Book Review — For Blood and Money by Nathan Vardi
Yesterday, I finished reading “For Blood and Money: Billionaires, Biotech, and the Quest for a Blockbuster Drug” by Nathan Vardi, published in 2023. Vardi, a seasoned financial journalist and former senior editor at Forbes, has spent decades covering the intersection of big money and biopharma.
Most of us take medications without considering their origins or the complex process of their creation. In this book, Vardi unveils the gripping story behind the development of not one, but two blockbuster drugs, providing a rare glimpse into the biotech and pharmaceutical industries.
Vardi traces the journey of two Silicon Valley startups as they navigate the tumultuous path of developing cancer drugs. Along the way, we meet a diverse cast of characters: medical professionals, dedicated research scientists, ambitious investors, entrepreneurs, and demanding CEOs. It’s a high-stakes world where job security is a myth, and people are often let go despite years of dedicated work if they no longer align with the company’s direction. Investors pour in millions, expecting tangible results, creating intense pressure but also the satisfaction of being at the forefront of scientific breakthroughs.
If successful, those who remain with the company until the end receive generous payouts, though the lion’s share goes to the investors. In the two cases Vardi covers, the startups produced blockbuster drugs eventually sold to large pharma companies for billions. Employees who stayed on reaped rewards ranging from a million to tens of millions, while a few leaders pocketed over a hundred million. Investors with substantial stakes became billionaires. The book engages readers in the debate over whether investors with capital are justified in reaping greater financial rewards than the founders and employees who contribute their labor.
The book is a fascinating read with numerous takeaways. It profiles high-stakes entrepreneurship but also sheds light on the drug development process. One striking realization is how many potential drugs are shelved in favor of a few deemed worth the risk. People who criticize the pharma and biotech industries often overlook this fact. Both blockbusters in the book were initially overlooked until small biotech companies picked them up cheaply. It’s incredibly expensive to develop a drug, conduct clinical trials, and secure FDA approval, so many promising drugs languish on shelves. Large pharma companies are picky, seeking billion-dollar revenue streams with minimal risk, often prioritizing cancer and orphan disease drugs that can command high prices over more affordable drugs like antibiotics.
Vardi also delves into the competitive dynamics of the industry. Big pharma companies patent every possible aspect of their drugs and can legally overpower smaller competitors. For instance, one startup in the book struggled to buy a standard drug for a clinical trial because their competitor wouldn’t sell it to them, forcing them to pay a higher price through a third party. This drug, normally priced at $170,000 annually per patient, made clinical trials prohibitively expensive, limiting competition and keeping costs high.
While Vardi narrates the business side of the story, he doesn’t delve deeply into the broader implications. To me, the system appears dysfunctional, shaped by FDA bureaucracy, arcane patent laws, and a legal system favoring wealthy companies over smaller, more innovative ones. It’s troubling to see that personal experience can drive reforms, as when the chief of oncology and hematology at the FDA only decided to streamline the review process after his wife was diagnosed with ovarian cancer. Many people suffer without the drugs they need due to high costs, delayed development, or the drugs never being developed. Still, the book makes clear why holding biotech companies to high standards is crucial.
I enjoy reading about biotech drama, and this book didn’t disappoint. Like “Bad Blood,” about the Theranos scandal, “For Blood and Money” offers a thrilling narrative, though fortunately without the fraud. It highlights the significant impact on both cancer patients and the scientists involved, making it a compelling read I always had on during my running rounds.
The financial aspects of the story were surprisingly engaging. Vardi’s background at Forbes shines through, making the business side of biotech startups and venture capitalists’ funding processes fascinating. Watching big companies compete to acquire successful startups was equally compelling. I found myself looking up the actors mentioned in the book online to see where they are now. I’m particularly interested in Ahmed Hamdy, a man of science who felt increasingly out of place in Egypt due to personal connections, corruption, and the role of religion in public life, and decided to move to America — a decision that proved pivotal not just to him but to hundreds of thousands of cancer patients across the globe.
If the biotech industry fascinates you, “For Blood and Money” is a must-read. It’s one of those books that stays with you long after you’ve finished. Even this morning, as I brushed my teeth, I found myself thinking about “Imbruvica,” one of the drugs mentioned in the book. It’s that memorable.