Bottle of Lies: The Inside Story of the Generic Drug Boom (2019) is a work of nonfiction by investigative journalist Katherine Eban. Eban discusses some of the deceit and fraud within generic drug manufacturing with a special focus on Ranbaxy, a prominent Indian pharmaceutical company. Eban explores the consequences of compromised drug quality and regulatory shortcomings, including the challenges of ensuring the safety of generic medications. Throughout the work, Eban discusses The Consequences of Cost-Cutting and Speed, Corporate Attitudes and Regulation, and The Importance of Manufacturing Safeguards. 

This guide uses the 2019 HarperCollins edition.

Summary

In the Prologue, US Food and Drug Administration (FDA) investigator Peter Baker inspects Wockhardt Ltd., a generic drug company in India. Eban emphasizes the critical role of FDA inspections in ensuring drug safety, as manufacturing irregularities could jeopardize both patient safety and a company’s reputation.

In Part 1, “Shifting Ground,” Dinesh Thakur faces a career-altering decision: stay at Bristol-Myers Squibb, where he works on innovative drugs, or join Ranbaxy Laboratories, a generic drug maker with ambitious plans. Eban contrasts the objectives of name-brand and generic drug companies. In Chapter 2, “The Gold Rush,” Eban examines the intense competition triggered by Ranbaxy’s attempt to create a generic version of Lipitor. The first-to-file provision—a key aspect of the Hatch-Waxman Act—adds to the pressure, creating a lucrative opportunity. Ranbaxy’s pursuit of profit, even at the expense of drug safety, results in the company launching a generic drug with known issues.

In Chapter 3, “A Slum for the Rich,” Thakur experiences cultural shock after moving to Gurgaon, India to work for Ranbaxy. Eban describes how President Clinton visits India to thank Ranbaxy and other companies for providing generic AIDS medication to developing countries. Chapter 4, “The Language of Quality,” delves into FDA inspections, illustrating inspector Jose Hernandez’s comprehensive approach. Eban traces the evolution of FDA standards, emphasizing the agency’s commitment to scrutinizing manufacturing processes rather than solely focusing on end products.

In Chapter 5, “Red Flags,” Thakur faces resistance at Ranbaxy, hinting at an entrenched corporate culture. Thakur’s new boss tasks him with investigating data falsification in Ranbaxy’s drugs, marking a turning point in the narrative. In Chapter 6, “Freedom Fighters,” Eban looks at India’s pharmaceutical history through the contrasting approaches of Cipla’s Dr. Yusuf Hamied, who is focused on humanitarian goals, and Ranbaxy’s profit-driven founder, Bhai Mohan Singh. Eban discusses India’s reputation in the pharmaceutical world, shaped by the Patents Act of 1970. Chapter 7, “One Dollar a Day,” explores Dr. Hamied’s attempts to offer affordable AIDS medicine. He faces challenges from both the Indian government and from a global pharmaceutical backlash. Eban explores the sociopolitical dynamics surrounding AIDS medication accessibility.

In Chapter 8, “A Clever Way of Doing Things,” Ranbaxy employee Rajiv Malik transfers from Ranbaxy to Matrix Laboratories, a generic drug company which is later acquired by Mylan. Eban contrasts Malik’s training at profit-focused Ranbaxy with Mylan’s emphasis on quality and process. In Chapter 9, “The Assignment,” Thakur and his team unveil Ranbaxy’s widespread fraud, including manipulating data for drugs intended for lower-income countries. The fallout from the investigation leads to internal conflicts, resignations, and a corporate strategy to deceive regulators.

Chapter 11, “Map of the World,” portrays Thakur’s journey after resigning from Ranbaxy. Thakur reaches out to the FDA to expose Ranbaxy’s fraud, but grows frustrated with the FDA’s response. In Chapter 12, “The Pharaoh of Pharma,” Eban depicts Malvinder Singh, Ranbaxy’s chief executive officer (CEO), as a profit-oriented corporate figure obsessed with money and power. Even though the FDA uncovers serious violations committed by Ranbaxy, the organization faces pressure to approve Ranbaxy’s drug applications.

Chapter 13, “Out of the Shadows,” details the FDA’s preparation for a search warrant on Ranbaxy’s New Jersey headquarters. Thakur collaborates with the FDA, providing crucial information, while becoming concerned for his family’s safety. In Chapter 14, “‘Do Not Give to FDA,’” the FDA raids Ranbaxy’s headquarters, leading to internal panic and attempts to identify whistleblowers. A legal battle erupts under the False Claims Act.

Chapter 15, “How Big Is the Problem?” describes how FDA agent Douglas A. Campbell tackles the Ranbaxy case, despite facing some dismissiveness from his supervisors. Chapter 16, “Diamond and Ruby,” covers Ranbaxy’s acquisition by Japanese company Daiichi Sankyo. During the acquisition, Malvinder endeavors to conceal information about Ranbaxy’s fraud from Daiichi Sankyo.

Chapter 17, “‘You Just Don’t Get It,’” describes how Ranbaxy’s lawyers clash with CEO Malvinder Singh. The acquisition proceeds despite the FDA taking action against Ranbaxy. Daiichi Sankyo later discovers Ranbaxy’s issues and Malvinder’s deception, leading to legal action against Malvinder.

Chapter 19, “Solving for X,” introduces cardiologist Dr. Harry Lever, who grew concerned about generic drugs. Lever starts to research generic drugs and advises his hospital not to use many generic drugs. Chapter 20, “A Test of Endurance,” explores tensions between FDA agents and Justice Department lawyers during the Ranbaxy case. During this time, the Affordable Care Act increases pressure on the FDA. In settlement negotiations, Ranbaxy’s lawyers manage to reduce the FDA’s initial sum.

Chapter 21, “A Deep, Dark Well,” features generic drug advocates Joe and Terry Graedon, exposing instances of generic drug failures and the FDA’s dismissal of reported issues. Chapter 22, “The $600 Million Jacket,” depicts the FDA’s Karen Takahashi evaluating Ranbaxy’s application for a generic version of Lipitor. Despite concerns and debates, the FDA approves the atorvastatin application, leading to significant revenue for Ranbaxy.

Chapter 23, “The Light Switch,” depicts FDA investigator Peter Baker, who inspects a Ranbaxy plant after a glass contamination incident. This experience makes him resolve to be stricter in future inspections. Chapter 24, “We Are the Champions,” portrays the Ranbaxy settlement, which was approved in 2013 for $500 million.

Chapter 26, “The Ultimate Testing Laboratory,” sheds light on ineffective generics in Africa and the potential risks of drug resistance due to subpar drugs. Eban describes how African doctors struggle with limited access to quality drugs. In Chapter 28, “Standing,” Dinesh Thakur’s relentless pursuit of reform faces resistance from India’s government.

The Epilogue reflects on the aftermath of the Ranbaxy case, detailing the personal impacts on investigators and the lingering issues in generic drug manufacturing.