"'Immoral' and those others are strong words," Celia said.”No one disputes there's been some overprescribing. but-" "Some overprescribing! Excessive prescribing is a norm. But it's a norm you people work for, deliberately plan for, and most likely pray for! If you want an example, consider Valium and the others like it-probably the most overused, unnecessarily prescribed family of drugs in history, And because of overblown sales campaigns, launched because of insatiable greed by companies like yours, those drugs have left behind a trail of addicts, desperate people, suicides
"Also a good many," Celia said, "who really needed the drugs and benefited from them.”
"A minority, " the other woman insisted, "who could still have had them, but without the saturation advertising and sales promotion which brainwashed physicians into believing the Valium types were a panacea for everything. I know. I was one of the brainwashed doctors-until I saw how awful the drug scene was, and gave up private practice to start this organization.”
Celia said tentatively, "I know that you're an M.D.”
"Yes, and an internist. I was trained to keep people healthy and save lives, which I'm still doing here, though on a scale much larger than before.”
Stavely waved a hand to dismiss herself as subject.”Come back to Valium. It represents another way in which your business is unprincipled.”
"I'm listening," Celia said.”Not agreeing, but listening.”
"No one needed all the different variants of Valium which competing drug firms brought out. There is no benefit, no possible advantage in having five different Valiurns around. Yet after Valium was a huge financial success, other companies devoted months, even years, of research-precious scientific time, enormous sums of money-not with the aim of discovering something new and beneficial, but simply to have a Valium of their own under a different name. So they produced other Valiums-by shifting molecules around, making their drugs just different enough so they could be patented and sold profitably-" Celia said impatiently, "Everybody knows there are 'me-too' drugs, perhaps more than there should be. But they do sometimes lead to new discoveries; also they keep pharmaceutical companies -which society needs-solvent between other big breakthroughs.”
"Oh, my God!" Dr. Stavely put a hand to her head in an incredulous gesture. "Do you really believe that sophomoric argument? When it isn't just about Valium. When every major drug that one company brings out is copied by the others. That's why pharmaceutical research should be directed and controlled by government, though paid for by the drug firms.”
"Now I can't believe you're serious," Celia said.”You'd want drug research controlled by the same politicians who wrecked Social Security, fill pork barrels, can't balance a budget, and would sell their mothers for votes. Why, under that arrangement penicillin wouldn't be on the market yet! Okay, let's admit capitalist free enterprise is imperfect, but it's a country-mile better, and more ethical, than that.” Stavely went on as if she hadn't heard.”Your precious industry had to be beaten over the head with regulations before it would publish proper warnings about the dangers of its drugs. Even now, it fights for minimum warnings and usually wins. Not only that, after a new drug goes on sale, adverse effects are hidden--conveniently, callously, buried in company files.”
Celia protested, "That's nonsense! We're required by law to report adverse effects to FDA. Oh, there may have been a few instances where someone neglected...”
"There have been plenty of instances which this organization knows about, and I'll bet a lot more that we don't. Illegal withholding of information. But is it ever possible to get a prosecution launched by the Justice Department? Not when you people have that army of paid lobbyists working on Capitol Hill...”
Well, Celia thought, she had come here asking for opinions and she was getting them. While she continued listening, occasionally interjecting, the promised ten minutes lengthened to an hour. At one point Stavely mentioned a recent controversy which Celia knew about. A pharmaceutical company (not Felding-Roth) had experienced problems with one of its products, an intravenous fluid used in hospitals. Some bottles containing the supposedly sterile I.V. liquid had been found to have faulty caps, permitting the entry of bacteria which, in turn, caused septicemia-a blood disorder now blamed for several patient deaths. The dilemma was: the number of problem bottles was known to be small, and it was possible that all affected ones had now been found; also there would be no more, since the manufacturing problem had been discovered and corrected. Meanwhile, to place a ban on the entire supply of I.V. fluid in hospital inventories would cause acute shortages and conceivably more deaths than the original problem. The issue had been debated back and forth for several weeks between the manufacturer, FDA, and hospitals. Dr. Stavely criticized what she saw as "a disgraceful example of a drug company's dragging its feet while refusing to recall a dangerous product.” "I happen to know a little about that," Celia said, "and it's something which everyone concerned has tried to solve. Just this morning, though, I heard that FDA has decided to ban any more use of the existing LV. fluid supplies. They're preparing notifications over the weekend, and the decision will be announced at a press conference Monday morning.”
Stavely looked at her visitor sharply.”Are you certain of that?" "Absolutely.”
The information had come from an officer of the company concerned, whom Celia knew to be reliable. Stavely made a note on a desk pad and their exchange continued. Finally they came to Montayne. "Even now," Stavely said, "Citizens for Safer Medicine will do everything it can to stop that inadequately tested drug going on the market.”
Celia had become tired of the one-sided harangue and snapped, "To call Montayne inadequately tested is ridiculous! Besides, we already have FDA approval.”
"In the public interest, that approval must be withdrawn.”
"Why?" "There was a case in Australia Celia said wearily, "We know about the Australian case.”
She went on to explain how medical experts had refuted the allegations made in court and, both there and at the Australian government hearing, had given Montayne a clean bill. "I don't agree with those experts," Stavely said.”Have you read the transcript of the trial?" "I've read reports that have dealt with it thoroughly.”
"I didn't ask that. I asked if you had read the trial transcript.”
Celia admitted, "No.”
"Then read it! And do not presume to discuss Montayne until you have.”
Celia sighed.”I don't believe any more discussion will get you and me anywhere.”
"If you recall, that's what I told you in the beginning.”
For the second time there was a thin, faint smile below the other woman's piercing eyes. Celia nodded.”And you were right. Not about much else, but certainly about that.”
Dr. Stavely had already gone back to the paper she had been reading when Celia came in. She glanced up.”Good afternoon, Jordan.”
"Good afternoon," Celia said, and went out through the dismal offices to the equally dismal street outside.
Later in the afternoon, driving herself back from Manhattan to Morristown, Celia reflected on the nature of Dr. Stavely. Certainly Stavely was dedicated but also, to an extent, obsessed. It was equally clear that she was lacking in a sense of humor, unable to regard herself with less than total seriousness. Celia had met such people before; it was always hard to involve them in a thoughtful, objective conversation. They were so accustomed to thinking in black-and-white, antagonistic terms that they found it impossible to switch antagonism off and think in the shades of gray where much of life was lived. On the other hand, the CSM chairperson was clearly well informed, articulate, well organized, and had a keen, possibly brilliant mind. Her medical qualifications gave her stature and an automatic right to be heard on the subject of prescription drugs. Some of her views, too, were not all that far removed from Celia's, who remembered, fourteen years ago, describing "me-too" drugs and -molecular roulette" in much the same way as Stavely. It was Sam Hawthorne who, at that earlier time, had offered the arguments in response which Celia had used this afternoon. And despite using them, she was still not wholly convinced they were valid. But Stavely did become unbalanced when emphasizing the pharmaceutical industry's negative aspects while ignoring the many positive, humanitarian contributions to science and health the industry provided. Celia had once heard the United States drug industry described as "a national treasure," and believed the description was, on the whole, true. There was also Stavely's naive and absurd contention that drug research should be government controlled, and her gross misinformation and prejudice about Montayne. But all in all, Stavely and CSM were formidable opponents, neither to be ignored nor to be taken lightly. One thing Stavely had caught her out in, Celia thought ruefully, was the fact that Celia had not read the transcript of the Australian trial involving Montayne. Next week she intended to correct that omission, Still later that day, at dinner, Celia described her CSM experience and views to Andrew and he, as usual, had some wisdom to contribute. "You may not find those activist people-Maud Stavely, Sidney Wolfe, Ralph Nader and the others-easy to live with, and at times you may detest them," Andrew said.”But you need them, your industry needs them, just the way General Motors and the other auto companies needed Nader before he alighted on the scene. Nader helped make automobiles-for all of us-better and safer because of his needling and 1, for one, am grateful. Now, Stavely and Wolfe are keeping you and your people on your toes.”