Books: Bitter Pills, Bad Medicine

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With the euphoniously named diet-drug combo fen/phen all the rage in the mid-1990s, victory finally seemed near in the war on fat. Selling by the millions, the little pills appeared to melt away pounds without maddening diets, demanding exercise or nasty side effects. But as investigative reporter Alicia Mundy reminds us in her absorbing postmortem, Dispensing with the Truth (St. Martin's Press; 402 pages; $24.95), what began as a panacea for intractable obesity--and a bonanza for the pillmakers--quickly turned into a public health disaster.

By 1996, thousands of fen/ phen users started showing up in doctor's offices and hospitals with catastrophic heart and lung problems. One of them was an athletic but overweight Boston- area bride-to-be, Mary Linnen, 29. Hoping to look a little more svelte in her wedding dress, Linnen had been taking the pills for only 23 days before she developed a fatal lung condition, primary pulmonary hypertension, that effectively suffocated her within the year. Many other pill takers turned up with plaque-riddled heart valves requiring open-heart surgery.

Legal claims proliferated against American Home Products, whose Wyeth-Ayerst subsidiary made Pondimin (or fenfluramine, the "fen" in fen/phen) and marketed the related diet drug Redux. Though many of these suits were combined in a single multibillion-dollar class action, Mundy focuses on Linnen's case and one other. In the latter, a couple of outsize Texas lawyers named Kip Petroff and Robert Kisselburgh brought ole-boy tactics to bear on behalf of Debbie Lovett, 36, a manicurist with valve disease. Their client had a long history of smoking and high blood pressure, which suggests that more than diet drugs were at the root of her health problems. Still, she was awarded a whopping $23 million by a small-town jury. In the Linnen case a theatrical Boston attorney, Alex MacDonald, pleading passionately for Linnen's family and shredding the defense's witnesses, forced the drugmaker's high-powered legal team to capitulate in mid-trial and offer a multimillion-dollar settlement rather than risk an even larger jury verdict.

Though it's American Home Products that must pay the huge settlements, Mundy makes clear there were other villains--doctors who heedlessly prescribed the diet drugs "off label" (in unapproved ways); scientists who ignored early signs of trouble with fenfluramine; Food and Drug Administration officials who acted more like agents of industry than of the taxpaying public; and politicians who repaid campaign contributions from the pharmaceuticals by pressuring the FDA to rush dubious new drugs through the pipeline. Like her litigators', Mundy's language is sometimes hyperbolic. She also lets the public off a little too easily for relying on pill-popping solutions rather than changes in lifestyle. Nonetheless, she provides a read that will have you gritting your teeth.

--By Frederic Golden