"He is hiding somewhere. He is erratic, each morning a different direction," she explains with unrelenting melancholy.
"If he says the desert, is it a real desert?"
"It will be a place of great inconvenience. That also is typical."
To plead her cause she has absorbed phrases that he would not have credited her with: "I will fast-forward here… KVH are taking no prisoners." She even speaks of "my patients on death row." And when she presses a lawyer's letter on him, she quotes from it while he reads it, lest he miss the most offensive parts:
You are again reminded that under the confidentiality clause in your contract you are expressly forbidden to impart this misinformation to your patients… You are formally warned against any further dissemination, verbally or by any other means, of these inaccurate and malicious opinions based on the false interpretation of data obtained while you were under contract to Messrs. Karel Vita Hudson…
This is followed by the superbly arrogant non sequitur that "our clients deny absolutely that at any time did they attempt in any way to suppress or influence legitimate scientific debate…"
"But why did you sign the wretched contract in the first place?" Justin cuts in roughly.
Pleased by his animus she gives a mirthless laugh. "Because I trusted them. I was a fool."
"You're anything but a fool, Lara! You're a highly intelligent woman, for God's sake," Justin exclaims.
Insulted, she lapses into a brooding silence.
* * *
The first couple of years after Karel Vita acquired the Emrich-Kovacs molecule through the agency of Markus Lorbeer, she tells him, were a golden age. Initial short-term tests were excellent, the statistics made them better, the Emrich-Kovacs partnership was the talk of the scientific community. KVH provided dedicated research laboratories, a team of technicians, clinical trials all over the Third World, first-class travel, glamorous hotels, respect and money galore.
"For frivolous Kovacs, it was her dream come true. She will drive Rolls-Royces, she will win Nobel Prizes, she will be famous and rich, she will have many, many lovers. And for serious Lara, the clinical trials will be scientific, they will be responsible. They will test the drug in a wide range of ethnic and social communities that are vulnerable to the disease. Many lives will be improved, others will be saved. That will be very satisfactory."
"And for Lorbeer?"
An irritable glance, a grimace of disapproval.
"Markus wishes to be a rich saint. He is for Rolls-Royces, also for saved lives."
"For God and Profit, then," Justin suggests lightly, but her only response is another scowl.
"After two years I was making an unfortunate discovery. The KVH trials were bullshit. They had not been scientifically written. They were designed only to get the drug onto the market as soon as possible. Certain side effects were deliberately excluded. If side effects were identified, the trial was immediately rewritten so that they did not reappear."
"What were the side effects?"
Her lecture-room voice again, mordant and arrogant. "At the time of the unscientific trials, few side effects were observed. This was due also to the excessive enthusiasm of Kovacs and Lorbeer, and the determination of clinics and medical centers in Third World countries to make the trials look good. Also the trials were being favorably reported in important medical journals by distinguished opinion leaders who did not declare their profitable connections with KVH. In reality such articles were written in Vancouver or Basel and only signed by the distinguished opinion leaders. It was remarked that the drug did not suit an insignificant proportion of women of childbearing age. Some had blurred vision. There were some deaths, but an unscientific manipulation of dates ensured that they were not included in the period under review."
"Did nobody complain?"
The question angers her. "Who shall complain? Third World doctors and medical workers who are making money from the trials? The distributor who is making money from marketing the drug and does not wish to lose the profits from the whole range of KVH drugs — maybe lose their entire business?"
"How about the patients?"
Her opinion of him has reached rock bottom. "Most of the patients are in undemocratic countries with very corrupt systems. Theoretically they gave their informed consent to the treatment. That is to say, their signatures are on the consent forms even if they cannot read what they have signed. They are not allowed by law to be paid, but they are generously recompensed for their travel and loss of earnings and they have free food, which they like very much. Also they are afraid."
"Of the pharmas?"
"Of everybody. If they complain they are threatened. They are told their children will receive no more medicines from America and their men will go to prison."
"But you complained."
"No. I did not complain. I protested. Vigorously. When I discovered that Dypraxa was being promoted as a safe drug and not as a drug on trial, I gave a lecture at a scientific meeting of the university at which I described accurately the unethical position of KVH. This was not popular. Dypraxa is a good drug. That is not the issue. The issue is threefold." Three slender fingers have already gone up. "Issue one: the side effects are being deliberately concealed in the interest of profit. Issue two: the world's poorest communities are used as guinea pigs by the world's richest. Issue three: legitimate scientific debate of these issues is stifled by corporate intimidation."
The fingers are withdrawn while with her other hand she delves in her bag and unearths a glossy blue leaflet with the banner headline GOOD NEWS FROM KVH.
DYPRAXA is a highly effective, safe, economic substitute for the hitherto accepted treatments of tuberculosis. It has proved itself to be of outstanding advantage to emerging nations.
She takes back the leaflet and replaces it with a much-thumbed solicitor's letter. One paragraph is highlighted.
The study of Dypraxa was designed and implemented in an entirely ethical manner over a number of years with the informed consent of all patients. KVH does not distinguish in its trials between rich and poor countries. it is solely concerned to select conditions appropriate to the project in hand. KVH are rightly praised for their high quality of care.
"Where is Kovacs in this?"
"Kovacs is totally on the side of the corporation. She is without integrity. It is with the assistance of Kovacs that much of the clinical data is distorted or suppressed."
"And Lorbeer?"
"Markus is divided. This is normal to him. In his self-perception he has become chief of all Africa for Dypraxa. But he is also frightened and ashamed. Therefore he confesses."
"Employed by ThreeBees or KVH?"
"If it is Markus, maybe both. He is complicated."
"So how on earth does KVH come to set you up at Dawes?"
"Because I was a fool," Lara repeats proudly, putting to rest his earlier assertion to the contrary. "Why would I accept to sign unless I was a fool? KVH were very polite, very charming, very understanding, very clever. I was in Basel when two young men came from Vancouver to see me. I was flattered. Like you, they sent me roses. I told them the trials were shit. They agreed. I told them they should not be selling Dypraxa as a safe drug. They agreed. I told them that many side effects had never been properly assessed. They admired me for my courage. One of them was a Russian from Novgorod. "Come to lunch, Lara. Let's talk this thing through." Then they told me they would like to bring me to Dawes to design my own trial of Dypraxa. They were reasonable, unlike their superiors. They accepted that we had not made enough correct tests. Now at Dawes we would make them. It was my drug. I was proud of it, they also. The university was proud. We made a harmonious arrangement. Dawes would welcome me, KVH would pay for me. Dawes is ideally located for such trials. We have native Indians from the reservations who are susceptible to old tuberculosis. We have multi-resistant cases from the hippy community in Vancouver. For Dypraxa, this is a perfect combination. It was on the basis of this arrangement that I signed the contract and accepted the confidentiality clause. I was a fool," she repeated, with the sniff that says "case proven."