Miracle Cure (26 page)

“What happened?”

“I … I did what we’re supposed to do. I spoke to Art Weber about him. He told me there had been several allergic-type rashes with the drug, which he and his chemists had determined were due to an ingredient used in the chemical-stabilization portion of the synthesis. After that, the process had been overhauled, the contaminant removed, and no problems had been reported until this Ford guy. Weber and I checked his record carefully, and sure enough he had started on the drug before the synthesis was modified.”

“So what happened to the guy? How has he done?”

“Brian, listen. I’ve been on a tenure track since I arrived here. Now I’m just about to get approved. Tenure at Boston Heart and the medical school. The plum of plums, every academic cardiologist’s dream, and I’m about to realize it. You know as well as I do that I’m not the brightest bulb on the academic light board by any stretch, so I’ve had to resort to working that much harder than anyone else, keeping my nose clean, and most of all, playing by the rules. And at Boston Heart, one of the biggest rules of all is not going off half-cocked when it comes to research results on any BHI product or drug. I’ve really got to be careful.”

“I understand, Phil. I really do. Tell me, though, this Ford fellow, did they ever definitively diagnose pulmonary hypertension in him?”

Phil looked up at the drop ceiling.

“I … I don’t know,” he said. “Weber promised me he’d speak with Carolyn and that she would take over Ford’s care and decide whether his situation was reportable or not. I never made any effort to follow up on the case, and then I sort of forgot about it—until this morning. Bri, I feel like shit about this. I really do.”

“I can tell. You did right to get it off your chest, Phil.
And the truth is, we really don’t know whether either of these guys actually had PH.”

“That
is
true. And maybe we should let sleeping dogs lie. I think you know, Brian, but I want to warn you again. This drug is their baby. I can’t even begin to estimate how much is riding on it. The first thirty seconds it’s on the open market, it will probably bring in more money than they pay the two of us together in a year.”

“I know.”

Brian left it at that, sensing his friend was just too tense right now to handle any witty remarks about their salaries.

“Pickard, Jessup, Weber—they all seem to like you a lot,” Phil went on. “And you’ve done a couple of stellar things since you got here. But they’re all tough as nails when they’re cornered in an academic argument, or when someone makes trouble for them or threatens to cost them money. I’ve seen examples of it a number of times since I’ve been here. You have no way of knowing this, but Pickard and Jessup came to me after you admitted sending in the FDA report on that Ward-Dunlop catheter. Brian, they were going to can you. Right then and there. No second chances. No concerns about your future with the Board of Medicine, your kids, nothing. Here you saved my thyroid lady and Jessup’s patient, and they were prepared to send you into medical purgatory just for not making a team-oriented decision.”

“What saved me?”

“Probably a little of everything. I said my piece on your behalf. And you made a hell of an impression on Pickard. I think he finally persuaded Jessup to give you another chance. But it was touch and go for a while.”

“So, it would seem we’ve both got reasons for thinking things through pretty carefully.”

“That depends.”

“On what?”

A bit more relaxed, Phil could resist the pastry no longer. He opened it and took a big bite before answering.

“On how much you enjoy renting cars and how much I would want to be working the counter alongside you.”

Brian thought about Teri and her boss, searching for anything that they might use to postpone the general release of Vasclear. He thought about her warning that it was much more difficult to pull a drug off the market than it was to keep it from getting there in the first place. And finally, he thought about the hundreds of lives that might be saved every single day Vasclear was being prescribed.

“Phil, we can’t just let it drop,” he said.

“Why not? We’ve got two hundred cases with virtually no problems from therapeutic doses of the drug, one hundred and fifty of whom have been cured of a lethal disease. You’ve seen the patients. You’ve seen their results. And you heard Jodie Foster, M.D., up on the stage in the Hippodome saying how anxious the FDA was to get something, anything on Vasclear before it was released.”

“I don’t know, Phil.”

“Brian, I promise you. If we report these cases to anyone other than Jessup, Pickard, and Weber, and we get caught, or even if we go poking around and they get wind of it, we are finished. Here, there, and everywhere. Finished.”

Brian was still uncomfortable with letting the possibility of an unknown drug-toxicity just slip away. But everything—absolutely everything—Phil was saying made sense. Every single drug on the market had toxicities—many of them lethal. Risk-benefit ratio was the very backbone of clinical pharmacology.

Fatal aplastic anemia has been reported in less than one percent of patients taking drug A.… Hepatitis has occurred
as a complication of therapy with drug B, liver-function tests should be monitored frequently throughout the course of therapy.… Cases of irreversible hearing impairment have been reported.… Drowsiness … Fever … Renal shutdown … Blindness … Convulsions … Encephalitis … Paralysis … Sudden death
. The list of warnings and adverse reactions to FDA-approved medications filled much if not most of the three thousand or so pages in the
Physicians’ Desk Reference
.

So what if a small percentage of patients who received Vasclear developed a serious complication?

Risk-benefit ratio? No contest.

This was a case of miracle cure versus a couple of old men with commonplace symptoms that might or might not have had an uncommon cause. And, Brian reminded himself, Ford and Elovitz had received their Vasclear before the chemical-synthesis process had been modified. For the past two years, there had been no problems with Vasclear—none at all.

But still, he wanted to know more. He had chosen Vasclear as the linchpin of his father’s therapy, and now his father was dead. He needed to find out all he could about the drug. But at what cost?

“Look, Phil,” he said. “Supposing we poke around very quietly and see what we can learn about both Ford and Elovitz. If we don’t come up with anything more, we’ll just keep our mouths shut and let the chips fall where they may.”

“I don’t like it.”

“All right, all right. How about you just call up your man’s record and see if he had an elevated eo count? That can’t possibly hurt.”

Almost all White Memorial charts had been scanned into the record-room computers. Phil shrugged, turned to his terminal, and logged in. Brian came around the desk
and stood behind his chair. It took less than a minute for the record to be electronically retrieved.

Two and a half years ago, when he was first seen at Boston Heart, Kenneth Ford was a sixty-nine-year-old black divorced laborer from the Dorchester section of the city. He was referred to one of the staff cardiologists for evaluation of chest pain, found to have moderately advanced coronary artery disease, and started on Vasclear as part of the Phase One study. He showed excellent early response to his treatment, but then began to experience increasing chest pain, shortness of breath, and ankle swelling.

They scanned the visits to doctors and to the Vasclear clinic.

“There,” Phil said, pointing at the screen. “There’s my dictation.”

Brian scanned the two pages, which were a near double for the ones he had done on Elovitz.

“There’s your plan,” he said. “Chest X ray, EKG, cardiac ultrasound, chems, CBC. Nice going. Find the CBC.”

Phil scrolled through the rest of the chart. There were plenty of lab tests, including some complete blood counts, but none at or after the date on which he had seen Kenneth Ford.

“Strange,” he said.

He returned to the clinic notes. Ford was seen one more time, by a resident who either had not reviewed the chart or hadn’t bothered to write down a summary of the case. There was no mention of Phil’s extensive note nor of the recent lab work. Congestive heart failure, the resident concluded, making what was obviously a rubber-stamp diagnosis. Cause: arteriosclerotic cardiovascular disease.

Phil scrolled through the rest of the record and stopped at a letter written four months after he had seen Kenneth Ford in the Vasclear clinic. The letter was from
a general practitioner in Dorchester to the cardiologist to whom Ford had been initially referred, sadly informing the specialist of the death of Mr. Kenneth Ford at Boston City Hospital. The cause of death was pulmonary edema—overwhelming congestive heart failure—secondary to arteriosclerotic cardiovascular disease.

“Damn, but I wish I knew if he had an elevated eo count or not,” Brian said.

“What difference does it make? That test’s totally nonspecific.”

“Come on, Phil. You know as well as I do that the test is abnormal in allergic reactions and normal in most cardiac conditions. It’s certainly not something you’d expect to find in run-of-the-mill congestive failure from arteriosclerosis.”

“I’m telling you, Brian, let it drop.”

Brian snatched up the phone and tried calling the record room at Boston City Hospital. As he had expected, there was no way anyone would speak with him without a signed release from Kenneth Ford or his legal representative.

“Damn,” he murmured, setting the receiver down. “Phil, any thoughts as to why the CBC you ordered isn’t in Ford’s chart?”

“None.”

“Do you, um, think you might call the hematology lab and see if they can come up with it?”

“Brian, you’re fucking around with our future, here. And for what?”

“I don’t know, Phil. I don’t know for what. Why is that test missing?”

Phil called the heme lab. No CBC on Kenneth Ford after Phil had seen him in the clinic.

“Shit,” he whispered. “Brian, I don’t know what in the hell is going on, but I think you’re blowing this whole
thing way out of proportion. People with heart disease have congestive failure all the time. Lab reports don’t make it into charts every day. Patients are always having unexplained elevations in their eosinophil count from nothing more malevolent than a virus. And we are getting in over our heads.”

“I’m sorry,” Brian said, settling himself down with a bite of his machine-canteen pastry.

“Thanks, pal. Look, I don’t know the reason you’re acting like a terrier on a rat about all this. Maybe you’re just angrier than you realize at Vasclear because it didn’t work for your father. But I do know that you’re overthinking this whole business. Overanalyzing it.”

“Maybe.”

“Well, thank you, Jesus, for that ‘maybe.’ My pulse rate is beginning to recede.”

“So, what are we going to do?”

“Do? Why, nothing, Bri. That’s the point. We have nothing, we do nothing.”

“Maybe.”

“Amen to another ‘maybe’ from the lad. Please, let’s call it a day. My conscience is clear. Your conscience is clear. And we’re both still employed.”

“What do you want to bet Kenneth Ford had an eo count above ten percent?”

Gianatasio’s expression became an awkward, flushed mix of fear and anger.

“Enough, Brian, please,” he said. “I’m telling you, these are not people you want to cross—especially when you have absolutely nothing to gain.”

“How are they going to find out if I go over to Boston City and try to get hold of Ford’s labwork?”

“I don’t know. How did I hear from someone who heard from someone else that you nearly had a fistfight with that drunken cretin who runs the animal room?”

Brian stared at him.

“What? What did I say?” Phil asked.

“The animal room! Phil, the fight I got into with that jerk Earl was over a monkey—a chimp that I thought had massive fluid retention and some degree of pulmonary edema. I wanted to know what experimental study he was part of, and that doofus nearly tore my head off.”

“Oh, come on. Don’t add a fucking monkey to the conspiracy theory.”

Brian fished a paper out of his wallet.

“Four-three-eight-six,” he said. “That’s the chimp’s number. Wanna really make yourself some money? I’m going to make it a three-horse parlay. If any one horse loses, they all lose.”

“I don’t get it.”

“First, Kenneth Ford’s going to have elevated eos. Second, monkey number four-three-eight-six is going to turn out to be part of the early Vasclear studies. And third, he’s got some monkey version of pulmonary hypertension.”

“If you decide to go after this,” Phil said, “just do me one favor.”

“Namely?”

“Save me a luxury low-mileage sedan, and don’t bother with the insurance waiver.”