, and would the numbers be much higher if you did include that?

DR. LUCIAN LEAPE: Well, that's really a very separate issue. Certainly those would be in addition. This study is looking at--this study looked at just the effects when they're used properly. We do know that there are errors made in the use of medications, and we estimate that those account for a certain number of injuries as well. And so you would put them together, the total burden would be more.

MARGARET WARNER: How reliable do you think the numbers are in this study? I noticed the Journal of the American Medical Association, while publishing it, did say they had a number of concerns about the actual numbers.

DR. LUCIAN LEAPE: Well, you know, you can find something wrong with every study. There's no such thing as a perfect study. These authors, I think, did their best. They took all the studies they can find. They threw out the ones that were not well done. They restricted their use of data to the ones that met their I think fairly strict criteria. True, these are studies, many of them done in teaching hospitals. Clearly, the teaching hospitals are different from community hospitals. I could quibble with the number of drugs they found. Eight--I think the average number of drugs that are used in this country is closer to ten or twelve. We know in teaching hospitals it might be as many as 30. You can pick it apart, but probably it's not too far off the mark, and I think we should be willing to take it for what it is, which is to remind us that there's a problem, and we need to be aware of it.

MARGARET WARNER: All right. So what can be done about the problem?

DR. LUCIAN LEAPE: Well, there are several things. One is with regard to these drugs that have this low therapeutic index, that is, where the chance of damage is very close to the chance of benefit when you give the medication. Clearly, we have to be very careful when we use these drugs. I think doctors are. I don't think there's a widespread promiscuity in the use of these drugs. Probably a large percentage of the drugs in this study--we don't know because they weren't able to get that information--but probably a large percentage of the drugs in this study were anti-cancer drugs. These are drugs where the doctor and the patient agonize over whether to use the drug. They know that there are going to be--there are going to be problems, and they take that risk on knowingly. But being careful in selecting the right drug is clearly important. Second is monitoring. Another drug that the authors mention in the study is Warfarin, more typically known to most people as Cumadin, used by millions of Americans. It's a very effective drug. It's an anti-clotting drug that prevents the blood from forming blood clots used in people who have had heart attacks, strokes, people at risk for that, people with atrial fibrillation, other problems with the art rhythm, used after many kinds of surgery, a very effective drug but a very dangerous drug because individual reactions vary so much. One person five milligrams a day is just right; for another patient it's too much. So careful monitoring of those kinds of patients is very important in order to make sure that the dose is just right.

MARGARET WARNER: All right. If I had a family member going in the hospital tomorrow, how alarmed or concerned should I be about the prospect of this happening, and is there anything patients or individuals can do to not become one of these statistics?

DR. LUCIAN LEAPE: I think there's a lot you can do. My own feeling is that every patient should know and understand any treatment they are receiving. And that certainly applies to medications. If you are receiving a medication, you should know what it is, what it's supposed to do, how often you get it, what the dose is, and so forth, and then check it when the nurse brings in the medication and make sure it's the right medication. Mistakes do occur. I don't think they occur in a large number, but nobody is perfect. And the patient should be an active participant in their care.

MARGARET WARNER: Thank you, Dr. Leape. I'm sorry, we're out of time. Thanks very much.

DR. LUCIAN LEAPE: Thank you.

JIM LEHRER: Still to come on the NewsHour tonight, the Brazilian rainforest and Katherine Graham. FOCUS - DISAPPOINTING RAINFOREST

JIM LEHRER: Phil Ponce has the rainforest story.

PHIL PONCE: For almost four months this winter fires burned in part of the world's largest rainforest. The Amazon Forest and savannas in Northeast Brazil were ravaged first by drought and then by the worst fires in history. Last week, rains finally came to Brazil's state of Roraima, allowing residents of the area to start assessing the damage. Government officials estimated more than a fifth of the state had burned. Reporter Monica Yant and photographer Peter Tobia of the Philadelphia Enquirer were there last week on assignment, and they join us now. Welcome, Peter and Monica. Monica, first of all, what did you see?

MONICA YANT, Philadelphia Enquirer Reporter: Well, not the rainforest that you see in picture books by any means. I mean, this part of the Amazon Basin is not quite as lush or green or wet as the typical sense of the rainforest that we learn of, but what we saw was even drier and burnedand charred than you could really imagine. I mean, before we left, we couldn't fathom that there would be fires in the rainforest. And what we saw was just a land that had really been ravaged both by drought and by fire.

PHIL PONCE: Peter, what did it look like on the ground?

PETER TOBIA, Philadelphia Inquirer Photographer: On the ground was a lot of charred area, a lot of very dry area, area that was usually very damp and got a lot of moisture and could support some crops. When we got there, it was really pretty much dried over, and there wasn't much vegetation or crops growing when we got there.

PHIL PONCE: People talk about the thickness of the smoke in this area. How thick was it?

MONICA YANT: Well, when we got here, it wasn't that thick because the fires had come about a day before. But throughout several months that the fires were burning airports were closed, hospitals were filled with children that had been--had smoke inhalation problems, and they said respiratory problems were up 40 percent throughout many portions of Northern Brazil. But from what we could tell, even after the rains coming, to get an idea of how strong these fires were, even after rains that supposedly put out about 90 percent of the fires, when we went up on a plane four days later, you could still--there were still parts of the forest that were inaccessible by plane or by foot that were just clouded by smoke. And those--those are going to burn until they burn out.

PHIL PONCE: Peter, you took an aerial shot of the savannas. Tell us what we're looking at now and describe it.

PETER TOBIA: This is a picture taken leaving Boa Vista by airplane into the Yanomami Reservation. And the only way to get to the reservation was by taking an airplane because it was totally inaccessible. This picture shows the fires that just caught on the savanna and would just burn trails and would just grow rampant, and making their own path of fire.

PHIL PONCE: So that black band that we're looking at is the--is the path the fire took?

PETER TOBIA: That's correct.

PHIL PONCE: As far as the total amount of land that was involved, how much, Monica?

MONICA YANT: Well, about 20 percent of the entire state of Roraima they say was burned, and it's about 87,000 square miles total. We were able to tell for our readers it's about half the state of Pennsylvania. Now, there aren't--this fire didn't get as much attention initially as let's say the fires in Indonesia last year, because those were in areas where they clogged major metropolitan areas, you know, entire cities in Indonesia and Malaysia airports, where there were, you know, millions of people. Roraima is a very rural part of Brazil. There aren't that many people who live there; even its capital city has about a hundred and seventy thousand people. When you get out into the savannas and into the forest, I mean, you're talking about really remote villages with just scattered groupings of farmers, so it didn't necessarily get that much attention right away. Even Brazil's capital government is several thousand miles away. It's sort of an out of sight, out of mind mentality, and until you get in the thick of it, you can't really imagine or see how much damage has been done.

PHIL PONCE: And what is the speculation? What are the experts saying caused the fires? How did they get started?

MONICA YANT: Well, we're talking about really subsistence level farming here. These are folks who don't have a lot of experience with agriculture. They don't have very much technology, and they slash and burn farming. They believe that setting fire will rejuvenate the land. In some forests it does. In some pine forests, for instance, fire can help spread seeds. The heat can help release nutrients in the soil. It doesn't happen in a rainforest, however. And what typically happens is while the savanna grasslands that these folks normally farm on, they might see some benefit for a couple of years-- usually, the ground will go bad after a few years, and then they'll move on. And every year--I mean, these are folks who've learned this generation after generation. They have a controlled fire. They set the fire on their land. It usually doesn't progress beyond the savannas because you have to imagine this area, the sort of the humid barrier around the savannas is the edge of the rainforest. It's usually so wet, it's so moist, and there's so much moisture in the air that it would be inconceivable that a fire could reach into it. But this year you have a drought. They didn't see rain from about August on in many portions of the state. You had winds that they typically don't see, and the combination of the drought and the winds and the heat--here are these folks starting their fires like they always do, and they just--they went out of control. I mean, most of the farmers we talked to had no idea what had happened as soon as it happened. And there was just nothing they could do to fight them.

PHIL PONCE: Peter, was there a story that was particularly compelling to you?

PETER TOBIA: The first group of people that we met--Francesca Alvarez and her husband, Romando--they had 12 children that they relied on the crops to grow to feed their family. And when Monica and I drove two hours into the village of Apiau, we met this family, and they were very gracious and very open to us and invited us in, and they showed us that there was pretty much nothing left of their 25 acres.

PHIL PONCE: And this is their field that we're looking at here?

PETER TOBIA: This is the picture that shows Francesca pausing in front of a tree that's charred. And in the background is the rainforest. And, again, people knew nothing about El Nino. So here you have a picture that pretty much captures what it was like there, showing all the environment.

PHIL PONCE: Monica, how do you--what do experts tell you about the significance of the Amazon to the world's ecosystem and why it should matter to people in the United States?

MONICA YANT: Oh, it's of grave concern to people in the United States. I mean, sort of at its most rudimentary level we try to think of the rainforest as sort of functioning around the world as the lungs and the kidneys of the universe. Forests every day take in carbon gases, gases that we don't really want to breathe, take in gases and through the process of photosynthesis, you know, send back out oxygen. Well, when a forest burns, that process is reversed, and instead of absorbing those harmful gases, the forest sends back more of those greenhouse gases that contribute to global warming. And essentially the forest begins to, you know, contribute to the world's environmental problems instead of helping it. And certainly it's tough to envision how this affects people, but it impacts the air that I breathe in Philadelphia as much as it would impact the air that the people are breathing down in Roraima.

PHIL PONCE: Peter, we talked about the impact on farmers. How about the impact on the Indian population?

PETER TOBIA: The Indian population was impacted in that--one of the first things that I really noticed was that--the way they rely on the animals that they hunted for food--because of the fires, a lot of the animals left, which made it very hard for them to find food, which they had to go to relying on vegetation instead of, you know, hunting the animals that they usually relied on. Another way they were impacted was having never seen smoke. I mean, this was a very primitive tribe that is in the rainforest.

PHIL PONCE: Not having seen smoke on that scale. I mean, obviously, they have small fires and that sort of thing.

PETER TOBIA: It affected them and their respiratory systems, like Monica was saying before. The leader of the group, Paulo, said that, you know, his eyes hurt. And he prayed to God that He would take the smoke away.

PHIL PONCE: How did the smoke and everything that's happening to their land fit in with their belief system?

MONICA YANT: Well, it was interesting. We were able to talk to a couple of different groups of the Yanomami, and there are some that--there is a myth within the tribe that long ago, before time, the forest had burned once before, and there were no white men then; there were no other people encroaching on them, and the forest had burned once before. And so when these fires came, again, the Yanomami were afraid this was the end of the world. They believed that once the smoke would clear the sky would fall, and they would all die. And their shamans got together to try to assess how to deal with the situation. But because they don't have smoke and they've never experienced this before, they didn't have a regular ritual to try to send the smoke away. So they improvised. They explained to us that they used a lot of rituals that they would normally perform to aid someone who was sick, and the shamans got together and there's a hallucinogenic bark that they snort essentially to put themselves in a trance so that they could communicate with the spirits of the universe. And, you know, very methodically they went through several different types of ceremonies, and their singing and dancing and chanting, to try to both get rid of the smoke, stop the fires, and finally bring the rain on their own villages and throughout this state. And, you know, you don't necessarily have to be too much of a believer, but if you do the math and the days that they say they did those ceremonies, the next day the rains came, and they had not seen rain in those parts for six/seven months.

PHIL PONCE: And, Peter, you got a shot of the first rain as it was happening. What was the reaction of the people who were enjoying the rain?

PETER TOBIA: The children just were overjoyed. And I was really fortunate and probably pretty lucky just to be in a village that was just South of the Venezuela border, and it rained, and children just ran out and celebrated. Although that rain was good for them to come, the leaders of that village said, you know, that's a good start but we need a lot more because our wells are dry.

PHIL PONCE: How about the long-term impact, what are experts telling you about that, Monica?

MONICA YANT: There are a lot of facets to the concern. I mean, yes, the rains came in the immediate--and the immediate fears are over. But, I mean, for instance, in the rainforests this is not a forest that is adapted to fire, and most of the environmental experts I talked to said, you know, it could take 100 years before this forest would heal itself if left completely alone. Now, you get into then some political concerns that folks in Brazil are very concerned that well, now there has been another layer of deforestation, could this lead to more, more timber exporting from the forest, could this lead to more development in a land that was very pristine before? You've got health concerns. Because of the drought a lot of creeks and rivers have dried into just mosquito-infested puddles. Outbreaks of malaria are up 30 percent in many of the Indian villages, and, again, these are people whose immune systems are wholly different thanours, and not at all, and they're not at all prepared to deal with these things. So you have longer-term issues of food. I mean, these animals have run--we talked to some people who were actually competing with animals. A young woman said monkeys and jaguar have come down from the mountains, and they're fighting for the same food. She has lost all of her crops, and she's out looking for the same food that these wild animals are because they have run from the fires; they have run from areas where there is no water to drink. So the rains may have come temporarily but there are seriously some long-term concerns that are left in this region.

PHIL PONCE: Monica, Peter, thank you both very much. CONVERSATION

JIM LEHRER: Finally tonight, the 1998 Pulitzer Prize winner for biography: Katherine Graham. Author of "Personal History," not "A Personal History," as I said at the opening of the program, she's the former publisher of the Washington Post and the present chairman of the Post executive committee. I spoke to her a short while ago from the Post newsroom.

JIM LEHRER: Congratulations, Mrs. Graham.

KATHERINE GRAHAM, Pulitzer Prize for Biography: Thank you so much, Jim.

JIM LEHRER: Tell us how it feels to have won the Pulitzer Prize today.

KATHERINE GRAHAM: I can't. It's so exciting. It's a real thrill and beyond my imagination. It isn't that my hopes are fulfilled or my dreams are fulfilled. This never occurred to me.

JIM LEHRER: Did it occur to you when you were--your first job was a newspaper reporter covering a labor beat in San Francisco--did it occur to you, hey, if everything goes right for me, someday I'm going to win the Pulitzer Prize?

KATHERINE GRAHAM: I was just thinking about getting from one block to the other.

JIM LEHRER: It never occurred to you this was going to happen even when the book--what about when you started the book? A lot of writers, when they put that first--write those first words, they say, ah, ha, I'm going to win the Pulitzer Prize. You didn't think about that when you started this book seven, eight years ago?

KATHERINE GRAHAM: I just thought, is the book ever going to get finished and is it going to appear and will it be all right? I mean, I wasn't dreaming about prizes.

JIM LEHRER: Many--this, of course, is a terrific thing, but there have been many other terrific things that have happened to you in this past few years since this book was published. Tell us about that. Have you been overwhelmed, in a way, by the response this book has gotten?

KATHERINE GRAHAM: Yes, I honestly have been. I think in the beginning the reviews really surprised me because they were so favorable. Later on, when it sold well, of course, that was wonderfully satisfying. But I still never thought--because this is the one book I'd written and I had a lot of help from my researcher at Small and from Bob Gotlieb at Knopf-- but I just thought, was it all right? It never occurred to me that it would win a prize if you write one book in your life. You don't think about prizes, do you?

JIM LEHRER: No. You're batting a thousand, though. One time out, one big, huge prize. But in addition to the book being successful as a piece of--in terms of the critics and in terms of sales--it was also successful, was it not, in terms of the response it received from individuals, from people that nowhere--did not live lives anywhere--closely resembling the kind of live you lived. Explain that.

KATHERINE GRAHAM: Well, you know, in a way it's still hard for me to understand. It rang bells of certain kinds with various people but especially with women in the work force who wrote me that it helped them because I describe all the feminine baggage I brought to work and how it got in my way. And they say that they still have some of this, although obviously less, and that it helped them to know that I went through this and eventually got over these things. And some people just said this changed my life and really helped me so much. And, you know, that has to be really wonderfully satisfying, and I'm still incredibly getting those letters, of course, not in the amount that I got them at first. But to feel that you are of help to people with something just by writing what happened to you is surprising and wonderful.

JIM LEHRER: And that wasn't what you set out to do, was it?

KATHERINE GRAHAM: No. I was just writing what happened. I thought people might be interested in the fact that I'd led what I thought of as two separate lives, wife and mother for 23 years, and then working person for 30. And so I hoped that that would interest people.

JIM LEHRER: Where does winning the Pulitzer rate on your list of great things that have happened to you? You've had a lot of time to think about your life up till now because you had to when you wrote the book. Where does winning the Pulitzer go on the list?

KATHERINE GRAHAM: I think it very top because it's so wonderful and so unexpected and such a thrill.

JIM LEHRER: Are you tempted to try again for another book, to kind of continue the dialogue that you've begun with so many people?

KATHERINE GRAHAM: I have a motto, which I didn't originate, which is "Quite while you're ahead."

JIM LEHRER: So I take it that's a "no?"

KATHERINE GRAHAM: That's a "no."

JIM LEHRER: That's a "no."

KATHERINE GRAHAM: There are a couple of things that I'm playing with that tempt me but I'm not ready to even formulate them yet.

JIM LEHRER: Have you given any thought to the fact, whether you follow up on it or not, that there are so many people out there who want to be talked to at a kind of a straight, let me tell you what happened to me level, the way you did?

KATHERINE GRAHAM: Well, I feel that I'd done that, and that I can't add to what I said, as far as I'm concerned. There are a few other things I might pick up on.

JIM LEHRER: But were you impressed by the need people had, the way they identified with you, and that maybe there is--I'm not suggesting you do it-- but that there is a need to talk about these kinds of things that you talked about based on your experience more than we're doing it in our society maybe?

KATHERINE GRAHAM: Well, there were various things that interested different people. Part of it was learning business from the beginning, part of it was the women's issues, and then part of it was mental illness, which I talked about at rather great length, because I thought that in my day the one thing we wanted to do was hide it. And to some extent I think people are still unwilling to talk about that. And I got amazing and somewhat distressing numbers of letters saying that people related to this in one way or another. Either they were ill, or they had a spouse who was ill or a parent who was ill. And so they really liked the fact that I said we've got to talk about it.

JIM LEHRER: And that, of course, was in reference to your husband.

KATHERINE GRAHAM: Yes, who had manic depression.

JIM LEHRER: Manic depression. Do you--how are you planning to celebrate the winning of this award?

KATHERINE GRAHAM: Well, I don't exactly know. I haven't had time to plan ahead, and Don and I are giving a speech tonight in Northern Virginia.

JIM LEHRER: That's your son, Donald.

KATHERINE GRAHAM: Yes.

JIM LEHRER: How are your colleagues there on the Washington Post? I mean, the Pulitzer, I mean, that is the biggest thing that happens in the world of journalism and in that newsroom there behind you. How have your colleagues received this news today that Mrs. Graham won the Pulitzer Prize?

KATHERINE GRAHAM: They were wonderful, supportive. All turned out and were--applauded and came and shook my hand. I feel that the book talked about this place and talked about the company and about the Post, and, indeed, to my satisfaction, some of the younger people said, we're so happy that you told the story of what preceded us. And I feel that they're really behind me, and they know I'm behind them.

JIM LEHRER: And this prize is--is a personal prize, but it's also a Washington Post prize. Is that how you feel about it?

KATHERINE GRAHAM: It is because I told my story, but I told the story of the company and the paper and how it developed and what preceded me, and I talked about my parents and about my husband, Phil Graham, and so I felt that I told a whole lot of stories, although I call--it's called "Personal History." It's really the history of a lot of other things.

JIM LEHRER: Well, look, I know you've got--as you said, you have to go make a speech with your son and you need to celebrate, but, again, congratulations, and more power to you.

KATHERINE GRAHAM: Thank you, Jim. And thank you for letting me be here. RECAP

JIM LEHRER: Again, the major stories of this Tuesday, President Clinton told NASA employees in Houston he remained committed to a strong, stable, balanced space program. Vice President Gore announced a plan to create a new computer Internet that will be up to a thousand times faster than the current one. And Franklin Raines resigned as director of the Office of Management & Budget. An editor's note before we go tonight: It's about Stuart Taylor, who's been doing regular and superb reporting on the NewsHour about the Supreme Court. He will no longer be doing such reports, and I wanted you to know why. We have always separated those who report the news from those who analyze or comment on it. I do not give my opinion about anything; neither do Elizabeth Farnsworth, Margaret Warner, Phil Ponce, or any of the other staff correspondents. The same rule applies to reporters from other news organizations who are debriefed about a story. We leave the opinions to Mark Shields & Paul Gigot, our historians, our regional commentators, and our essayists, as well as other invited and clearly identified commentators and advocates. The distinction is very important to us. And we believe Stuart's recent commentaries in print and on other TV programs about the Starr investigation have caused some blurring of the lines and some confusion about his role with us. He may still appear on the NewsHour from time to time but as a clearly labeled commentator, not as a straight news reporter. We'll see you on-line and again here tomorrow evening. I'm Jim Lehrer. Thank you and good night.