“Then yes—they’re the result of Memorine,” Habib said.
“And what do you think, Dr. Mavros?” Vidali asked.
“I’m being more open-minded, although the correlation is troublesome.”
“It’s more than troublesome,” Habib said. “I frankly think the drug is flawed, and we have to address that.”
Flawed. The word fluttered in the air like a bat.
“I don’t believe that for a moment,” Maloney said. “But even if that were true, these anomalies are more than compensated for by the patients’ extraordinary progress in cognition and daily functionality.”
Vadali and others in the room nodded in agreement.
René felt a battle line cut across the table like a seismic fault: GEM Tech reps and home administrators on one side; she, Peter Habib, one nurse, and Nick on the other. Jordan Carr had thus far not responded.
“The problem is that when patients get stuck in past experiences and become disruptive, they have to be medicated with antiseizures, antipsychotics, and sedatives that impede their mental recovery.” René looked toward the unit nurse, who concurred.
“How so?” Maloney asked.
“They’re doped down.”
“Our strategy here and at other sites,” Nick said, “is to try to come up with just the right dosages and combination of agents.”
Maloney kept his eyes on René, but she disregarded their heat. “My suggestion is that instead of simply addressing the events with antipsychotics and other meds, it might make sense to determine the nature of the connection, because I believe these flashback seizures are adverse reactions to the use of Memorine.”
Jordan cleared his voice. “If I may, and with all due respect, Peter, in patients with moderate-to-severe dementia, delusions that are related to post-traumatic stress disorders are not uncommon. And that’s what I believe we’re seeing here, since all these so-called flashback victims are patients within that population. Furthermore, according to nurses’ reports, since Mr. Martinetti was first treated with antipsychotic drugs he hasn’t had any sustained flashbacks.”
“That’s not exactly true,” René said. “He was lost in a closed loop, reexperiencing some horrible episode when he was a POW.”
An uneasy silence filled the room as she described the earlier episode.
René continued: “What bothers me is that according to his wife and daughter, Louis never suffered PTSD flashbacks before, and now he’s getting trapped in them.” She didn’t need to remind them that this flew in the face of the public perception of Memorine as a miracle cure and Louis as poster boy for GEM’s half-billion-dollar marketing campaign.
“I’m seeing the same thing,” Peter Habib said. “Patients getting caught in some dark past-time traumas. And nothing in their medical history shows they had suffered PTSD disorders.”
“But nothing in the reports in the earlier phases point to any such efficacy problem,” Maloney said. “So I think Dr. Carr is correct. But that’s not to say we shouldn’t continue monitoring patients’ behavior problems, et cetera.” And he offered a conciliatory smile.
“Well, that’s our intention.” And Nick outlined a plan to measure cognitive progress while trying to determine a medical, demographic, or even genetic cause to any flashback seizures.
As he and the others continued, René receded and took notes. She had already created for herself a reputation as some self-appointed Ralph Nader watchdog. Besides, Nick was in charge and laying out a sensible strategy.
As she sat there, she tried to remind herself that everybody in this room—GEM Tech reps, nurses, physicians—were decent, well-intentioned professionals dedicated to the relief of patients suffering from dementia. Yet she could not help thinking that corporate agendas were at least as important as medicine—that decisions made in this room had as much to do the stock portfolios of GEM Tech investors as with science.
WHEN THE MEETING WAS OVER, Jordan Carr pulled her aside. “I think we’ve mapped out a good strategy. And maybe to an extent you’re right.”
“I think it makes sense.”
“And if there’s something to these episodes, we’ll deal with them.” And he patted her on the shoulder.
She nodded.
He lowered his glasses. “So how come you don’t seem pleased?”
“Because what I felt in there was just more pressure to downplay problems.”
“What pressure? What are you talking about?”
She opened her briefcase and pulled out a set of pearl earrings, two complimentary tickets to a Celtics game, more tickets to Boston Symphony Orchestra and Boston Pops concerts, and a year’s membership to Kingsbury Club, an upscale fitness center on the South shore. “And I’m not alone. Nurses, aides, and other home staffers are being flooded with GEM gifts including trips to Bermuda and Jamaica.”
“Complimentary gestures for working on the trials.”
“You mean standard practice in the industry.”
“In any industry, and nothing’s wrong with that.” Then he picked up the BSO tickets. “Not exactly payola.”
“No, but this is,” and she held up a letter. “From a Tanner Walker, chief financial officer at GEM—an offer of stock options.” She did not cite the specifics, but the letter, which had just arrived, said that in recognition of her services to the company and to victims of Alzheimer’s disease she was being granted options to purchase five thousand shares in GEM Tech for five dollars each. And that she had three years to exercise her option.
“Well, congratulations.”
“Congratulations?”
“Yes, you could be a wealthy woman in a few years.”
He was right. If Memorine was approved by the FDA, her own Memorine-driven stocks would in a year wipe out all her loans and still leave her with more money than she had ever dreamed of having. But that bothered her. For as long as she could remember, René had viewed health care workers, especially physicians, as good and trustworthy by nature. But while working on these trials she was witnessing bold-faced avarice—like that growing collection of Ferraris out the window.
As if picking up her thoughts, Carr said, “Look, don’t get me wrong. I’m not like that Michael Douglas character from Wall Street—you know, ‘Greed is good.’ But anyone who says they’re not interested in money is a liar.” Then he added, “And nothing wrong with doing well by doing good.”
“Jordan, this isn’t an incentive, it’s bribery.”
“Bribery? That’s ridiculous.”
“Then tell me what I’m missing. First they intimidate us to silence about the Zuchowsky murder. Now they’re buying us off to underplay the flashbacks.”
“Nobody is buying anybody off. All that’s simply encouragement to do your best work—what you call employee incentives.”
“But I’m not an employee of GEM.” And she wanted to add that neither was he, or the fact that, under the guise of “incentives,” drug companies lined the pockets of doctors, showering them with fancy gifts to spouses and free trips to flossy ski slopes and tropical resorts in order to get them to write prescriptions for their products. And how nobody protested. Nobody raised the conflict-of-interest flag. And the reason was that drug companies had bottomless coffers to buy the best legal defense teams.
“This is about making sure we’re all insiders so we put the best possible light on the trials without appearing to cross the ethics line.”
“Nobody is asking anybody to cross the ethics line. And just keep in mind that if it weren’t for pharmaceutical companies, you wouldn’t have a job.” Then, as if an afterthought: “Or me, for that matter.”
“True, but it just doesn’t feel right.”
“Well, René, if you’re not comfortable with the stock options, then don’t exercise them.” And before he walked away, he added, “This is a fast-moving train coming down the tracks, and jumping in front won’t stop it.”