Part 2

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

(Page 2 of 3)

Back in the ER after a clean scan, we were then told the prevailing wisdom about all adverse drug reactions: that the effects would subside when the medication left her system. And we were sent home - with a supply of the milder, cheaper antibiotic she probably should have taken in the first place for her urinary tract infection (UTI) - to wait for that to happen. On our way out, we walked past the main ER desk. On the wall behind it was a light box for reading X-rays, which was still illuminating pictures from the inside of Diane's brain. To the left of the viewer was a shiny metal towel dispenser. It was adorned with Floxin advertising magnets that had been left by some enterprising drug sales rep.

At that moment I thought the Floxinalia would actually make a nice detail for our emergency room horror story, the recitation of which would commence as soon as Diane was fine, ostensibly in a couple of days. But her symptoms did not disappear as promised. Some waned, but new ones developed. Besides the "melting" and the fixed pupils, she had really aggressive, buzzy insomnia, visual distortions that made the world seem six-dimensional and aphasia: she would get halfway through a sentence and just couldn't get the rest of the words out. For a woman with a high school trophy for "best negative debater" sitting on a shelf behind her desk, this was probably the scariest symptom of all.

Over the next two weeks, she endured an electroencephalogram (EEG), which tests electrical function in the brain; a magnetic resonance imaging (MRI) of her head, which offers more structural detail than the CT scan; and a spinal tap, to check the cerebrospinal fluid for infections, as well as some blood work. All these tests just to rule out any other possible explanation for her continuing symptoms than an adverse reaction to the drug - the same drug that was supposed to be long gone from her system. While the tests themselves were creepy, what they were testing for was absolutely horrifying. I found myself weighing which awful result would be most acceptable, watching the life we had planned to have pass before my eyes.

The tests all came back on a Thursday, one of the most harrowing days of our lives. As we were read the results over the phone by our internist, I found myself mentally checking off all the nightmares that had been eliminated by the process - "brain tumor, no; stroke, no; AIDS, no." But Diane still wasn't well. The doctors concluded that the drug reaction had triggered some genetic predisposition to neurological illness. Since her body hadn't been able to correct the situation naturally, she would need to take a combination of heavy-duty drugs, each with its own possible side effects, to do it. If, in fact, it could be done at all.

But at least that urinary tract infection had cleared up.

It has now been five years since Diane got Floxed. In that time, we have learned more than we thought we'd ever want to know about what has been called "the other drug problem." The one with legal drugs.

Since that day in the emergency room, I have been on a quest. An investigative journalist and exasperated husband, I am trying to find out if my wife was the victim of a pharmacological foul-up or just a statistically acceptable casualty of "friendly fire" in the war on disease. I am also trying to find meaning in our experience, a married couple searching for each other through a medical emergency that never seems to end, the siren never completely quieted.

Along the way, I have met the people behind the studies, the statistics, the press releases and the lawsuits: heroes, scoundrels, geniuses and idiots, victims and victimizers, the amorphous "less than one percent" of the population who have the adverse reactions you read about in the fine print on your drug labels and even the people who massage the numbers to get them under one percent. I have seen close up what happens at that moment when science officially becomes commerce, when exciting new drugs are handed over from the lab nerds to the marketing types. I have watched everyone in the pharmaceutical food chain describe everyone but themselves as unhealthily arrogant. I have seen the world's top drug cop, the head of the U.S. Food and Drug Administration (FDA), excoriated as a "thug," a "bully" and even a "killer" by an industry-friendly legislator. And I have listened to the head of one of America's largest drugstore chains turn to me and growl, "These drug companies always hide under the cloak of "We're these great research and development houses and without us there would be no medications.' I think they're full of shit."

The Europeans have a very elegant word for a certain type of drug safety research. The word is pharmacovigilance, and it refers to research that is supposed to be done after a drug has been approved and we're taking it. Because the people who do this work are the sole link between the pharmaceutical world and the real world and are often the bearers of unwelcome news, they sometimes seem like pharmacovigilantes. Over these years, I have been doing my own form of pharmacovigilantism. I use my press credentials to move effortlessly between the camps warring for control of your medicine cabinet.

My quest began with tracking down everything I could find about Floxin. But I realized that the only way to understand what had happened to Diane was to see beyond one pill and journey to the heart of the legal-drug culture: the international pharmaceutical industry, the government drug police in countries large and small, the physicians, the researchers, the pharmacists, the nurses, the consumer advocates - and the patients who unwittingly place their blind faith in this system. In college there was a book we had to read for political science class called The Dance of Legislation, about how a bill becomes law. Since Diane's drug reaction, I have been investigating politicized science and watching "the dance of medication" - how a pill becomes law.

© 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.