The Effect. Written By Lucy Prebble. Directed by Bill English. Sf Playhouse, 450 Post Street, San Francisco, California.
Bill English’s clever direction, Theodore J. H. Hulsker’s clinical sound design, Nina Ball’s technically savvy set design and four sterling performances more than make up for the soap opera-ish implausibility’s in Lucy Prebble’s award-winning look at pharmaceuticals, medical ethics and physical attractions. Prebble’s script takes major liberties with the conduct of the clinical trial involved here and working in the field I was gob smacked with certain plot twists. Now I admit, most laypeople would not even recognize these faults and to some extent we must give ourselves over to theatrical license. Ok, now that I got that out of my craw, I did enjoy The Effect for its look under the skin of pharmaceutical research and its implications.
Dr. Lorna James (Susi Damilano) is a skeptic when it comes to treating depression with a new super-antidepressant. Adding to this conflict of interest, she’s had an affair with the trial’s Medical Director Dr. Toby Sealey (Robert Parsons). Damilano is excellent as the stressed Principal Investigator; spurned after an affair with Dr. Sealey and clearly with psychological problems of her own. Dr. Sealey has his own agenda – show that the drug is succeeding. Even when the trial’s two subjects break the rules, he remains steadfast in his purpose. Parsons successfully bridges the fine line between corporate shill and medical ethicist in an unsympathetic role.
To balance the clinical equation we have two subjects, Connie Hall (Ayelet Firstenberg) and Tristan Frey (Joe Estlack). Tristan had done trials before for the cash and he’s got his shtick down; burner phone and banned cigarette stash in tow. Estlack plays him with an endearing self-confident swagger. Connie’s got a sort of boyfriend and seems ambivalent about the whole proceedings. Ayelet’s Connie is standoffish at first, then succumbs to Tristan’s advances. She makes it difficult for us to decide whether she really likes him or is just feeling the effects of the drug. As the dose escalations continue, the two engage in innocent flirtations that eventually lead to sex which of course begs the big question: is this just a side effect of the increased dopamine levels?
The question becomes even more muddled when we find out one of them is taking a placebo. Can they both be falling in love or is only one subject’s emotions genuine? It’s fun to watch Tristan and Connie’s romantic maneuvering set amidst the confines of the research facility. Throw two guinea pigs in a cage and watch what happens. There’s plenty of drama in the second act when the star-crossed lovers are made aware of their dosing status (a big no no in blinded clinical trials) and Dr. James goes off the deep end out of ethical guilt.
The sounds and set design create the scientific atmosphere nicely. Images of brain scans and vital signs with beeps and whirs of the CAT scan are convincing. Bill English’s direction is sharp and concise, creating the canvas for his actors to discover their characters motivations and the implications of their interactions. When the broken Dr. James reaches for the pills that she abhors, but that might save her life, it’s a powerful finale to this thoughtful speculation. We’re all the beneficiaries of clinical trials, we’d have no approved drugs without them. Most people never consider the ramifications to the subjects and those who run them and this makes The Effect so perceptive.
Performances run through April 28, 2018 www.sfplayhouse.org 415.677-9596