I’d been practicing my pitch for weeks, and as I gained confidence, I tried it out on anyone who would stand still for 90 seconds. Then, suddenly it seemed, it was the day of the pitch session at the annual Pacific Northwest Writers Association conference in Seattle.
Roughly a dozen literary agents sat behind a long table along the back wall of two hotel conference rooms combined as one. Each agent looked across at us, an eager mass of writers of all sizes, shapes, ethnicities, genders, and ages. We were cueing up, each line aimed at an agent they wished to “pitch.” We stood behind a blue line ten feet in front of the row of agents. Someone called the buzzing room to order, and at a signal, the first person in each line walked four paces forward to that long table and sat down at a chair across from someone who might change their future course.
I was first in line for one of the agents I had selected. I had four minutes to convince him that if he represented Migraine, my 80,000 word thriller, his retirement would be assured, that I and my story were the diamonds in the rough, and not too rough, that with the right publisher would advance both our careers. After that four minutes, the person behind me would repeat the process with their book.
I sat down, introduced myself. and gave my 90 second pitch. His follow-up question prompted me to write this story. What, he wanted to know, prompted you to write this story?
The question took me back to the 1970s, and Central Point, the small town in Southern Oregon where I was a young physician in a three-physician Primary Care medical practice. I told him an abbreviated version of the following story, something I rarely mention.
Oral contraceptives had been introduced only a decade earlier, but the high hormone dose of those early ones caused significant side effects. As an alternative, intrauterine contraceptive devises were approved in 1968, and the Lippes Loop and Copper 7 jumped into the market.
They weren’t perfect either, with a small but persistent failure rate. The Lippe’s loop was prone to spontaneous expulsion, and in the early 70’s I began prescribing and inserting the new Dalkon Shield, which A.H. Robins claimed was more effective. It’s crab-like shape looked a little grizzly, but made it seem less likely to be expelled. By 1973, it was the most popular IUD on the market.
There were occasional uterine infections, though, and in those rare pregnancies that occurred with the Dalkon Shield in place, some were fatal.
A.H. Robins’ VP of Medical Affairs, Dr. Robert Kold, was quick to blame physicians–without evidence–for the complications. He suggested it was due to poor technique during insertion.
Studies suggested a different story. The multifilament string attached to the shield could act as a wick and allow bacteria to migrate into the uterus, especially during the occasional pregnancy that occurred with the device in place. A.H. Robins immediately began producing Dalkon Shields with only monofilament strings like other IUDs, but it was too late. In 1974 the FDA halted sales of the Dalkon Shield before the new design could be vindicated.
That was not the end of the misery. While the company ceased sales of the Dalkon Shield, the company did not call for those using the Dalkon Shield to have it removed. Lawsuits began piling up.
Many physicians, including me, smarting from being blamed for a problem that was really a design flaw, not only ceased using the Dalcon Shield, we also stopped prescribing medications produced by A.H. Robins whenever there was an alternative. After settling thousands of damage claims, the company ultimately declared bankruptcy in the 1980s and was sold.
That experience has stayed with me, and a couple decades ago, I began thinking of a story of big pharma and a physician’s struggle for justice. As Migraine has evolved in my head and on the page, I’ve come to understand it is not a story about a faceless Goliath and a Cherubic David. Instead it is a story of individuals. Migraine emerges as a story of greed and generosity, friendship and betrayal, and a story of a single dad and his struggle to balance the demands of his profession with the needs of his daughter.
I hope it will be in a bookstore near us soon. But “soon” in publishing time can still be measured in years.
Dan Roberts M.D., Author 