Strong Medicine (64 page)

Over a hurried breakfast in Andrew's and Celia's suite, interrupted by

several telephone calls relating to their departure, it was Andrew who

had explained the tragic situation to the children.

"I will talk about it," Celia had said, "but if you don't mind, not any

more for a while. I guess you could say I'm shell-shocked at this

moment." Even now, she wondered whether she had done the right thing by

agreeing to go back, then reminded herself that her insistence on having

Montayne withdrawn at once would save at least some babies and mothers

from their otherwise terrible fate.

That Felding-Roth's promise to Celia had been kept became evident shortly

before they left the Kahala Hilton for Honolulu Airport. A radio music

program was interrupted for a special news bulletin. It reported the

withdrawal of Montayne from public sale because of "possible harmful

effects which are being investigated," and added a warning that doctors

should cease prescribing the drug and pregnant women should stop taking

it.

On a regular newscast, soon after, an amplified report had

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Montayne's withdrawal as the top item and, at the airport, an afternoon

edition of the Honolulu Star-Bulletin carried an Associated Press news story

on the subject on its front page. It seemed clear that a barrage of

publicity had begun and was likely to continue.

For the Jordan family it proved a very different day from the quiet one on

a beach which they had planned the night before.

The airplane was crowded, but their four-abreast seats in the aft section

at least allowed some private conversation and after a while Celia told the

others, "Thank you for being patient. Now you can ask questions if you

wish."

Bruce was first.

"How could something like this happen, Mom, with a drug being okayed, then

having so much bad effect?"

She organized her thoughts before answering.

"What you have to remember first," Celia said, "is that a drug, any drug,

is an alien chemical in the human body. It's put thereusually when a doctor

prescribes it-with the aim of correcting something that's wrong in the

body. But as well as doing good, it may also do harm. The harmful part is

called a side effect, though there can be harmless side effects too."

Andrew added, "There's also something known as 'risk versus benefit.' A

physician has to judge whether the risk of using a particular drug is worth

taking in order to get results that he and the patient want. Some drugs

involve morc risks than others. But even with simple aspirin there's a

risk-a serious one at times, because aspirin can cause internal bleeding."

"But surely," Lisa said, "drug companies test drugs before they're sold,

and the FDA is supposed to find out about riskswhat they are and how bad."

"Yes, all of that's true," Celia acknowledged. "But what often isn't

understood is that there are limitations with testing, even nowadays. When

a new drug is tested, it's used first on animals. Then if the animal data

looks okay, it's tried on human volunteers. All of that takes several

years. But at the end of human trials, when everything about the drug may

appear to be fine, it has still been used by only a few hundred, or perhaps

a thousand people."

"And none of those people," Andrew said, "may have suffered any adverse

effects--or only minor, unimportant ones."

Celia nodded agreement, then went on, "But when the drug is on the market,

and being taken by tens of thousands, maybe millions, adverse reactions can

show up in a few people, sometimes a tiny

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percentage of the population-reactions that could not have been foreseen

during testing. Of course, if the percentage proves large enough and the new

reactions are serious or fatal, the drug has to be withdrawn. The big point

is, there's no way to be certain how safe a drug is until it has been used

widely."

"Those reactions," Bruce said. "They're supposed to be reported, aren't

they?"

"Yes. And if a drug company hears about any, in this country the law

requires us to report them to the FDA. Usually that happens."

Lisa's forehead wrinkled. "Only 'usually'?"

Celia explained, "That's because it's difficult sometimes to decide what is

a true adverse reaction to a drug, and what's caused by something else.

Often it's a matter for scientific judgment, with room for genuine, honest

disagreement. Something else to remember is that a hasty decision could

cause the loss of a good, perhaps lifesaving medication."

"In the case of Montayne, though," Andrew reminded them, "everything went

the other way." He told Lisa and Bruce, "Your mother's judgment was right

about those disputed reactions, the other judgments wrong."

Celia shook her head. "Even that isn't quite true. Mine was an instinct,

not a scientific judgment, an instinct which could have been in error."

"But it wasn't," Andrew said. "That's the important thing. More than that,

you stuck with what you believed, and had the moral courage to resign on

principle, which few people ever do. And for all of that, my dear, this

family is proud of you."

"I'll say it is!" Bruce echoed.

Lisa leaned over and kissed her mother. "Me too, Mom."

A meal was served. Picking at the contents of his tray without enthusiasm,

Andrew observed, "The one thing you can say about airline food is that it

helps to pass the time."

Soon after, they returned to what was on all their minds.

Bruce said, "Something that's hard to believe, Mom, is that newspapers and

TV didn't know what's been happening about Montayne-at least not the big

picture, and not until today."

It was Andrew who answered.

"It can happen, and it's happened before, almost in the same way. The other

occasion was with Thalidomide, which is something I've done a lot of

reading about."

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For the first time in many hours, Celia smiled. "This family has two

history buffs."

"In 1961 and '62," Andrew said, "the American press ignored what was

already a Thalidomide disaster in Europe. Even when an American

physician, Dr. Helen Taussig, testified before Congress, and showed

slides of deformed babies that made congressmen shudder, not a word

appeared in American newspapers."

"That's incredible," Lisa said.

Her father shrugged. "It depends on your view of the press. Some

reporters are lazy. Those assigned to that hearing weren't in their

seats, and afterward didn't read the transcript. But one who wasn't lazy

was Morton Mintz, a Washington Post reporter. He put all the pieces

together, then broke the Thalidomide story, beating everyone else. Of

course it immediately became big news, just as Montayne is becoming now."

"I should tell you both," Celia said to the children, "that your father

was opposed to Montayne all along."

Lisa asked, "Dad, was that because you thought Montayne would do the

awful things it did?"

Andrew answered, "Absolutely not. It was simply because, as a doctor, I

don't believe a drug should be taken for anything that is just

uncomfortable or self-limiting."

"What does 'self-limiting' mean?" Lisa again.

"Sickness during pregnancy is an example. It's limited, normally, to the

early months of pregnancy and before long will go away, leaving nothing

harmful behind. To take any drug at that timeunless there's some other

medical emergency-is foolish and always a risk. Your mother didn't, with

either of you. I made sure of that." Andrew eyed his daughter. "When your

time comes, don't you take anything, young lady. And if you want a sound,

healthy baby-no liquor, wine, or smoking either."

Lisa said, "I promise."

Listening, Celia was struck by an idea that might perhaps, in time, turn

Felding-Roth's Montayne experience into something positive.

Andrew was still talking.

"We doctors are at fault in a lot of ways about drugs. For one thing, we

prescribe too often-much of the time unnecessarily, and in part because

it's well known among us that there are patients who feel cheated if they

leave a doctor's office without a prescription. Another thing, writing

a prescription is an easy way to end a

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patient interview, to get that patient out of the office and another one

in."

"This sure is confession day," Bruce said. "What else do doctors do wrong?"

"A lot of us are not well informed about dr-ugs--certainly not as much as

we ought to be, especially about side effects or the interactions of one

drug with others. Of course, it's impossible to carry all that information

in your head, but doctors usually don't bother, or are too proud, to open

a reference book while a patient is with them."

Celia said, "Show me a doctor who isn't afraid to look something up in the

presence of a patient, and I'll show you a secure, conscientious doctor.

Your father is one. I've seen him do it."

Andrew smiled. "Of course, I've had some advantages where drugs are

concerned. That comes from living with your mother."

"Are there bad mistakes made by doctors with drugs?" Lisa asked.

"Plenty of times," Andrew said. "And there are other times when an alert

pharmacist will save a doctor from his own mistake by querying a

prescription. Generally, pharmacists know a lot more about drugs than

doctors do."

Bruce asked shrewdly, "But are there many doctors who admit it?"

Andrew answered, "Unfortunately, no. As often as not, pharmacists get

treated as an inferior breed, not the colleagues in medicine they really

are." He smiled, then added, "Of course, pharmacists make mistakes too. And

sometimes patients themselves mess up by doubling or trebling a prescribed

dose to get-as they explain later in the ambulance-a quicker effect."

"And all of that," Celia said firmly, "is more cans and more worms than

this tired drug person can handle in one day. I think I'll try to sleep."

She did, and remained asleep through most of the remaining journey to

Chicago.

The connecting flight to New York was uneventful-though more comfortable

because the family's reservations were in first class, which had not been

possible from Honolulu.

Then, to Celia's surprise, a Felding-Roth company limousine and chauffeur

were waiting at Kennedy Airport to drive them to Morristown. The chauffeur,

whom she knew slightly, saluted and

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handed her a sealed envelope which contained a letter from Seth Feingold.

Dear Celia:

Welcome home!-in every sense.

The car and chauffeur are with the compliments of the

board of directors, and for your exclusive, regular use as exec-

utive vice president.

Your colleagues and subordinates-this one included-look

forward to meeting you when you are rested from your jour-

ney.

Yours,

Seth

At the Jordans' Morristown house there was a joyous reunion with Winnie and

Hank March-Winnie hugely extended and in her final weeks of pregnancy. As