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One Pill Makes You . . .

Ren Descartes
Ren Descartes (From "Descartes' Secret Notebook")

Warning: Katherine Eban's Dangerous Doses: How Counterfeiters Are Contaminating America's Drug Supply (Harcourt, $25) can give you headaches, raise your blood pressure and provoke anxiety. In extreme cases, it can leave you staring at a bottle of medicine and wondering: What do these pills really contain?

Eban's book opens with the owner of a wholesale drug company who has just lost more than $300,000 worth of medicine in a rapid-fire, tire-squealing heist from his Miami warehouse. Within a couple of days, the crime is compounded: Another Florida merchant -- apparently ignorant of whose drugs they were -- offers to sell the booty back to the theft's victim at a bargain price.

"Our medicine moves through a gray market of middlemen who trade the drugs as they would any other commodity," writes Eban, an investigative reporter based in New York. "These sales can obscure the medicine's origin and make its purity impossible to guarantee." Because at least a few of these middlemen -- licensed ever so loosely by the states -- are former narcotics traffickers and similar lowlifes, bad things sometimes happen to people filling prescriptions. Unaware -- as are their pharmacists -- that the medicine has been mishandled, watered down or "labeled up" to promise far more potency than it actually delivers, these victims take their drugs, and they don't get better. Or they get a whole lot worse. Or they die. In her vibrant tale, Eban introduces us to these people and makes the message clear: It shouldn't happen to anyone, and it could happen to you.

How much of this occurs? Certainly not much, since the major wholesalers -- the firms that supply most pharmacies -- get almost all their drugs directly from the manufacturers. But the majors sometimes buy from the middlemen; such a transaction led to the recall in 2003 of 18 million tablets of the cholesterol-lowering drug Lipitor, Eban points out.

-- Tom Graham

Marketing and Merchandising

It's surely a coincidence that Selling Sickness (Nation, $25) was published at about the same time that the actress Cheryl Ladd began appearing in a public-education campaign sponsored by the drug giant Wyeth. You may think it's good that, according to Wyeth, 30 percent fewer women have been seeing their doctors for reasons related to menopause in the past three years. Wyeth thinks otherwise and hopes, according to a July statement, that Ladd's lovely face and warm delivery will remind women "that menopause may be a good time to talk to their health care professionals about health issues." And if those talks produce a few million more prescriptions for Wyeth's hormone drugs? Maybe that's a coincidence, but it sure would be good for business. Authors Ray Moynihan and Alan Cassels cite such celebrity shilling to show, as the subtitle of their book puts it, "How the World's Biggest Pharmaceutical Companies Are Turning Us All into Patients."

"One of the key ways of making healthy people believe they are sick," they write, "is direct-to-consumer advertising of drugs and diseases -- and there is now more than $3 billion worth of it every year in the U.S. alone; more or less $10 million a day." The major drug companies recently promised to restrain their sales pitches by the end of the year; aside from more tasteful placement of ads about erectile dysfunction, it remains to be seen how much difference this will make. Inherently self-serving, ad campaigns make easy targets. But they nonetheless merit scrutiny: Deciding that you need a drug for such fuzzy ailments as premenstrual dysphoric disorder or social anxiety disorder is, as the authors contend, different from deciding you need an upgraded iPod. One is just a consumer item, while the other is a substance with powerful and often unpredictable impacts.

If drug companies won't tell you the whole truth about their wares, who will? Not most journalists, say the authors, because they're prone to focus on the benefits of new products without fully explaining their negative or unknown dimensions. Not doctors: They're "under the influence," thanks to the small and large favors that many receive from drug companies, starting in medical school. And not the government, whose watchdogs are too often tame and timid.

The authors don't work hard to present a balanced view, and only a dunce would consider this book conclusive evidence of the drug industry's avarice and immorality. Still, reading its chapters on the industry's efforts to define -- and then redefine more broadly -- depression, irritable bowel syndrome and osteoporosis amply supports the thesis that drug companies don't want to sell only to the sick.

-- Tom Graham

Mysteries of the Cosmos

Rene Descartes, the great 17th-century philosopher and mathematician, is probably best known for saying Cogito, ergo sum ("I think, therefore I am"). What he thought and who he was provide the grist for Amir D. Aczel's Descartes' Secret Notebook: A True Tale of Mathematics, Mysticism, and the Quest to Understand the Universe (Broadway, $24.95). The book's prologue opens not with such familiar triumphs as the Cartesian coordinate system but with Aczel's mysterious quest for writings that Descartes concealed, never intending to publish.

To understand the roots of such secrecy, Aczel, the author of Fermat's Last Theorem , traces Descartes's Catholic upbringing among Protestants during an era when scores of adherents to both denominations lost their lives over how they worshiped God. The budding genius took time to interpret his own dreams, and he began to develop friendships with mathematicians whose beliefs extended into the occult and astrology.

Descartes's emerging philosophy of rationalism -- based on the idea that knowledge comes from the intellect, not the senses -- was at odds with the Catholic Church's adherence to the hierarchical philosophy of Aristotle, which was based on observation. Because the Church often tried to suppress new ideas by labeling them heresy and then persecuting their followers, Descartes and his friends were at risk.

They protected themselves with hidden writings, pseudonyms and coded language. But suspicions arose that Descartes belonged to the secret Brotherhood of the Rosy Cross, a group of scientists and thinkers who advocated reform of the Church, another heretical idea. Aczel catapults the reader into a world where burgeoning intellect was cloaked in intrigue. And in the last chapter, he lays bare Descartes's secret notebook in a quietly satisfying denouement.

-- Susan P. Williams

The reviewers are editors at The Washington Post who cover science, health and national news.

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