18 September 2015

Review: Miracle Drug by Richard Mabry

Too Many Glitches

After a colleague dies of a heart attack, Dr Josh Pearson finds himself personal physician to David Madison, former President of the United States. And he’s sick. Very sick. And not responding to any of the usual treatments. If that wasn’t bad enough, Josh’s girlfriend, nurse Rachel Moore is showing the same symptoms as the ex-President …

Sounds simple enough. Two sick people: will the good doctor find a cure? But it wasn’t that straightforward.

Here’s where I got confused. The medicine came in liquid form, but it was measured in milligrams. I was raised on the decimal system of measurement: I know a milligram is one-thousandth of a gram (one gram is a little less than a quarter of a teaspoon, so one milligram is tiny). 

However, grams are a measure of weight, not volume. Liquids are generally measured in litres, with a millilitre being one-thousandth of a litre. A litre of water weighs one kilogram, and is the amount of liquid that would fit in four metric cups. The doctors say they have 270 milligrams of medicine, but it’s clearly a liquid, so why are they measuring a liquid by weight, not volume? Do they actually mean millilitres?

But if the doctors actually have 270 millilitres of medicine, then that is just over a metric cup—which would be stored in a bottle, not a “small vial”. Later on they refer to bottles with 1000 millilitres (that's a litre, which is around a quarter of a gallon). Storing a litre of liquid in a bottle seems reasonable … if it’s millilitres, not milligrams. Because 1000 milligrams is just one gram—less than a quarter of a teaspoon.

Yes, this is getting pedantic and someone who grew up with pounds and fluid ounces probably wouldn’t notice. But doctors prescribing medicines should know that one gram is equal to one thousand millilitres (people, that’s the simplicity of the decimal system. A litre is the amount of water that fits in a 10cm x 10cm x 10cm container, and it weighs approximately one kilogram, 1000 grams. Everything is in 1’s, 10’s, 100’s and 1000’s, and it’s all related).

Another place I got confused was with the actual medical dosage (and here I hoped either I was reading it wrong or that this has been fixed in proofreading, because otherwise Dr Josh has some serious medical malpractice suits pending). Derek says the correct dosage of RP-78 is one milligram per kilogram of patient body weight per day.

The two patients have a combined body weight of 134 kilograms, which means 270 milligrams (or millilitres—I’m now going to take a leaf out of The Martian and call them milliwhatevers) of medicine is enough for TWO doses each, not one (equally, that 270 milliwhatevers is enough for three doses for just the President, or five doses for just Rachel).

I’ve got this horrible feeling they’ve mixed up pounds and kilos, because if the correct dose was 1 milliwhatever per pound of body weight, 270 milliwhatevers would be about right for one dose (technically, they’d need 290 milliwhatevers, but its obvious exact amounts aren’t important). Anyway, these simple conversion errors can happen to anyone. Just ask the people who did the calculations for the Mars Climate Orbiter and didn't get the conversion right. Yeah, so that didn’t go so well. Oops.

Also, we were supposed to believe that 270 milliwhatevers was only enough for one dose each, but 2000 milliwhatevers was enough for the other nine doses despite 2000 divided by 270 being just 7.4 doses … no, the maths simply doesn’t add up. We were also supposed to believe it was a major catastrophe when the last three doses of the President's medicine went missing, when it was obvious all along that they would have to give him some doses out of the second vial (Rachel's). (Sorry, that was a spoiler. But it was supposed to be a major source of tension—will the President get the medicine in time?—whereas the tension was actually when will this stupid doctor realise the obvious).

The net result of all this is I found the medical plot frustrating rather than thrilling, which just left the who-was-trying-to-kill-the-ex-President plot, and the romance and faith subplots. The murder plot had potential … until we found out whodunit, and on whose orders.

I wasn’t convinced.

If Mr X wanted the President dead, why didn’t he simply lie when asked if he had some of the medicine? (We’ll leave aside the complete cheese factor in the eventual identity of Mr Big who wanted the President dead. That came completely out of left field and broke one of the central rules of the whodunit: that it must be a character in the novel. Like, in the novel proper. Not appearing for the first time when the police arrive to arrest him. And as for question 6 in the Discussion Guide at the end … there are no words. Oh, yes there are. Cliché stereotype).

The romance subplot was fine, but not enough to redeem the other issues. The faith subplot was so-so, but I didn't understand why Rachel, a Christian, was going out with Josh in the first place, as he wasn't. No, I'm not a believer in mission dating.

This isn’t the best Richard Mabry medical thriller I've read. In fact, I think it’s the worst, which sounds awful (but, realistically, as soon as you read more than one book by an author, one has to be the worst). Miracle Drug was an excellent concept, and could have been a great medical thriller. But there were too many glitches which had a material effect on the plot, and those glitches ruined my ability to believe in the plot or care about the characters. Although I’m glad no fictional characters had to die because of Dr Josh’s bad maths.

P.S. In countries which use grams and litres, its maths (short for mathematics), not math.

Thanks to NetGalley and Abingdon Press for providing a free ebook for review.


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  2. Iola, you lost me with all the math (maths)! LOL So I asked my doctor husband and he explained dosing to me. Sort of lost with his explanation too, but he said dosages are in milligrams per milliliter when in liquid form and are dependent on concentration. He thought that the author didn't go into detail because it would be confusing. Well I am still confused, so I will do what I usually do in such cases, skim!! Thanks so much for your reviews.

    1. Hi Beckie, Thanks for getting your husband to explain the measurements (with more spelling differences - we use litres, not liters!).

      Yes, mg per ml makes sense as a dosage, but it still doesn't make sense in the context of the novel. I'd be interested in your husband's medical take on it. :)

    2. I am reading this book in a few weeks. I'll make sure to read him the pertinent passages.

    3. Iola, Sorry I didn't know of this review until you mentioned it. Let me assure you that physicians in the US are well-versed in the metric system. Medication dosages are usually in milligrams, but once a concentration is established (and many meds have one or, or most, two), it's easier to deal with milliliters. And not only did I check my math several times, but medical professionals have given no feedback on it. Nevertheless, I'm sorry you didn't find this best-selling novel to your liking. Maybe the next one... Thanks for reviewing it.

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