It began with a pill. One pill.

Bitter Pills: Inside the Hazardous World of Legal Drugs
by Stephen Fried

We take our medicines on faith. We assume our doctors are well-informed, our drug companies scrupulous, our FDA diligent--and our medications safe. All too often we're wrong. Just how wrong is documented in this critically acclaimed portrait of the international pharmaceutical industry by one of our most highly respected investigative journalists.

According to the Journal of the American Medical Association (JAMA), adverse drug reactions are the fourth leading cause of death in America. Reactions to prescription and over-the-counter medications kill far more people annually than all illegal drug use combined.

Stephen Fried's wife took a pill for a minor infection--and ended up in the emergency room. Some drug reactions go away in a few hours or days. Diane's did not. This emotionally wrenching experience launched Fried into a five-year examination of the entire pharmaceutical industry, the most profitable legal business in the world. Rigorously documented, Bitter Pills is a full-scale portrait of pill making and pill taking in America today, presented through the powerful human drama of doctors, patients, drug companies, the FDA, and government regulators as they war for control of our medicine cabinets.

My wife's gynecologist gave her samples of a new antibiotic to treat a urinary tract infection so minor, she didn't even know she had it. The doctor told her to take this new wonder drug twice a day for three days.

Your doctor gives you a pill, you take it. When I left for work the next morning, I said good-bye to Diane as she swallowed the first pale yellow oval tablet with breakfast.

Six hours later I was bringing her, delirious, to the emergency room. Our lives haven't been the same since.

Diane called me at work several hours after she took that pill and said she felt strange. I knew something was really not right, because my wife comes from a long line of "it's just a flesh wound" stoics who underreact to all physical discomfort. She said she was disoriented and hallucinating. Her mouth was dry, and she felt tingling in her left arm and hand. She was having trouble talking.

After we spoke, she found herself wandering around in her small home office, and when she located her desk, she couldn't figure out how to turn off the computer she writes on every day. When she went to lie down, she started shaking uncontrollably and then saw white. She was sure she was dying.

Then she heard the phone ring. It was me, calling to see if she was feeling any better. Luckily, she was able to reach over, pick up the receiver and mumble to me about what was going on. I called her gynecologist, who told me to take her to the hospital. When the cab got me home from the office, I found Diane lost in her closet. She stammered that she wanted to get dressed to go out but couldn't find her white shirt. I looked down and saw that it was an inch from her hand.

Married people can afford to panic only one at a time, so I pretended I was not scared as I helped her on with the shirt and took her to the hospital closest to where we live in Philadelphia, which happens to be Pennsylvania Hospital, the oldest hospital in America and one of the very best. As Diane spoke - haltingly, elliptically - to the ER doctors, more symptoms emerged. Her jaw was terribly sore from clenching against what we assumed had been a seizure. Her pupils were fixed and dilated, like blobs of black ink. She said she felt as though something were "melting" just behind her green eyes.

It was late Friday afternoon at the ER, just before the weekend rush, so we got a good, slightly private, curtained-off area. An emergency medicine specialist and several neurology residents tag-teamed in and out of our space. Each one asked a slightly different version of the same questions. I worried that we weren't being clear because there didn't seem to be any accumulation of knowledge taking place. They all had tests they wanted Diane to perform.

"Spell the word "world' backwards," one asked. She did it and was then asked to name the U.S. presidents in reverse chronological order.

"Can you spell "world' backwards?" the next one asked. Then he requested that she touch her finger to her nose.

"I'd like you to try to spell - " the next one began.

" - yeah, yeah," Diane said, "'world' backwards." But she was bobbing in and out of full lucidity. Only seconds after cracking a joke, her mind would be sluggish again, and she would barely respond when I stroked her cheek or her shoulder-length brown hair.

After nearly five years of marriage, this was the first medical emergency we ever had to face. The only thing that kept me from really losing it was a woman in the next cubicle who already had lost it. Dragged in by the police in the middle of a major psychotic episode, she screamed continually in English and Chinese about everything from her husband's homosexuality to her close personal friendship with the president of the United States. Her screams pierced the crackly trauma calls from ambulances all over the area, which were being broadcast on a loudspeaker system for the ER staff to monitor. The combined noise was oddly stabilizing, a constant reminder that things could be considerably worse.

After several hours of neurological exams, the word came back - from a place called the Poison Control Center - that all of Diane's symptoms had been previously reported as reactions to the antibiotic she took. The drug is called Floxin. She had, as we now say, been "Floxed."

My wife took a pill. It made her sicker than she was before.

World backwards. Tell me about it.

The ER doctors, however, were not through with us. They still wanted to run more tests. Even though Diane's symptoms, such as "acute delirium," were consistent with a reaction to the Floxin, they could also be caused by a brain tumor, a stroke or a big horrible infection with larger neurological implications, like spinal meningitis. They wanted to do a CT scan.

I got to sit in the CT control room and watch the machinery visually slice and dice. There is nothing quite so frightening as watching your loved one's brain being scanned for tumors, especially when you're not exactly sure what a normal brain looks like. But it is also very moving to peer directly into your wife's mind. What spouse hasn't at one time or another wished to be able to do that?

© 1999 by Stephen Fried.

About the Author

Stephen Fried, an award-winning investigative journalist and essayist, is the author of Thing of Beauty: The Tragedy of Supermodel Gia and Bitter Pills: Inside the Hazardous World of Legal Drugs. His work has appeared frequently in Vanity Fair, The Washington Post Magazine, Glamour, GQ, and Philadelphia magazine. He lives in Philadelphia with his wife, author Diane Ayres.