Review: New book spotlights rogue lab and a shadow industry

"Kill Shot: A Shadow Industry, a Deadly Disease," by Jason Dearen (Avery)

Lower back pain. Spinal stenosis. Cataracts. All those conditions are treated with drugs manufactured by compounding pharmacies. And those drugs can blind or kill you, due in large part to an almost total absence of regulatory oversight.

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In his terrific but unnerving new book, "Kill Shot," Associated Press investigative reporter Jason Dearen explores the shadow industry of compounding pharmacies and various unsuccessful efforts to rein it in. The story centres on the New England Compounding Center, which in 2012 produced mould-infested batches of an injectable steroid that killed more than 100 people and sickened nearly 800 others across 20 states.

Eventually, the lab in Framingham, Massachusetts, half an hour west of Boston, was shut down, and 13 people, including co-owner Barry Cadden and supervising pharmacist Glenn Chin, were convicted of federal crimes. But as Dearen makes clear in his gripping, tautly written narrative, the problems posed by pharmacy compounding — which accounts for at least 10% of the country’s drug supply — are far from over.

Relying on transcripts, interviews, FDA inspection reports and other sources, he reconstructs this slow-moving tragedy in scenes of almost cinematic intensity. We meet the sympathetic victims, many of them elderly people living with chronic pain, who, after receiving the injections, died slow, horrible deaths from fungal meningitis and its complications. We also meet the callous lab owners, who set out to enrich themselves by cutting corners, hiring unqualified staff, running a filthy operation and relying on payoffs to drum up business.

And while some NECC employees were eventually held accountable, they had a host of enablers. These included the lobbying group Alliance for Pharmacy Compounding; members of Congress, who accepted their campaign contributions and killed meaningful reform; and the U.S. Supreme Court, which in 2002 struck down a section of a law designed to give the FDA more oversight.

Thankfully, there were good guys as well: mostly, the dedicated doctors and scientists in hospitals, state health labs and federal agencies, including the FDA and CDC, who tracked the mysterious outbreak of deadly infections in real time and limited its scope by alerting the public.

"Kill Shot" is coming out in the midst of the COVID-19 pandemic, which has exposed the overall fragility of the U.S. health care system. By calling attention to just one facet of it, Dearen has performed a tremendous public service.

He includes a handy checklist of questions to ask prescribers about compounded drugs, but his takeaway is inescapable. Consumers would do well to educate themselves about treatment options and press for tougher regulations. Their lives — and those of their loved ones — may depend on it.

Ann Levin worked for The Associated Press for 20 years, including as national news editor at AP headquarters in New York. Since 2009 she’s worked as a freelance writer and editor.

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