The Antidote: Inside the World of New Pharma

Overview

IN THE ANTIDOTE, Barry Werth draws upon unprecedented inside reporting spanning more than two decades to provide a groundbreaking closeup of the upstart pharmaceutical company Vertex and the ferocious but indispensable world of Big Pharma that it inhabits.

In 1989, the charismatic Joshua Boger left Merck, then America’s most admired business, to found a drug company that would challenge industry giants and transform health care. Werth described the company’s tumultuous early ...

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Overview

IN THE ANTIDOTE, Barry Werth draws upon unprecedented inside reporting spanning more than two decades to provide a groundbreaking closeup of the upstart pharmaceutical company Vertex and the ferocious but indispensable world of Big Pharma that it inhabits.

In 1989, the charismatic Joshua Boger left Merck, then America’s most admired business, to found a drug company that would challenge industry giants and transform health care. Werth described the company’s tumultuous early days during the AIDS crisis in The Billion-Dollar Molecule, a celebrated classic of science and business journalism. Now he returns to tell a riveting story of Vertex’s bold endurance and eventual success.

The $325 billion-a-year pharmaceutical business is America’s toughest and one of its most profitable. It’s riskier and more rigorous at just about every stage than any other business, from the towering biological uncertainties inherent in its mission to treat disease; to the 30-to-1 failure rate in bringing out a successful medicine even after a molecule clears all the hurdles to get to human testing; to the multibillion-dollar cost of ramping up a successful product; to operating in the world’s most regulated industry, matched only by nuclear power.

Werth captures the full scope of Vertex’s twentyfive- year drive to deliver breakthrough medicines. At a time when America struggles to maintain its innovative edge, The Antidote is a powerful inside look at one of the most intriguing and important business stories of recent decades.

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Editorial Reviews

Publishers Weekly
01/13/2014
With page-turning pace and action, Werth returns to the biotech company Vertex, spinning readers through the ups and downs of pharmaceutical research in its current state nearly 20 years after first visiting it in The Billion Dollar Molecule. Werth takes readers inside the daily operations of Vertex, profiling the efforts of Vertex scientists to develop drugs for HIV, rheumatoid arthritis, hepatitis C, and cystic fibrosis. He dives the science behind the research, untangling dense biological problems in everyday language: "The miracle of biology," he writes, " is how chains of inert atoms receive, via other inert atoms, the operating instructions for how and when to fold precisely into bits of living matter, then interact with other bits to produce life." Werth also focuses on the corporate culture, the company's interactions with competition, and the complexity of the drug approval and regulation systems. Readers will feel the sadness when a promising drug fails in clinical trials along with the elation when years of research and trials lead to success. Recommended for those interested in the nuts and bolts of R&D in the pharmaceutical industry. (Feb.)
Boston Globe
“Barry Werth’s new book does for the world of biotech drug development what The Soul of a New Machine did for the dawn of the computer age. It presents an exciting narrative about the business of bringing new products to market.”
Fortune
“Werth's excellent writing takes the reader deep into the heart of Vertex and into the dilemma facing the biotech pioneers, and us all.”
Nature
"A riveting mix of molecular science, big personalities—and big money."
Nature
"A riveting mix of molecular science, big personalities—and big money."
The Wall Street Journal
“You can read The Antidote as a book about predicaments encountered by just about any company whose future depends on constant innovation. Yet, given Mr. Werth's welcome attention to personalities and circumstances—as well as to the recalcitrance of particular molecules and particular suffering bodies—you can also take the book at face value, as a story about what happened in one company in one fairly short period of time. ... The vividness and rich detail of "The Antidote" make it a gripping coming-of-age story for modern corporate and scientific times.”
The Economist
“Werth keeps a brisk pace, describing Vertex as the antidote to older pharma and Merck in particular. He infuses the book with drama, even managing to make a regulatory meeting seem exciting.”
Pittsburgh Tribune
“The book is an in-depth look at a company in a daunting, high-stakes, highly regulated business in which science, commerce and politics intersect.”
New York Journal of Books
“Werth very aptly captured the drama of the pharmaceutical industry … Werth was able to obtain extraordinary inside information on the workings of the pharmaceutical industry. He was able to capture the emotional and psychological state of the players, the day-to-day workings of the companies with failures and successes of research, as well as collaborations with other companies and acquisitions. … Succinct and understandable.”
Pharmagellan.com
“Werth doesn’t shy away from technical details, and The Antidote has plenty of “inside baseball” for pharma industry cognosenti ... But although these nitty-gritty details are important and interesting, Werth uses them as the backdrop to ask a more broadly relevant and philosophical question: not just how to build a large drug company, but what to grow up to become? …. Sometime, somewhere, a future biopharma CEO will hopefully read The Antidote and be inspired to continue the quest.”
Kirkus Reviews
2013-12-18
This follow-up to the author's book about upstart Vertex Pharmaceuticals (The Billion-Dollar Molecule: One Company's Quest for the Perfect Drug, 1994) details the firm's transition from boutique creative group to profitable prescription drug maker. Business and science writer Werth (Banquet at Delmonico's: Great Minds, the Gilded Age, and the Triumph of Evolution in America, 2009, etc.) offers a blow-by-blow account of visionary Harvard chemist Joshua Boger's struggle to create a pace-setting drug company to develop breakthrough drugs for serious diseases. Attracted by Vertex's seemingly quixotic quest to put patients first in an industry dominated by profits and Wall Street, the author once again obtained unusual access to company scientists and officers and followed their passion and work as they shepherded their first drugs through discovery, development and introduction to the marketplace. Covering the years 1993 (Vertex's fourth year) to 2012, Werth sets his story against controversies facing the massive prescription drug business, most notably public outrage over skyrocketing drug prices. Until 2009, the ambitious, Steve Jobs–like Boger held center stage, determined to make Vertex "Merck, but better," hiring scientists who "craved the chance to compete at the forefront" and developing new drugs to treat such diseases as rheumatoid arthritis and hepatitis C. Werth provides an inside look at the setting of priorities, the making of deals and partnerships, and the complex, high-risk challenges facing research scientists whose discoveries rarely make it to market. His molecular-level descriptions of drug making will appeal mainly to science-minded readers, but his rendering of bright, quirky individuals and their determination to make Vertex sustainable will satisfy anyone seeking an exciting biotech business story. In 2011, after two decades and more than $3 billion in losses, the Cambridge, Mass.–based company launched a breakthrough drug that combats the leading cause of advanced liver disease. A revealing, readable book about "some of competitive capitalism's most complicated science and most cutthroat marketing maneuvers."
From the Publisher
"A revealing, readable book about 'some of competitive capitalism's most complicated science and most cutthroat marketing maneuvers.'" —-Kirkus
Library Journal
09/15/2013
Award-winning journalist and author Werth continues the story he started in The Billion-Dollar Molecule, showing how the upstart drug company Vertex—created by a bunch of visionary young scientists who broke away from Merck—have sought for 25 years to deliver innovative medicine while radically changing the drug industry. Billed as Moneyball for Big Pharma.
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Product Details

  • ISBN-13: 9781451655667
  • Publisher: Simon & Schuster
  • Publication date: 2/4/2014
  • Pages: 448
  • Sales rank: 137,574
  • Product dimensions: 12.40 (w) x 8.10 (h) x 2.00 (d)

Meet the Author

Barry Werth is an award-winning journalist and the acclaimed author of six books. His landmark first book, The Billion-Dollar Molecule, recounts the founding and early struggles of Vertex. Werth’s articles have appeared in The New Yorker, The New York Times Magazine, and GQ, among others. He has taught journalism and nonfiction writing at Smith, Mount Holyoke, and Boston University.

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Read an Excerpt

Antidote


  • Why I Went Back Inside Vertex

Twenty years ago, I wrote a book about a bold and bruising quest. It told the story of a group of entrepreneurial young scientists who left the world’s best drug company—the most admired business in America year after year—because they were confident they would be more productive on their own, starting from scratch. They aimed to design better drugs, atom by atom. Most people across the industry thought their project in a refitted construction company garage in Cambridge, Massachusetts—to build an organization that could produce dramatically improved medicines to transform the lives of people with serious diseases—was a pipe dream, a money pit, a consuming act of arrogance, an exhausting feat of hubris, a fool’s errand.

“Don’t you think this is five years too early?” founding scientist and president Joshua Boger was often asked. “Yes,” he would say, “but five years from now it’ll be five years too late.”

I found their passionate belief in science and in themselves, brimming with high purpose and combative glee, stirring and infectious as I followed them around for a couple of years while they tried to get their cash-starved company, Vertex Pharmaceuticals, off the ground. It was a rocky, exhilarating, eye-opening ride. The chase for new leads was fierce, not just against “Mother Merck” but also top academic labs, including those led by some of their own scientific advisors, who they feared were sharing Vertex’s most prized insights with its rivals. When Boger settled for a tie in a race to publication against one of them, a Harvard professor, he told me: “I’ll take it. But I want to rub his nose in the dirt and step on his head.”

Such was the knife-edge between cooperation and competition in the new biopharmaceutical order. Whatever unease I felt at witnessing up close how ferocious capitalism and scientific rivalries—rather than, say, altruism—drove the search for new lifesaving drugs receded in the wake of Vertex’s precocious early success. Boger assembled a team of talented, rampantly motivated biologists, chemists, biophysicists, and computer scientists while he and his chief lieutenant tap-danced their way around the world to raise the money they would need to compete with the pharmaceutical behemoths. Though they were spectacularly outspent and outmanned in every area, he let them organize themselves, rather than try to direct them from above. He let them fail, time and again, until they came up with better approaches. He was a visionary goal setter, an inspirer.

Against all odds, within four years Vertex proved it could compete at the forefront of drug research, against the industry leaders, in several major areas at once. It had gone public and Wall Street considered it a hot stock. What I saw impressed me as a worthy, honest, compelling, even noble effort both to beat and influence the world around it—a world where life-changing new drugs were getting harder and harder to find despite the best efforts of hundreds of companies employing tens of thousands of equally gifted and passionate researchers and spending hundreds of billions of dollars on research and development.

That was the story I told in The Billion-Dollar Molecule. I was encouraged by the company’s progress; pleased, too, that the book was acclaimed as an insightful look inside the world of commercial medicine. But I understood that the upstart-biotech-looks-promising version of events that I had reported wasn’t the full story, or even the main one. Boger had set out to build a drug company, but Vertex hadn’t yet produced a drug. Nowhere near it. For him and the other company pioneers, the larger prize wasn’t organizing a research group to find better compounds; it was to build a business that could go head-to-head with the world’s most profitable drugmakers against the hardest diseases, involving some of competitive capitalism’s most complicated science and most cutthroat marketing maneuvers.

I’d described the opening skirmish, not the war.

The modern pharmaceutical industry emerged from one of the great triumphs of twentieth-century science. Before the 1940s, there were medicines and companies that made them, but no one had invented a method for actively finding and developing new drugs. Profits in medicine were disdained as suspect—immoral—and the companies were essentially manufacturers of fine chemical compounds. Since their products could do as much harm as good, integrity was key. Then university laboratories advanced a new approach: microbial screening. Systematically harvesting large numbers of chemicals from “good bugs” and feeding them to “bad bugs,” then monitoring and improving their activity, drugmakers produced and brought to patients the first antibacterials that had been actively sought and developed.

The chase was on: for new diseases to treat, testing strategies, business opportunities, scientists, alliances with leading doctors, prestige, and money. As with all things in America, World War II was the great catalyst. Just as the companies were flexing their research and development arms to tackle other diseases, the government enlisted them in the war effort. In 1941 the Germans were rumored to have isolated the chemical secretion of the adrenal cortex, cortisone, and given it to their pilots, amping them up, emboldening them. Battlefield wounds and home-front contagions drove the need for better antibiotics, vaccines, pain relievers, and surgical products. Drugmakers were marshaled to counter the threat of a pharmacologic arms race. By midcentury, US companies had more than matched the government’s urgency, and were racing ahead, developing new biological models to screen against. Profits began to pour in. Wall Street stood up and took notice. The companies grew spectacularly.

Merck, where Boger started his career in 1979 after getting a PhD in chemistry at Harvard and doing a postdoctoral stint with future Nobel laureate Jean-Marie Lehn, was their paragon. It best represented the qualities that the industry exalted, a patient-centered, high-science focus combined with unrivaled organizational commitment to R&D. It wasn’t always the most profitable drug company—Pfizer and others were better at making money—but its research campuses in New Jersey and outside Philadelphia attracted the most promising scientists. It was where you wanted to be, the top of the pyramid.

In the 1970s and 1980s, with the swift expansion of government-sponsored research spurred on by the “war on cancer,” and as the universities and Wall Street simultaneously discovered a bonanza in the life sciences, there was an explosion in medical understanding, and the low-hanging fruit were quickly plucked. Merck’s labs launched the first or second significant drugs for cholesterol, hypertension, osteoporosis, and asthma, as well as a class of pain medications known as COX-2 inhibitors. At Merck as elsewhere, scientists burned to do pathbreaking work on new medical frontiers, but increasingly, in management suites and boardrooms across the industry, the consequences of success yielded a conservative strategic consensus: move cautiously rather than struggle to produce breakthroughs; settle for modest “quick-to-market” improvements where treatments already exist, and where the resulting products can be aggressively marketed to doctors and people with chronic diseases.

Gradualism held zero appeal for Boger. “Now, I don’t think there’s anything wrong with bringing an incremental advance to the marketplace; you’re not a bad person,” he says. “It’s just I don’t want to do that; life’s too short.” Biotechnology companies by now had joined the competition. A few top university professors or government scientists with a tantalizing idea could raise tens of millions of dollars, go out and test it, then go public—public—when all they had to sell to investors was a theory and the only certainty in their business model was years and years of progressively more unprofitable darkness. Wall Street blew hot and cold, periodically falling hard for their stories of genetic breakthroughs and miracle cures before returning to its senses. Merck, recognizing Boger’s talents (if not buying into his ideas about building better drugs by applying advances from the biotech, software, and computer graphics industries), encouraged him to do his experiment, letting him piece together a team in immunology. But he quickly felt thwarted, impatient. Pent-up.

His frustrations crystallized in the late 1980s, as many things did across the medical world, with the AIDS crisis. Drugmakers at first ignored the epidemic, seeing a small market. Off-the-shelf compounds were ineffective and toxic. When Merck entered the arena, many doctors, public health officials, and even some activists felt that the cavalry had arrived. Boger’s closest scientific friend in the company, a brilliant and brash young biologist named Irving Sigal, led Merck’s project, and Boger cleared the decks in his group to help. CEO Roy Vagelos announced he was “damn optimistic” about Merck’s chances. In late 1988, returning from a meeting in Europe, Sigel was killed when Pan Am Flight 103, carrying 259 people and a terrorist organization’s bomb in a cargo container, exploded in a fireball over Lockerbie, Scotland. He was thirty-five. Merck scrambled to recover from its loss.

Within a month, Boger was gone.

So I was there when Vertex set out in its garage to overtake the “bigs.” And what I saw were staggering contrasts. The major pharmaceutical companies were lumbering along; mightily equipped, cash-rich, charging higher and higher prices while bringing out fewer and fewer important new drugs, their reputation for putting profit before patients replayed and reinforced in the AIDS epidemic. It was fifteen years into the war on cancer, and cancer was winning in a rout. The biotechs had yet to pay out, and Wall Street was skittish about their high failure rate and the chronic risk and volatility of an industry where horizons were measured in decades. It was into this environment that Boger led his young company.

Now leap ahead to early 2011: the grinding recovery from the worst financial crisis in eighty years, the raging political storm over Obamacare, a drumbeat of lurid press reports about the drug business, revealing an industry in crisis and under siege. Vertex, after twenty-two years and $3.6 billion in losses, was about to launch its first drug under its own name, a major breakthrough against the leading cause of advanced liver disease. It had a second drug nearing regulatory approval that promised to revolutionize the treatment of the most common inherited fatal disease in the United States and Europe. Just as the world around it was shuddering, Vertex was poised to soar. What better vantage point for witnessing the mounting collision of medicine, money, and society?

I went back inside Vertex to learn what it takes—to succeed in science and business, yes, but also in fleshing out and struggling to achieve a radical vision of a better future. Could a group of very bright, very determined people make a difference in a market dominated by profits and Wall Street? Could true believers in the idea that the purpose of pharmaceutical research is to put patients first and transform the lives of sick people compete in an industry where it was far preferable to develop, say, a marginally better fifth statin compound for high cholesterol and market the hell out of it, as Pfizer had done with the bestselling drug of all time, Lipitor? Or bury a $500 million sweetheart reimbursement in the Fiscal Cliff deal, as Amgen did with its army of seventy-seven lobbyists? Or pay a generic company $42 million not to market a cheaper version of your drug, so you can keep selling it at ten times the cost to consumers, as in a recent restraint-of-trade case before the Supreme Court? Could Vertex still be Vertex in our genomic age, when understanding which drugs to prescribe will depend on an ever-deepening biological profiling of individual patients?

What was I seeking? Hope, really. The $325 billion prescription drug business is America’s most challenging and one of its most profitable. It’s tougher and riskier at nearly every stage than any other business. Yawning biological uncertainties haunt every experiment; the failure rate even after a candidate clears all the myriad hurdles to reach human testing is 30 to 1; the cost of ramping up a successful product typically exceeds $1 billion. Drugmakers operate in the world’s most regulated commercial environment, matched only by nuclear power. Small companies face an extra test. Dependent on Wall Street for financing, they must navigate a myopic trading culture that disdains and crowds out long-term thinking and investment. All progress in the pharmaceutical business is backbreaking, freighted with unknowns, takes twice as long as you think it will, and is liable to “blow at any seam,” as Tom Wolfe wrote about the endless ineffable peril of staking it all on a lofty high-risk mission.

Mostly I wanted to see what it had taken to prevail against such harrowing obstacles: What had Boger’s vision become, and did it represent a true way ahead in our boundlessly promising and still barely comprehended new biological epoch? After he’d resigned from Merck—alone, without first taking anyone with him, and without any assurance that anyone would follow—Boger went home and sketched his goals on a whiteboard: “Make better drugs, faster. Create the 21st century biopharmaceutical company. Become Merck, only better.” It was almost a haiku. He thought it would take him twenty years and $1 billion. Now, just two years late, at nearly four times the cost, Vertex verged on proving all that he had set out to do.

“One of the most common questions I’ve gotten lately is, ‘Gee, did you ever imagine this would occur?’ ” he told Vertex’s sales troops that spring. It was a few days after Osama bin Laden was killed in Pakistan after a decade-long manhunt, and the company was counting down to launch, primed to go one-on-one against Merck for the richest commercial opportunity in pharma. “My completely unsatisfying answer is, ‘Yes, absolutely.’ Now, that comes across to some people as fairly arrogant, and to that I say arrogance is only a problem if it doesn’t turn out to be true. If it turns out to be true, it’s just persistence.”

I’d discovered at Vertex that biomedical research emits a high emotional heat. It may be tempting to think that the competitive commitment in other disruptive tech industries is similar but the comparison is slender. In Silicon Valley, you’re trying to make a better product, not cure cystic fibrosis or Parkinson’s disease. Here the difference between success and failure can be the difference between life and death. Vertex was about to debut not only the first drugs discovered and developed by its own people and commercialized under its own label. It was about to debut itself, an organization of nearly two thousand people sculpted as much by the changing health care economy and the gyrations of its industry over the past two decades as by Boger and the others who joined him. They had had notable early success in the crucible of that new biomedical order—AIDS—but that victory had been pyrrhic because, while it had produced a drug, Vertex hadn’t fully emerged along with it. Now the company would correct that disparity.

Boger was right about arrogance. We may not like it in our faces, but it’s a problem only when it doesn’t turn out to be true.

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