Malice By Design: An Authentic Medical Thriller

Madison Shaw and Jack Wyatt Medical Mysteries #2

by Gary Birken

Dr. Jack Wyatt is renowned for solving the unsolvable. When a colleague approaches him about a dangerous new malady affecting only Leukemia patients at a prestigious oncology hospital, the mysterious case is too intriguing to pass up. So he and the brilliant Dr. Madison Shaw, a physician who shares not only his expertise but also his secrets, embark in a race against time to save the children as cases mount. Within the hospital walls, they confront a labyrinth of medical conundrums, hostile colleagues guarding their territory, and a web of political intrigue. Their only the cryptic journals of a brilliant scientist haunted by an atrocious past. But as they inch closer to a breakthrough, they must navigate a treacherous path where betrayal, sacrifice, and justice blur the line between right and wrong. Their pulse-pounding race for a cure will confront the ultimate can medical progress justify using research born of evil for the greater good? Malice By Design is a chilling medical thriller by Gary Birken, MD that’ll keep you guessing to the very end. If you like twists and turns balanced with medical authenticity, then you'll love this thriller of courage and conscience. Read Malice By Design today to get lost in a pulse-pounding medical mystery.

Genres: Thriller, Fiction

390 pages, Kindle Edition

First published October 15, 2023

About the author

Gary Birken is a full-time pediatric surgeon, medical thriller author, husband, father, grandfather, and more.

Born and raised in New York, Birken completed his undergraduate studies in Ohio, spent two years studying in Paris, before returning to complete his general and pediatric surgery training at the Ohio State University Hospital and Columbus Children’s. Upon completion of his fellowship in pediatric surgery, Birken moved to Hollywood, Florida where he has spent his entire professional career. Presently, Birken serves as the Surgeon-In-Chief of the Joe DiMaggio Children’s Hospital.

As an Author, Gary Birken approaches novel writing as a means not only to entertain, but to educate the reader in a particular area of medicine. Birken’s approach to each book is first selecting a timely or controversial topic in medicine and then, using it as a springboard, Birken weaves a story of suspense and conspiracy around it.

When Birken is not in the operating room or writing his next medical thriller, he plays tennis, basketball and holds a black belt in martial arts.

Reviews

[myreadingescapism · Rating 5 out of 5]

Medical thrillers are my 😍

[Elizabeth · Rating 3 out of 5]

SO MANY UNNECESSARY ERRORS!!!!! Really doesn't deserve 3 stars, but it is a good story.

AUTHOR, please have better proofreading done before publishing! How has this book been out for 2 years & no corrections have been done?

[Beth · Rating 3 out of 5]

I felt this story theme was a repeat of Error in Diagnosis - people becoming ill from a mysterious illness which is eventually solved. Also felt the character development was weak.

[R.E. E. Derouin · Rating 4 out of 5]

Malice by Design by Dr. Gary Birken, M.D. 8/31/2025 Kindle

Dr. Jack Wyatt has a rightly earned reputation as the guy to call the unsolvable diagnosis. When an oncology hospital is losing hope for deathly ill leukemia patients, he responds. There, he joined a brilliant associate, Dr. Sarah Shaw. Their pairing starts on a rocky path as she blames him for a years-earlier med school failure.

As cases of ill children pile up, the pair fights time and a hostile political environment, especially in the hospital. Hints of past research with terrible ramifications emerge from the background. Is it justifiable to use old, heinous research for the good?

Lots of medical jargon slows down this read at times, but overall the story flows along nicely. I found the book interesting and entertaining and would recommend it to others.

[Nancy · Rating 4 out of 5]

Malice by Design is the second installment in the medical mystery series by Gary Birken featuring Madison Shaw and Jack Wyatt. Madison and Jack are still together as a couple and Madison has moved to Ohio and taken a position at a hospital there. They are getting ready to take a much needed exotic vacation when they are summoned to Oster Children’s Hospital to assist on a mysterious illness. Several leukemia patients have developed a serious, unknown condition. This illness involves symptoms of starvation and none of the children are doing well. Frantic staff and parents work to identify the condition, what causes it, and to develop a treatment. Meanwhile a young resident investigating the death of his brother with leukemia dies during a Tough Mudder competition. A parent who is asking questions is attacked in a nearby city. Someone clearly wants to keep secrets. A fast-paced read.

[Kathie Sherman Minardo · Rating 5 out of 5]

A Great Medical Thriller!

A heart-pounding medical thriller that delves into the dark underbelly of cutting-edge medical research, where a brilliant but haunted physician uncovers a sinister conspiracy threatening to unleash a devastating medical breakthrough that could change humanity forever. As the protagonist races against time, navigating treacherous medical institutions and shadowy government agencies, they must confront ethical dilemmas, personal demons, and a ruthless antagonist determined to suppress the truth at any cost. With pulse-racing suspense, intricate scientific details, and high-stakes medical intrigue, this gripping narrative explores the thin line between scientific innovation and moral corruption.

[Michael Wells · Rating 5 out of 5]

you’re the end, justify the means

This is a great medical thriller, which began during World War II and ended up in the present day. I found the plot very good and it had many twist and turns. I like the characters and their strengths and weaknesses. I think the great question is should medical research be conducted if it is fatal to some and save other lives. I recommend this book for all medical thriller readers.

[Andrea · Rating 5 out of 5]

Engaging read

Another very engaging medical and emotional book. Brings up so many ethical questions that often come up when working in the profession.
I do question the fact that laboratories in the 1940s were sophisticated enough to do the type of research that is pivotal to the book.
Altogether a very well written, strong storyline. Hard to put down, kept me reading past my bedtime.
Looking forward to the next one.

[Christine · Rating 5 out of 5]

Good to the very end

5☆ Book! This mystery held up to the very end. I really tried to savor the book. Loved the storyline & really loved the characters. I dont give spoilers as I believe each reader has a chance to form their own opinions. This is a new genre for me. I'm more of a historical cozy mystery reader so I'm branching out. The characters Jack and Madison work well together and are believable. So the author has done his homework well. Great ending too.

[Matt Egan · Rating 5 out of 5]

Another winner from Birken!

Malice by Design is about a mysterious affliction affecting only pediatric leukemia patients. As with all of Birken's works, the plot, pacing, dialog, characters, and background research are beyond reproach. I can confidently recommend this book for every audience, not just fans of medical thrillers. 5/5 stars!

[Mikki · Rating 3 out of 5]

This was an OK read but the plot line was very similar to that of the first book. Different illness, same rush to find the cure and save lives - and therefore the world from deadly catastrophe. Sadly, I got bored and skipped a few chapters. I read the denouement in final three or four chapters.

I will give the rest of this series a miss.

[Claude Lindley · Rating 3 out of 5]

good book, but?

Gary Birken could use a better proof reader. Personally I came across at least seven, maybe eight errors. Small error, but errors never the less.

Beyond the errors it was a relatively good book. Similar plot line as in his first book. In my opinion it was not as good as his first book. Still an interesting read.

[Susanne · Rating 4 out of 5]

Good medical suspense!

This is the second book I've read by Dr. Birken. I really like that there is an intriguing plot in which I learn some new arcane medical stuff!! This book wasn't as enjoyable as #1 because the two main characters are already a duo. Also this plot had so many side issues...but I will keep reading this author!!

[Kathryn · Rating 5 out of 5]

Thrilling Medical Mystery

Loved the characters, the tplot and the pace. Very entertaining and thought provoking. I am hooked on the author! Very good read! Couldn't put it down.

[sue · Rating 5 out of 5]

great book. original and interesting

Terrific book. Unusual story with just the right amount of twist. Not the same old predictable tale. Well written with just the right amount of medical jargon

[Martha Ann Zehner · Rating 5 out of 5]

A great medical mystery

What I live about this author’s wirk is how much I learn about medical issues, hospital protocols and the disease process. While it is fictional, it still gives a glimpse of the complexities .

[Laura Poppenwimer · Rating 4 out of 5]

The overall plot of the book was good but the execution was not as good as the first novel. The writing style seemed a bit stilted and at times I lost interest. I did go ahead and get the 3rd book in this series, do see some potential in the plots and characters.

[Judi Ann · Rating 5 out of 5]

Educational insight

Another book with educational insight into medicine and research to understand what can become of the healthy and unhealthy people involved.

[roxanne russell · Rating 5 out of 5]

very good book

I’m hooked on reading books about the medical field, and this one did not disappoint. I’d definitely recommend this book for you to read

[Karen J. Currie · Rating 5 out of 5]

wonderful storyline

GB has outdone himself with this second novel in the series. I loved the characters, especially Madison and Jack. Thank you, GB

[Jane C. Anderson · Rating 5 out of 5]

Malice by Design

This novel offers a range of possibilities to cure a deadly disease!
It's interesting to follow the Drs in their quest to find the truth! A good read!

[Carla P. Stearns · Rating 5 out of 5]

Excelleny

This is a gripping medical thriller up there with Michael Palmer.
I want to read more!

I love the characters

[Maryjo · Rating 5 out of 5]

another obscure medical disease!

Gary’s stories are always fast paced and keep the reader interested. How he keeps writing so I can keep learning!

[Breia · Rating 4 out of 5]

Another month of being behind on reviews. Mom and I are loving medical series!

[Jonathan Sirman · Rating 3 out of 5]

good story, very poorly edited

The story was fairly gripping, but rife with typos and errors. It made for frustrating reading. Not sure whether I can get through another.

[Michael Tewksbury · Rating 4 out of 5]

4.5

[kathleen r. · Rating 2 out of 5]

I'm sorry I don't have a more favorable review of this book, because I think the science was probably there, but the process of getting to it and making it somewhat thrilling, more than a half century after the fact of the initial effect from ghastly experimentation and human cruelty in Nazi concentration camps, it began to dull the senses and blur the entire mystery.
I think the author gets bogged down in back-and-forth mundane conversation and the setting of numerous discussions over meals....all the chatter happens over eggs, sandwiches, salads and snacks; nice if you can stand the chit-chat similarity of cocktail party nuance, but I found it boring and pointless.
The entire story could have been done with much less verbal back-and-forth and pointless minimally helpful or stimulating points of view from all the borderline characters that brought nothing new to the mystery.
The heart might be in the right place, but the electrical conductivity is going by way of the left foot. I became bored, paged through most of it until I found the core, which was about 4 pages in length. The rest was random chatter and mindless scene settings that brought nothing to the final picture.
Not recommended, which is sad because I love a good medical mystery.
Unfortunately, this is not a good medical mystery.
Sorry, not for me.

[Diane · Rating 5 out of 5]

Highly recommend, couldn't put the book down