Malcharist began life as The Hemingway Effect, and possibly other things before that. For a long time it was The Placebo Suicides before Paul John Scott decided to experiment and see if people would buy a book with a title that didn’t conjure up images they might identify with – other than something vaguely dark and threatening. The book is a page-turner about the corruption of clinical trials told through a medical ghostwriter’s crisis of conscience.
Set in Manhattan in 2010 and laced with dark humor throughout its fast 352 pages, it finds Shivani Patel in its opening chapters in a Town Car with a private driver, “off to recharge the fading hopes of the neurotransmitter era.”
The reader has already met a clinical trial participant experiencing a terrible side effect, a magazine journalist desperate for paying work of any kind, and now the highest-paid ghostwriter for Krøhn-McGill Pharmaceuticals is suiting up to assist the world’s largest drugmaker with marketing a spinoff drug to a room full of Key Opinion Leaders in training.
Patel writes medical journal articles for authors TBD, doing so with data summaries generated by Contract Research Organizations. Hers is work destined to become the evidence base as doctors know it, and the folk who write the guidelines that dictate the treatments we get. She also writes clinical study reports, letters to the editor, review articles, commentaries, published clinical trials and CME – continuing medical education – material for doctors.
Unfortunately, she is “a relic from the weak, pre-industrialized evidence base,” according to her marketing director, “a scientist first, with all the risk that entailed.”
The plot never slows, switching chapters between the viewpoints of an interconnected cast of characters who bring this panoramic tale about the industrialization of medicine in our time to life, including:
- a down-on-his-luck magazine writer who is cajoled into promoting a new pill by a slick PR pitch,
- a telegenic KOL who has parlayed medical ghostwriting to fame, overstaying his welcome with his well-financed masters,
- a trial participant who has developed a terrifying preoccupation with death,
- a pharmaceutical marketing director who needs to make another 7 figures so that he can cash out and move to Florida,
- a widow who is seduced by a strangely well-endowed patient advocacy group, and,
- a regulatory boss who pals around with drug industry goblins on his weekend cycling trips.
Their paths intersect around a new drug that is the subject of a vigorous indication creep. It is a drug that has been rebuilt from an old drug, one itself having been rebuilt from an even older drug, a real-life medication that may have helped take the life of Ernest Hemingway.
We would tell you more but would rather you take the journey yourself.
We can tell you this: it is a work of fiction about subjects that never appear in fiction – akathisia, miscoding, protocol-switching, data-dredging, me-too drugs, CRO’s, KOLs, monoamines, astroturf groups, the illusion of data transparency – all wrapped up in a thriller that will have you turning to the last page. A thriller that will open doors to discussing the shortcomings of SSRIs and other drugs in polite company – something you couldn’t do unless it was ‘fiction’ and the conversation can be diverted to what is concealed under the skirts of key participants. Did she or didn’t she?
Scott has the writing skills to fold this all too real world into dialogue that will leave you in stitches in places, terrified in others, and glad this is not the world you live in – just fiction like The Handmaid’s Tale.
Buy it, read it and review it – we will post your review on Samizdat.org and in an update of Print your own teeshirt, we will give a glossy publication featuring your name – See https://samizdathealth.org/category/malcharist/