I stumbled onto the central theme of this book while writing a cover story on drug pricing for The American Prospect magazine during the 2000 election campaign. Material that eventually found its way into several chapters first appeared in its pages. So I am deeply indebted to Robert Kuttner, whose wise counsel and patient editing allowed this daily news reporter to make the difficult transition to the more thoughtful, longer forms of our craft. I met Bob more than two decades ago while he was reporting his first book, and over the years his public commitment to the unfashionable idea that the public sector and public investments play a crucial role in American life has inspired my own journalism. He is an excellent editor and has become a friend, and for both, I thank him.
The book would not have been possible without the cooperation of the more than two hundred doctors, scientists, company executives, government officials, patient advocates, and patients whom I interviewed. While far too numerous to mention, many took time out from busy schedules to patiently explain their complex worlds, and I want every one of them to know that I deeply appreciated and benefited from their generosity. If I made mistakes translating their science and lives into layman’s language, the fault is entirely my own.
This project received the generous support of the Kaiser Family Foundation, whose media fellowship program provided both financial and emotional sustenance during its crucial midpassage. My fellow fellows—Raney Aronson, Bob Davis, Don Finley, Andrew Julien, and Andy Miller—provided me with a virtual newsroom for talking shop and lots of good times to remember. And the director, Penny Duckham, has made the program indispensable to the field of health care journalism. I look forward to our reunions.
I received critical help at various points in the process. People who read early drafts of portions of the manuscript and provided comments include Marcia Angell, John Erickson, Don Bollinger, Joseph Weiner, and Karen Goozner. Thank you Eric Nelson for suggesting there was a book in the article. Thanks also to Lucia Fanjul for her valuable research assistance, and to Brooke Kroeger at New York University, who made my brief stay in academia more enjoyable and suggested the title for this book. And the project’s early stages received financial support from Vernon Loucks, who hired me for an unrelated writing project and agreed to support my work on the initial book proposal.
Finally, I want to give thanks to my family and their unique inputs into this project. Alan and Terry are cancer survivors and constantly reminded me of the hope people bring to their thinking about the pharmaceutical industry. Robert is a patent attorney, and I hope our frequent discussions have been as useful to him as they have been to me. And my mother Estelle, now in her eighties, went through a number of medical crises in the two years leading up to the publication of this book. In addition to all the love she gave me over the past five decades, she provided an unfortunate but informative window into the world of senior citizen medical care.
The book is dedicated to my children: Rebecca and her husband Chris, Thad, and Zoe; and to my grandchild, Rachel. But my deepest thanks go to my wife Karen, who not only read the manuscript but provided a sounding board during the five years I was thinking and writing about the world of legal drugs. Without her constant support and encouragement, this book would not exist.