BRANCACCIO: Welcome to NOW.

In the aftermath of Hurricanes Katrina and Rita, and with Wilma churning dangerously as we speak, there's been lots of talk about restoring the coastal marshes of Louisiana.

The theory is that those wetlands act like a giant rug at the state' s front door, absorbing some of the power of storms before they reach places like New Orleans.

It's something we've been reporting on for several years, but now there's a new urgency, a new price tag, and a new question: is it already too late?

HINOJOSA: We came to explore Louisiana's coastal wetlands after the double hit of Katrina and Rita.

Not only are these wetlands crucial for the state's seafood and oil and gas industry, they also act as a natural barrier, weakening the force of incoming hurricanes.

The problem is this land is vanishing. Every 30 minutes, wetlands roughly the size of a football field disappear into the Gulf.

Three years ago, we'd come to see these same marshes with British-born scientist Denise Reed. She's been trying to save this landscape for years.

REED: This marsh cannot survive in this state much longer. It hasn't had any sustenance. It hasn't had any sediments from the Mississippi River. And it's still there, but we don't think it's gonna be there for much longer.

HINOJOSA: The wetlands are disappearing because they're being starved. The levees built along the Mississippi River to protect people from floods block the freshwater and dirt the marshes need to survive.

Back in 2002, Reed showed us an innovative fix that mimics what the river used to do. It's called Canaervon. Gates open and flood the area, replenishing the marshes.

Reed took us downstream to show us the project was working. She said, several years ago this area was thin and patchy. Now, new healthy marsh was popping up everywhere.

REED: A lot of people think it's hopeless down here in coastal Louisiana. But just coming down here and looking at this, this gives us more than hope. This makes us believe that we can do this.

HINOJOSA: And back then, many in the state government were convinced as well, they had pressed the federal government for billions of dollars for coastal restoration projects. But in the end, they only received a fraction of that.

Denise Reed was already worried.

REED: We haven't had a big hurricane hit the area of major land loss in here for decades. A lot has changed since the last big hurricane hit this landscape. The landscape is totally altered. We don't want to have a disaster before we get action.

HINOJOSA: Now, six weeks after Katrina, Denise Reed is making her first trip back to survey her beloved wetlands.

The hurricane destruction is everywhere — clumps of marsh from miles away were ripped up and scattered all around here.

REED: Wish me luck....

HINOJOSA: The healthy green marsh we saw three years ago seems completely destroyed. This freshwater marsh has been singed brown by the saltwater the storms brought in.

It looks bad, but Reed says you gotta dig in to see what the storm's real effect has been.

REED: Let's see what we get. Whoa! It's not comin' up. It's got a consistency a bit like yogurt, which is also the kind of consistency that we get from these new sediments. I don't know if I can get it. There we go. Okay. It got a bit messed up here. Okay. This is great!

It looks like all of the marsh has been torn off. But a lot of what has happened here is that mud has been placed on top of the marsh and that is good.

HINOJOSA: She's even found some life in all of that mud.

REED: We can see that some of these really seem to be growing, you know? This is definitely not dead and it's been six weeks since the storm. So I'm very optimistic that this whole area that looks fairly brown and pretty dead at the minute is gonna be lookin' really healthy next spring.

HINOJOSA: So, good news around the area of Canaervon, but the rest of the wetlands didn't fare as well. After the hurricanes, thousands of acres of marsh were completely destroyed. With so much of that natural buffer gone, the Louisiana coast is now more vulnerable than it was before.

Now, Democratic Senator Mary Landrieu says restoring the wetlands must be a national priority.

LANDRIEU: The wetlands can be restored. And, the cities of New Orleans and cities all along the coast can be protected. But it takes money and action. That is what we have not had from the federal government. We've not had money. We've not had action. And now, the cost is great.

HINOJOSA: And so is the amount of money Louisiana is asking for the state's reconstruction.

Senator Landrieu introduced a bill asking the federal government for 250 billion dollars to rebuild, but only about 14 billion of that would go towards coastal restoration.

And there are those who are accusing state officials of adding too much pork, which could jeopardize the entire proposal and leave the wetlands restoration with nothing.

HINOJOSA: Within those $250 billion, some people might raise questions about eight million for alligator farms, 25 million for sugar cane research, 35 million for marketing seafood. People are gonna say, "Oh my gosh."

LANDRIEU: If you and the rest of the country stay focused on those three items, you will miss the big picture. It was a $250 billion request. Not every single item in there is of an emergency nature. But every single item was important to some member of our delegation. Alligator skins might sound funny to some people but they mean jobs to Louisiana. And...

HINOJOSA: But, some people might say right there, you might be...

LANDRIEU: But, we don't...

HINOJOSA: ...risking losing what's really important to rebuild because you've thrown in marketing seafood.

LANDRIEU: Maria, if I could've written every item and line item in that bill, I might've written it differently. But, the point remains that this country needs to invest in the energy coast of America.

HINOJOSA: It's uncertain whether Landrieu's reconstruction bill will pass. But scientist Rob Young says even if they do get the money for the wetlands, selling the project as storm protection might give people a false sense of security.

YOUNG: What really makes it the most dangerous is the idea that we can do this and then allow all the people to remain.

HINOJOSA: Young studies the effects of hurricanes on coastlines. And much as he believes in restoring wetlands, he says it will take years for those projects to be up and running, and the nation should be just as focused on discouraging people from living in such risky areas.

YOUNG: We'll all be talking about the next disaster again ten years, 20 years from now, who knows when it would happen. And we'll be wondering why we didn't get more of those communities out of the high-risk areas.

HINOJOSA: Denise Reed says you have to start somewhere. She insists some wetlands, maybe not all, can be rebuilt. But even she admits that people who choose to live on the gulf will never be fully protected.

REED: There'll always be a bigger hurricane than the last one. And I think we just have to be realistic about how much protection we can provide to people. We've gotta work on those issues and how they go together and see how we can fit in this whole jigsaw puzzle that is coastal Louisiana and make it what we want it to be in the future.

BRANCACCIO: There's more to say about the damage left by Katrina. One of the hardest hit areas in Louisiana is the city of Chalmette, just east of downtown New Orleans. It's a place we visited for a story on chemical plant security just weeks before Katrina hit.

The section of Chalmette where resident Ken Ford and I had taken our walk ended up under as much as 25 feet of water. We checked up on these nice people. All survived the storm, but Joy Lewis lost her 92 year old mother who was stranded in a nursing home.

The flood waters also ruined their house. It, along with some 1,200 others in St. Bernard parish, was contaminated by about 1 million gallons of crude oil that spilled from the local Murphy Oil refinery.

That's just down the river from the plant we'd come to report on last summer.

Exxon's Chalmette refinery stayed dry enough. That plant had been charged with violations of environmental regulations. Last week, Exxon agreed to pay 4 million dollars in fines. Other violations could lead to new fines.

A year ago, Vioxx was one of the most widely prescribed painkillers in the world. Then the bombshell: for years, Merck, the maker of Vioxx, had known that the drug increased the risk of heart attacks.

Merck pulled the drug from the market last fall.

And where were the federal regulators all that time? Back in January, we talked to a senior official at the food and drug administration who said his warnings about Vioxx were dismissed by the very government officials who are supposed to keep you safe from problem medicines. A lot has happened since we first brought you that story.

BRANCACCIO: The drug company Merck has been reeling from more than 5,000 law suits over its once blockbuster drug Vioxx. Merck is now wrapping up a trial brought by this man: a postal worker who alleges the drug may have led to his heart attack. We'll see the results of that case next week.

But in August, a Texas jury awarded $253 million to the family of a man who died of a heart irregularity after taking the painkiller. That first Vioxx case was a resounding defeat for Merck, which is appealing the ruling.

Among the pieces of evidence that persuaded jurors that Merck was negligent: a slew of internal emails and documents, some of which we first reported last January, that indicate Merck knew early on of the risks the drug posed.

Documents including this one: a March 2000 memo from Merck's chief of research, telling colleagues that "the cardiovascular events are clearly there." And then there's a Merck training manual which uses the word "dodge" when instructing salesmen how to handle questions doctors may have about Vioxx and heart attacks.

Merck says those company documents have been "taken out of context" and says it acted appropriately and responsibly by voluntarily withdrawing the drug last fall.

GILMARTIN: We are taking this action because we believe it best serves the interest of patients.

BRANCACCIO: The scandal forced Merck chief Raymond Gilmartin to resign this past spring. But that hasn't stemmed the fallout. Merck share prices have taken a beating since the recall. And analysts say the once venerable company could stand to lose tens of billions of dollars in damages.

But there's more to this story than Merck's fall from grace. Vioxx also exposed some disturbing flaws in the way the Food and Drug Administration — the FDA — regulates the pills we take.

GRAHAM: FDA is there to serve its client industry. It is not there to serve the public. FDA is an institution that has become a factory for the approval of new drugs and safety is not a consideration.

BRANCACCIO: Last January, we spoke to Dr. David Graham, an insider turned whistleblower. Graham is a senior official in the FDA's Office of Drug Safety. That's the office responsible for monitoring drugs once they've been approved for sale. Graham studied Vioxx for nearly three years and found that the drug may have caused as many as 139,000 heart attacks.

GRAHAM: 100,000 people in the United States, that's 50 people a day for five years, had heart attacks. One by one, in the silence, in the loneliness of their homes, their workplaces, wherever it is, it could've been down the street from where you live, it could have been down the street from where I live. And it basically just continued to happen while FDA said, "This drug is perfectly safe."

BRANCACCIO: Graham then told his managers he wanted to make his results public. Instead of going after Vioxx, they went after him.

GRAHAM: The response of management was just one of negative reaction. And rejection. And criticism.

BRANCACCIO: You really felt that?

GRAHAM: Even on September 22nd, a week before Vioxx came off the market, senior managers within FDA were saying to me, "Why on earth did you study Vioxx and heart attacks anyway?

BRANCACCIO: What does that say to you, that they would make such a statement?

GRAHAM: What it says to me is that you had an agency that was completely oblivious to safety, completely insensitive to safety, that basically was willing to tolerate a 500% increased risk of heart attack with no demonstrable counter balancing benefit for the drug because it suits their client to allow the drug to be marketed in America.

BRANCACCIO: The essential question the FDA's handling of Vioxx raised is, who is the FDA serving?

GRAHAM: A former manager of mine from the Office of Drug Safety told me that industry was our client. And when I said to him, "No, the public is my client," he said I was wrong and it was industry. And my response back to him was, "Industry may be your client but it will never be my client."

BRANCACCIO: Earlier this year, an FDA advisory panel recommended that Vioxx go back on the market with stricter labeling. Graham says label changes are a standard technique the FDA likes to fall back on — but he points out that the last label change to Vioxx proved to be tragically ineffective.

GRAHAM: So every time FDA says we have managed the risk of a drug by labeling, by instituting a labeling change, FDA is being, I think, in my view, cynical and untruthful with the American people.

BRANCACCIO: Republican Senator Charles Grassley has introduced a bill that would create an independent Office of Drug Safety, free from industry influence. That office would also have more authority to regulate drug makers.

GRASSLEY: FDA is saying that the pharmaceutical companies have a seat at the table. The only seat at the table across from FDA should be "John Q. Public."

BRANCACCIO: Since our piece first aired, the FDA has established a new committee to watch over drugs already on the market. But the group is stocked with the same folks who let them on the market in the first place.

And what is the White House approach to the FDA? For much of his term, President Bush has left the top post at the FDA vacant. This past summer, Lester Crawford was finally confirmed as Commissioner. But just two months later, he suddenly resigned amid allegations that he failed to disclose financial ties to a wholesale drug company.

This is the new acting commissioner, Dr. Andrew von Eschenbach. Consumer watchdog groups believe he's the wrong man for the job. He's strongly committed to speedy drug approvals, which they worry could lead to more lax agency oversight. One group, however, applauded the move. The drug industry's lobbyists, Phrma, says the FDA is "in good hands" with Von Eschenbach.

BRANCACCIO: Earlier this year, I met a pretty great guy in Buffalo, New York.

After a hairy tour of duty in Iraq, Sergeant Jeremy Lewis had come home, only to find himself haunted by the war.

Lewis, and over twelve thousand other returning veterans, is suffering from post traumatic stress disorder. PTSD is predictable, given conditions in Iraq, but there's evidence the Veterans Administration hasn't equipped itself for the onslaught of cases.

This past summer, a wartime president promised ample funding for the health care of veterans.

BUSH [8/22/05]: My administration is helping the veterans who fought and sacrificed for America to get the quality care they deserve.

BRANCACCIO: But last May, retired army Sergeant Jeremy Lewis told us a very different story.

LEWIS: It's criminal the way the veterans are being treated today by the system.

BRANCACCIO: Lewis is a decorated veteran who has served his country for more than two decades. When we caught up with him at his home in Buffalo, New York, he had returned from a year-long tour in Iraq physically unscathed.

But the frequent ambushes that he faced running convoys in the Sunni triangle had changed him, affecting his livelihood back home as a long-haul truck driver.

LEWIS: If I saw a dead deer on the side of the road or something like that, I'd always try to move over thinking there was a bomb under the deer. And if traffic got heavy, it wasn't comfortable because one of the ways they ambush you is to block you into traffic.

Jeremy suffers from post-traumatic stress disorder, or PTSD. The trauma of up-close combat and the constant fear of death followed him home, bringing anxiety to everyday tasks and sleeplessness at night.

Lewis sought treatment at his local VA hospital, but he had to wait two months for his first doctor's appointment. It took another three months for him to meet with a therapist. And his subsequent visits were few and far between.

LEWIS: Once a month with a therapist and once every three months with my primary care doctor. It doesn't seem like they have the resources to do more. Or...

BRANCACCIO: It sounds like you could use more.

LEWIS: And both doctors told me I should be getting more. But they said that we just don't have the money in our budget.

BRANCACCIO: Back in May, we asked Dr. Jonathan Perlin, the man in charge of health care at the VA, if anything could be done.

PERLIN: Well, you know, I appreciate hearing about this incident. And if you share details, I will take care of this immediately.

BRANCACCIO: In fact, says Lewis, his primary care appointments did pick up, but in August, his doctor was deployed to Iraq. He received a letter from the VA reassigning him to a new doctor only just this past week. He still sees his therapist only once a month.

And overall, there have been some troubling developments at the VA.

In May, we asked if the VA was prepared for veterans returning from Iraq and Afghanistan. Their answer?

PERLIN: The resources are absolutely substantial.

BRANCACCIO: But a month after our interview, Perlin admitted at a Congressional hearing that the VA did not have enough money for health care for the current fiscal year. His boss, VA Secretary Jim Nicholson, made an emergency request for more funding.

NICHOLSON [6/30/05]: We now believe that it is appropriate to request additional resources for fiscal year 2005.

BRANCACCIO: One of the reasons for the shortfall: the VA's budget had anticipated 23,000 War on Terror vets seeking treatment this year. That number turned out to be almost 95,000 vets.

Congress came through with a billion and a half dollars but the damage had already been done. Hospitals, feeling the pinch, were delaying appointments for veterans.

The waiting list for a first appointment at VA hospitals nearly doubled from April through August, only slightly receding this fall.

Some in Congress were hopping mad, because they had been warning about a lack of funding all along.

REP. BOB FILNER (D-CA): You should be out at every damn hospital in this country to say, "I'm sorry. We made a mistake, and we're not serving you right.

NICHOLSON: Certainly, there may be exceptions here and there, but I am proud and will stand behind the excellent delivery of health care services that the VA is providing to our veterans

BRANCACCIO: But there was more room for doubt when it came to mental heath care services.

REP. MICHAEL MICHAUD (D-MA): Yes or no, do the current estimates for 2005 account for the mental health care needs of Operation Iraqi Freedom or Enduring Freedom?

NICHOLSON: I can't answer that yes or no, I don't think, Congressman. The answer is that it's a high priority.

BRANCACCIO: The VA assured us this week that mental health care needs are covered in their 2006 budget proposal, which was increased by $200 million since the summer. And they point to the ambitious treatment plans they've developed for PTSD.

But this year, some VA facilities are still cutting corners to meet lean budgets.

Take, for example, the VA mental health clinic in Portland, Oregon. An internal staff newsletter from January said the program is "unquestionably underfunded." In this memo, VA therapists were encouraged to "get creative with scheduling" by shortening sessions and meeting with their patients less frequently. Portland told us this week that they're applying for more funding.

And at the VA hospital in Puget Sound, Washington, job vacancies in mental health care are left unfilled because of a two million dollar budget deficit.

What's more, the budget battles in Washington DC aren't over yet.

BUSH [10/14/04]: Congress needs to pay for as much of the hurricane relief as possible by cutting spending.

BRANCACCIO: This month, with the costs of the Katrina recovery skyrocketing, the President asked Congress to reign in spending. House Republicans have proposed a 2% cut for every department. The cutbacks at the Veterans Administration: $600 million, which according to the VA itself would have a "significant impact" on veterans' health care.

Veterans like Jeremy Lewis, whose anxiety and sleepless nights have not gone away. There's financial hardship, too. The disease and its treatment left him unable drive long distances as a truck-driver, and he lost his job.

Back in May, he was flat broke.

LEWIS: I got about $8.00 in the bank left. So basically I'm living off of my friends.

BRANCACCIO: Over the summer, Jeremy's best friend got him a job developing photographs, but it pays only $220 per week, a third of his old salary. He's waiting on the VA to decide if he'll get disability payments, which he hopes will kick in before the end of the year.

But he feels abandoned by the government he served, and wants the country to change its priorities.

LEWIS: People who send troops to war have to know there's an aftercost of sending troops to war. You can't get them back and say: "Okay goodbye. You know we got what we wanted out of you, see ya."

BRANCACCIO: Next week the public will learn the outcome of the special prosecutor's two-year investigation into the leak of an undercover CIA agent's identity. What does this case say about how this administration spins the media and the public?

COOPER: I wrote a piece basically decrying the leaks, and saying these leaks were unusual and strange, and they're worth calling attention to. So, I feel good about what I wrote, and I don't feel like I was spun.

BRANCACCIO: And that's it for NOW. From New York, I'm David Brancaccio. We'll see you again next week.

BRANCACCIO: Connect to NOW online at pbs.org.

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