Side Effects: A Prosecutor, a Whistleblower and a Bestselling Antidepressant on Trial

Nursing Book Club

Side Effects: A Prosecutor, a Whistleblower and a Bestselling Antidepressant on Trial

The cost and effect of marketing drugs

By Alison Bass; Algonquin Books of Chapel Hill, 2008
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Reviewed By Christine Contillo, RN, BSN

I was listening to my car radio in 2004 when I heard the news that pharmaceutical giant GlaxoSmithKline would be required to put a “black box warning” on their antidepressant, Paxil. The drug was one of a new category of antidepressants called selective serotonin reuptake inhibitors and the company had marketed it for use in children who had not responded to standard treatment. Increasingly, the drug had been found to cause suicidal thoughts in adolescents.

It didn’t seem to me to be a long walk from being clinically depressed and needing medication to having thoughts about suicide. I didn’t realize, however, that this was more than just occasional thoughts about wishing to end your life. Paxil could conceivably cause violent, homicidal and uncontrollable rages. I was also not alone in not understanding the full extent of the problem. The information had been deliberately withheld from prescribing physicians, those same physicians being encouraged to write the scripts even though studies had repeatedly proved the decidedly negative side effect to be true.

Side Effects, Alison Bass, book reviewSide Effects documents the investigation and lawsuit filed by then Attorney General Eliot Spitzer in New York State in which GSK ultimately settled for $70 million. This staggering amount indicates the large profit made from the blockbuster drug, which used questionable marketing that promoted off-label use for children and teenagers.

Alison Bass is a prize-winning journalist and has been a health, technology and medical writer for the The Boston Globe and other national media outlets. She helped to break the original story, and the book reads much like a medical thriller.

As the author interviews the families with mentally ill youngsters who have exhausted their opportunities for cure, we’re able to understand why they would jump at any chance to stabilize their sick children.  Bass puts all the pieces together and builds to the climax. By the end we understand the how and why of  clinical drug testing, why results were kept from release, and the powerful forces that limit the ability of the FDA to protect the public. We meet the characters who bravely carry on the fight and in the end cheer for the stunning courtroom conclusion.

Again and again we hear that runaway pharmaceutical costs are a major problem for the American health care system. With the help of authors like Bass we’re better able to see exactly what these costs can mean to us. It’s not just the mug with the drug company label that drives up the price of your prescription. Marketing done in far more subtle ways is vastly more expensive. It will take crusaders like Bass and Rose Firestein, the attorney in the case, to fight for increased transparency and allow providers to do their job with predictable results. In the end we’ll all win.

Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.

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