“Thanks for the warning.”
Half way through lunch Neef’s bleeper went off. He excused himself and went to call the unit.
“We’ve just had a referral from East Side General,” said Lawrence Fielding. “I think you should come over.”
Neef hurried back to the unit and found Fielding in the light-wall room. This was a long narrow room next to the duty room. One entire wall was translucent plastic with a fluorescent light source behind it. Scans and X-rays could be pinned up on it for examination.
“What have you got?” asked Neef as he entered and found Fielding examining a series of three X-rays with the aid of a hand-held lens.
“Jane Lees aged fourteen,” replied Fielding. “I’ve not seen anything quite like this before, especially not in a child. She has multiple tumours on both lungs.”
Neef felt a sudden sense of foreboding come over him. Fielding had more or less said what Frank MacSween had said the other day about Melanie Simpson.
“I have,” he said, as he took the lens from Fielding and took a closer look at the X-rays. “I saw exactly the same thing in Pathology on Monday. Frank MacSween was doing a PM on a patient from University College, a thirteen year old girl. She’d been admitted as a bilateral pneumonia, but the lab couldn’t find any bugs. She died and they called it viral.”
“They didn’t realise she had cancer as well?”
“Nobody did until Frank opened her up. We’ve had to call in the Public Health team because of the extent of the malignancy. This looks like number two.”
“In more ways than one,” said Fielding.
“How so?”
“Jane was admitted to East Side General, as a bilateral pneumonia! They didn’t find any evidence of bacterial involvement so they too called it viral. Unlike your girl, Jane recovered from the acute pneumonia but her clearance X-rays showed up the tumours so she was transferred here. The early X-rays were clouded by excess mucus and inflammation caused by the pneumonia. I suppose that must have been the case with the first girl too.”
“I suppose it was,” said Neef thoughtfully. “I want you to call the Public Health people. Ask for Dr Lennon and explain what’s happened. The sooner he traces the cause of this thing the better.”
“Will do,” said Fielding.
“How is the girl?”
“We’ve made her comfortable for the moment but once these tumours get a real grip there’s not going to be much we can do for her.”
“We’ll do our best,” said Neef, putting his hand on Fielding’s shoulder. “Like we always do.”
Lunch was over by the time Neef got back to the administrative block. He had opted to see Jane Lees himself before leaving the unit and this had taken a good thirty minutes. Although the girl was very ill, she was conscious and Neef had hoped she might have been able to shed some light on the nature and source of the carcinogen that she and Melanie Simpson must have been exposed to. Unfortunately, she hadn’t. Jane Lees lived in another part of the city and she had not known Melanie Simpson. Neef was thinking about this as he ran up the steps of the administrative block in time for the ethics committee meeting.
“Problems?” asked Tim Heaton who was just about to leave along with Phillip D’Arcy. They would not be required to attend the ethics committee meeting.
“I’ve never known a day without them,” replied Neef. He didn’t want to get into conversation with Heaton about the two girls before he himself had had time to consider the implications.
“Life’s rich pattern.” smiled Heaton and swept out, checking his watch as he did so and almost leaving Phillip Danziger in his wake.
The ethics and safety committee on this occasion comprised two churchmen, the Roman Catholic chaplain for University College Hospital and the Church of England chaplain for St George’s, Alan Brooks, the Dean of University College medical school, Major Ronald Jackson, a local magistrate, Dr David Farro-Jones, Reader in molecular biology in medicine at University College medical school and Miss Emma Taylor, area organiser of the Women’s Royal Voluntary Service. Major Jackson was in the chair. Steven Thomas, Max Pereira and Neef were present throughout. Andrew D’Arcy was available to be called upon. All members of the committee had copies of the formal written application in front of them.
Major Jackson opened the proceedings by requesting evidence of Menogen’s successful application to licensing authorities at national level.
Steven Thomas handed over a series of documents, one at a time, announcing each in turn. “Our formal application, which I think you already have, Approval Certificate from the Medicines Control Agency, and certification from the National Gene Therapy Advisory Committee.”
“Thank you Mr Thomas. A necessary formality you understand.”
“Of course.”
“As I understand it, no transfer of human genetic material is involved in the proposed therapy. Is that right?”
Max Pereira replied, “Quite right, sir.”
“I think that makes our task considerably easier,” said Jackson. “So what gene do you intend transferring to our patients?”
“It’s the thymidine kinase gene, taken from Herpes simplex virus, sir. The TDK gene for short.”
“Isn’t that dangerous?” asked the WRVS woman.
Neef thought for an awful moment that Pereira was about to be rude to her but he controlled himself.
“No Ma’am, it’s only a single gene from the Herpes virus, not the virus itself. Its presence will render the tumour cells sensitive to a drug called Gancyclovir so that when we give the patient the drug, it will kill the tumour.”
“I see,” said the WRVS woman vaguely.
Major Jackson turned to the two churchmen. “Is there anything you gentlemen would like to ask?”
Both men shook their heads. “Nothing here to concern us,” said the Roman Catholic priest. I hope it works.
“Then perhaps I should hand over to Dr Farro-Jones as our expert in this case. I’m told you two chaps know each other?”
“Indeed we do, Major,” smiled Farro-Jones, then to Max Pereira, “How are you Max? It’s been a while.”
“Fine, David. Good to see you.
Neef could not help but be aware of the striking physical differences between the two men. Farro-Jones was tall, blonde and athletic looking. He had the easy charm and accent that often comes from a public school and Oxbridge education while Pereira looked like a small, swarthy sailor and spoke like a New York cab driver.
“Max, I’m a bit worried about the gene transfer vector you intend using to take the TDK gene in; it’s a leukaemia retrovirus, isn’t it?”
Ears pricked up around the table at the mention of the word, leukaemia.”
“It’s the standard Moloney vector,” said Max. “It’s been around for a while. It’s never given any problems in the lab and we’ve disabled it even further.”
“Yes, I see that,” said Farro-Jones hesitantly. He looked down at the papers in front of him. “But you’ve also altered its envelope proteins?”
“We’ve made it much more effective and, because we have a range of them, much more specific. That’s what we’ve all been working towards, efficient transfer vectors that can be targeted at specific tumours?”
“Yes indeed,” agreed Farro-Jones. “And it all sounds very effective on paper but I really do worry about safety...”
Neef hadn’t anticipated David Farro-Jones being lukewarm to the proposal. If anything he had expected his support, being a fellow molecular biologist who had already been involved in the introduction of Gene Therapy at University College Hospital. He thought he would point this out.
“Is the Menogen vector significantly different from the one you and your colleagues used in your cystic fibrosis trial, David?” he asked.