You probably would never have heard of Mary Linnen if she hadn't wanted to lose twenty-five pounds for
her wedding dress. On Memorial Day 1996, she was just another bride-to-be, coming home to her
parents' house to celebrate her engagement. She was bursting with plans for her wedding and for a
family full of children, just like her own parents' Irish clan.
The "surprise" baby who came along late in her parents' lives, Mary, the family's peacemaker and
pacifier, had been the last to leave the nest. At twenty-nine, she was still unmarried, despite a pretty
freckled face, a mane of dark hair, and a high-pitched laugh. Her folks worried that she'd end up one of
those unhappy single women making a life out of the parish Altar Guild.
But now she was hugging Mary Jo and Tom Linnen on their front porch in Orchard Park, New York, as
her fiance, Tom Caruso, stood nearby smiling. Mary began babbling about the details she'd pinned down.
It would be a Roman Catholic mass, of course, in Hingham, Massachusetts, where she lived. She'd
picked a little place on the water for the reception-her sister Nancy's house. Mary, a graphic artist, would
probably do the invitations herself.
As for the dress, nothing too frilly. Something that would show off her five-foot seven-inch frame and
minimize her big-boned Irish stock. She promised her mom, "We'll go shopping for the dress real soon.
I've been to see a doctor. I've started losing weight." About ten days earlier, her doctor had prescribed a
popular combination of diet drugs called Fen-Phen. Mary started taking them mid-May, and the results
were already showing. She'd been on the drugs eleven days.
But that weekend, as Mary, Tom, and her parents were going up "Heartbreak Hill" at the nearby golf
course, Mary signaled to the rest of the foursome to slow down. "I can't breathe," she said. "I think I'm
going to faint."
Until that spring, weight had never been a problem for Mary. She was an athlete, a high school champion
swimmer, a hiker, and a member of the tennis team at Colby-Sawyer College in New Hampshire. "Always
on the move," friends would say. She'd bragged about being able to drag a sofa up three flights of stairs
into her apartment in Quincy, near Boston.
That was the apartment she shared in the early 1990s with Connie Lovejoy, a lonely girl she'd met at
Colby. Mary had been a dorm counselor, clucking over freshmen like a mother hen; Connie was one of
her little chicks.
There was nothing spectacular for good or bad about Mary during her college years. She partied on
weekends. She smoked with the crowd or when she was studying. Her weight bobbed up a little during
exams when she became a sedentary snacker, but it always came off as soon as she got back to her
normal state of motion.
Mary dropped out of Colby, looking for independence. She and Connie moved in together in a Boston
suburb, and Mary began learning design and graphics. She had a bright red VW Fox; a closetful of
Talbots and fuzzy sweaters-safe clothes; and a dog called Dustin, named in a fit of laughter after the song
"Dust in the Wind." Mary became almost too serious for her age in her mid-twenties. She developed
career plans, sketching out for Connie her idea for her own business in graphic design. She set up
exercise and cleaning routines for herself and Connie. On her Fridaynight pub crawls she began
substituting Diet Coke for beer. She quit smoking and began giving Connie stern looks when she caught
her roommate lighting up. She stopped indulging in the occasional joint. She and Connie made a pact not
to date guys who did drugs.
Mary also began attending St. Paul's Catholic Church. She often visited her oldest sister, Nancy, who had
helped raise her. She ritually called her mother and father every week. The only time the creative Mary
would emerge was later at night, when she penned emotional poems or pecked away at her secret work-
in-progress, a steamy romance novel.
In psychobabble, Mary might have been called a "fixer." She attracted the luckless in lifestray dogs, stray
roommates. She didn't need things to be perfect, she needed to be needed. That was how she came to
fall in love with Tom Caruso. She'd been waiting at work for an elevator when its doors opened, revealing
the bluest eyes she'd ever seen. They belonged to Tom Caruso, who was repairing the lift. He flashed a
huge, white smile at her. Mary was carried away-at least for a couple of floors. As she drifted off that night
in her apartment, all she could talk about were Tom's eyes and his smile, as Connie listened.
Over the next two years, Mary would tell Connie and her sister Nancy the rest about Tom. About his
alcoholism, his attempts at recovery, his juvenile record. Tom had confided to Connie that he was scared
to tell Mary about his past, she was so straight. But he told Connie that Mary was going to save him.
When Tom and Mary finally moved in together, they would pray together over the kitchen table at night,
asking God to keep Tom sober.
When Tom proposed, he took her on a walk through the woods and promised that he would never stop
trying to live up to her hopes for him. It was after this that Mary called ecstatically to tell her parents she
was officially engaged.
However, she wasn't quite wedding-ready. She had gained thirty pounds over the winter, cooking for
Tom. She was pushing 180, a high-water mark for her. And, annoyingly, this time she couldn't shed the
weight just by exercising and cutting out snacks. There was a history of thyroid problems in Mary's family.
So in April, Mary made an appointment with a Boston endocrinologist, Dr. Abby Landzberg.
No thyroid problems, said her medical tests. But Landzberg had heard of the FenPhen combo from one of
her patients, and she thought it might get Mary down to her regular weight in time to buy the dress.
In early June, about a week after the incident on the golf course, Mary stopped in to see the nutritionist
attached to Landzberg's office and mentioned the shortness of breath. The nutritionist popped out to see
the doc for and came back with the order that she stop the pills. But Abby Landzberg didn't come over to
examine Mary or send her off for tests. When Mary quit taking Fen-Phen she'd only been on them twenty-
Almost immediately, she seemed to get better: no dizziness, no shortness of breath. But by the end of
summer, the symptoms returned worse than before. Mary was so exhausted that she postponed the
wedding; she had no energy for it. A mere flight of stairs would wipe her out. When Labor Day came,
Mary had to forgo the customary last-blast-of-summer trip to the beach. Too tired for TV, she didn't notice
the news reports about a study in The New England Journal of Medicine, which said the diet drugs
Pondimin and its chemical sister Redux were causing a terrible lung disease among women in Europe.
During these months, Mary cried to Nancy that she was in agony. Abby Landzberg sent Mary to a couple
of specialists, including a gynecologist. Mary was frustrated, collapsing at her job, her legs and stomach
swelling strangely from water retention. She begged Landzberg to put her in a hospital and check out her
breathing problems, but neither Mary nor Nancy could get Landzberg to admit her.
On a chilly day in October Mary called her parents. "She'd just gotten home," said her mother, Mary Jo.
"She said she'd gotten so tired she'd had to leave work." She added that Mary was crying and quite
scared. "She said she'd barely been able to drive home. I told her to get to a doctor."
Finally, in November, Mary landed in the emergency room of South Shore Hospital. After a quick, and
cheap, EKG, doctors tested her heart using a catheter, and then said that it appeared she had pulmonary
hypertension. Now Abby Landzberg needed to get Mary under the care of a pulmonary specialist, and
she chose the best one she knew: her husband, Michael.
He put Mary into Brigham & Women's Hospital in Boston. After a battery of tests and a flurry of respiratory
crises that had left Mary gasping for air, he reached his conclusion. On November 14, he told her and her
assembled family members that she had primary pulmonary hypertension. The mechanics of PPH were
complicated to explain. But the condition it caused was simple: death by slow suffocation.
The capillaries sending oxygen to Mary's lungs had thickened and were closing. Mary's condition was so
bad that her only options were either a combination heart/lung transplant, with a 50 percent rate of
success, or the implantation of a tube directly into her chest that would pump a drug called Flolan around
her heart to make it pump harder.
Nancy, Mary, her parents, and Mary's other siblings huddled in a hospital conference room watching a
video about what the Flolan option entailed. "It was how she'd spend the rest of her life," said Nancy. "We
watched it, and just burst into tears."
For the rest of her life, Mary would be hooked up to a portable machine. She would have to make up her
solution daily, fill her tube, clean all the equipment. Infection would always haunt her. The machine was
equipped with an alarm. If it malfunctioned, she had only two minutes to fix it or call an ambulance,
because she would probably go into cardiac arrest. She would always have to worry about dislodging the
pump-whether by bumping into people, turning in bed, playing with Dustin, or making love.
Worse news for Mary was that she would never be able to bear children. Mary wept bitterly over that; she
and Tom already had some names chosen for babies. But what really frightened Mary was death. "She
was so scared," Nancy said. "She was terrified of dying. She was living in hell."
Before she went into surgery in early December 1996, Mary made her parents promise that if anything
happened to her, they would "get the truth out"-tell her story, and work to get the diet drugs off the market
so other women wouldn't be hurt.
Then, she tearily released Tom from his vow to marry her. "You were engaged to someone who was well.
I'm not. You don't have to stay." When she awoke from the heart surgery with the catheter in her chest,
Tom was standing next to the bed with a tiny box he'd bought that day. In it was a wedding ring.
Mary's father, Tom, had heard about medical problems with Fen-Phen. A former CIA employee, he had a
background in research and quickly absorbed everything he could in medical literature on the diet drugs.
By the end of November, he had also found an attorney, Alex MacDonald of Robinson & Cole in Boston.
Now unemployed, Mary had just been told that her Flolan could cost $200,000 a year. She would need to
go on disability. Tom and Mary Jo were retired, living on a pension. Since Mary's doctors had now agreed
that diet drugs were the culprits, Tom Linnen hoped that Alex would be able to get a settlement from the
pharmaceuticals that would cover the cost of Flolan and further hospitalization for her remaining years.
MacDonald anticipated eventually filing suit against Wyeth-Ayerst, the makers of Pondimin, and against
Fisons, the distributors of Phentermine. He and Mary would talk for hours about her situation. One
afternoon she phoned him at his office. "I don't know what my parents will do if anything happens to me,"
she told him. "You'll watch out for them for me, won't you? I'm trying not to let them know how scared I
am," she said, as Alex heard her sniffling.
"Of course," Alex said, "but you'll be okay."
For a while at least, Mary said to herself; the outside survival rate for her disease was four years.
Except around Nancy, Mary tried to maintain her sense of humor. She sent her sister Michelle into
hysterics making bizarre jokes about some of the stranger aspects of her medicine, such as the unwieldy
Meanwhile, Tom Caruso was devastated by Mary's illness. He was terrified he'd crush her at night. The
tube contraption was a mess, and Mary was always just one infection away from another trip to the
hospital. Now when the two of them sat holding hands at the kitchen table, they were praying for Mary to
One morning Nancy got a phone call from Mary-"The tube's come out!" Mary screamed. "There's blood
everywhere!" Nancy jumped in the car and tore over to Mary's. When she arrived, the med techs from
Mary's emergency 911 call were just leaving. They had secured Mary's tubing back into the hole in her
chest. When Nancy entered the apartment, she found Mary with a sponge washing the floor and walls. "I
didn't want you to see all the blood," Mary sobbed.
By January, Mary's eyesight had begun failing, and she eventually lost it completely in one eye. She cried
to Nancy, "What will happen to me if I can't see to do my medicine? How will I check it to see if it's right? I
don't want to go into a home."
To cheer her up, Nancy took Mary to a movie matinee. They chose a daytime show because, as Nancy
explained, "It wasn't as crowded during that time and we didn't have to worry about anyone pushing into
Mary or knocking into her [machine]."
The film had been running a short time when the beeping alarm on Mary's pump went off in the darkened
theater. "We panicked," said Nancy. "We knew we only had a two-minute period in which we could find
out what was wrong and fix it [or] she would go into heart failure." They rushed to the lobby where they
stood under the brightest lights they could find, adjusted the machine and tubing, and turned off the
alarm. "It was so terrible," said Nancy. The two cried and went home.
Problems with the pump and Mary's shortness of breath continued. On February 20, she landed back in
the hospital. Two days later, she was released. Tom picked her up and drove her to her apartment, where
guest lists for the postponed wedding invitations and business cards for the company she wanted to start
littered the tables. He carried her up the stairs and placed her on the bed. That's when she gasped,
"Something's wrong, I can't breathe."
By the time paramedics came and took Mary out on a stretcher, Mary's eyes had rolled up in her head
and she had stopped breathing. The EMS tech who responded to Tom's 911 call said later that after they
had resuscitated her temporarily in the ambulance, Mary cried and grabbed him. She told him how scared
she was of dying and begged them to save her. She was pronounced dead at the hospital. She was thirty
Afterwards, Connie said, "Mary had such a big heart. I never thought it could break."
By the time Alex MacDonald stood before the jury three years later, he was part of one of the largest
mass tort lawsuits in American legal history. Around 45,000 women-an epidemic by any person's
standards-were believed to have developed one of two different diseases linked to their lungs or to their
heart from taking the drugs. Another 300,000 women were prepared to sue Wyeth and American Home
Products in order to get expensive tests to determine whether they also had heart disease.
As it turned out, Mary Linnen was very close to the profile of most of those who took the drugs-a woman
who was neither truly obese nor old but the perfect target of a carefully orchestrated diet drug fad aimed
specifically at women and that made the companies hundreds of millions of dollars. Mary's was just one
lawsuit, the first wrongful death suit over the drugs in America. But thanks to the refusal of her lawyers to
allow the drug companies to bury the details of her story along with her, Mary Linnen's case would
become the most important single suit the company would face.
However, it wasn't Mary's case that led to the drugs' ultimate withdrawal in 1997. It was another deadly
side effect, heart valve damage, that would embarrass both the drug company and the U.S. Food and
Drug Administration. Ironically, heart valve damage wasn't pinpointed by American Home Products'
million-dollar computerized worldwide surveillance system of its drugs' safety; or by the Food and Drug
Administration, with its international database on drugs and their side effects. It was a couple of hands-on
medical personnel in two out-of-the-way places-Fargo, North Dakota, and Belgium-who identified the
deadly side effect that had been present all along. They merely treated their patients, noticed a pattern,
added two plus two, and got the answer.
The FDA washed its hands of the issue and let the tort lawyers take over. The company began a nearly
$100 million public relations spin campaign that would put presidential consultants to shame. Using
several PR firms, American Home Products stage-managed a tableau involving the FDA, Washington
lobbyists, politicians, medical journals, and some of America's most celebrated medical schools and
hospitals, in order, apparently, to ward off paying damages and risking punishment by the government.
Meanwhile, a mismatched, warring band of barristers began battling in federal and state courts, trying to
outmaneuver a corporate giant.