Strong Medicine

by Arthur Hailey

  “What does finance matter when pregnant women are still taking Montayne? When unborn babies …”

  Celia stopped, realizing that argument was useless, that the conversation was going nowhere, and wondering again why she was talking with the comptroller and not Sam Hawthorne.

  She said decisively, “I must speak with Sam.”

  “Unfortunately, that isn’t possible. At least, not now.” An uneasy pause. “Sam is … well, not himself. He has some personal problems. That’s one of the reasons we want you—need you—back.”

  Celia snapped, “Double-talk. What does it mean?”

  She heard a long, deep sigh.

  “I was going to tell you this later because I know it will distress you.” Seth’s voice was low and sad. “You remember … just before you left us, Sam had a grandchild.”

  “Juliet’s baby. Yes.” Celia recalled the celebration in Sam’s office in which she had shared, though she dampened it later with her doubts about Montayne.

  “It seems that when Juliet was pregnant, she suffered a good deal from morning sickness. Sam gave her Montayne.”

  At Seth’s last words, Celia went icy cold. She had a horrible foreboding of what was coming next.

  “Last week the doctors established that Juliet’s baby was adversely affected by the drug.” Seth’s voice was close to breaking. “Sam’s grandson is mentally defective and has limbs that won’t function—a vegetable like all the others.”

  Celia emitted a strangled cry of grief and anguish, then incredulity replaced it. “How could Sam have done it? At that time Montayne wasn’t approved for use.”

  “There were physicians’ samples, as you know. Sam used them, telling no one except Juliet. I suppose he had so much faith in Montayne, he assumed there was no risk. There was some personal involvement too, and maybe pride. If you remember, Sam acquired Montayne himself from Gironde-Chimie.”

  “Yes, I remember.” Celia’s thoughts were whirling—a mélange of frustration, anger, bitterness and pity. Seth interrupted them.

  “I said we need you, Celia, and so we do. As you can imagine, Sam is torn with grief and guilt and, at the moment, isn’t functioning. But that’s only part of it. Everything here is a mess. We’re like a damaged, rudderless ship, and we need you to assess the damage and take charge. For one thing, you’re the only one with sufficient knowledge and experience. For another, all of us—including the board—respect your judgments, especially now. And, oh yes, you’d come back as executive vice president. I won’t go into the financial arrangements, but they’d be generous.”

  Executive vice president of Felding-Roth. Only one rung below the presidency, and higher than she would have been as vice president of sales, the promotion she had forfeited by resigning. There was a time, Celia thought, when the offer just made would have been a cause for rejoicing, a shining landmark in her life. How strange that suddenly it meant so little.

  “You may have guessed,” Seth said, “that some others—a few members of the board—are with me, listening to this conversation. We’re waiting here, hoping your answer will be yes.”

  Celia became aware of Andrew signaling to her from the bathroom. For the second time since the conversation began, she said into the telephone, “Wait, please.”

  Andrew hung up the extension and came out. As before, with her phone mouthpiece covered, she asked him, “What do you think?”

  He told her, “You’ll have to make the decision. But remember this: If you go back, it won’t matter that you resigned and have been away. Some of the Montayne mess and responsibility will rub off on you.”

  “I know.” She considered. “But I was with the company a long time. They were good years, and now they need me. I’ll only go back, though, if …”

  She returned to the phone.

  “Seth, I’ve listened carefully to what you’ve said. I will accept, but under one condition.”

  “Name it.”

  “Montayne must be withdrawn from sale by Felding-Roth today, and a public statement made about its dangers. Not tomorrow, not next week, and no more waiting while the FDA makes up its mind. Today.”

  “Celia, that’s impossible. I explained the warnings from our lawyers, the question of liability. We could be inviting millions of dollars’ worth of lawsuits—enough to break the company.”

  “There’ll be lawsuits anyway.”

  “We know that. But we don’t want to make the situation worse. Withdrawal is bound to happen soon. Meanwhile, with you here we could discuss it …”

  “I don’t want it discussed. I want it done. I want it on national TV and radio today, and in every newspaper in the country within twenty-four hours. I’ll be watching and listening. Otherwise, no deal.”

  It was Seth’s turn to say, “Just a moment.”

  Celia could hear a muted discussion at the other end. There was some obvious dissension, then she heard Seth say, “She’s adamant,” and a moment later, “Of course she means it. And remember, we need her more than she needs us.”

  The debate in New Jersey continued for a few minutes more, most of it inaudible to Celia. Finally, Seth returned to the phone.

  “Celia, your terms are met. What you insist on will be done at once—within the hour. I guarantee it personally. Now … how soon can you be back?”

  She told him, “I’ll get the first flight out of here. Expect me in the office tomorrow.”

  4

  They managed to get four coach seats on a United Airlines 747, leaving Honolulu at 4:50 P.M. The flight was a nonstop to Chicago, where they would change to another flight due in New York at 9 A.M. local time the following day. Celia intended to get what sleep she could en route, then go to Felding-Roth headquarters that same morning.

  Lisa and Bruce, who had planned to spend two more days in Hawaii, made the decision to return east with their parents. As Lisa put it, “We haven’t seen you for so long, we want to be with you as much as we can. Also, if I’m by myself I know I’ll be sad, and probably cry, thinking about those poor deformed babies.”

  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 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 there—usually 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 more 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 risks—what 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 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.”

  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 time—unless 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 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 drugs—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 reserva
tions 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 Morris-town. The chauffeur, whom she knew slightly, saluted and 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 executive vice president.

  Your colleagues and subordinates—this one included—look forward to meeting you when you are rested from your journey.

  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 Lisa and Bruce, then Celia and Andrew, embraced her, Winnie cautioned, “Don’t squeeze me too ’ard, m’loves, or little thingummy might pop out right now.”

  Andrew laughed. “I haven’t delivered a baby since I was an intern—a long time ago—but I’m willing to try.”

  Hank, never talkative like his wife, beamed at them happily and busied himself unloading baggage.

  It was a little later, with the trio of Winnie, Celia and Andrew exchanging news in the kitchen while other activity was going on outside, that a sudden shocking thought occurred to Celia.

  Almost afraid to ask, she said, “Winnie, while you’ve been pregnant, have you been taking anything?”

  “You mean for bein’ sick in the mornin’?”

  With growing dread, Celia answered, “Yes.”

  “Like that Montayne?” Winnie pointed to a copy of that morning’s Newark Star-Ledger spread open on a countertop, a news story about Montayne prominent on the front page.

  Dully, Celia nodded.

  “Me doctor give me some samples an’ told me to take it,” Winnie said. “I would ’ave, too. I was always bein’ sick in the mornin’s. ’Cept …” She glanced at Andrew. “Is it okay to say, Dr. Jordan?”

  He assured her, “Yes.”

  “’Cept, before you both went away, Dr. Jordan told me—’e said it was a secret between us—if I was given any of that Montayne, not to take it, but flush it down the loo. So that’s what I did.”