The Med City has a new novelist, and his medical thriller prescribes a dose of doubt about the pharmaceutical industry that not even a spoonful of sugar can help go down.
Paul John Scott’s book “Malcharist,” while imminently entertaining, is also thought-provoking and deeply disturbing. It invites the reader to consider the perils created when science succumbs to marketing while telling a tale about side effects, suicide, patients, doctors, journalists and medical ghostwriters.
Scott is an established journalist currently employed by Forum Communications. While he’s written for publications like The New York Times, Cosmopolitan and Men’s Health, his debut novel exhibits a knack for both clever dialogue and making dense ideas enjoyable.
What was the process like, bringing the book from concept to publication?
I used to spend a lot of time waiting for an editor to let me write articles on some of these subjects in "Malcharist." They were kind of radioactive, is my impression. I also had been wanting really badly to break out of the journalism drudgery of needing to constantly learn something new in a hurry, polish it for weeks, and then drop it forever. I had been excited to write about small conversations people have with each other, all these funny thoughts a person has all day.
So one day back in about 2012, I must have become extraordinarily frustrated while waiting for an editor to email me back because I turned to my heroically understanding wife and said I think I want to just write a novel. I told her it would take no more than six weeks, and it ended up taking eight years.
I bought books on how to write novels. I had no idea how to write dialogue or point of view or plot or backstories. It was all exposition, people blabbing on and on. I threw out hundreds of pages. I stopped and started. I hired an editor. I renamed the book, the characters, changed the setting. I showed early drafts to friends, and, after one really brutal evaluation, I put it away for a year. I was too stubborn to move on.
What did a typical day of writing "Malcharist" look like for you?
No real typical day. I had an idea of a beginning and an end, and even bought a whiteboard and notecards to plot out the in-between, but I never used it that much. I wrote things on napkins and stole phrases I liked from people who say clever things and go back to jam them in the book. I would write a scene and polish it to death and eventually come to hate it. There was lots of procrastination on social media, until one day I quit Facebook just to free up time, and that really helped a lot.
The first 100 pages came easy, the second 100 pages were filled with doubt and despair, and then I found I had hundreds of pages more in me as the end approached. Sometimes I would work in the early evening just to salvage the day’s output, but I tried to never work past 10 because it was usually not as good in the morning as you thought it was at midnight. During revisions, I would try to get away for a weekend at my mother-in-law’s condo in the Cities and work from morning until dinner. I spent three days in a cabin by myself as well.
How did you connect with the Samizdat Health Writers Co-operative Inc. imprint that published your book?
That is an imprint created by a Welsh psychiatrist and author named David Healy. He is a historian of psychopharmacology, a brilliant man who has been burdened with an unwelcome message about a popular narrative in our time. I basically wrote the novel to tell the world about his work. The day I sent him the manuscript was terrifying, because I thought he might sue me for stealing all his ideas, but instead he called me up and said, “What are you going to do with this?”
Can you elaborate on how your real-world writing assignments served as inspiration?
I was always interested in psychology, emotion, mood. Mostly because I was a very moody child, I suppose? I tried to explore these subjects in magazine assignments, but also wrote what was needed to pay the bills. I had never seen a medical subject get the kryptonite treatment until I started reporting on this side effect [akathisia, a disorder that can be caused by antipsychotics and create suicidal thoughts, aggression and violence], and that both upset and intrigued me.
As a reporter and freelance writer who has published articles about antidepressants and suicide for Men's Health, and as someone who grew up in Minneapolis, there seems to be some connection between you and your character Griffin Wagner, a freelance writer. How much, if any, of Griffin is based on autobiographical impulses?
I had many of the situations he experiences, but I definitely made them much more comic in the novel. The people asking you why you haven’t written anything for The New Yorker. The writing in coffee shops all day. The pitching to distracted editors. Griffin writes for a really dumb men’s magazine and thinks that the intellectual magazines are where he belongs, but he just can’t get in the door. That was my status for many years. But my magazine editors were not the dopes he works for. Well, most of them.
How did living in a town like Rochester, known for its close ties to the medical industry, impact your novel?
I was for many years secretly very jealous of people in medicine (although maybe not the hours), because this is their town and we are all outside the window looking in. But I think seeing their human side day in, day out has allowed me to step away from the idea that medicine is pastoral caste. I think that’s harder for people to do from other cities, who aren’t at the co-op watching Dr. Noseworthy buy his Grape Nuts, thinking, wow, he was at the White House last week.
In many ways, this book seems to be about the power of writing, but also the demise of print. What sort of commentary do you think your novel gives about the significance of print?
I hope it gives a sense of the contraction going on, and that it’s going to catch up with everyone outside of print if we are not careful. Digital journalism is always in a hurry because it’s an hourly game. You can’t reflect very much in that space, let alone report. Everyone writes hot takes all day long. I am guilty of it myself. I worry our kids will grow up and not know what it means to read reporting.
How do you feel regarding connections readers have made between the ideas in your novel about the dangers and violence related to fictional drugs like Serotonal and Bioferex to real-world drugs like Paxil?
I am very troubled by akathisia, a rare but dangerous side effect of dozens of drugs and a well-documented if little-discussed event that can cause violence and suicide. I just wrote a school system health teacher about it the other day, highlighting the dangers of the acne drugs. It is real and quite old, and yet seems to elicit confusion among clinicians who should know better, when it isn’t getting the brush-off for paternalistic reasons. So if the novel puts akathisia on anyone’s radar or they keep an eye out for it in their kid or loved one while on a medication, I will feel as if that is a success.
"Malcharist" by Paul John Scott is available at Counterpoint at Galleria at University Square, the Rochester Public Library, and through online booksellers.