BITTER PILLS

A big, sprawling, highly personal inquiry into the making, approval, selling, and prescribing of drugs. When a single dose of the antiobiotic Floxin sent Diane Fried to the emergency room in delirium and left her with serious neurological problems, her journalist husband turned his investigative eye on Floxin’s safety. It is a well-told story, fascinating and often frightening, occupying nearly a third of this book. From it, Fried (Thing of Beauty, 1993) then began a broader investigation into the pharmaceutical-industrial complex, seeking to find the flaws in the process by which drugs make it from pharmaceutical lab to family medicine cabinet. Fried attended medical and scientific conferences and government hearings, compiled enormous files of documents, and seemingly interviewed just about anyone with anything pertinent or interesting to tell him about the hazards of legal drugs: researchers, pharmaceutical company reps, FDA officials, and patients with adverse-reaction stories. Trying for the big picture, he seems more often to resemble the blind men struggling to figure out the nature of an elephant from its separate parts. While this work lacks focus, Fried has an ingratiating personal style and he provides some insightful interviews with insiders as well as information on the safety of quinolones (the drug family embracing Floxin), how the FDA dealt with thalidomide in the 1960s, the development of powerful protease inhibitors to treat AIDs, and the growth of direct-to-consumer marketing of prescription drugs. As might be expected, pharmaceutical companies come in for heavy criticism, but so does the federal government, for inadequacies in surveillance of drugs for possible adverse affects once they’re on the market. To reassure the nervous consumer, there’s an appendix on how to read a drug package insert and how to ask the right questions of one’s physician and pharmacist. For all its virtues, a collection of absorbing articles that never quite coalesces into a cohesive whole.