MIRACLE CURE by Michael Palmer, MD, Bantam Books, New York, 1998, 424 pages, $7.50 (paperback) ISBN: 0.553-57662-3
Dr Palmer, Internist and ER physician, whose books have been translated into thirty languages, has written his eighth medical thriller. His practice now includes being the associate director of the Massachusetts Medical Society's physician health program. He dedicates this novel to Judith Palmer Glantz for her talent as a mother and her grace as an ex-wife.
The Boston Globe announces that researchers at Newbury Pharmaceuticals are developing a new drug, Vasclear, that clears the arteries of atherosclerosis in just a few weeks. The protagonist, Dr Brian Holbrook, a cardiologist in drug rehabilitation, is promised that his medical license will be restored when he has secured a job and continues to see his drug counselor for another year. He lands a position at the Boston Heart Institute, which is doing the beta-testing of Vasclear. His father, his own coach in varsity football, has severe coronary occlusive disease, and it is recommended that he have coronary artery bypass grafts (CABG). But he sees the marvelous results of Vasclear tries to pulls strings to get his father on Vasclear, even though having previously had a CABG clearly excludes him by the drug protocol. His father does not respond to Vasclear, develops crescendo angina, has his CABG, but his heart does not come off bypass. The heart surgeon blames the death on Dr Holbrook, for even thinking that an untested new drug about to be released would be preferable over the standard surgical treatment.
Meanwhile Holbrook is noticing that the patients in the previous Phase I trials are all developing eosinophilia and pulmonary hypertension. As this is uncovered, these patients all mysteriously are lost to follow up, their records are purged from the Boston Heart computers, and doctors who become too nosey and try to contact the patients, no longer show up for rounds. Holbrook's counselor, Freeman Sharpe, through his AA and NA contacts finds out that Newbury Pharmaceuticals is a front for the Russian Mafia which is laundering funds.
When Holbrook finds the pre-treatment and post-treatment cath videos are not of the same patient, that Senators are making nighttime visits to Boston Heart to get their Vasclear injections outside of "drug protocol," that the president is personally signing an FDA marketing approval for the drug, he becomes aware that anybody who interferes with the release of the drug, and an estimated $5,000 in revenue from millions of patients, will be annihilated. An FDA doctor's sexual trysts with Dr Holbrook effectively adds to the suspense as Holbrook begins to understand that a plaque dissolving drug is most successful if there is no disease in the first place! But how do you do fake coronary angiograms?
The roller coaster ride is a tour de force. The 6 hour audio tape format is an excellent abridgement that keeps your suspense high, your car speed quite slow and makes you take the long route between hospitals until you can bear to turn it off. One evening I thought I might have to drive to SF just to finish the tape.
WORST PILLS, BEST PILLS - A Consumer's Guide to Avoiding Drug-Induced Death or Illness by Sidney M Wolfe, MD, Larry D Sasich, Pharm D, MPH, Rose-Ellen Hope, R Ph, Pocket Books, New York, xxxv & 772 Pages, $16, ISBN: 0-671-01918-X.
Doctor Wolfe expands this revised edition of his guide and doesn't pull any punches. He literally tells our patients about 160 drugs to avoid, such as Ultram and Darvocet for pain, Rezulin and Glucophage for diabetes, Lopid for lipids, Meridia for weight, birth control pills such as Desogen or Orthocept, allergy drugs such as Hismanal and Entex, antibiotics such as Raxar and Zagam, and Alzheimer's drugs such as Cognex, Aricept, and Hydergine. Previously he has written Pills That Don't Work and Over-the-Counter Pills that Don't Work. These shouldn't be confused with Dr Bosker's Pills That Work - Pills That Don't or with Dr Brodin's The Over-The-Counter Drug Book which were recently reviewed in this journal.
Wolfe cites a study from JAMA which found that each year adverse drug reactions afflict 2.2 million people per year with serious drug-induced diseases, 1.5 million of whom require hospitalization, and 100,000 of whom die. He highlights many drug interactions such as a diabetic on insulin receiving Inderal, a patient on Prozak receiving Meridia, or a patient on quinidine receiving Calan SR. He feels that FDA oversight has decreased because of political pressures to bring drugs to market quickly. This has resulted in three drugs being recalled shortly after being released which, he feels, is a new development.
He gives good advice for our patients--learn both the brand and generic names of all their drugs, know the reason for taking them, the risk factors, and all possible interactions. He designs charts for patients to use to record their drugs and the effects observed. He cautions that if some new symptom develops in the first days or weeks after starting a new drug, be sure to discuss it with your doctor and never change your medication without first discussing it with us.
He offers a subscription newsletter for patients to keep up with new problems with drugs as they occur. He advises patients to obtain a copy of their medical records. His foundation sells copies of Questionable Doctors for the 18 regions in this country for $20 each. We may not agree with his forthright stand on individual drugs in this book, but with increased patient awareness, both we and our patients benefit. Reading this may fall in the same category as a medicine professor once told his class, "You have to read Readers' Digest to keep up with your patients."
Both Books allude to the lessening of FDA oversight to new drugs and being politically influenced for early release, which started when HIV drugs were introduced after phase II trials rather than the phase III clinical trials.
Del Meyer, MD