Alas too late to alter my medical practice, I recently read a review of Katherine Eban’s Bottle of Lies: The Inside Story of the Generic Drug Boom, in the New York Times. As a retired physician and a longtime advocate for generic medications– part of the answer to the spiraling costs of healthcare (assuming that the Food and Drug Administration vigorously regulated their production), I was shocked to learn the extent of corruption in the generic-drug industry.
Apparently, poorly-regulated factories in India and China produce the majority of these suspect generics, often after reverse-engineering true medications which have been proven in clinical trials. Maintaining the quality of ingredients and production methods, however, is mostly up to the drug companies, which undergo infrequent inspections and supervision. As a result, drugs with unexpected toxicities due to added contaminants are released into the market, the majority of them cynically targeting Africa and other developing areas of the world.
But even worse than their toxicity, in my opinion, is the fact that many of these drugs are intentionally under-powered, like a watered-down drink at a bar, in order to maximize yield and profit. Patients take them with the false hope that they will work as promised, whereas these generics might only vaguely resemble the originals. There is also the larger problem of drug resistance: for example, widespread use of under-powered antibiotics will lead to serious infections (and eventually epidemics) unresponsive to a growing number of antibiotics.
There is an air of opportunism, a whiff of incompetence, a stench of greed surrounding the generic-drug industry. In my former practice of rheumatology, support for generic medications– including the emerging “bio-similars” used to treat auto-immune diseases, such as rheumatoid arthritis, at lower cost but similar efficacy– has always been tempered by a healthy skepticism regarding the motives of Big Pharma and the efficiency of government regulatory agencies. That skepticism pervades my writing in the Fourth World science-fiction trilogy to an extent that surprised my acquaintances, colleagues, and even myself!
In Fourth World Nation, the second novel in the trilogy, Dr. Carla Patel tries to enlist a victim of Ordrax-induced dementia/psychosis in her trial of an antidote, MA-14:
“Mr. Otis Walker? I’m Dr. Carla Patel.”
Walker made no response, instead focusing on her da-disc. For the moment, Carla was content to watch him in silence. He trembled slightly, but at least he wasn’t lying curled under the sink in a puddle of urine, like the last patient. “Mr. Walker?”
“Your datadisc is brand-new. Are you American?” he spoke with a grainy voice, repeatedly licking his chapped lips.
“I’m sorry, but did you say American? You must be aware that there are no more Americans, Mr. Walker.”
“Yes more. Not what I want to hear. You’re testing me, right? You run this secret clinic for the Resistance, so you’ve got to know about the Americans.”
Carla frowned, then forced herself to relax. “We’re not here to talk about Americans, Mr. Walker. I see from your chart that you’ve had a rough time of it for seventeen years, ever since you were forced by MWI to undergo drug treatment for…”
“It was the PWE!” He licked his lower lip, which began to bleed. “The Wellness folks develop their drugs and run their studies. To control us. And those the PWE can’t control are killed.” Walker’s trembling increased.
Classic paranoid ideation- except that it was true! Paranoids are sometimes right, thought Carla—especially when it came to the PWE. “Yes, I understand that. But we’re here to discuss treatment for you. To improve your memory, and to help you focus on… on the reality of your situation.”
“The reality? How many of us—how many of you—know reality? My reality, your reality! His, her, our, your (plural), their reality?”
Carla suppressed a smile. “That’s right, your chart says you were a teacher. Maybe you’ll be able to return to teaching, Mr. Walker. There is a new drug we are trying called MA-14, an antidote which reportedly reverses the mental effects of psychopeptides. I can’t promise it will do anything after seventeen years, but one way or the other, your response would provide us with valuable information.” She suddenly realized that she had slipped badly by mentioning “valuable information” at a delicate moment of decision; over the past ten days, a surprising number of patients had outright refused treatment with MA-14, which they viewed suspiciously as yet another cruel experiment.
Walker grimaced, narrowing his eyes to slits. “I’m used to dealing with that. Valuable information. Me, data. That’s what I am. American data. The Americans need to know this, too. My response to… what you said… will be data, valuable information. The Gang of Three will do what he, she, they do with it.”
“Did you say Gang of Three? What do you know about the Gang of Three? Are you saying that they are former Americans?” demanded Carla, before reminding herself that Walker was known to be severely psychotic.
“American. One of them is. Americana. American here. He’ll do with it.” Walker’s face brightened at the thought.
One of the Gang of Three heads the Committee, Ran had said. An American? Whatever that label meant these days—and coming from a psychotic, it probably meant nothing. With a sigh, Carla returned to the original question. “Do you wish to try the medication, Mr. Walker? The MA-14?”
“MA-14. Antidote. Anti-PWE. Antebellum. Auntie Normal. Yesyesyes. Yes. Yesterday. Yes, today. Day I tried. Diatribe. Die trying. Dying to try. MA-14.” Wide-eyed, Walker regarded her eagerly, panting like a dog waiting for its treat. Delighted to have won the cooperation of a difficult patient, Carla signaled for her assistant to load the Dermamist injector. Working at the counter behind Carla, Ying started to hum in a self-satisfied manner, as though saying, I told you so, didn’t I, Dr. Patel.
[Not only does Walker not improve with the antidote, he goes way over the deep end! Weeks later, on her way to Highland City (where she hopes to reverse-engineer MA-14), Carla gains access to an advanced sequalyzer in the Mars colony of New Miami and makes a shocking discovery, which she promptly reports to the Mayor]:
“Although my work here is finished, I’m not sure that I need to go there now,” Carla interrupted. “I’ve completed the sequencing, Liza, and the results are disturbing. MA-14, which we had hoped would be an antidote to toxic psychopeptides, turned out to be identical to Ordrax—the most toxic of them all.” The Mayor looked astonished; she clearly remembered Ordrax from the early days of PsySoc Rehab.
“But how could that be? Perhaps you made some sort of error in calculations or… “
“No, I’ve checked the results many times,” Carla dismissed the suggestion impatiently. “As I see it, there are two possible explanations. One, MA-14 is not identical to Ordrax, but is a similar peptide designed to competitively displace drugs from their receptors, and your sequalyzer simply lacks sufficient resolution to tell the difference. That’s fairly doubtful. My own instinct tells me that the second explanation is correct: that is, Eunigen has actually sent Ordrax under the guise of an antidote, for some nefarious purpose.” Carla thought of poor Otis Walker, who had already been damaged by Ordrax years ago at Tharsis. If the “antidote” was indeed a sham, she had unknowingly given him a second dose of Ordrax, which would explain his shocking reaction. “Without knowing for sure which theory applies, Liza, I can’t very well produce MA-14 for the Resistance, can I?”
We’ve relied on generic drugs for decades, and of course not all of them– at least in this country, where methods of detection exist– are fakes. But for my colleagues still in practice, the great uncertainty introduced by Eban’s book must be disorienting, if not devastating.
Fourth World 