Side Effects by Alison Bass

These days, so much has been written about the dark side of Big Pharma and the payola retained by ethically bereft doctors that Alison Bass’s new book Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial can read like familiar disturbing territory. Even so, Bass executes such a revealing expose on the shadowy world of medical research and the pharmaceutical industry that it proves important stories, like timeless truths, need repeating.

Side Effects tells a shocking story about the pharmaceutical giant GlaxoSmithKline and the landmark lawsuit against its blockbuster drug Paxil, once the world’s bestselling antidepressant. Bass, a Pulitzer Prize nominee for investigative journalism, constructs a connect-the-dots legal drama written in a news reporter’s style of precise and plain prose. Although the author uses a questionable nonlinear narrative at times and doesn’t dazzle in the descriptive talents, the book remains strong enough and disturbing enough to hammer home how simple it was for a wealthy pharmaceutical industry and a lame Federal Drug Administration (FDA) to dupe millions of people. In the end, many kids paid the ultimate price and the deception almost went unnoticed.

Underscoring the human stakes, Bass begins her story by writing about a shy girl, Tonya, who sees a slick commercial for Paxil and believes the drug can be the quick fix that will assuage her social anxiety. Bass, as one would expect, culled reams of research on Big Pharma and its baffling financial relationship with the FDA. But what makes Side Effects an engaging read is how the author also interviewed and profiled the story’s behind-the-scenes players. Profiles range from shady doctors to upstanding researchers and determined lawyers to indomitable mothers. With this method, Bass humanizes a complex and chilling court case by introducing little known heroes and shaming the high-profile doctors who participated in a spectacular erosion of medical research and health care.

The most memorable trailblazers are two women who witnessed a blatant wrong and boldly took on a powerful industry. Donna Howard got the ball rolling when she decided she’d had enough. It was 1999 and she was working as an assistant administrator for Brown University’s department of Psychiatry. At work, she witnessed something not quite right at the Ivy League school and linked Dr. Martin Keller, the chief of psychiatry at Brown, to the wrongdoing. Howard had grown so disgusted with the corruption she saw at Brown that she gathered documents proving Keller was receiving hundreds of thousands of dollars from the Massachusetts Department of Mental Health for research that wasn’t being done. Howard also suspected Keller was misrepresenting data for drug trials that included Paxil. She reported the findings to her supervisors at Brown but no action was taken. Unsatisfied, she started looking for another job, picked up the phone, and called the Boston Globe. Bass, a reporter working the medical beat, ended up writing numerous articles on the scandal.

Whistleblowing, as Bass points out, was a bold move guaranteeing Howard’s dismissal from Brown. Yet, Howard risked retribution for simple reasons. As a mother of a daughter suffering from a mental illness, Howard knew all too well that state cutbacks were hobbling mental health services. The knowledge that a wealthy institution like Brown was profiting when low-income families were suffering was unbearable. Calling Bass, Howard joined the ranks of many other famous female whistleblowers from Karen Silkwood to Sherron Watkins and adds to the disproportionate number of women who seem more capable of stepping up and reporting corruption than their male colleagues.

All the same, the book shows whistleblowing as a thankless task. Dr. Keller retains his high post at Brown while Howard has had the pleasure of jumping from job to job. Still, the publication of Side Effects should raise more questions about Keller’s participation in the Paxil scandal. In particular, the book details how a spike in adolescent suicides began occurring at the same time that a record number of kids starting taking Paxil. Bass documents how doctors, who were receiving money from GlaxoSmithKline such as Keller, were spinning medical reports that touted the drug’s efficacy even though there was no proof that the drug performed any better than sugar pills in treating children. Further, doctors suppressed evidence that Paxil might be harmful. Harmful in the sense that kids taking Paxil were suddenly contemplating suicide and some were succeeding in the deed. Not receiving full disclosure, doctors and patients were kept in the dark. Prescriptions for Paxil soared.

The accusation of obscuring evidence in medical reports would eventually form the basis of an unprecedented consumer fraud lawsuit filed by the New York State Attorney General against GlaxoSmithKline. The key attorney working the case was Rose Firestein. A New York assistant attorney general, Firestein is not your average-looking crusader. Blind, she walks with a cane and stands at a wee five-feet-one-inches tall. Even her job in the low-profile, ho-hum consumer bureau division didn’t position her to generate headlines. But on 2 June 2004, she helped launch this key lawsuit and exposed a remarkably sick system of fraud. The lawsuit scored a significant blow against Big Pharma and paved the way for a new public registry system as well as those truth-in-advertising black box warning labels that Big Pharma continually resists because it hurts their marketing. In the book, readers learn Firestein’s motives and what gave her the will to seek justice against difficult odds.

Ex-New York Gov. Eliot Spitzer provides an unforeseen twist to the story. When Firestein was pulling all-nighters on the Paxil case, she was working for then New York Attorney General Eliot Spitzer, a rising star. Spitzer’s recent prostitution scandal and subsequent resignation creates an unfortunate blemish on Side Effects. Maybe it’s just me but every time I read “Eliot Spitzer” I couldn’t help but conjure his alter ego, “Client–9”. Still, Spitzer operates as a minor character. This is a story about the pivotal contributions of Rose and Donna, an unlikely duo that reformed Big Pharma and gave the public a dose of truth.