Strong Medicine (52 page)

For the first time Maud Stavely permitted herself a faint smile, though it

quickly disappeared. "I said ten minutes, not ten hours."

"Why not make a start in the time we have?"

"Very well. The most immoral segment of your business is precisely the one

you are involved in-sales. Your company and all the others

oversell-grossly, cynically, wickedly. You take what are essentially

reasonable drugs, though with limited medical uses, then through massive,

ruthless sales campaigns have those drugs prescribed for countless people

who either don't need, can't afford, or shouldn't have them-sometimes all

three."

"'Immoral' and those others are strong words," Celia said. "No one disputes

there's been some overprescribing. but-"

"Some overprescribing! Excessive prescribing is a norm. But it's a norm you

people work for, deliberately plan for, and most likely pray for! If you

want an example, consider Valium and the others like it-probably the most

overused, unnecessarily prescribed family of drugs in history, And because

of overblown sales campaigns, launched because of insatiable greed by

companies like yours, those drugs have left behind a trail of addicts,

desperate people, suicides

"Also a good many," Celia said, "who really needed the drugs and benefited

from them."

"A minority, " the other woman insisted, "who could still have had them,

but without the saturation advertising and sales promotion which

brainwashed physicians into believing the Valium types were a panacea for

everything. I know. I was one of the brainwashed doctors-until I saw how

awful the drug scene was, and gave up private practice to start this

organization."

Celia said tentatively, "I know that you're an M.D."

"Yes, and an internist. I was trained to keep people healthy and

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save lives, which I'm still doing here, though on a scale much larger than

before." Stavely waved a hand to dismiss herself as subject. "Come back to

Valium. It represents another way in which your business is unprincipled."

"I'm listening," Celia said. "Not agreeing, but listening."

"No one needed all the diffierent variants of Valium which competing drug

firms brought out. There is no benefit, no possible advantage in having

five different Valiurns around. Yet after Valium was a huge financial

success, other companies devoted months, even years, of research-precious

scientific time, enormous sums of money-not with the aim of discovering

something new and beneficial, but simply to have a Valium of their own

under a different name. So they produced other Valiums-by shifting

molecules around, making their drugs just different enough so they could be

patented and sold profitably-"

Celia said impatiently, "Everybody knows there are 'me-too' drugs, perhaps

more than there should be. But they do sometimes lead to new discoveries;

also they keep pharmaceutical companies -which society needs-solvent

between other big breakthroughs."

"Oh, my God!" Dr. Stavely put a hand to her head in an incredulous gesture.

"Do you really believe that sophomoric argument? When it isn't just about

Valium. When every major drug that one company brings out is copied by the

others. That's why pharmaceutical research should be directed and

controlled by government, though paid for by the drug firms."

"Now I can't believe you're serious," Celia said. "You'd want drug research

controlled by the same politicians who wrecked Social Security, fill pork

barrels, can't balance a budget, and would sell their mothers for votes.

Why, under that arrangement penicillin wouldn't be on the market yet! Okay,

let's admit capitalist free enterprise is imperfect, but it's a

country-mile better, and more ethical, than that. "

Stavely went on as if she hadn't heard. "Your precious industry had to be

beaten over the head with regulations before it would publish proper

warnings about the dangers of its drugs. Even now, it fights for minimum

warnings and usually wins. Not only that, after a new drug goes on sale,

adverse effects are hidden--conveniently, callously, buried in company

files."

Celia protested, "That's nonsense! We're required by law to report adverse

effects to FDA. Oh, there may have been a few instances where someone

neglected . . ."

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"There have been plenty of instances which this organization knows about,

and I'll bet a lot more that we don't. Illegal withholdings of information.

But is it ever possible to get a prosecution launched by the Justice

Department? Not when you people have that army of paid lobbyists working on

Capitol Hill . . ."

WeR, Celia thought, she had come here asking for opinions and she was

getting them. While she continued listening, occasionally interjecting, the

promised ten minutes lengthened to an hour.

At one point Stavely mentioned a recent controversy which Celia knew about.

A pharmaceutical company (not Felding-Roth) had experienced problems with

one of its products, an intravenous fluid used in hospitals. Some bottles

containing the supposedly sterile I.V. liquid had been found to have faulty

caps, permitting the entry of bacteria which, in turn, caused septicemia-a

blood disordernow blamed for several patient deaths.

The dilemma was: the number of problem bottles was known to be small, and

it was possible that all affected ones had now been found; also there would

be no more, since the manufacturing problem had ~een discovered and

corrected. Meanwhile, to place a ban on the entire supply of I.V. fluid in

hospital inventories would cause acute shortages and conceivably more

deaths than the original problem. The issue had been debated back and forth

for several weeks between the manufacturer, FDA, and hospitals. Dr. Stavely

criticized what she saw as "a disgraceful example of a drug company's

dragging its feet while refusing to recall a dangerous product. "

"I happen to know a little about that," Celia said, "and it's something

which everyone concerned has tried to solve. Just this morning, though, I

heard that FDA has decided to ban any more use of the existing LV. fluid

supplies. They're preparing notifications over the weekend, and the

decision will be announced at a press conference Monday morning."

Stavely looked at her visitor sharply. "Are you certain of that?"

"Absolutely." The information had come from an officer of the company

concerned, whom Celia knew to be reliable.

Stavely made a note on a desk pad and their exchange continued. Finally

they came to Montayne.

"Even now," Stavely said, "Citizens for Safer Medicine will do everything

it can to stop that inadequately tested drug going on the market."

Celia had become tired of the one-sided harangue and snapped,

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"To call Montayne inadequately tested is ridiculous! Besides, we already

have FDA approval."

"In the public interest, that approval must he withdrawn."

"Why?"

"There was a case in Australia

Celia said wearily, "We know about the Australian case." She went on to

explain how medical experts had refuted the allegations made in court

and, both there and at the Australian government hearing, had given

Montayne a clean bill.

"I don't agree with those experts," Stavely said. "Have you read the

transcript of the trial?"

"I've read reports that have dealt with it thoroughly."

"I didn't ask that. I asked if you had read the trial transcript."

Celia admitted, "No."

"Then read itl And do not presume to discuss Montayne until you have."

Celia sighed. "I don't believe any more discussion will get you and me

anywhere."

"If you recall, that's what I told you in the beginning." For the second

time there was a thin, faint smile below the other woman's piercing eyes.

Celia nodded. "And you were right. Not about much else, but certainly

about that."

Dr. Stavely had already gone back to the paper she had been reading when

Celia came in. She glanced up. "Good afternoon, Jordan."

"Good afternoon," Celia said, and went out through the dismal offices to

the equally dismal street outside.

Later in the afternoon, driving herself back from Manhattan to

Morristown, Celia reflected on the nature of Dr. Stavely.

Certainly Stavely was dedicated but also, to an extent, obsessed. It was

equally clear that she was lacking in a sense of humor, unable to regard

herself with less than total seriousness. Celia had met such people

before; it was always hard to involve them in a thoughtful, objective

conversation. They were so accustomed to thinking in black-and-white,

antagonistic terms that they found it impossible to switch antagonism off

and think in the shades of gray where much of life was lived.

On the other hand, the CSM chairperson was clearly well informed,

articulate, well organized, and had a keen, possibly bril-

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liant mind. Her medical qualifications gave her stature and an automatic

right to be heard on the subject of prescription drugs. Some of her views,

too, were not all that far removed from Celia's, who remembered, fourteen

years ago, describing "me-too" drugs and -molecular roulette" in much the

same way as Stavely. It was Sam Hawthorne who, at that earlier time, had

offered the arguments in response which Celia had used this afternoon. And

despite using them, she was still not wholly convinced they were valid.

But Stavely did become unbalanced when emphasizing the pharmaceutical

industry's negative aspects while ignoring the many positive,

humanitarian contributions to science and health the industry provided.

Celia had once heard the United States drug industry described as "a

national treasure," and believed the description was, on the whole, true.

There was also Stavely's naive and absurd contention that drug research

should be government controlled, and her gross misinformation and

prejudice about Montayne.

But all in all, Stavely and CSM were formidable opponents, neither to be

ignored nor to be taken lightly.

One thing Stavely had caught her out in, Celia thought ruefully, was the

fact that Celia had not read the transcript of the Australian trial

involving Montayne. Next week she intended to correct that omission,

Still later that day, at dinner, Celia described her CSM experience and

views to Andrew and he, as usual, had some wisdom to contribute.

"You may not find those activist people-Maud Stavely, Sidney Wolfe, Ralph

Nader and the others-easy to live with, and at times you may detest

them," Andrew said. "But you need them, your industry needs them, just

the way General Motors and the other auto companies needed Nader before

he alighted on the scene. Nader helped make automobiles-for all of

us-better and safer because of his needling and 1, for one, am grateful.

Now, Stavely and Wolfe are keeping you and your people on your toes."

"I admit it." Celia sighed. "But if only they were all more moderate and

reasonable!"

Andrew shook his head. "If they were that, they wouldn't be successful