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April 2002
Vol. 5, No. 4, p 55.
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Book Cover - Dispensing with the TruthDispensing with the Truth:
The Victims, the Drug Companies, and the Dramatic Story behind the Battle over Fen-Phen

St. Martin’s Press, New York, 2001, 402 pp, $24.95 hardback
ISBN 0-312-25324-9

Alicia Mundy’s Dispensing with the Truth opens with the story of Mary Linnen, a 29-year-old woman from Hingham, MA, who announced her engagement on Memorial Day in 1996. Anxious to begin planning her wedding, she had already decided that she wanted a simple wedding gown—“nothing too frilly”. Mary also wanted to lose weight— just a dress size or two—so her doctor prescribed a popular diet drug called fen-phen about 10 days earlier. However, a few days later, she complained of shortness of breath and dizziness during a family golf outing. Mary stopped taking fen-phen after only 23 days and briefly felt better. But soon her symptoms grew worse. She felt dizzy, exhausted, and severely short of breath on a daily basis.

Mary couldn’t understand what was happening to her. Although she was overweight, she was not obese and had never had these health problems before. Ironically, fen-phen’s maker, Wyeth-Ayerst (a division of American Home Products), had been receiving reports for years about patients like Mary who had similar problems after taking the diet pills for only a few days or months. Even worse, Mundy claims that the FDA was also aware of these effects but dismissed them as insignificant, in part under pressure from the pharmaceutical company.

Fen-phen is a combination of two drugs: fenfluramine (also known as Pondimin), which was sold by Wyeth-Ayerst, and phentermine, distributed by Fisons Corporation. Both were lackluster diet drugs that failed to attract much attention in the marketplace during the 1980s and early 1990s because one of their main side effects was intense drowsiness. Then in 1992, a study announced that the combination of the two drugs canceled out the sleepiness. What followed was a media frenzy touting fen-phen as an obesity wonder drug, including a 1995 profile in the women’s magazine Allure. By 1997, between 6 and 7 million American women had taken fen-phen, along with its prescriptive sister Redux. And it was not just the obese who were gobbling these diet drugs—those who wanted to quickly shed 10 or 15 pounds begged their doctors for a prescription.

Fat: Fighting the Obesity Epidemic
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Skinny on Fat: Our Obsession with Weight Control
By Shawna Vogel
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Losing It: False Hopes and Fat Profits in the Diet Industry
By Laura Fraser
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Seven months after she took her first dose of fen-phen, Mary found herself in the emergency room going through a battery of respiratory tests to find out what was wrong. She was referred to a specialist, who soon gave her his depressing diagnosis: primary pulmonary hypertension (PPH). Her capillaries were thickening and closing, and consequently, her lungs were not getting enough oxygen. She was quickly fitted with a chest tube and put on Flolan, a drug fed through the tube that makes the heart pump harder to transport oxygen to the lungs. But Flolan bought her only a few months. Although PPH survival rates can be around four years, Mary Linnen died on February 22, 1997, only 10 months after taking her first dose of fen-phen.

Before her death, Mary and her parents hired a young, ambitious attorney named Alex MacDonald, who had a history of successful medical malpractice trials. Initially, they just wanted fen-phen pulled from the shelves, but after the Mayo Clinic released studies linking the drug to PPH and heart valve damage, the Linnen case was swept up in what would become one of the largest mass tort lawsuits in U.S. legal history. Even MacDonald was not aware of what this case would become and what disgraceful behavior it would unearth.

Mundy’s exhaustive research and acute observations make Dispensing with the Truth not only a taut legal thriller brimming with suspense but also a heartbreaking tale of corporate greed and federal corruption that left hundreds, if not thousands, of innocent victims with deadly heart and lung conditions. She makes a case that claims that the FDA caved in to pressure from the pharmaceutical company to get fen-phen approved quickly and tells how Alex MacDonald and his team of lawyers stumbled upon a Wyeth-Ayerst report listing pulmonary-hypertension-connected fen-phen cases dating from the early 1990s (including 101 deaths). Other revelations include evidence that an American Home Products executive approved the removal or “overwriting” of 13 reports of fatal valve disease from a doctor in North Dakota. Finally, Mundy exposes a company memo condemning a potential warning label on fen-phen concerning heart and lung damage because it would cost Wyeth-Ayerst $800 million in revenue.

Dispensing with the Truth is a page-turning courtroom drama that never slows down, but it is also an unflinching account of a case in which it appears that profits were more important than patients.

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