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33 of 34 people found the following review helpful
VINE VOICEon February 5, 2014
As a biomedical scientist I really enjoyed this book. It is the sequel to the author's previous volume "The Billion Dollar Molecule". Both books provide a fly-on-the-wall account of Vertex Pharmaceuticals, an innovative biopharmaceutical company that brought two breakthrough medicines - one for hepatitis C and the other for cystic fibrosis - to market two years ago. Both these drugs were the first of their kind and have given thousands of patients a new lease on life. From a broader perspective however, the author's goal is to shed light both on the immensely challenging process of bringing a new drug to market and the brilliant scientists and driven personalities that make it possible.

Werth's account of Vertex focuses mainly on the hepatitis C drug, with the cystic fibrosis drug playing a smaller but still important role. The previous book was much more science-heavy than this one, emphasizing the chemistry, biology and computer science that goes into the early stages of drug discovery. In spite of the intense scientific competition and research depicted in that volume (much of it spanning the late 80s and early 90s), Vertex did not bring a successful drug to market until 2010, underscoring the challenge of drug discovery in which you have to furiously paddle simply to stay afloat. The two books thus mirror two different phases of the company: the first dealing mainly with the science and the birthing pains of a new startup, and the second dealing with the transformation of the startup into a commercial enterprise. You will thus find much more of the business, legal and commercial aspects of drug development in this volume. Boardroom deliberations and the subtleties of drug pricing litter the narrative. Both books, however, provide an excellent overview of the multiple challenging stages of drug discovery, from discovering an initial "hit", to optimizing its properties to formulating it and finally selling it in the form a once-a-day pill. The account of formulation difficulties was especially revealing to me. As the founder of Vertex put it, taking a drug all the way from initial discovery to the market is harder than putting a man on the moon, partly because the biology is so complex and incompletely understood.

Werth has always been a skilled purveyor of the personalities and egos that populate the highest echelons of the science and business and he continues this tradition in this book. Along with highly driven scientists we meet egotistic but talented lawyers, executives, government officials, Wall Street analysts and venture capitalists. The founder of Vertex is described as having a "reality distortion field" akin to Steve Jobs. The character descriptions are far more colorful in the previous book but this volume does have its share of sharp profiles: for instance one management consultant "dressed like George Will but sounded like Don Draper channeling Alan Ginsburg". One of the strengths of the previous volume was that many of the personalities portrayed in it - including academic giants like Robert Burns Woodward and industrial giants like George Merck - were fundamentally more interesting but the present account on the other hand does a better job of describing the vast and sundry set of individuals required to sustain the diverse drug enterprise. We also see how cruel the business can be, bringing failure to years of intense effort and laying off dedicated scientists who have given their heart and soul to the process.

Werth's discussion of the two Vertex drugs also raises important questions about the future of the industry. The hepatitis drug is targeted toward a vast patient population, much of which is located in poor countries. The cystic fibrosis drug is targeted toward a small patient population, much of which is located in rich countries. The stories of patients in both groups - one of which Werth documents in detail - are heartbreaking, but in both cases the challenge is to balance profits with cures. In one case the company was compelled to charge exorbitant amounts of money because of the small patient population while in the other case the lack of wealthy patients led to lower revenues. Whether you are developing a drug for millions or for thousands, the R&D costs are roughly the same - and enormous. This is the moral and financial challenge the industry faces right now; how, when it is trying to develop highly personalized therapies for smaller and smaller patient groups, can it get away with both charging reasonable prices and recovering the expenditure on R&D that it can plug into developing the next drug. Werth deftly discusses these issues along with the underlying ones of FDA approvals and Medicare and government controls.

Ironically, the successful Vertex story - which culminated last year in a move to a shining, sprawling new building near Boston Harbor - ends in a somewhat somber note. Many of the most important scientists - including the founder - who discovered the two medicines are no longer with the company and the highly-science driven approach that was described in the first book seems to have taken a backseat to commercial pursuits. The future of the company is thus not completely certain, and Werth ends with an afterword in which he discusses the fate of big pharmaceutical companies which seem to be laying off thousands, making incremental advances and cutting each others' throats to bring the next "me-too" pill to market. Unlike Vertex, many of these organizations spend much more on marketing than on R&D and are busy pleasing Wall Street and shareholders rather than patients. As Werth reminds us, if we want to advance the next groundbreaking medicines we need to remember George Merck's advice: focus on patients, the profits will follow. The story of Vertex provides both a shining example and a cautionary note.
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13 of 14 people found the following review helpful
on February 13, 2014
As a retired "Merckie" in R&D, I found Barry Werth's insider views incredibly interesting and educational. More non scientists should read these two books. Most people haven't the faintest idea what it takes to discover, collabarate, scaleup, purify, clinically test, manufacture and market a new drug or vaccine. Not to mention publication and patent and naming issues. Great books.
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6 of 6 people found the following review helpful
on April 19, 2014
This book is amazing because I never thought a corporation can have so many souls dancing inside, let alone a Pharma company. I want to say that I exaggerated only a little to compare this book's story to the 10 year Trojan War.

What really touched me are the stories of individuals. The Bogers who "bore the torch" in the early days of doing great science and exploring the frontiers, the successors who financed and commercialized the founders' vision, the Wall Street analysts wanting to milk the new Pharmas like they did with the old, the patient advocates who wanted Vertex to remain true to its mission even when it is burning through hundreds of thousands of dollars a day... Those are real people competing viciously with selfish aims and playing out in a ruthless business world where billions of dollars would be won or lost on any single day. The deciding factors at the end of the day are two things: luck and balls.

Who doesn't become exited when warm humanitarian ideas and cold hard cash were tossed together and shaken violently by a group of crazy scientists? I will have that straight up any day.
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2 of 2 people found the following review helpful
on May 31, 2014
My son participates in Phase 1 and Phase 3 drug trials at the Univ of Texas. That is complex stuff. The scientific development of the drugs being tested is much more difficult. This book gives you some idea of what is involved. I wish that there were more books like this on other drug companies. This book was particularly good on giving you some idea of the gyrations of the stock price of these companies and what is behind the gyrations. Vertex brought a drug to the market to cure hepatitis C. Possibly one might come up with some discounted cash-flow analysis which would give a value for the company......but after Vertex got its drug to market someone came along with another better drug. How do you model that?

I admire Vertex's quest for innovation. But 20 years of research before it can bring a drug to market is almost unbelievable. How they managed to finance this is amazing.

The key to all economic growth is innovation. One of the vital issues is how to finance this innovation which requires so much research. There aren't any easy answer. The US seems to be doing better than most other countries.
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3 of 3 people found the following review helpful
on April 16, 2014
I work in Pharma and the book goes a long way to depict the inner workings and dynamics of the industry with real-life happenings.
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1 of 1 people found the following review helpful
on April 9, 2014
Fascinating, accurate look inside pharmaceuticals! The author, Barry Werth, gets inside an industry that is often closed and difficult to explore. HE ROCKS!
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on August 27, 2015
Having been personally acquainted with some if not many of the issues discussed in The Antidote, I can only praise this book for its forthright stance. The pharma industry has become increasingly a world-wide group of international conglomerates. However, there are national differences. I think this book especially addresses and is importantly relevant to the US pharma industry as a whole. Nor am I suggesting the book is relevant to professionals only. On the contrary it's not only broadly relevant but readable too.
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on June 30, 2015
An incredibly detailed look inside the world of Pharma.
One gets to see the sausages getting made, and how many compromises are needed and how much perseverance and straight up good luck in needed to get a drug to market. Drug discovery and Development is hard, expensive and non-linear. But ultimately the payoff can be fantastic. This book takes you on that journey.
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7 of 12 people found the following review helpful
on April 9, 2014
I cannot figure why the author wrote this book, and he really does not explain the reason. The book is grossly tedious and filled with a seemingly endless cast of characters, only one of whom seems to have a defining personality. There is little help for us to understand the way pharmaceutical science is conducted, or how new chemical findings emerge. In contrast, there is a great focus on the various movements of the company's stock price. The writer relies a great deal on prepared, long-winded statements by various corporate heads. And the writing seems lazy--little guidance for the layperson and lots of "gonna"s. Yes, gonna. I hope the language doesn't move that way.
The good point: The author provides a beautiful portrayal of the tension, and the actual process, of presenting an application for government drug approval. Unlike the way Rush Limbaugh portrays science as "either-or", the best scientific work needs to be mercilessly scrutinized, and openly criticized, by highly learned experts who actually vote a consensus.
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2 of 4 people found the following review helpful
on March 16, 2014
This book was well done, but it lost its message somewhat along the way. It is worth reading but the characters are not as real as they probably are in real life.
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