Fiction: Off-label.

Abstract

When the lights started blinking in the ballroom, quite a few of the regional neuroscience specialists looked rather sick. It was the usual collection of drug reps: the older ones were men; the “kids,” under 30, were of both sexes. We were trying to enjoy the croissants and the orange juice, but there was a growing apprehension. None of us wanted to attend an update on Yettol, our antiepilepsy drug, even as part of a free weekend at a Palm Beach hotel. We knew the drug was way behind in prescriptions for partial seizures: the latest figures showed it was last among ten anticonvulsants. So, what would the company tell us now? Unlike most of the reps, I chose a seat toward the front. I preferred to see the facial expressions and nuances of the speakers at close range. I sought hidden meanings in all things, possibly from having studied psychology and biology in college. The first speaker, Joseph Harnden, the pharmaceutical vice president, strode to the podium after an unnecessary introduction: everyone in the room had met him and had received his weekly e-mails for over a year. He always moved and talked in a hurried manner, but especially so today. Normally he would ceremoniously shed his sports jacket, but today he didn’t pause for that. He lowered the podium, leaned forward on his elbows, and began. “At Elite, we do believe it’s how you play the game that counts. We promote good health, and not profits; satisfaction, and not market shares. An educated, healthy, and satisfied consumer of our products is what we view as winning. When we launched Yettol, we knew there was a crying need for a drug to treat partial seizures, a need unfulfilled in a third of the world’s epileptic patients. Our company had …