Saturday, April 14, 2007

Grisham's King of Torts: Fictional Depiction of Evil Drug Industry

I am grateful to a colleague for calling my attention to John Grisham's novel, The King of Torts, originally published in 2003. I admit to not being a devotee of Grisham's novels and so wasn't sure what to expect. The novel depicts the rise and --well, maybe I had better not give away the ending--of the career of one Clay Carter, who enjoys a rapid rise from a poor public defender to one of a select group of mass tort (or class-action lawsuit) plaintiffs, a tribe for which Grisham apparently has little sympathy.

For readers of this blog, the interesting aspect of the novel is its depiction of the behavior of the large drug companies, analogous to John Le Carre's novel, The Constant Gardener. The novel depicts in turn three drugs. The first, "Tarvan," is a wonder drug that has unprecedented powers to kill the craving in drug addicts and to keep them clean. The bad news is that for a small percentage, it unleashes unpredictable homicidal tendencies. The company is depicted as having to cover up this terrible side effect because it had set out to evade FDA regulations by launching a secret set of trials, without research board approval or informed consent. The closest analogy in real life seems to be the suicidal and occasionally homicidal urges caused by the serotonin-reuptake-inhibitor class of antidepressant drugs.

The next bad drug in the novel is "Dyloft," a heavily marketed arthritis drug that turns out at first to have the unanticipated side effect of causing bladder tumors, again in a relatively low percentage of patients. Initially these tumors are for the most part benign, so the actual harm done by the drug is limited--though as the novel unfolds, Dyloft turns out to have another trick up its sleeve. The company is depicted as aware of this side effect and engaged in covering it up so as not to damage sales. The closest analogy to "Dyloft" seems to be Vioxx and its cousins, though the risk they created was the more serious one of heart attacks.

Finally we encounter the drug "Maxatil," a female hormone that ends up causing excess cases of breast cancer and some other diseases. This drug turns out to be a booby trap for the unwary mass tort lawyer; it is difficult to prove that the drug was the actual cause of any given case of cancer, so the company is able to dig in its heels and fight off the legal threat. "Maxatil" obviously seems to have been suggested by the unexpected findings in the Women's Health Study that post-menopausal estrogens increase the risk of cancer and heart disease. (Wyeth's track record in defending lawsuits against its hormone drug, Prempro, appear so far to be mixed.) The fictional company that makes "Maxatil" is depicted as less evil than the makers of the other two drugs; it is not so clear that they hid any evidence of risks.

If these parallels are correct, then Grisham gets credit for a fair amount of prescience; his book was published in 2003, but it was not till 2004 that most people knew about the serious risks associated with SSRI antidepressants and with Vioxx.

All this is clearly fiction, so what does it matter? I take up space here simply to note indirect evidence of a feature of popular culture--the notion that a big drug company would market a drug with clear dangers, and hide the evidence so as to maximize its profits, apparently seems today to be a sufficiently plausible scenario to the average member of the American public, that best-selling authors have no qualms about basing a novel on such a premise.

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