Strong Medicine

by Arthur Hailey

  Mrs. Thom returned. “All right. Go in there.” She pointed to a doorway. With murmured thanks, Celia did so.

  The room she entered was as shabby as the offices outside.

  “Yes, what is it?” Dr. Maud Stavely, seated at another dented desk, looked up from a paper she was reading as her visitor entered.

  After her impression of these surroundings, coupled with what she had heard about the person she was facing, Celia was surprised to see an attractive, auburn-haired woman, slim and well groomed, with carefully manicured hands, and probably in her early forties. The voice, though incisive and impatient, was cultured, with a slight New England accent. The clothes she had on—a maroon wool skirt and a pink tailored blouse—were inexpensive, yet worn stylishly. The eyes—Stavely’s strongest single feature—were blue, direct, penetrating, and conveyed to Celia that an answer to the question was overdue.

  “I’m a pharmaceutical executive,” Celia said. “I apologize for barging in, but I wanted to meet you.”

  There was several seconds’ silence. The eyes boring into her had hardened, Celia thought, and were making an appraisal.

  “I suppose you’re Jordan.”

  “Yes.” Celia was surprised. “How did you know?”

  “I’ve heard of you. There aren’t many women executives in that rotten industry, and certainly no one else who has sold out decent womanhood as much as you.”

  Celia said mildly, “What makes you so sure I’ve—as you put it—sold out?”

  “Because you wouldn’t work in the selling end of the drug business if you hadn’t.”

  “I worked originally as a chemist,” Celia pointed out. “Then, like others, I moved up through our company.”

  “None of that interests me. Why have you come here?”

  Celia tried countering antagonism with a smile. “I meant what I said about wanting to meet you. I had an idea we might talk, hear each other’s opinions. Even if we disagree, we could both gain something.”

  The friendliness achieved nothing. The other woman inquired coldly, “Gain what?”

  Celia shrugged. “I suppose, some understanding. But never mind. Obviously it wasn’t a good idea.” She turned away, prepared to go, unwilling to accept further rudeness.

  “What do you wish to know?”

  The words were a shade less hostile. Celia hesitated, uncertain whether to go or stay.

  Stavely pointed to a chair. “You’re here, so sit down. I’ll give you ten minutes, then I’ve other things to do.”

  In different circumstances Celia would have expressed herself forcefully, but curiosity caused her to remain low-key. “One thing I’d like to know is why you hate the pharmaceutical industry so much.”

  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 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 different variants of Valium which competing drug firms brought out. There is no benefit, no possible advantage in having five different Valiums 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 …”

  “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 …”

  Well, 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 disorder—now 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 been 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 I.V. 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, “To call Montayne inadequately tested is ridiculous! Besides, we already have FDA approval.”

  “In the public interest, that approval must be 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 it! 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 brilliant 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 naïve 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 I, 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 activists. Another thing—when they’re ruthless and unethical, as they can be sometimes, you should ask yourself: where did they learn to be that way? The answer is: from companies like yours, my dear, because, when no one was watching them, ruthless and unethical is the way they were.”

  Celia would have appreciated Andrew’s last remark more if she had witnessed a scene at the Citizens for Safer Medicine offices a few minutes after she left on Friday afternoon.

  Summoning an assistant, Dr. Stavely asked, “Has that woman who was with me gone?”

  When the answer was yes, Stavely instructed the young man, “I want a press conference called for tomorrow morning—as early as you can arrange it. You will say that the subject is an urgent, life-and-death matter affecting hospitals and patients. Make sure you get the television networks and press wire services. There’ll be a news release to be issued at the same time, which I’m going to write now. Someone will have to work tonight to …”

  The brisk, efficient instructions continued, and at 10 A.M. next morning the press conference began.

  Facing reporters, and on camera, Dr. Stavely described the I.V. fluid problem she had discussed with Celia the preceding day—the bacteria-contaminated bottles and the resultant septicemia, believed responsible for several deaths. What the CSM leader did not mention was either Celia or the information Celia had given her, namely that the FDA had already decided to forbid further use of all existing I.V. fluid supplies from the company concerned, and that an announcement to that effect would be made on Monday.

  Instead, Stavely declared, “Citizens for Safer Medicine deplores the inaction both of the Food and Drug Administration and the manufacturer of this potentially deadly material. Further, we demand—yes, demand!—that all supplies of this I.V. fluid be banned from use and recalled …”

  The effect was immediate. The major TV networks carried the story on their evening national news, while next day’s Sunday newspapers gave it prominence, in many cases using an Associated Press photo of Stavely in action. Thus on Monday, when FDA delivered its announcement, most reporters—not bothering to check—began their stories, “Today, responding swiftly to a demand by Dr. Maud Stavely and her Citizens for Safer Medicine, the FDA announced a ban on further use by hospitals of …”

  It was a triumphal coup d’éclat for CSM and, soon afterward, was used prominently in a mailed brochure appealing for donations.

  Celia, who followed the sequence of events with some embarrassment, kept the knowledge of her own involvement to herself. She had learned a lesson. She had, she realized
, been foolishly indiscreet, and then had been made use of by a master tactician.

  11

  To Celia’s surprise there was not, anywhere at Felding-Roth headquarters, a trial transcript of the Australian court case which had involved Montayne. Nor could the company’s legal department locate one in the United States. There were plenty of reports that quoted it, but now Celia wanted to read the proceedings in their entirety. Although, obviously, Maud Stavely had a copy, Celia felt disinclined to ask Citizens for Safer Medicine to lend it; she therefore instructed the legal department to cable a correspondent law firm in Australia and have one sent by air.

  Meanwhile there were plenty of other things to do. The promotional program that would launch Montayne was now proceeding at a frantic tempo as the February deadline neared. Celia, aided by her deputy, Bill Ingram, was responsible for the several million dollars spent already; still more money was allocated for the months ahead.

  Elaborate advertising—expensive four-page multicolor inserts—was appearing in a profusion of medical magazines, while an avalanche of direct mail was going out to the nation’s physicians and pharmacists. Among promotional items being sent was a cassette tape—on one side, a recording of the beautiful Brahms “Wiegenlied” (Lullaby), on the other, a clinical description of Montayne. Backing up the advertising and direct mail, the company’s detail men and women were delivering thousands of sample packages of Montayne to doctors, at the same time dropping on their desks golf tees and ball markers imprinted with “Montayne.”