Review by Choice Review
Werth writes a modern-day story of bright student Joshua Boger, who pursued an early career in medicinal chemistry, working with some of the world's best, including Max Tishler and Robert Woodward. He attained a top position in research at Merck but at age 37 left to form a company of his own, Vertex. His goal was to develop new drugs on the basis of the molecular biology of the disease: one would first decide the action desired, such as binding to a given cell substance or inhibiting a particular enzyme, and would then synthesize molecules with atoms arranged to attach or fit the disease-causing substance. Previously, new drugs were mostly chemical modifications of substances already known to affect diseases and, with this approach, new drugs were unlikely to be greatly different from the parent compounds. The initial research target for Vertex was an immunosuppressant, selected to meet future needs for organ transplants and diseases involving the immune system. Werth tells how difficult it is to establish a successful drug research organization and demonstrates the great talent of scientists in this field; he also gives the reader a sense of the amazing knowledge being accumulated about drug actions on the cellular level. A fascinating history. All levels. A. M. Mattocks; University of North Carolina at Chapel Hill
Copyright American Library Association, used with permission.
Review by New York Times Review
MEDICAL KNOWLEDGE IS evolving at warp speed, spinning out reams of new information into sound bites, articles and more and more new health books to overload your sagging shelves. But if you're tempted to toss out all the old stuff, better think twice - despite the changes in medical science, some constants endure. The human body still sickens and recovers much the way it always has; our dogged, heartfelt efforts to prevent and relieve pain and suffering are no different than they ever were. Even books published decades or in some cases centuries in the past may still speak clearly to today's medical issues. So squeeze all the shiny new books in among the dusty old ones, and let this column, Prescribed Reading, justify the clutter. When health care makes headlines, these occasional essays will take a look back at other volumes on that bulging shelf, for a curated perspective on resources available to the interested reader. No health topic has made more news in this country over the last two decades than the opioid crisis, with heartrending journalism and a handful of comprehensive books. Barry Meier's 2003 "Pain Killer" was the first to probe the deceptive advertising pushing the addictive prescription opioid OxyContin into the American market. Sam Quinones's compulsively readable "Dreamland" linked the popularity of OxyContin to an exploding nationwide traffic in a cheaper alternative, potent Mexican heroin. Beth Macy's recent "Dopesick" outlined the synergistic destruction that legal and illegal narcotics wreak on users and their communities. These authors all covered a similar territory of clueless doctors, rapacious drug sales forces (both the corporate and the criminal varieties), hurting patients and their frantic friends and relatives. Some may wonder what America's doctors could have been thinking all those years, doling out quantities of potent narcotics like so many aspirin. Granted, a few of us were criminals, methodically defrauding Medicaid in pilldispensing "mills." But mostly we were just well-intentioned schlubs with prescription pads, dutifully following then-current practice guidelines. It is impossible to overstate how difficult it was a dozen years ago to ignore the resounding calls for effective pain control by any means possible, narcotic dependency be damned. Our leaders, our teachers, our regulatory agencies and our patients demanded no less. The slick ad campaigns backing OxyContin and all the other addictive prescription opioids assured us all would be well. Dr. Anna Lembke's small but powerful "Drug Dealer, MD" summarizes other seldom-enunciated reasons doctors became complicit. A specialist at Stanford in addiction medicine, Lembke delivers a bottom line as bizarre as it is true: Most doctors hate and fear dealing with pain, and are utterly unequipped to do so. Treating pain properly requires specialized training; it consumes vast amounts of time few doctors have. It requires an ability to set limits and negotiate and to fail and fail again. And, as Lembke points out, doctors are a group chosen for more or less exactly the opposite characteristics. We are habitual pleasers, accustomed - even addicted - to patients' admiration and gratitude. We like to do what we do well, and most of us don't do pain well. So it's no big surprise that when we find ourselves in a pain-filled room we just want to escape fast, and prescribing another round of pills lets us do just that. What about the part played by pharmaceutical companies in this crisis? Was Purdue Pharma, manufacturer of OxyContin, an aberration in its misleading promotion of the drug, with assertions that ultimately resulted in $600 million in fines and penalties? Or is this just how Big Pharma always operates, dodging the law and relevant moral principles in single-minded pursuit of Big Profit? Back in 2004, Dr. Marcia Angelí, a former editor of The New England Journal of Medicine, wrote in "The Truth About Drug Companies" that the pharmaceutical industry "has moved very far from its original high purpose of discovering and producing useful new drugs." Her book presents instead a vision of an industry motivated largely by greed. Pretty much every specific outrage critics have identified in Purdue's behavior appears in Angell's analysis, including the "jaw-dropping" gifts doctors may receive for prescribing a company's drugs, the subtle advertisement masquerading as education and the lukewarm, often ineffective protestations by regulatory agencies. Writing from Britain, Dr. Ben Goldacre echoes Angell's concerns, charging in " Bad Pharma" that the worst misbehavior in the pharmaceutical industry actually occurs not when prescription drugs are being burnished for market, but far earlier in their development. Lackluster compounds are evaluated in ways guaranteed to make them look good, Goldacre writes, then prettied up even further with distorted claims of efficacy. While "bad behavior in marketing departments is unpleasant," he concludes, the real scientific outrage and the big public danger lie in uniformly dubious practices of drug development. The immersion journalist Barry Werth provided a more sympathetic view of the pharmaceutical industry after taking two deep dives into the workings of a young biotech company. In exchange for many years of fly-on-the-wall privileges at Vertex Pharmaceuticals, Werth allowed his manuscripts to be vetted by corporate executives, and presumably some of their sharper edges were sanded down. What remains, though, is an impressively detailed, dense epic in two volumes, "The Billion-Dollar Molecule" and "The Antidote," describing the truly herculean labors needed to birth a panel of marketable drugs. Vertex developed early H.I.V. and hepatitis C drugs, and many of the executives Werth trails are clearly committed to the humanitarian aspects of their work. But they are also committed to their own proprietary molecules, sometimes with a passion bordering on worship. As the head of Vertex once announced at an industry conference, "It's a tremendous responsibility to live up to a molecule like VX-950." A regulator for the F.D.A. put it a little more bluntly, screaming over the phone to another Vertex executive, "You guys believe in your drug too much." Opioid-dependent patients may be trapped in a web of pain and addiction for months, years or a lifetime. One of the most eloquent descriptions of that hard fate comes to us from more than 200 years ago, back in the days when opium and laudanum (a solution of opium in alcohol) were perfectly legal in England, and as widely available as, yes, aspirin is today. It was in the fall of 1804 that Thomas De Quincey, a 19-year-old wannabe intellectual, decided to try a little opium for a bad toothache. When De Quincey published his "Confessions of an English Opium-Eater" 17 years later, his poetic depictions of the wild hallucinations that punctuated his years with the drug transfixed his contemporaries. To us, though, his story is revelatory mostly for its eerie familiarity. As a writer, De Quincey was dominated and arguably ruined by his habit. He produced quantities of hack prose, but nothing as enduring as the "Confessions." He lovingly embroidered the original version of that classic into sequels and revisions, all of which were increasingly wordy and decreasingly interesting. De Quincey had wonderful ideas he could never remember, often scribbled down on pieces of paper he could never find. What he might have accomplished sober is anyone's guess. ABIGAIL ZUGER is a physician and a frequent contributor to Science Times. Rx Pad DRUG DEALER, MD: How Doctors Were Duped, Patients Got Hooked, and Why It's So Hard to Stop, by Dr. Anna Lembke. The best summary around of the perils of owning a prescription pad. THE TRUTH ABOUT THE DRUG COMPANIES: How They Deceive Us and What to Do About it, by Dr. Marcia Angelí. An eloquent classic. No one has despised Big Pharma for as long as Dr. Angelí has. BAD PHARMA: How Drug Companies Mislead Doctors and Harm Patients, by Dr. Ben Goldacre. Read it and you may never put another pill in your mouth. THE BILLION-DOLLAR MOLECULE: The Quest for the Perfect Drug, by Barry Werth. THE ANTIDOTE: Inside the World of New Pharma, by Barry Werth. The drug business presented meeting by meeting. Tedious, but you won't find this level of detail anywhere else. confessions of an English opium-eater, by Thomas De Quincey. Bear with the antique prose for a mind-blowingly modern story line.
Copyright (c) The New York Times Company [June 30, 2019]
Review by Booklist Review
In a prose style emulating the speed and freneticism surrounding a marathon, Werth reveals the guts of the not-so-new field of biotechnology by focusing on a Cambridge, Massachusetts, company called Vertex. The company's story reads not like a thriller but like a clash of childish egos. It was started by a biochemist; recruiting top talent, Vertex then found its employees, products, and progress impeded by things both human and not. What began as a search for the ultimate immunosuppressant soon shifted into a drive for venture capital funds and partnerships; a major scientist then defected, and Vertex discovered its future promise lay in developing AIDS, anticancer, and anti-inflammation medicines rather than in immunosuppressants. The behind-the-scenes machinations make riveting reading. ~--Barbara Jacobs
From Booklist, Copyright (c) American Library Association. Used with permission.
Review by Publisher's Weekly Review
A startup pharmaceutical company is the focus of this intriguing look at the nexus of biotechnology and high finance; features a new epilogue by the author. (Mar.) (c) Copyright PWxyz, LLC. All rights reserved
(c) Copyright PWxyz, LLC. All rights reserved
Review by Library Journal Review
Werth, a freelance writer on science and business issues, chronicles Joshua Boger's start-up of Vertex, a biotechnology company dedicated to the discovery of new drugs. Boger, a successful organic chemist with Merck, left his position as a senior director to establish Vertex. He recruited an exceptional group of researchers with the aim of integrating the most advanced disciplines in molecular biology to develop an immune-suppressing drug used in organ transplants and a potent HIV protease inhibitor to help thwart AIDS. Werth also discusses Vertex's financing and initial public stock offering. Recommended for science and business collections in public libraries and for special libraries in the pharmaceutical industry.-- Bruce Slutsky, New Jersey Inst. of Tech. Lib., Newark (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
(c) Copyright Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Review by Kirkus Book Review
A you-are-there account of the turbulent early days of Vertex, a high-tech, high-risk biotechnology firm. Werth (a freelance science and business writer) spent nearly four years following the travails of Vertex, where he seemingly had considerable access to its inner workings. His story begins in 1989, shortly after the company was launched with $10 million in venture capital--and with a plan to design superior new drugs, atom by atom if necessary. Vertex's chief, the brilliant and exuberant chemist Joshua Boger, is convinced that the company can design a safer immunosuppressive drug and capture the multimillion-dollar-a- year transplant market. Doing so will require brains, time, and lots of money, but Boger brings together the brains and raises the money that buys the time. Negotiating with pharmaceutical firms in England (Glaxo) and Japan (Chugai), he gives Vertex temporary financial security by striking a deal with Chugai and, in 1991, he takes Vertex public. Meanwhile, back at the lab, it turns out that the scientific side of the firm's endeavors aren't as straightforward as Boger's presentations to would-be investors might suggest: There are complications, rivalries, disappointments, and no end of technical problems, and, at the conclusion of the narrative, Vertex still has no product to sell, although its expectations remain high. Throughout, Werth--adept at explaining both science and business--provides enough history to anchor the present, and peoples his story with memorable characters: Besides the energetic, charismatic Boger and his crew of talented, eccentric, overworked chemists and biologists, notable are Harvard researcher Stuart Schreiber--exasperating as a colleague, devastating as a rival--and aging transplant-wizard Thomas Starzl (The Puzzle People, 1992). Colorful, packed with facts, and delivering a clear message: that the risks of investing in biotechnology aren't just high- -they're stratospheric.
Copyright (c) Kirkus Reviews, used with permission.
Review by Choice Review
Review by New York Times Review
Review by Booklist Review
Review by Publisher's Weekly Review
Review by Library Journal Review
Review by Kirkus Book Review
