Pharma in the Jungle

by Danielle Ofri
The Lancet

Review of “State of Wonder” by Ann Patchett

How to make pharmaceutical R&D worthy of James Bond-like drama. It’s not easy, but Anne Patchett gamely tries. An American drug company based in the dull stretches of Minnesota is racing to develop the holy grail of fertility drugs—a simple pill to allow women to get pregnant at any age. The stockholders are rubbing their palms rapaciously at the mere thought.

Deep in far reaches of the Amazon, the Lakashi tribe has been living quietly, procreating well into their eighth decade. An elusive but brilliant scientist—Dr. Annick Swenson—has discovered that these women gnaw on the bark of a unique tree and that this imparts fertile longevity that would make an IVF clinic blush. However, she has been taking her time on the research and the pharmaceutical company is getting impatient—especially as she has eschewed all contact.

            They send a fellow scientist—Anders Eckman—to find her and also to report on the state of drug development. Unfortunately, native Minnesotans don’t do well in the Amazon, and within weeks he is dead of a febrile illness.

            Thus his lab partner—our heroine—is dispatched to uncover the details of his death. Marina Singh is a loner pharmacologist, having quit her obstetrics-gynecology residency at Johns Hopkins after a horrendous medical error, oddly enough under the auspices of the imperious department chair—Dr. Annick Swenson. As is often the case, the senior physician abandoned the junior physician in the face of medicolegal calamity, and we know who was left to face the flames.

            Marina suffers the various insults of the tropics during her hunt for the elusive Swenson—flotillas of insects, lost luggage, venomous snakes, psychogenic side effects of anti-malarials, intermittent fevers, generalized disorientation. Despite carefully-crafted prose, none of these misadventures have the sizzle of Conrad’s Heart of Darkness, which is so obviously beating in the background.

            The pharmacologic drama—and, dear medical reader, you would be forgiven for thinking that this phrase is an oxymoron—is that the bark of the magical tree turns out to confer immunity to malaria, in addition to fertile longevity.

            The scientists realize that the drug company would quickly pull the financial plug when it becomes apparent that the goal of the scientists are to help the world’s poor fight mosquito-borne parasites, rather than wealthy western women achieve pregnancy in their sixth and seventh decades. The industry wants a block-bluster fertility drug, not a pennies-per-pill malaria vaccine. Hence the secrecy of the Dr. Swenson, and her refusal to update the drug company and its anxious stockholders on her progress.

Somehow, the frissons of Big Pharma, and the tenacious scientist bucking the system for malaria over infertility just doesn’t have the scintillations of a good, old-fashioned Cold War thriller. (The CEO of the drug company—when he does make an appearance—does not have the cloak-and-dagger bite of a Kremlin operative, even if he is having a covert affair with the mid-level researcher who is our heroine.)

Of course the protagonist and her former mentor have a past to work out, but even this human element doesn’t offer much resonance. Practicing physicians who’ve experienced medical error and the devastating, lasting emotional ramifications, will find that this portrayal does not come close to the real McCoy.

Adding novelistic drama to a medical error is wholly unnecessary, since real errors tend to be sufficiently dramatic—at least to the involved parties—on their own, thank you very much. The fact that the good Dr. Swenson has been nibbling the ambrosial bark herself and has managed to become pregnant—and preeclamptic—at age 72, and that her former underling who quit midway through training is the only available MD to perform the emergency C-section in the teeming Amazonian jungle—is not how most medical errors get worked out.

“State of Wonder” is well-written, and the author is talented. But for high drama, pharmaceuticals and their vicissitudes don’t quite cut it. Even if you stick them in loneliest outpost of the Amazon.

Maybe next time we ought to try a sci-fi show-down between drug companies and insurance companies. Now that would be an Armageddon worth watching.