“Sympathy for the Devil” – Book review

Here is my review of “Sympathy for the Devil” by Gary Acton MD, as published in the September 2013 issue of Clinical Research focus. If you are interested in reading the book, click here to order it via Amazon.

Clinical research is a tough area to work in. I’m sure most people reading this piece know how it feels to work on a study that under-performs or even fails. But what if that under-performance caused the drug’s development to be terminated? Or led to the failure of the whole company? This raises the stakes. Magnify that by the fact of working in a relatively small biotech company, and then by choosing to work almost entirely in niche areas of oncology, and you’ll get an idea of the pressure experienced by people like Gary Acton and described in this excellent book.

This is a true story. It follows the rise and fall of Antisoma, a company that worked with monoclonal antibodies and other classes of novel compound to develop treatments for conditions including Acute Myeloid Leukaemia and Chronic Lymphocytic Leukaemia. Those of you who follow news around the biopharma sector will know that Antisoma failed in 2011, after pivotal trials of both its flagship drugs were terminated. Through a quirk of the corporate world, Antisoma still exists as an entity, but is now nothing more than a vehicle for investing in other businesses, not necessarily even in the biomedical sector. Gary was Antisoma’s Chief Medical Officer, taking a leading in designing the company’s development portfolio.

The book is as much about business as it is about medical science and regulatory affairs. While the science is certainly at centre stage, significant sections of the narrative deal with the challenges around determining whether the market value and potential price-point of a treatment makes it viable to invest in its development. Even more significantly, a constant concern is securing investment to provide the cashflow that any small company to find out whether their drug will make it to market at all. This aspect of the story is as thrilling as the science, and echoes other books I’ve read on companies living through the dot-com boom and bust.

Of course, there is plenty of science in this book too, with plenty of detail about specific classes of tumour and the approaches taken to combat them. As someone without a specific background in oncology, I felt that I learned a great deal from reading this book, but it certainly didn’t feel like a textbook. Gary also puts the inner workings of the FDA and EMA committees under the spotlight, and he makes a strong case for reform to the regulatory systems, particularly around treatments for rare forms of cancer. I hope to explore these views with Gary in a future interview.

Although it is a weighty book (physically and conceptually) it is also very readable, and has a clear narrative line focusing on the people involved. As a reader, you become involved with the struggles faced by the Antisoma senior management team, and Gary’s pen-portraits of other key figures in the story, and characters throughout the oncology community, are vivid and engaging. But more gripping by far are the descriptions of individual patients, whose courage in the face of (often terminal) illness is inspiring.

Although the story is ultimately one of a company’s failure, it highlights the passion throughout the clinical research community to make a difference to the lives of patients, and the resilience to take a hit, stand up and keep fighting. If anyone needs to be reminded why they first got involved with drug develop will find it here.