Book review: “The Antidote: Inside the World of New Pharma” by Barry Werth

When you long for something, when you dream about finding something, you’re hoping.

The word “hope” in this sense doesn’t appear in The Antidote: Inside the World of New Pharma by Barry Werth until about two-thirds of the way through the book, and it’s only used three more times before the end.

But hope is the heart and soul of the  book.

In The Antidote, Berry Werth chronicles two decades in the life of Vertex Pharmaceuticals, a Boston-based drug development company that started in 1989 and was the subject of his earlier book The Billion-Dollar Molecule (1994) for its development of one of the first treatments for HIV. 

In this second book, published in 2014, Werth describes the efforts by the company from 1992 through 2012 to develop new drugs for other hard-to-treat diseases, detailing their failures and successes.

There are three major themes in The Antidote:

• The scientific detective work to discover drugs that can help patients — and the parallel search for the best way to go about that detective work, for a rational drug design.
• The struggles on the business side to raise money, despite years of losses, to fund the scientific sleuthing that, 299 of 300 times in the industry and 29 of 30 times at Vertex, runs into a brick wall — and then, when a winning drug is found, to build out the company to market and sell the new product.
• The head-to-head crash of value differences between the company and Wall Street, between the company’s planning and working long-term and the investment community’s demand for short-term profits.

In his introduction, Werth writes about his decision to go back into Vertex:

“What better vantage point for witnessing the mounting collision of medicine, money and society?”

Patients as individuals are mentioned rarely in The Antidote, but they are implicit in what Vertex does.  As Ian Smith, the chief financial officer tells a newly hired crowd of salespeople:

“This company has something that a lot of companies don’t have.  We create hope in a lot of different diseases.”

“We create hope”

I know about the hope that Vertex creates because two of my nephews, one in his 30s and one in his 40s, are living fuller and healthier lives today by taking one of the company’s drugs, Ivacaftor, called VX-770 and Kalydeco in Werth’s book.  The drug was developed with innovative funding — venture philanthropy — from the Cystic Fibrosis Foundation.

Initially, Ivacaftor was used with great success against a type of cystic fibrosis that afflicts four percent of those who have CF.  Since then, it’s also been combined with other drugs to benefit many more people with the disease.

I was a liberal arts major in college and have never had much of a grasp of scientific concepts, even the simplest.  Much of The Antidote was heavy sledding for me.  I was able to keep up because Werth writes well and clearly about the science of drug-search.  Still, I know my understanding of what he describes is very vague and incomplete.

When it comes to finances and the processes of companies to raise money, make alliances and deal with Wall Street, I’m a bit less clueless but still easily perplexed.

The Antidote is a book about science and finance, and, although I read every page, I am left somewhat hazy about it all.

Crystal clear

What I can say — what’s crystal clear for me — about what The Antidote shows is this:

• The search for a safe and effective drug is endlessly daunting in terms of the science involved and in terms of the huge amount of money needed to pay for the search.
• The work results in failure many more times than scoring a winner.  Indeed, Werth mentions that, in the drug industry, the average researcher works an entire career without having a winner.
• High drug costs are a consequence of the reality that research often ends in failure.
• Profits from a winning drug only last a few years until the drug can be copied and sold as a generic.
• The demands of Wall Street for short-term gains often hurt efforts for long-term research.
• Diseases that afflict only a small percentage of the population are called orphan diseases.  Even when a company creates a winning drug for such a disease, even when it results in cures, it won’t make as much money as for a drug that, in a relatively minimal way, lessens the impact of a disease in a large portion of the population.

“Courage”

The hero in The Antidote is Josh Boger, the co-founder and guiding visionary of Vertex who, for corporate reasons, is pushed out of the CEO job in 2009 although he remained on its board.

It is Boger who is quoted every fifty pages or so about how those who work at Vertex are doing so for the fear and fun of the search for drugs — the fear of trying to solve the hardest problems and failing and the fun of trying to solve the hardest problems and succeeding.  At one point, he says:

“Research is all about hope.  It’s about possibility.  It’s not about certainty.”

At another point, a colleague describes how Boger, for many years, would have lunch with every new Vertex employee.  In each conversation, Boger would say something along these lines:

“You’re here to save the universe.  Drug development stinks, we’ve got to be smarter, we’ve got to do it differently, you’ve got to have courage.”

The Antidote is about the many technical things in science and finance that complicate the work of Vertex — and, by extension, all drug companies. 

But, at its simplest, the book is about courage.  And about hope.

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Patrick T. Reardon

1.14.21