It’s a truism that we trust doctors with our lives. From the moment they take the pledge to do no harm, physicians are invested with authority—and the implications of this power are rarely questioned.
Michael Rushnak, an M.D. and M.P.H., does question these implications. His latest novel, Terminal Neglect, is a medical thriller that considers the contradictions inherent in investing individuals with public power. Committed to facts and “truth in fiction”, he uses the novel to consider the political ills of the healthcare system, veiling his personal experience as a physician under the drama of the plotline. This Thursday evening, he will be speaking at Morningside Bookshop, to promote the novel and discuss current medical politics and efforts to protect the safety of prescription drugs.
Rushnak centers the drama around the conflicted loyalties of a talented physician, Dr. Jonathan Rogers. Rogers is recommended for appointment to Surgeon General, but becomes suspicious of Washington’s ties to the pharmaceutical industry. Wary of a healthcare system that places profits before patients, Rogers considers the Surgeon General the ultimate “patient advocate.” Moments after expressing these views, he is shot by the anonymous Healthcare Club and, on recovery, is informed that he must approve Zazotene, a new drug with a dubious safety record. Threateningly, the caller suggests that the consequences of renouncing the post are deadly. Rogers is thus forced to choose between protecting his own safety and that of hundreds of patients.
It is this doctor’s divide between public duty and personal safety that forms the political impetus for Terminal Neglect. Rushnak himself has been courted by the pharmaceutical industry, and he unequivocally stated that “Dr. Rogers is me.” Rushnak describes the push to prescribe the diuretic Selacryn as one of his most formative experiences as a doctor. In 1979, the year Rushnak qualified, pharmaceutical representatives visited his office with personalized gifts, including an M&M’s dispenser with Selacryn emblazoned on it. One year later, this drug was responsible for 46 cases of liver failure and was recalled. Rushnak considers the failure of the FDA to foresee these deadly implications as “a reminder to me throughout my career.”
Indeed, with pharmaceutical agents bullying physicians, FDA accountability is woefully inadequate. In a confidential study by Dr. Sidney Wolfe, 36 percent of surveyed FDA doctors had seen the organization approve drugs that they believed were hazardous. Before it was taken off the market in 2006, one drug, Rezulin, was response for 23 deaths and 43 cases of liver failure. Despite these warnings, Rushnak says that the situation “is getting worse.” Two-thirds of FDA doctors believe that pressure from pharmaceutical lobbyists is increasing. With pharmaceutical influence mounting, Dr. Rogers’ literary dilemma seems more plausible.
Rushnak insists medical practice need not, and should not, be dictated by pharmaceutical lobbyists. In most European countries, safety protocol is more stringent. For example, in England, the National Institute for Clinical Excellence monitors drug safety and provides all doctors with comprehensive information on efficacy, price, and side effects. This is “a total contrast to the American system,” said Rushnak, where doctors and lobbyists collaborate on safety labels.
By revealing current problems in the U.S. healthcare system through fiction, Rushnak dramatizes the risks inherent in politicized medicine. However, given these problems and the weight of the pharmaceutical lobby’s influence, Rushnak is justified in giving life-or-death significance to the decision over which drugs to approve. Dr. Rogers may be fictional, but the conflicts of interest at the FDA are not.
Michael Rushnak will be discussing and reading from Terminal Neglect at Morningside Bookshop this Thursday, March 12, from 7-9 p.m.
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