Thursday, 1 June 2017

REVIEW: "Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial" by Alison Bass

Book Review by Sapphire Ng

Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial
by Alison Bass
Algonquin Books
Copyright June 2008
Hardcover, 260 Pages

Greatly informative and factually useful. Set in the psychiatric drug industry, this book predominantly explores the theme of the ever consequential tension between the profit-oriented medical pharmaceutical establishment versus the issue of consumer safety. Culminating in the investigation and settlement of the symbolic People of New York v. GlaxoSmithKline case, a suit launched by the New York State attorney general against GlaxoSmithKline targeting the antidepressant Paxil, this is a compelling read for the psychiatric and medical community. 

This book would be of value to the American healthcare and mental health consumer, and the general public. The writing of the book is however rather dry and for the most part does not come across as particularly engaging or exciting, which aridity can be potentially accentuated for those mostly unacquainted or less enthusiastic with learning about details pertaining to the psychiatric and medical world.

The less than electrifying writing of the book does not negate its fact-based examination of the psychiatric drug industry, and particularly the intersection between research and drugs. This book might not be thrilling for some, but it humbly raises pertinent issues pertaining to academic medicine with potentially far-reaching implications. In highlighting issues and anecdotes that could nurture the average consumer’s healthy skepticism of drugs marketing and research, stimulate a more evaluative and less gullible approach toward publications of seemingly authoritative drugs studies and findings, and help cultivate a sharper eye in looking at data from clinical trials and the like, I daresay this book would have served its purpose.

The unostentatious and earnest look at the psychiatric drug industry from a legal perspective makes this book an interesting read for law students. The investigation of the GlaxoSmithKline case through the lens of the fiery and tenacious litigator Rose Firestein is fascinating; the reader would be privy to interesting details of the case through Firestein's legal thought process, discovery, investigation and negotiations. 

This book rather satisfactorily tackled the issue of the integrity of the spheres of academic medicine and drug research, and their practitioners and psychiatric researchers. Highlighting financial conflicts of interest as a pertinent issue, the book rightly explores the disproportionate influence of the pharmaceutical industry on supposedly non-biased medical and scientific research. By further highlighting the Prescription Drug User Fee Act (PDUFA), a legislation which seemed to facilitate the FDA’s financial dependence on the very industry “it was supposed to regulate,” the dual forces of academic researchers and institutions, and America’s federal health agency similarly beholden to the pharmaceutical industry—their sponsor—only seemed to impress upon the urgency of addressing such conflicts of interest, potential for bias, lack of transparency, and hidden agendas.

In further substantiation of the weighty matter, the author aptly highlighted certain norms in the academic publishing industry that would only unfortunately aid in perpetuating mispractices. Psychiatry journals were noted to singularly harbor “bias against negative findings” and that apparently “most medical journals were (and still are) not particularly interested in publishing negative findings.”

The point at issue of drug companies’s potential campaign against scientific truth fittingly culminated in the People of New York v. GlaxoSmithKline suit in the final third of the book. One of the three pediatric trials for the antidepressant Paxil, study 329—as authored by Dr. Martin Keller—was remarkably in the hot seat, and was an exemplification of GlaxoSmithKline’s seemingly deliberate attempts to “mislead” doctors. As the author recounted the seasoned litigator Firestein’s systematic journey in dismantling the contentious study 329 into its various allegedly misleading elements—flawed conclusion, underreporting of unfavorable results, use of misleading code words, and more—Firestein’s infectious excitement did not dwindle. 

It surely appears to the reader that the vivacious Firestein is a major contributor to the narrative’s inspirational touch. It is hard not to feel inspired in one way or another by the fiercely resilient lawyer who is also certified as legally blind. It is beyond amazing to learn of the ways Firestein bravely refused to let her disability hamper her legal and humanitarian ambitions. Her heartening characterization imbued the narrative with energy and vitality otherwise absent, definitively helped better engage the reader, and even appeared to serve a rather important function in the book—as indispensable glue holding various elements of the narrative together.

It is admittedly challenging for the author to weave together a narrative comprising multiple significant personalities and micro plots coalescing in a defining lawsuit nearing the last third of the book. The beginning of the book however with the various seemingly discrete anecdotes spotlighting different personalities engendered the impression of a lack of cohesion and integration in the overall narrative. The presence of a thematic relation between the separate set of circumstances at the start of the book does not obscure the author’s seeming oversight in failing to unite and communicate the relevance of the disparate narratives to the eventual GlaxoSmithKline case. 

With a variety of key characters in the narrative—namely Dr. Martin Keller, head of psychiatry at Brown University and a key opinion leader; Martin Teicher, psychiatrist, neuroscience researcher and co-inventor of R- fluoxetine for Sepracor; Donna Howard, an employee at Brown’s psychiatry department and whistleblower; the litigator Firestein as previously mentioned, and more—introduced and chronicled seemingly without explicit or implied indication and distinction of their relative importance, role and relevance to the overarching narrative and to the GlaxoSmithKline case, it seemed inevitable that it might sow confusion amongst readers and affect the overall enjoyability of the reading experience.

The resulting sense of disjointedness from such lack of narrative signposting to meaningfully bind and reconcile the separate anecdotes which feature different protagonists at the beginning of the book conveys a less than ideal first impression. It certainly felt rather unfortunate that it seemed to require at least making through the first two-thirds of the book before one could begin to realize fully how the various constituents of the book work together in the final big picture.

The title of the book, “Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial” also seemed to exude a certain ambiguity. Considering that the blurb of the book did not clarify nor explicitly state the presence or not of an actual court trial in the narrative, certain readers might be in for a surprise, positive or negative. Having personally interpreted the title of the book as implying the existence of a legal court trial, I felt somewhat disappointed by its subsequent lack thereof for the GlaxoSmithKline case in addition to the case’s rather abrupt settlement at the end of the book. The author certainly could not be faulted for such an ambiguity in the book’s title and blurb, but it surely is less than gratifying for the reader who might have persisted through the book in hopeful anticipation of an exciting court trial.

Disclaimer: I am not affiliated to the publisher nor the author of the book. This book review is the result of my personal reading and honest opinion.

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