Canadian Journal of Family and Youth, 10(1), 2018, pp 321-325 ISSN 1718-9748 University of Alberta http://ejournals.library.ualberta.ca/index/php/cjfy Young, T.H. (2012). Death by Prescription. Oakville: Mosaic Press. Reviewed by: Dominique Filipek, MacEwan University Terence Young s book Death by Prescription captures Young s determination as he works to discover the inner workings of the pharmaceutical industry and reason for his daughter s unexpected death. Young s daughter Vanessa was prescribed Prepulsid inappropriately for a stomach disorder, which resulted in fatal consequences. Young trusts that the drug directly caused Vanessa s death, leading him to initiate a class action suit against Johnson and Johnson, which becomes the first inquest of Prepulsid to come before a jury. Powered by grief, Young investigates underlying marketing strategies of Big Pharma and the detrimental impact it has on patient health. Through the use of clear and understanding language, Young captivates the reader with his thorough examination of the pharmaceutical industry. More specifically, he dissects marketing strategies such as warning labeling and commercial techniques into easily understood examples and components. Not only does he expose the troublesome truth of Big Pharma but also, provides beneficial solutions and alternatives to the problem. Perspectives involved are well rounded, varying from those who have previously worked in big Pharma industries to those who have also experienced the death of a loved one from prescription drugs. The book discloses a father s journey in finding justice for his daughter while simultaneously providing the reader with the underlying processes of the pharmaceutical industry. Young analyzes pharmaceutical marketing strategies in great detail. While solving the mystery of his daughter s death, he unravels what Big Pharma and Health Canada s true 321
intentions are. The term blockbuster is used frequently and refers to the drugs that sell billions of dollars a year (p. 63). This term becomes an important starting point, as Young discovers why blockbuster drugs such as Prepulsid remain on the market, even with known adverse health effects. Through the use of descriptive examples, Young portrays how marketing strategies are used to influence doctors and patients on which prescription drugs to prescribe or take. For example, majority of brand names are produced in specific ways that work to manipulate the consumers emotions and action (p. 190). Young makes it evident that the goal of Big Pharma is not to decide whether the patient needs a drug but which drug the patient will take. The term detail rep becomes a crucial factor in how doctors are influenced by Big Pharma, regarding their knowledge of prescription drugs (p. 221). Young demonstrates that detail representatives do not promote proper patient care but instead focus on building marketing relationships with doctors. For example, many detail reps use incentives such a free dinners and vacations to persuade doctors into prescribing specific drugs. Young strengthens this finding by demonstrating the affect that Big Pharma s wealth has on the three trusting major sources of information that doctors rely on. These sources include: (1) Continuing education; (2) medical journals; and (3) their peers (p.235). Young reveals that detail representatives influence these sources by funding events and hiring credible thought leaders (p. 235). Ultimately, Young s examination of marketing strategies provide evidence that Big Pharma s concerns regarding wealth outweigh the importance of patient health. Young argues that unclear warning labels and poorly written dear doctor letters for prescription drugs have resulted in many adverse health reactions and death. During an interview with an insider from a pharmaceutical company, it is discovered that these labels and letters are not produced to inform doctors and patients, but to protect Big Pharma from lawsuits (p. 66). 322
Young explains that marketers avoid clear warning labels that may scare people away from drugs like Prepulsid. This claim is strengthened by examples of incomprehensible warning labels that present risks in unclear medical talk (p. 85). Young claims that these muddy warning labels are intentional and provides improved ways to state risk factors. For example, instead of the coadministration of grapefruit juice with Cisparide increases the bioavailability of Cisparide and concomitant use should be avoided, warning labels should instead state WARNING: NEVER mix Prepulsid with grapefruit juice. The combination could result in death (p. 85). Young not only demonstrates how changes in marketing strategies would affect patient health, but how it would have directly affected his daughter s chances of survival. More specifically, if clear warning labels were provided for Vanessa s doctor, then Prepulsid would have never been prescribed for her gastroparesis. Throughout the book, Young states which strategies used by pharmaceutical companies are harmful to patient care. He also determines what is fundamentally wrong with these strategies by providing beneficial alternative tactics. For example, Young suggests that warning labels should reduce the use of medical speak, making it difficult to interpret the risks of the drug (p. 85). Young is also informed from Dr. Joel Lexchin who claims, unless a drug is a really major advance, it should be used very cautiously for the first few years (p. 161). Young also claims that doctors not reading about adverse reactions and the Compendium Pharmaceuticals and Specialties (CPS) is a problem (p.181). Therefore, it is suggested that patients should sign a consent form before receiving a prescription drug. This would assure that both the patient and doctor have read all adverse health reactions (p. 181). However, Young demonstrates that change within the pharmaceutical industry is difficult. Even after Young proved in trial that Prepulsid toxicity lead to Vanessa s death, the influence it had on Johnson & Johnson was minimal. Also, 323
fifty-nine recommendations made by the jurors would have revolutionized drug safety in Canada but were non-binding recommendations (pp. 312-313). Even though Young demonstrates lasting progress, the strength of the pharmaceutical industry becomes clearly evident. Even though Young works to expose the underlying mechanisms of Big Pharma and Health Canada, he predominately focuses on the case of Prepulsid and his daughter s death. Young successfully determines the cause of Vanessa s death with the help of credible sources. This is evident as Young progressively reveals what factors made Vanessa vulnerable to Big Pharma. The term off label becomes a significant factor and is defined as a drug that has been prescribed to treat symptoms for which it has never been officially proven safe (p. 67). Young relates this concept to Prepulsid, which has not been proven safe for children. This factor makes Vanessa vulnerable to the drug since she was given it as a young teenager. A second factor involved is the US Prepulsid Medication guide stating do not take if you have persistent vomiting (p. 88). However, this clear warning was not evident in the Canadian guide thus, making Vanessa vulnerable due to her mild bulimic behavior. The use of Vanessa s case intensifies the impact that Big Pharma has on its patients and encourages the reader to become more aware of Big Pharma s procedures. Young s book provides the reader with compelling insight regarding the pharmaceutical industry and its harmful mechanisms leading to inappropriate drug use. However, Young s argument is strongly unipolar and does not consider many present positive outcomes from the pharmaceutical industry. One of the few positive claims made by Young is that safe use of prescription drugs holds the highest potential to save lives and reduce injury in our hands today (p. 323). A more rounded discussion would be produced if more existing positive claims were 324
included. By including counterarguments claimed by experts Young could potentially work to refute those arguments effectively and strengthen his own argument. Throughout the book, Young faces conflict between serving justice for Vanessa and enabling his family to find closure. Even though he intends to prove Johnson & Johnson s role in Vanessa s death, it is evident that this enduring investigation impacts the family emotionally. This emotional aspect throughout the book portrays the strength of the parent-child bond, and the determination of Young to get to the root of Vanessa s death. Young captures audiences who may have experienced similar tragedies by including real accounts of similar incidents. By doing so, the court trial becomes important to readers who are not able to take similar action based on limited resource. I believe this book would be highly beneficial for both the general public and those in the health care profession. This book would provide readers with valuable information and teach individuals to become more critical with the use and administration of prescription drugs. I believe it also would be appropriate for business students who wish to understand the underlying marketing strategies of the pharmaceutical industry. Ultimately, Young uses his book to demonstrate the damaging impact that the pharmaceutical company has on its patients. However, Young provides hope for a future pharmaceutical industry that focuses less on selfinterest and more on patient health. 325