Wednesday, December 03, 2008

Face-Lift 583

Guess the Plot

Drug Money

1. When heartthrob Justin Spears is killed on the set of his new movie "Drug Money", homicide detective Zack Martinez knows two things: the stunt gun was replaced by a real .45, and he'd better get an original picture of Spears if he doesn't want his wife to shoot him.

2. After a bad night on the town, Falzy Eclandis can't tell the difference between his hallucinations and reality. A particularly bad flashback leaves him seeing fifty dollar bills everywhere. Now he's in trouble with Big Ed Washington, whose gang owns the fast food outlet where he just tried to pay for three hundred cheeseburgers with a bus pass, three clothes pins and a toilet brush.

3. It is 1969 and Iguana Dave is delivering the goods to Swami Bob at Sleaze-Dog Howie's infamous Rainy Bar & Grill, where Mae Wong and the Psychadelic Virgins are perfecting their future hits. But Swami keeps all his money in a battered old guitar case and when Howie fires Mae's crew halfway through their second set, the girls leave in such a rush, they grab the wrong "guitar" by mistake and run. Car chases and hilarity ensue.

4. Spike and Woody are waiting for Jack to deliver the smack, when along comes Sarah Murphy, undercover cop, in her long tall leather boots and microskirt and lures them away with rumors of cheap sex -- a dream quickly destroyed by handcuffs and a ride to jail. Next, these idiots plan to rob Jack, hoping to pay their legal bills with drug money. Plus, a flying witch named Roxanne and her vampire hoard.

5. Wanda Murphy invests everything in Todd's new formula for Wrinkles-Go-Bye, a miraculous rejuvenating creme, and soon they're both billionaires, but will they find happiness together on their little love beach in the Bahamas? Not with a hurricane swirling toward them and Ernie Gumball slinking around the shrubbery with his spy gadgets, trying to steal the formula for the Russians, they won't.

6. Psychiatrist David Randall, conducting a study of a new antipsychotic drug, discovers an alarming side effect: death. Should he blow the whistle on the drug company? Or should he listen to the drug company's "pharmacologist," Borgo the Disemboweler?

Original Version

Dear Agent/Editor:

Academic psychiatrist Dr. David Randall discovers that big pharma is downplaying the risks of a new blockbuster antipsychotic medication and finds out how far the company will go to protect its investment. [Assuming "big pharma" is the entire industry, I would change that to the name of the drug company.]

Randall, an assistant professor at Boston's celebrated Trent University Hospital, is conducting a study for a drug company, at his chairman's behest. When his young study patient dies from malignant diabetes only a day after his last visit, Randall feels compelled to investigate how he could have missed the diagnosis. His investigation reveals what looks like a pattern of deliberate statistical dirty tricks covering up similar risks of the experimental drug in other patients, and he has to decide whether he's sure enough to blow the whistle on the company at a professional meeting in Bermuda. [If you're planning to halt your employer's cash-cow drug study, it's best to wait till after they've sent you to Bermuda.]

But Randall's chairman challenges his evidence and pressures him to drop the issue or lose his promotion and academic appointment.

[Randall: Sir, I gave the drug to a patient, and he died.

Chairman: You're saying he's no longer psychotic? That is promising.]

His girlfriend, the chairman's daughter, fears he will ruin her prospects for marriage and advises him to give the company the benefit of the doubt.

[Randall: The drug I'm testing is killing my patients. I have to stop administering it immediately.

Girlfriend: Not today, honey. Today's the day you promised to help me decide between the vellum and ecru wedding invitations.]

Randall doesn't know about his chairman's conflict of interest, or about his girlfriend reporting on him to her father. Or about the drug company's "special projects" operative, [Borgo the Disemboweler,] a cashiered pharmacologist with a penchant for torture, who is brought in when the usual influences prove insufficient.

[Borgo: You the guy who's been spreadin' rumors about the new drug?

Randall: Who the hell are you?

Borgo: Drop your pants. It's time for your anal probe.]

To grasp the right thing to do and then to get it done, Randall will need to overcome his need for approval from authority and finally become his own man. [If you're being pressured to approve a drug that cures patients by euthanizing them, and you're having trouble grasping the right thing to do . . . ]

DRUG MONEY is a psychiatric thriller, complete at 90,000 words. Please consider it for representation/publication, until November 26, 2008 on an exclusive basis. [Oops, I'm too late. I should have bumped this one to the top of the queue.]

Thank you for your time. I am a professor of psychiatry at Yale. [Make sure you put your novel on the required reading list. That's always good for a few dozen sales every semester.] You can reach me ...


While med students spend a lot of time in the hospital, I assume that's not where they take classes. I never see assistant professors wandering the corridors on House. So maybe Randall should be an assistant professor of psychiatry at Trent University.

Did they put an assistant professor in charge of a major drug study because they knew a full professor would never play along, even after Borgo was sent in? It's easy to be ethical once you have tenure.

Was the patient who died diabetic to begin with or did the drug make him diabetic?
Chemist: The boys have come up with a new antipsychotic drug, but it kills people over time. Should we scrap the project?

Drug company president: Hmm. Tell them to add an ingredient that gives patients a fatal disease that kills them even faster. That way--

Chemist: Say no more. I see now why you get the big bucks.
I assume a patient in a drug study would be having his blood and urine tested constantly, and that even the rapid onset of diabetes would be discovered in time to prevent it from causing almost immediate death. Of course what do I know? I get all my medical knowledge from House. Do you think it might have been Lupus?


Chris Eldin said...

OMG! I'm glad I read this all the way through.
This cracked me up:
[Randall: Sir, I gave the drug to a patient, and he died.

Chairman: You're saying he's no longer psychotic? That is promising.]

When I read this, I wondered how this could be different than The Constant Gardener, which I really loved. I read the book and saw the movie.

none said...

Randall comes across as something of a wimp. Why should we care about him?

Evil Editor said...

OMG! I'm glad I read this all the way through.

You didn't have to read halfway through to get to that line. Furthermore, a true minion reads everything all the way through.

Ulysses said...

Sorry, EE. I stopped reading after "You didn't have to read halfway through..."

Anonymous said...

This sounds like a competent query, for a pretty solid story, but I have to bores me to tears. I've seen whistle-blowing a billion times before, and nothing seems to happen that couldn't be accomplished while seated at a desk. Is there anything you can pull out to mention that would make it sound unique and exciting? Interesting personalities or conditions? Stunning locales? Angsty backstory? Weird hobbies? What's your book have to offer that existing books don't?

Beth said...

I'm having trouble believing that a big pharma company--which presumably got big by make smart business decisions and developing good, reliable products--would cut its own throat by peddling a drug that kills the patient. So, for me at least, there's a big credibility problem right off the bat.

Randall does sound like a wimp, I'm afraid. He needs a compelling reason not to blow the whistle, and I don't see one there.

Finally, offering an exclusive kind of screams amateur. For one thing, exclusives are not particularly desirable, because they prevent you from sending the manuscript to anyone else. Wait to be asked for one, and then grant two-three weeks, tops. (And only as long as no other agent is already reading the manuscript.)

EB said...

I think Randall comes off as not so strong in part because of the writing:

"Randall feels compelled to investigate how..."

"he has to decide whether he's sure enough..."

"Randall will need to overcome his need for approval from authority..."

These are all internal actions. Supra-tentorial, doctor. Not necessarily the stuff of a thriller. Randall's not swinging an axe or ravishing the chairman's daughter or cradling a dying patient in his arms. Not that he need do any of these particular things, but they're more *active* than feeling, deciding and overcoming an emotional need.

I'll echo Beth's comment. Big pharma (give us a company name, please) is taking an awful risk by covering for up a drug that causes such florid diabetes that it kills in a day. Statistical manipulations are one thing, but hiding something as rare as death by malignant diabetes by pushing the numbers around a bit seems a bit far fetched.

Unless, of course, EE's on the right track with Borgo the disembowler and this is a fun, fast-paced excuse to romp on the beach and burst through boardroom doors with the aforementioned axe.

Anonymous said...

Good news! Vellum is a material and ecru is a color, so the invitations can be both of these things.

(Students are eating my brain. I promise to have something [more] useful to say after the semester ends.)

Unknown said...

You lost me at "malignant diabetes." Malignant's not usually a term associated with diabetes. Cancer? Yes? Diabetes which usually entails either a coma or a slow death where Drs cut bits off you as you go? Not so much.

I don't really see anything in the query that makes this different from the normal, the big bad drug companies are bullying people and little guy has to fix it. This is the plot of so many stories and it doesn't even have a one armed man.

I'm sure the story has lots of reasons for us to root for Randall and why he's in a tough spot but none of that is coming through in the query. Try to focus on what give your novel that something more.

Stacia said...

Yeah, sorry, but this didn't work for me either. I'm not interested in an adult hero who doesn't want to do the right thing--and save lives--because he's worried his bosses won't like him if he does.

I'm also not getting any sense of urgency or danger from this at all.

The book may be full of danger, and the hero's conflicts may seem far more mature than an eight-year-old's peer-group worries in the actual book. I'm very willing to bet they do. But it needs to be in the query.

And yeah, take out the thing about exclusives. Most agents don't even ask for them anymore.

Good luck! :-)

Anonymous said...

Ugh. Aside from the fact that this has been done (The Fugitive movie, anyone?), clinical trials do not work this way. Doctors enroll patients and carry out the protocol, but they are not involved in compiling the data. They don't know whether the patient receives the medication or a placebo (or, if the patient is certainly receiving study medication, they are blind to the dose). The drug companies don't touch the data until it has passed the scrutiny of independent monitors and statisticians hired for the purpose. Monitors trained in international standards of good clinical practice (ICH/GCP) review each patient's medical files every few weeks and ensure that *all* information has been collected and passed on. All adverse events, down to a mild headache, get reported quickly, and anything serious gets reviewed immediately. That includes deaths after a patient has completed a trial.

Clinical Research Organizations exist to remove bias from drug trials. Ten to hundreds of people outside the drug company work on even the smallest early-phase trials. In short, the intentional "bad drug cover-up" would have to involve so many different people working in different roles on a trial as to be ludicrous.

In summary, I will not read this book.

Robin B. said...

[If you're being pressured to approve a drug that cures patients by euthanizing them, and you're having trouble grasping the right thing to do . . . ]

Hee. I really have to remember to read these. I keep thinking I'll skip the queries because I have nothing useful to say about them, but hell, I can still enjoy the show, can't I? Especially with JB in AZ, and the Blondster gone for the night, it's just me and the cat and the white wine. Well, and Chris.

Anyway, this sounds like there's a good story in there, author. Good luck with your work!

Hey - I just read the comments right before clicking "publish your comment". I sometimes skip around in comments - all this time I thought I was a true minion. Hmmm.

Oh...crap. Now I've read through the rest of the comments. My guess is, as the author is a professor of psychiatry at Yale, he may know more about how new drugs are vetted than we do. Just a guess, mind you. But an educated guess, nonetheless.

Damn. Maybe I really should read the whole thing all the way through, as I used to...

Anonymous said...

If Randall is dating the chairman's daughter, why does he think she won't talk to Daddy?

How does diabetes become malignant?

Add my name to the "I'm sick of the Evil Corporation/Business theme" list. I haven't seen it done well in many years, and even then only as a comedy.

Adam Heine said...

Just in case you missed it, I also throw in a vote to remove this text: , until November 26, 2008 on an exclusive basis

Agents decide whether or not they want an exclusive, not authors.

And don't give them any kind of date in the query. Given the average agent response time, EE's response is likely to be the norm, except it will be more like, "Oops, I'm too late. I'll just throw this out then."

none said...

Presumably then the big scandals about companies suppressing negative results wrt their products and their "unfortunate side-effects" (see frex Seroxat: ufs, suicide) have passed some of the minions by....

pulp said...

*The academic psychiatrist and assistant professor running a drug study does the medical diagnostic work? Also, it sounds as if he has only one subject. Okay, the author knows more about this than I, but it doesn't sound right.

*Statistics?! Aaa!...
Followed by ...zzzzz.

*"His girlfriend, the chairman's daughter, fears he will ruin her prospects for marriage..." I don't understand this. She's his girlfriend, so her prospect for marriage is David Randall. Does this mean she's afraid he'll get killed or fall out of love with her, or she won't marry him if he loses his job, and she's unmarriagable without him, or what?

*Repeating what others have said, it is hard to identify / sympathize (ooh, I accidentally typed wympathize. heh.)with a man who can't tell right from very, very wrong. Growing a spine is a good character arc, but the query makes him look not only spineless but morally clueless.

talpianna said...

Sqrl: The big scandals about suppressing negative results of drug trials have all happened AFTER the drugs have been approved and are already being prescribed; therefore the potential financial loss is much bigger than if the drug was still in R&D. Also, the executives who approved it would probably lose their jobs.

I am a diabetic. I looked up "malignant diabetes"; and all I could find were references to the fact that diabetes is sometimes caused by a malignant (or for that matter, a benign) tumor on the pancreas.

I agree with the others; I cannot imagine giving a damn about a hero who agonizes about whether or not to reveal that the drug he's researching kills people. What on earth reason could he have for NOT doing so that would not reflect badly on his character?

Anonymous said...

Tough crowd. Very helpful, though.

I do want Randall to develop during the book, from a "good boy" to "his own man," but I didn't mean to paint him as morally bankrupt. One reason it looks that way, I see now, is that I put the cause of death up front in the query, when it is ambiguous in the novel until near the end. Thanks for these comments; I'm too close to it and wouldn't have been able to self-edit this now obvious rejection-maker.

Re: malignant diabetes. I was searching for something more accessible than diabetic ketoacidosis. Maybe a malignant form of diabetes. Or a noxious form, to avoid the cancer connotation.

I'm happy to see that the idea of drug companies downplaying risks is controversial. My own view is that they sometimes do, and that the risks don't become generally known until years after FDA approval--a primary motivator for me in writing the book.

Phoenix Sullivan said...

Ooh, ooh, ooh ... a thriller. I love writing thrilling queries. But it's late now. If I can steal some time tomorrow, I'll take a swing at this. FWIW. Got anything more hook-y for the story as the minions are suggesting? Are the other study patients in his group at risk, too? Time deadlines are oldies but goodies in thrillers, but the upcoming professional meeting in Bermuda doesn't really make for a grand sense of urgency. How close is this drug to hitting the market?

EE, I see you've hit your stride once again with this one *giggle*. You seem to know a little too much about the drug market, though. Perhaps you've been raking in cash on the side as a perennial drug-study volunteer? That would explain much.

Anonymous said...

Any assistant professor who decides to start running clinical trials on the side and then gets busy boinking the drug boss's daughter sounds like a devious manipulator to me. Or did he meet the chick first, then convince Pop to help him out with a lucrative little project to do on the side? Sounds like the guy is Dr. Scumbag, either way.

Maybe you'd be better off rewriting so the naive little girlfriend is the protagonist and this creepy doctor boyfriend she got mixed up with is an evil fiend who fudges the clinical data, covers up the deaths, etc, and will stop at nothing to keep the drug company in ignorance so they don't cancel his perks. That would be a more original and believable plot than what you've got here.

EB said...


Malignant diabetes due to, say, pancreatic tumors is exceedingly rare. "Malignant" obviously has certain resonance with readers. Perhaps you could use a descriptor like "fulminant."

As presented, your story presents a problem of sample size. Are Randall's suspicions aroused by one death due to a relatively rare condition? One death may be an outlier or unrelated to a therapy. But more than one, particularly if the death is shocking and rare, becomes a pattern. If this is indeed "a new blockbuster," presumably this is a multicenter trial encompassing many investigators -- large enough to tease out such variance. (See, for ex, how the elevated risk of cardiac death related to Vioxx was really brought to light when use of the drug was broadened and included in all sorts of trials unrelated to it's arthritis usage. This resulted in the accumulation of piles of data which eventually exposed the apparent data manipulations of the early trials. These manipulations were possible, in part, because cardiac death is relatively common.)

All this said, I think a certain amount of artistic license makes for a more entertaining story. E.g., just about anything Michael Palmer writes.

Deborah K. White said...

I'm having trouble believing that a big pharma company--which presumably got big by make smart business decisions and developing good, reliable products--would cut its own throat by peddling a drug that kills the patient. So, for me at least, there's a big credibility problem right off the bat.

I add my agreement to this comment. After all, dead people can't spend more money on your products. Now, if they were trying to cover up that the drug addictive, I might accept it.

Randall does sound like a wimp, I'm afraid. He needs a compelling reason not to blow the whistle, and I don't see one there.

I also agree with this.

Malignant's not usually a term associated with diabetes.

Which was also my first thought.

...clinical trials do not work this way.

And I also wondered about that.

Sorry I don't have much original to say.

none said...

Sure, the scandals broke after the drugs were approved, but the cover-ups happened prior to approval. Otherwise the drugs wouldn't have got approval, or would have had greater restrictions placed on their use.

Anonymous said...

I like the idea of doctor-as-villain, and stories of greedy academics certainly have been all over the news recently. But, as several of my closest former correspondents last spring put it, "I don't love it enough."

For any Minions still following this (Phoenix?), here goes: a less supratentorial, hopefully more thrilling version. Please pulverize.

Please consider representing DRUG MONEY, set in 1996 on Boston’s Beacon Hill and in Bermuda, complete at 90,000 words.

Academic psychiatrist Dr. David Randall discovers that Braddock Wilson Pharmaceuticals is downplaying the risks of a new blockbuster antipsychotic medication and finds out how far the company will go to protect its investment.

When a young patient in Randall’s clinical trial dies suddenly, there is nothing to link the death to the experimental medication, but no other explanation either. Although his chairman and his girlfriend counsel him to give the company the benefit of the doubt, and despite the puzzling disappearance of the patient’s chart and labs, Randall finds evidence that indicators of similar risks have been minimized and learns of other cases like his. He plans to use his talk at an FDA Advisory Committee to blow the whistle, but the company’s “special projects” operative, a cashiered pharmacologist with a penchant for torture (Borgo Kevorkian), kidnaps him and renders him psychotic by injecting ketamine. Randall ends up in restraints in his own ER. Borgo, however, has underestimated Randall, who figures out how to recover more quickly than expected, makes the plane, and gives the talk anyway. And gets the girl, too. The right one for him.

Thank you for your time and consideration. You can reach me ...

Yours sincerely,

Scott Woods, M.D.

Anonymous said...

Overall, I find pharmaceutical research-skewing convincing and compelling as the basis for a story. I liked the first query's emphasis on Randall's internal conflict. That conflict makes a lot more sense once you make it clear that he has questions but no certainty about the drug’s lethal effects and the deliberate cover-up until the end. I do think the specifics about Borgo K in the second version are helpful. I don’t like giving away the ending.
Perhaps some combination of internal and external struggle could go into the query without giving a synopsis? Here’s a rough attempt that occurred to me:

Academic psychiatrist David Randall is as well-adjusted as they come. He plays by the rules and asks no questions. He has an assistant professorship at Boston's celebrated Trent University Hospital and the approval of his peers. When he agrees to conduct a study for a drug company at the request of his chairman and prospective father-in-law, it looks like another step toward success. Until a young study patient dies a day after his last visit.

There is nothing to link the death to the experimental medication, but no other explanation either. And the patient’s chart and labs have disappeared. Randall doesn’t want to make waves, but he keeps asking questions and reluctantly uncovers a pattern of misinformation. His chairman and his fiancĂ©e tell him his concerns are crazy. When he persists in his investigations the drug company’s ‘special projects’ operative takes the pressure one step further. His ketamine injection leaves Randall psychotic, in restraints in his own ER.
DRUG MONEY, complete at 90,000 words, follows Randall’s struggle to overcome his own fears and the machinations of the drug company, to bring the truth to light, and to grow from a ‘good boy’ to his own man.
Side note: something about giving Randall his title in the query, and signing it "M.D.', brings out my uncredentaled resentment of people who wave their titles've said you're a doctor, you;ve said he's one, we know that now. But this might be just my quirk.

Anonymous said...

I like. Thanks for the time and the effort!

talpianna said...

Scott: What about having the drug cause an autoimmune reaction in which the body destroys all the insulin in the system, whether naturally produced or injected?

I also think having him involved in the trials wouldn't work as well as having him come in from outside--say, the young patient who dies is his niece, and his sister begs him to find out what went wrong. This would give you a chance to follow the trail of both the science and the sinister from the beginning, instead of having to do an "As you know, Bob" for everything the doctor already knows. For how to do this well, check out Jonathan Kellerman.

Benwah, I was actually thinking of thalidomide rather than anything more recent. And as you pointed out, the data didn't need to be fudged until the use of the drug was broadened and the negative results started coming in.

And I think the company should be called Cerberus Pharmaceuticals.

I remember that shortly before my father retired as Deputy Commander of the Army Finance Center, he was interviewing for a possible job at Mead Johnson. When their host on the tour of the company said that they were a manufacturer of "ethical pharmaceuticals," my mother remarked that they would scarcely mention it if they marketed unethical pharmaceuticals.

I wonder why they didn't hire him?

Phoenix Sullivan said...

Back again. Hope you're still around, Scott.

I think between EE, the Minions and you, you can develop a query bound to get requests. Something written in genre format that hints at the "thriller" aspect of your story. Once the agent has pages in hand, though, will they find a real hook here? Something different from other stories of this ilk? That's my concern after reading over both your query versions. They seem to paint a very pedestrian tale -- one we've seen many a time. Still, your writing and the actual novel may overcome that perception. So our job here is to create a query that will get those pages read. (Also, I'm wondering why it's set in 1996? Unless it's based on a true story, that takes a lot of the immediacy of a thriller away, doesn't it?)

Joanna's given you a nice option. Here's mine. Maybe you can combine yours and ours to produce a really great letter...

When a young patient in Dr. David Randall's clinical trial dies suddenly from what appears to be a missed diagnosis, the guilt-ridden psychiatrist starts his own probe into the boy's mysterious death. Increasingly, he's convinced the fault lies not with him but with the blockbuster antipsychotic drug being tested. To prove it, though, he needs solid evidence he can take to the FDA. Evidence like patient charts and lab results that have a habit of disappearing before he reaches them.

Is it worth putting his career in jeopardy, then, to continue his investigation based on suspicion alone? Even his girlfriend and chairman -- who might just have his own conflict of interest here -- counsel him to turn a blind eye. But as he uncovers more deaths that can only be linked to the new drug, Randall begins to understand the extent to which Braddock Wilson Pharmaceuticals is downplaying the drug's risks. If he's to save lives and keep his conscience clean, he realizes he'll have to blow the whistle soon.

That's when the "special projects" operative the pharmaco sics on Randall delivers a warning. A hefty dose of ketamine forces a psychotic episode in Randall that puts him in restraints in his own ER. Now, Randall must weigh his life against the lives of others. If he decides to pursue justice, he'll have to find a way to escape the psych ward and get his evidence to the FDA Advisory Committee before Braddock Wilson's operative can get to him again.

DRUG MONEY is a medical thriller, complete at 90,000 words. I look forward to sending you the complete manuscript.

Scott Woods, M.D.
Professor of Psychiatry, Yale

Anonymous said...

And thanks to you, too, Phoenix. (Joanna, that last comment from Anonymous was me, must have forgotten to sign.)

I guess it is a little boring. There are other aspects that keep it interesting, for me: psychiatric procedural (a patient hanging, etc), mystery (what's the cause of death, who stole the chart), romance (will Randall go for Ms Right or Ms Wrong), a yoda character, a rival, the paternal conflict with the chairman (Randall's father died when R was 11), Roxy's neuroses (she's the chairman's daughter, also hospital counsel).

If I can't sell it maybe SEED MONEY will do better, and then people will want to read the 'prequel.' I plotted DRUG MONEY 1.5 years ago, and I've learned a little since then.

About 1996. I think I need to keep it then, because the fictional drug is based in fact, on a real drug that was approved by FDA that year, and the diabetes risks have become pretty well known in the last few years, in some circles. The expose is important to me, and part of my motivation is to get that message to a wider audience via fiction.

I have toyed with not telling the reader what year it's set in until fairly late (the autopsy report), make it another little mystery that is revealed gradually through anachronisms (like pay phones, movies Randall and Roxy see). Do you think that would be better? If so should I leave it out of the query?

For a sample of the actual writing look at the upcoming new beginnings.