One evening in late May, four senior employees of Merck, the pharmaceutical company, sat in the bar of a Hilton Hotel in Rockville, Maryland, wearing metal lapel pins stamped with the word “TEAM.” They were in a state of exhausted overpreparedness. The next morning, they were to drive a few miles to the headquarters of the Food and Drug Administration and attend a meeting that would decide the future of suvorexant, a new sleeping pill that the company had been developing for a decade. Merck’s team hoped to persuade a committee of seventeen, composed largely of neurologists, that suvorexant was safe and effective. The committee, which would also hear the views of F.D.A. scientists, would deliver a recommendation to the agency. If the government approved suvorexant—whose mechanism, inspired partly by research into narcoleptic dogs, is unlike anything on the market—it would be launched within a year. Some industry analysts had described it as a possible blockbuster, a term usually reserved for drugs with annual earnings of a billion dollars. Merck had not created a blockbuster since 2007, when it launched Januvia, a diabetes drug. The company was impatient. A factory in Las Piedras...