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Blood Medicine: Blowing the Whistle on One of the Deadliest Prescription Drugs Ever
“ Blood Feud rivals A Civil Action for best non-fiction book of the past twenty years.” — John Lescroart, New York Times bestselling author of Damage
Procrit seemed like a biotech miracle, promising a golden age in medical care. Developed in the 1980s by Amgen and licensed to the pharmaceutical giant, Johnson & Johnson, the drug (AKA Epogen and Aranesp) soon generated billions in annual revenue—and still does. In 2012, world famous cyclist, Olympian, and Tour de France champion Lance Armstrong was banned from professional cycling on doping charges for using EPO (the blanket name for the drugs Procrit and Epogen), resulting in a global controversy about abuse, big pharmaceutical companies, and the lies and inaccuracies concerning performance-enhancing drugs.
Mark Duxbury was a J&J salesman who once believed in the blood-booster, setting record sales and winning company awards. Then Duxbury started to learn unsavory truths about Procrit and J&J’s business practices. He was fired and filed a whistleblower suit to warn the public.
When Jan Schlichtman ( A Civil Action ) learned of Duxbury’s crusade, he signed on. Now, he’s fighting on behalf of cancer patients and for every American who trusts Big Pharma with his life.
Procrit seemed like a biotech miracle, promising a golden age in medical care. Developed in the 1980s by Amgen and licensed to the pharmaceutical giant, Johnson & Johnson, the drug (AKA Epogen and Aranesp) soon generated billions in annual revenue—and still does. In 2012, world famous cyclist, Olympian, and Tour de France champion Lance Armstrong was banned from professional cycling on doping charges for using EPO (the blanket name for the drugs Procrit and Epogen), resulting in a global controversy about abuse, big pharmaceutical companies, and the lies and inaccuracies concerning performance-enhancing drugs.
Mark Duxbury was a J&J salesman who once believed in the blood-booster, setting record sales and winning company awards. Then Duxbury started to learn unsavory truths about Procrit and J&J’s business practices. He was fired and filed a whistleblower suit to warn the public.
When Jan Schlichtman ( A Civil Action ) learned of Duxbury’s crusade, he signed on. Now, he’s fighting on behalf of cancer patients and for every American who trusts Big Pharma with his life.
448 pages, Paperback
First published September 20, 2011
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Displaying 1 - 30 of 33 reviews
June 25, 2020
I really enjoy investigating journalism. I think the author did do a good job laying out the problems within the Ortho/JJ company. There was a lot to take in, but she did make it fairly easy to understand. There could have been a bit more editing, as I was interested in the personal toll this took on the main person, Mark Duxberry, but thought it could have been shortened. However, it does explain the horrible cost of doing businesses for profit takes. The reps gave free EPO and rebates and other incentives to doctors to push this drug. It had never been deemed safe, yet the amount given was 4x higher. This is a big problem and it is driven by the need to make profits for a company, hospital, and doctors. All benefited. The FDA has very little power to look out for the public. There is way too much conflict of interest. Reps work for the FDA and then go to powerhouse drug pharmaceuticals and back. This is an egregious practice and should stop, but it does not. When Dr’s are given big financial compensation for prescribing a drug, s/he may truly want to believe it is in their patients best interest. It very well may not be and in this case, it was shown that it worked poorly for most patients. Very disturbing and sad.
January 25, 2012
My rating is a weighted rating. The author is a great story teller. The narrative was compelling. I wanted to know what happened next. (=4 stars) But...like reality television, the story is probably only coincidentally linked to the facts of the case, which if one is advertising the 'true, inside, story' isn't a good thing to do. (=1 star).
The book begins with the tragic death of a patient who had suffered from recurrent cancer. It is suggested that the patient died as a result of an adverse reaction to the medication epoetin alpha (Procrit), without discussion of the natural consequences of the disease or an alternative reason for the patient's death.
Mark Duxbury was a drug rep who worked for Ortho Biotech detailing a new therapeutic biologic (Procrit) that was initially approved for the treatment of anemia associated with chronic renal failure. Initially very successful, Duxbury was eventually fired from his position, for reasons that were unclear. Ortho Biotech and Amgen had an agreement to co-promote the drug and to share sales according to an agreement that seems to have been doomed from the beginning with neither partner happy with the terms and Duxbury's career follows the ups and downs of the agreement. After being fired, Duxbury struggles to find a job. He also has concerns about the marketing strategies used to promote the drug and shares his concerns with both Amgen and eventually with FDA.
The book then follows the form recognized by most as a morality tale in the 'narrative reality' genre. Details are provided that cannot possibly be verified to make a better story. There is no index and the facts are largely taken from court records and interviews rather than review of medical literature. Duxbury may not be a reliable narrator, but his limitations are must be understood by the reader. During the time related in the book, he suffered from alcohol abuse, was treated for depression and manic depression, sleep apnea, was injured in several serious car accidents and during one altercation with a neighbor was 'tasored' 4 times during his arrest.
The narrative is primarily told from the sales and marketing perspective, because of the materials available for the author's use. It is not clear if the apparently improper practices were limited in scope or reflect what was common practice at the time. Research and development are not discussed. It is not clear as to which studies were conducted as part of the development, including new indications not part of the initial new drug application. Several requested safety studies are mentioned several times throughout the book, however the particular safety issue is never described. The development studies would have contained both efficacy and safety data. Additional safety data are certainly collected after the drug is marketed, but deficiencies of the safety data (beyond the obvious lack of an understanding the the impact of higher doses as well as the impact of different pathophysiology) are not described.
There are various technical details that are incorrect or misleading - such as the identification of a sleeping pill as a 'barbiturate' when it was in fact belonged to another class of medications that are less toxic. There are comparisons such as 'one of the deadliest drugs' that are provided without any context. 'Deadliest drug' - compared to what? The high cost of the medication is frequently discussed, however there isn't a clear link between the cost of drugs sold and the number of likely doses administered - so the scale of the potential problem is hard to understand. The author never makes clear what is different about biotech drugs such as they must always be administered by injection and were frequently stored under refrigerated conditions. The cost of conduct of production is also never discussed. Quality of life data (assuming studies are properly designed and conducted) can be important in optimizing drug use and helping prescribers and patients may choices between different products, are dismissed by the author as simply marketing ploys.
My major disappointments however are related to the continued perpetuation of the expectation that medications don't have adverse effects and that everything should be known about medications when they are initially approved.
But, a compelling read!
The book begins with the tragic death of a patient who had suffered from recurrent cancer. It is suggested that the patient died as a result of an adverse reaction to the medication epoetin alpha (Procrit), without discussion of the natural consequences of the disease or an alternative reason for the patient's death.
Mark Duxbury was a drug rep who worked for Ortho Biotech detailing a new therapeutic biologic (Procrit) that was initially approved for the treatment of anemia associated with chronic renal failure. Initially very successful, Duxbury was eventually fired from his position, for reasons that were unclear. Ortho Biotech and Amgen had an agreement to co-promote the drug and to share sales according to an agreement that seems to have been doomed from the beginning with neither partner happy with the terms and Duxbury's career follows the ups and downs of the agreement. After being fired, Duxbury struggles to find a job. He also has concerns about the marketing strategies used to promote the drug and shares his concerns with both Amgen and eventually with FDA.
The book then follows the form recognized by most as a morality tale in the 'narrative reality' genre. Details are provided that cannot possibly be verified to make a better story. There is no index and the facts are largely taken from court records and interviews rather than review of medical literature. Duxbury may not be a reliable narrator, but his limitations are must be understood by the reader. During the time related in the book, he suffered from alcohol abuse, was treated for depression and manic depression, sleep apnea, was injured in several serious car accidents and during one altercation with a neighbor was 'tasored' 4 times during his arrest.
The narrative is primarily told from the sales and marketing perspective, because of the materials available for the author's use. It is not clear if the apparently improper practices were limited in scope or reflect what was common practice at the time. Research and development are not discussed. It is not clear as to which studies were conducted as part of the development, including new indications not part of the initial new drug application. Several requested safety studies are mentioned several times throughout the book, however the particular safety issue is never described. The development studies would have contained both efficacy and safety data. Additional safety data are certainly collected after the drug is marketed, but deficiencies of the safety data (beyond the obvious lack of an understanding the the impact of higher doses as well as the impact of different pathophysiology) are not described.
There are various technical details that are incorrect or misleading - such as the identification of a sleeping pill as a 'barbiturate' when it was in fact belonged to another class of medications that are less toxic. There are comparisons such as 'one of the deadliest drugs' that are provided without any context. 'Deadliest drug' - compared to what? The high cost of the medication is frequently discussed, however there isn't a clear link between the cost of drugs sold and the number of likely doses administered - so the scale of the potential problem is hard to understand. The author never makes clear what is different about biotech drugs such as they must always be administered by injection and were frequently stored under refrigerated conditions. The cost of conduct of production is also never discussed. Quality of life data (assuming studies are properly designed and conducted) can be important in optimizing drug use and helping prescribers and patients may choices between different products, are dismissed by the author as simply marketing ploys.
My major disappointments however are related to the continued perpetuation of the expectation that medications don't have adverse effects and that everything should be known about medications when they are initially approved.
But, a compelling read!
November 4, 2011
“Blood Feud” is the tragic and true story of two drug reps trying to expose the unethical and illegal practices of a pharmaceutical giant in marketing a dangerous biotech-based drug. I ordered it at the same time that I ordered Jeffrey Eugenides' new book, The Marriage Plot. Usually I race through fiction and leave nonfiction for weeks on end, reading a bit at a time. I started both books and quickly put the novel aside. That's never happened before.
At first I was a little disbelieving of the astonishing attention to detail, and the precisely remembered conversations. I'm a narrative nonfiction writer myself, and for my last book lawyers carefully removed any remnants of conversation I could not directly back up. But Blood Feud is different. The author did indeed have access to detailed, riveting information, thanks to the careful record keeping of the two protagonists. It all rings true in a way that other books in the genre do not (i.e. how, exactly, could a different present-day writer have known what an illiterate woman thought in a bathtub half a century ago at the moment she somehow discovered her cervical cancer???)
Blood Feud was one of the best reads I've had in years.
At first I was a little disbelieving of the astonishing attention to detail, and the precisely remembered conversations. I'm a narrative nonfiction writer myself, and for my last book lawyers carefully removed any remnants of conversation I could not directly back up. But Blood Feud is different. The author did indeed have access to detailed, riveting information, thanks to the careful record keeping of the two protagonists. It all rings true in a way that other books in the genre do not (i.e. how, exactly, could a different present-day writer have known what an illiterate woman thought in a bathtub half a century ago at the moment she somehow discovered her cervical cancer???)
Blood Feud was one of the best reads I've had in years.
July 27, 2019
I ran across this at my library when it was newly released and found it fascinating reading. Ms. Sharp does a wonderful job of telling the story of Mark Duxbury's disenchantment with Epogen after originally being Johnson & Johnson's star salesman of the drug. It's been a long time since I read it, but I never forgot it, and I've just acquired the ebook under its new name Blood Feud: The Man Who Blew the Whistle on One of the Deadliest Prescription Drugs Ever. Looking forward to reading it again some day soon.
June 7, 2018
if you are interested in big pharma and the behind the scenes lives of the reps who are taught to do anything it takes to get a sale, check this book out. such a sad and important story. sometimes the author drags on in terms of medical or legal jargon but otherwise i found myself zipping through the book like it was a thriller. i wonder how many other books like this could be written about other drugs.
May 6, 2018
A compelling story of deception and greed. As someone who reluctant relies on big pharma for daily medication I was appalled by all who were complicit. The author is an excellent story teller and I found myself quickly turning pages to reach the conclusion.
October 4, 2019
Great story with fantastic level of detail, but let down by last few pages
This entire review has been hidden because of spoilers.
April 21, 2023
A rambling book about a selfish salesman who thinks he is the victim. Hard pass.
January 29, 2012
Yes, the label of "Big Pharma" can be thrown around indiscriminately.
Then, a book like this suggests we need to use it even more.
There's an ugly world out there of drug company sales reps essentially bribing doctors, hospitals and clinics to use their brand of drugs. There's gimmes galore, and far beyond note pads or pens. Add in lines of credit, rebates, discounts, free initial supplies of drugs and more, and its sickening.
Then, the George Bush FDA decided to roll back most of the limited amount of regulation the agency had done before.
Sickening, and more. Ultimately, deadly, in the case of "epo," the drug at the center of this book.
It's within this background that Mark Duxbury gets trapped in a corporate web of pressure, eventually being forcibly extricated by firing after Ortho, a Johnson & Johnson subsidiary, decides to dump him on the curb because it didn't like his testimony in a sales territory legal hearing vis-a-vis Amgen. But, he wasn't fired until he'd undergone an extensive "gaslighting" campaign by his bosses.
Duxbury ultimately got legal standing for a whistle-blower suit against the "venerable" but not-worth-venerating J&J. But, it was too late.
Essentially a victim of PTSD, he died just months later, not yet 60 years old.
If this sounds like a novel, it's not.
That said, some of the "touches" in the book came off as too "featury." The author, or an editor, should have whacked down more. And, I would have liked to have heard more from Duxbury's early sales compadre at Ortho, Mark McClellan.
It's still a five-star book, though. Including five stars of Big Pharma disgust.
Then, a book like this suggests we need to use it even more.
There's an ugly world out there of drug company sales reps essentially bribing doctors, hospitals and clinics to use their brand of drugs. There's gimmes galore, and far beyond note pads or pens. Add in lines of credit, rebates, discounts, free initial supplies of drugs and more, and its sickening.
Then, the George Bush FDA decided to roll back most of the limited amount of regulation the agency had done before.
Sickening, and more. Ultimately, deadly, in the case of "epo," the drug at the center of this book.
It's within this background that Mark Duxbury gets trapped in a corporate web of pressure, eventually being forcibly extricated by firing after Ortho, a Johnson & Johnson subsidiary, decides to dump him on the curb because it didn't like his testimony in a sales territory legal hearing vis-a-vis Amgen. But, he wasn't fired until he'd undergone an extensive "gaslighting" campaign by his bosses.
Duxbury ultimately got legal standing for a whistle-blower suit against the "venerable" but not-worth-venerating J&J. But, it was too late.
Essentially a victim of PTSD, he died just months later, not yet 60 years old.
If this sounds like a novel, it's not.
That said, some of the "touches" in the book came off as too "featury." The author, or an editor, should have whacked down more. And, I would have liked to have heard more from Duxbury's early sales compadre at Ortho, Mark McClellan.
It's still a five-star book, though. Including five stars of Big Pharma disgust.
May 15, 2012
Good but not great. This is the story of a whistle-blower who lodged a complaint against Johnson and Johnson arising out of the sale of Procrit. The story is an interesting one, and I learned quite a lot about medical reps, and unfortunately about the sale of drugs in America, waste fraud and abuse in the system, and the injustice and inefficiency of our medical regulatory system. It is a scary story.
The book itself focuses on one of the two whistleblowers, and how his disillusionment and journey to tell the truth finally killed him. The prose is straightforward, if not compelling. He would be an interesting character in a novel, and is no less interesting in non-fiction. But perhaps too much of the book is spent discussing his personal neurosis and the effect of the corporate injustice on his personal life. Or perhaps his personal life wasn't as interesting or important as the larger story, so it seemed almost banal. This is both a book about injustice and peronal tragedy, and a much greater societal wrong, and it seemed to waiver in which story it was telling.
That, and of course, the story has not reached the ending yet, as the case is still going on. It is a bit like watching high noon until 11:45 -- not fully satisfying.
I am going to have a drink. I have given up pills. They aren't safe.
The book itself focuses on one of the two whistleblowers, and how his disillusionment and journey to tell the truth finally killed him. The prose is straightforward, if not compelling. He would be an interesting character in a novel, and is no less interesting in non-fiction. But perhaps too much of the book is spent discussing his personal neurosis and the effect of the corporate injustice on his personal life. Or perhaps his personal life wasn't as interesting or important as the larger story, so it seemed almost banal. This is both a book about injustice and peronal tragedy, and a much greater societal wrong, and it seemed to waiver in which story it was telling.
That, and of course, the story has not reached the ending yet, as the case is still going on. It is a bit like watching high noon until 11:45 -- not fully satisfying.
I am going to have a drink. I have given up pills. They aren't safe.
March 17, 2012
While this is a book about an important issue (the shady world of prescription drug marketing and approval in this country), I didn't really feel like it was a book about what it says it is about. I picked it up because the subtitle is "The Man who blew the whistle on one of the deadliest prescription drugs ever--Procrit"; a drug I know and studied well. I had no idea it had become the deadliest prescription drug ever. After reading the book, I STILL don't know that. The book was way more about the unethical marketing and financial side of prescription drugs...the health issue it claims isn't even accepted fact. UGH! It took me two weeks to power through this thing. The writing is weak, the story is incomplete--the reality is there probably isn't really a "book" there. Whatever happened to editing??
I want my two weeks back.
I want my two weeks back.
July 3, 2012
This was an interesting read. Although the timeline bounced here and there (making for a bit of confusion), the content will blow your socks off. This is a whistle-blower story and will simply piss you off that big pharma companies behave so slyly and slickly. The story illustrates, in part, how lame the FDA is based on who its political leader is, allowing for big pharma to sell unproven drugs for unpermitted uses and kill Americans in the process; all in the name of profit and to outsell the competition. Guaranteed to piss off the reader (oh, did I mention that already?). Freaking politicians and bigger freaking profit-greedy corporations. Say no to Johnson and Johnson and AmGen. Amen.
March 4, 2013
I read this book because it was recommended by the Editor of MedPage Today; however, I would not recommend this book to others. It was much too long for the real story I wanted to know about. The writing is not very good at all. By the last 100 pages, I could have returned it to the library without finishing and would have no problem with it. At the end of the book, I hated the main character, Mark Duxbury, and he's the one we're supposed to care about! That's never a good thing. She also misspelled "Silver Spring, MD" as "Silver Springs, MD," which is a real pet peeve of those who live or have lived there. In retrospect, I would have skipped reading this one.
May 4, 2012
Ive been in differnt types of sales work, time share, alarm systems,
advertising and they could be considered at times a bit shady. The drug saleman is in a different class of sales altogher. They hype the benifits and skip over the risk. The risk factor of someone getting killed from a sale is beyond me how they are not aware of damage that
a "customer" should be educated on. I had sympathy for Duxbury but as
the book goes his wilful blindness is unbeliveable. If asprin was just
invented these guys would be charging 50 bucks a pill.
advertising and they could be considered at times a bit shady. The drug saleman is in a different class of sales altogher. They hype the benifits and skip over the risk. The risk factor of someone getting killed from a sale is beyond me how they are not aware of damage that
a "customer" should be educated on. I had sympathy for Duxbury but as
the book goes his wilful blindness is unbeliveable. If asprin was just
invented these guys would be charging 50 bucks a pill.
October 10, 2013
I have listened to audio book read by Coleen Marlo. I enjoy financial fraud stories. But having been exposed to medical field myself and knowing how things with insurance work firsthand, made me appreciate this book so much more. Nothing good can come out when health care becomes a financial instrument to launder money through false Medicare claims. The scheme is as outrageous as Ponzi scheme, but it had become a staple in a healthcare business and will remain for years to come. From now on I will always think twice before taking another pill that my MD prescribes.
March 14, 2015
Captivating and insightful. Written in a thriller style, "Blood Feud" takes a close look at the highly unethical (but highly effective) pharmaceutical marketing practices of the 1990's into the 2000's. The topic is Johnson & Johnson's marketing of anemia drug Procrit. The results -- hastened deaths for many and much fraud (particularly billing to Medicare, Medicaid, and private insurance companies). All driven by greed. And despite the whistle blower, not adequately or fairly addressed by the legal system. Definitely worth reading.
November 7, 2011
A fantastic expose not only about the particular drug at issue--Procrit--but the world of pharmaceutical sales. The author seems like she's in a creative writing class at times--just horrible similes and metaphors--(e.g. spread like scurvy on a galleon) and everyone has a "winsome" smile. And the "hero" of the book is a pharmaceutical salesman that the author tries to redeem, but is really just a slimey drug rep. Still, a great look into what goes on in this industry.
May 21, 2013
The amazing true story of the pharmaceutical company Amgen and the anti-anemia drug Procrit. This book explains the great lengths that drug companies and their sales reps will go to in order to make money selling a drug. Fast paced and interesting book.
This book is about the drug best known as a red blood cell producer used for patients on dialysis and chemotherapy, as well as by professional bike riders to increase their endurance.
This book is about the drug best known as a red blood cell producer used for patients on dialysis and chemotherapy, as well as by professional bike riders to increase their endurance.
November 29, 2014
I wish that I could give this book 5 stars because I think everyone should read it. Sadly it moves so slowly that it is a chore to read. There is really important information swirled around a narrative that focuses on two men (one more than the other) that try to do the right thing when they realize that the drug they are selling is not the wonder drug their bosses tell them it is, and that the company they work for expects them to help doctors bilk medicare. This read made me so MAD!
October 12, 2011
Sharp tells the story of Mark Duxbury, employee of Johnson and Johnson. He sales a new drug called Procrit. Duxbury becomes a whistleblower when he realizes company is using biased marketing, doctors are being paid to use drug, promotions for drug are questionable and patients are dying. Book details his efforts to beat the system.
May 20, 2023
Written from the whistleblowers perspective and I found often lacked balance as well as any meaningful insights into the legal ramifications of the issues and conflicts it presents. For those interested in the subject what may make it worth reading is that, for all its faults, it does do a good job of depicting an element of the culture of pharmaceutical sales representatives.
October 26, 2012
I wanted to like this book more than I did as it was the story of a man's fight against Big Pharma. But it dealt a whole lot with his personal life, which was a mess and, to me, at least a little bit detracted from the righteousness of his story. It has frequently been compared to
A Civil Action but I liked ACA better.
A Civil Action but I liked ACA better.
October 26, 2011
Real story about a red blood cell drug and the drug rep who blew the whistle on it. Reads like a thriller and is a real eye-opener about the pharmaceutical industry and regulators who are supposed to keep dangerous drugs off the market.
November 14, 2011
This book is a biographical-like story of the sales career with and later struggles against the Johnson and Johnson company and their drug, Procrit. This is a must read for anyone who hates the pharmaceutical industry.
February 2, 2013
An important read regarding the potential for misdeeds in pharmaceutical marketing. Good insight into how sales quotas are more important than facts and risks. Not that well written but important in content.
Read
February 21, 2016I suppose as a career pharmaceutical chemist I should make it perfectly clear that I have no recollection of reading this book. But if one were to read it one might better understand just how American Health Care and Justice operate in the service of We the People.
November 7, 2011
Best book since Civil Action
December 30, 2011
this was way longer than it had to be to tell the story...it is an important topic though (drug reps pushing drugs)
December 8, 2011
Interesting but silly in parts. Details the drug wars between Amgen and Ortho-Biotech.
April 9, 2015
Very eye opening and interesting!
Displaying 1 - 30 of 33 reviews