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Jan-Mar2004-12(1)
BOOK REVIEW
Drug deals
B C Rao
John Grisham. The king of torts. Mumbai: Arrow Books, Random House Group Ltd, 2003. Rs 225, pp376. ISBN 0-09-941617-4
Clay Carter, a lawyer who holds a none-too-well paying job, that of
defending an indigent in the office of the public prosecutor, is asked to defend
a teenager who has committed a murder. What initially appears to be a fairly
simple, open and shut case of one street junkie killing another, turns out to be
a case of murder without a motive. Why would a criminal, who has never gone
beyond petty shoplifting, suddenly murder a person, and that too, while on a
de-addiction programme? A bit of investigation reveals that these de-addiction
centres have more such cases and are trying to hide some facts. When Carter is
at this stage of the investigation, a representative of a major pharmaceutical
company approaches him and makes an astounding proposition. This man, Max
Pace as he calls himself, is a fire-fighter, one who solves a problem
before it flares up. In this case, it involves a drug major that experimented
with a de-addiction pill called Tarvan without following the necessary
protocols. The drug succeeds in de-addicting a considerable proportion of
patients, a figure high enough to become a major selling point in the pharma
market. There is, however, a major side-effect, one that will bury the drug-and
the potential profits-entirely. Max Pace swings into action and… I shall not
spoil the interest in the book for future readers by revealing more of the
plot.
The stakes in this episode and in the rest of the book are so huge that the
lawyer's conscience is quickly buried and the unfolding story is one of the
meteoric rise of Clay Carter and what follows. To add spice to the intrigue is a
romance that has twists and turns as the story progresses.
There are some lessons here for doctors who are ever ready to prescribe any
drug without reading the fine print. Avaricious drug companies may market drugs
without proper safeguards, push clinical trials and hide facts. An established
drug in the market, such as the one mentioned in this book causes tumours-a fact
that may have drawn the attention of the medical community. The question that
arises is: why did the medical profession not complain? The author makes a
pertinent comment: 'doctors and pharmaceutical companies sleep together!' The
other reason is that undesirable side-effects are seen by doctors only rarely,
whereas if one takes the population as a whole these side effects form a
sizeable proportion and tort lawyers are experts in harnessing these numbers.
Imagine a scenario wherein 500 patients suffer a untoward disabling side-effect
and the drug company that wants to settle with them pays a compensation of one
million dollars each. The total 'cut' the lawyer representing all of them would
get would be colossal compared to one person fighting the case for which he may
not have the wherewithal to do so. This is what mass action is all about.
What makes the novel attractive to a medical reader is that it so very
possible in real life. Indeed, perhaps it is happening in Third World countries.
I refer to the ongoing cisapride story, which I wrote about in 2000 (1) as well
as its variations (2). With poor laws and ineffective machinery to enforce them,
it is conceivable that major pharma companies might try out their experimental
drugs on our population as Ackerman did with their anti-addiction drug Tarvan in
the far East initially, and then with poor African-American patients in
rehabilitation homes in the US.
This is the usual John Grisham story-eminently readable, but with a message
to all of us. 'Think twice before prescribing, and prescribe only if it is based
on evidence.'
References
1. Rao BC. Withdrawing drugs: Need for global uniformity. Natl Med J India 2000;13:165.
2. Pai, SA, Lakshmi PK, Rao BC, Sahni P. Pharmaceutical companies and the third world [Correspondence]. Lancet 2003;361:1136.
1. Rao BC. Withdrawing drugs: Need for global uniformity. Natl Med J India 2000;13:165.
2. Pai, SA, Lakshmi PK, Rao BC, Sahni P. Pharmaceutical companies and the third world [Correspondence]. Lancet 2003;361:1136.
B C RAO, Family Physician, 847, II Cross, 7th Main, HAL II Stage
Indiranagar, Bangalore 560008 India. e-mail:badakere@vsnl.ne