“Go on.”
“You perform tox studies, qualify the degradation products. Determine what’s acceptable, what’s not acceptable. Then you do a Trap.”
“A what?”
“A Trap. Toxicological risk analysis procedure. That’s what we call it here at the center, anyway. You run the functional groups—the different parts of the drug molecule—against a knowledge base of existing chemicals and pharmaceuticals. You’re essentially looking for adverse reactions that might cause different, and more dangerous, functional groups. Toxicity potential. Carcinogenicity, neurotoxicity, so forth.”
“And if you find such toxic potential?”
“That’s known as a structure alert. Each alert is flagged and studied for severity.”
“I see. And if the drug passes?”
“Then it goes on to clinical trials, first in animals usually, then humans.”
“These structure alerts. Can a drug cause a structure alert and still go on to be developed?”
“Of course. That’s one reason you have warning labels on medicine bottles. ‘Don’t take with alcohol’ and the rest.”
“Are these alerts listed somewhere, in a book? The Physician’s Desk Reference, maybe?”
Goodkind shook his head. “Structure alerts are too low-level, too chemical, for the PDR.”
“So they’re proprietary? Kept secret by individual researchers or pharmaceutical companies?”
“Oh, no. They’re all stored in a central database. Government regulations.”
Lash sat forward slowly. “Who has access to this database?”
“The FDA. Pharmaceutical manufacturers.”
“Biochemistry labs?”
Goodkind inhaled sharply as he realized where Lash was headed. Then he nodded. “With the proper accreditation.”
“The Weisenbaum Center?”
Goodkind nodded again. “In the research library. Two flights up.”
“Mind leading the way?”
Goodkind licked his lips. “Chris, I don’t know. Access to that database is government-sanctioned. You sure this is official?”
“It’s of the greatest importance.”
Still, Goodkind hesitated.
Lash stood up. “Remember what you said when I called? That you couldn’t predict suicide, that it was just a roll of the dice? That it made no sense, for example, why Poland had a drastically higher suicide rate than normal in 2000?”
“I remember.”
“Perhaps you forgot something, a fact I just dug up on my way here. Poland is the country where, because of the low cost to run studies, most drugs were tested in 2000.”
Goodkind thought for a moment. “You mean—?”
“I mean you should show me that toxicology database. Right now.”
Goodkind hesitated just a second longer. And then he, too, stood up.
THIRTY-NINE
T he center’s research library did not look like a library at all. It was a low-ceilinged space, uncomfortably warm, its walls lined with carrels of blond wood. Each contained a seat, a desk, and a computer terminal. The room’s only occupant was the librarian, who looked up from her typing to stare suspiciously at Lash.
Goodkind chose a carrel in the far corner. “Where are all the books?” Lash asked in a low voice as he pulled over the chair from the adjoining carrel.
“In the basement stacks.” Goodkind drew the keyboard toward him. “You need to requisition titles from Ms. Gustus, there. But almost everything we need is online, anyway.”
Lash watched as the man typed in his name. A menu appeared, and Goodkind made a selection. The screen refreshed:
FDA - DIVISION R
PBTK
PHARMACEUTICAL AND BIOMEDICAL
TOXICITY KNOWLEDGE BASE
REV. 120.11
LAST UPDATED: 10.01.04
PROPRIETARY AND CONFIDENTIAL. OFFICIALLY SANCTIONED USE ONLY.
UNAUTHORIZED ACCESS CONSTITUTES A FEDERAL CRIME.
ID: ____________
PASSWORD: ____________
Goodkind looked at Lash, who nodded encouragingly. With a shrug, Goodkind completed the fields. A new screen appeared:
FDA - R/PBTK 120.11/00012 10/04/04
ENTER QUERY BY:
1. CHEMICAL COMPOUND
2. TRADEMARK
3. GENERIC
PRESS F1 FOR INDEX:
Goodkind looked over again. “What’s the name of the medication you’re interested in?”
“Scolipane.”
“Never heard of it.” Goodkind tapped a series of keys, and the screen filled with text. “Here it is.”
Lash peered more closely:
FDA - R / PBTK 120.11 / 09817 10/04/04
SCOLIPANE
Hydoxene, 2 - ((6 - (p-methylparapine) phenylchloride) alkaloid) -, sodium salt
MR: PhG
MF: C23H5O5N3•Na
USE: (primary) S. M. R. (secondary) see p. 20
MUTATION DATA: N/R
REPRODUCTIVE REFERENCES: p. 15
SYNONYMS: p. 28
DOSAGE DATA: p. 10
PAGE 1 OF 30
“Biochem was my worst subject at U. Penn. Remember?” Lash looked away from the screen. “Why don’t you hold my hand a little here.”
Goodkind scanned the text. “Scolipane’s primary use is as a skeletal muscle relaxant.”
“A muscle relaxant?”
“It’s a relatively new formulation, about five years old.”
“Dosage?”
“One milligram. A little feller.”
Lash slumped. The theory that had begun to seem so promising started to slip away again.
He glanced back morosely at the top of the screen. Between the chemical description and the formula was a line he didn’t recognize. “What’s ‘MR’ stand for?”
“Manufacturer. They all have codes. You know, sort of like airports. Take this one: PhG. That’s short for PharmGen.”
Lash straightened again.
PharmGen.
He began looking more closely at the data. The acute toxicity chart was a typical feature of such reports; it usually recorded the LD50, or dosage at which half the sample population would die. He ran down the columns.
“Canine mania,” he said quietly. “What the hell?”
“We have to scroll to page twenty for more information.”
“And look—it says to see page twenty for data on human overdosage, as well.” Lash glanced at Goodkind. “Primary use is as a muscle relaxant, you said.”
“Right.”
“But look here. There’s another use. A secondary use.” He pointed at the screen.
“Page twenty again,” Goodkind murmured. “Seems that page has a lot to tell us.”
“Then let’s go.”
Goodkind moused quickly forward, the screen blurring, until he reached page 20. Both men leaned in to read the dense text.
“Jesus,” Goodkind breathed.
Lash said nothing. But he found himself going cold in the overheated room.
FORTY
T ara Stapleton sat behind her desk, motionless except for her eyes. Slowly, she scanned the office, letting her gaze settle on one thing, then another. The plants were watered and carefully pruned; her old fiberglass board leaned against the wall as it always did; the posters, bumper stickers, and other surfing paraphernalia remained in their usual spots. The institutional clock on the far wall told her it was ten minutes to four. Everything was as it should be. And yet everything looked unfamiliar, as if the office had become suddenly foreign to her eyes.
She leaned back slowly in her chair, aware her breathing had grown fast and shallow.
Suddenly the phone rang, its shrill warble shattering the quiet. Tara froze.
It rang again. Two beeps: an outside call.
Slowly, she lifted it from the handset. “Stapleton.”
“Tara?” The voice was rushed, out of breath.
“Tara?” it repeated. “It’s Christopher Lash.”
; Street noises filtered from the earpiece: the rush of traffic, the blatt of a truck’s horn.
“Christopher,” Tara said evenly.
“I’ve got to talk to you. Right now. It’s very important.”
“Why don’t you come by my office?”
“No. Not inside. Can’t take the chance.”
Tara hesitated.
“Tara, please.” Lash’s voice was almost pleading. “I need your help. There’s something I have to tell you nobody else can overhear.”
Still, Tara said nothing.
“Tara. Another supercouple is about to die.”
“There’s a coffee shop around the corner,” she said. “The Rio. On Fifty-fourth, between Madison and Park.”
“I’ll be waiting for you. Hurry, please.”
And the phone went dead.
But Tara did not rise from her desk. In fact, she made no move at all except to replace the phone in its cradle and stare at it, as if struggling with some terrible uncertainty.
FORTY-ONE
L ash walked into the Rio a few minutes after four. The walls were covered in gilt wallpaper, and the incandescent lights and resin-colored banquettes gave the diner a hazy, golden glow. He felt like an insect surrounded by amber.
For a moment, he thought he’d arrived first. But then he caught sight of Tara, sitting at a booth in the rear of the restaurant. He stepped forward and slid into the seat across from her.
A waitress approached; Lash ordered a coffee, waited until she walked away. Then he turned back. “Tara. Thanks for coming.”
Tara nodded.
“Did you talk to that doctor? Moffett?”
Tara nodded again.
“What did he say?”
“He was following instructions from an internal scrip.”
“What does that mean?”
“Medication regimen, based on the findings of an earlier examination.”
“In other words, he was following some other in-house doctor’s orders.”
“Yes.”
“Did he say whose orders?”
“I didn’t ask him that.”
“How easy would it be to fake such orders?”
Tara hesitated. “I’m sorry?”
“Everything at Eden is automated. You get a piece of paper, telling you to do something. Couldn’t somebody type false medical orders into the computer system?”
When Tara did not reply, Lash leaned a little closer. “I don’t have all the answers yet. But I have enough to know it’s not only the remaining supercouples who are in danger. We’re in danger, too.”
“Why?”
“Because somebody—somebody inside Eden—has set these women up to kill themselves and murder their husbands.”
Tara began to speak, but Lash quickly held up a suppressing hand. “No. Let me talk first, please. You’re not going to believe it unless I give you a little background.”
Tara relaxed, but only slightly. She was looking at him with shock, even apprehension. Lash glanced toward a nearby mirror and caught a glimpse of himself: haggard, hair askew, tired eyes animated with nervous energy. If he was her, he’d be apprehensive, too.
The waitress returned with his coffee, and Lash took a sip. “That prescription of Lindsay Thorpe’s, for one milligram of scolipane? It was the clue I needed. I spent the afternoon tracking down more information. Did Dr. Moffett tell you what scolipane is normally prescribed for?”
Tara shook her head.
“It’s a muscle relaxant. It works on the area of the brain that controls muscle spasms. Sports medicine doctors use it to treat strains. You say Dr. Moffett was following through on treatment prescribed in an earlier examination. But Tara, what earlier examination could have predicted Lindsay Thorpe would strain a muscle?”
“Then scolipane must be used to treat something else.”
“You’re more right than you know. Scolipane was originally intended to treat something else. But that something else was kept a close secret, locked up in drug development databases.”
He paused. “Ever see a TV ad for what sounds like a miracle drug? No more allergies, maybe. Or your high cholesterol, suddenly gone. And then all the side effects go scrolling across the screen . . . and it’s almost enough to make you swear off medicine forever. Those are just the drugs that make it past clinical trials. Many others never make it.”
He glanced across the table, but Tara’s expression remained unreadable.
“Okay. Let’s back up. Most aspects of personality are the result of genes controlling neurotransmitters in the brain. That includes undesirable traits like anxiety and depression. So we create drugs to deal with them. Things like SSNRIs, which suppress the reuptake of serotonin. But there are lots of serotonin receptors in the brain. How can you aim a drug at all the receptors at once?”
He took another sip of coffee. “So drug companies have been looking for other solutions. Ways they could alter brain chemistry to achieve better results. Sometimes they venture deep into unknown territory. Such as the neuropeptide known as ‘Substance P.’ ”
“Substance P,” Tara repeated.
“I hadn’t heard of it either, until this afternoon. It’s very mysterious: nobody knows exactly why it’s in the brain, or what its purpose is. But we do know the kind of things that cause it to be released. Acute physical pain. High levels of stress. It’s been closely implicated with severe depression, sudden suicide.”
He leaned closer. “At least one drug company became interested in Substance P. They decided if they could develop a pharmaceutical agent to ‘hit’ Substance P, to block its receptor, maybe they could make a whole lot of depressed people happy again. That drug company was PharmGen. Eden’s parent.”
“Not anymore. Eden is independent now.”
“PharmGen developed a new anti-psychotic drug that acted against Substance P. It had some rough going early on—red flags appeared during toxicology testing—and the drug was remodified. Four years ago, it was finally ready for group testing. The testing was done in Poland, which was common practice. Maybe ten thousand people were involved, all told. Ninety-nine times out of a hundred, the drug worked beautifully. And it wasn’t limited to single indicators: schizoids, borderlines, chronic depressives, all seemed to benefit.”
He sipped his coffee. “But there was a problem: that other one percent. If a person without mental illness took the drug—specifically, a person with high levels of serum copper in their blood—terrible side effects resulted. Depression, paranoia, homicidal rage. There were mass instances of suicide, enough to skew the suicide statistics for the entire country that year.”
He glanced across the table to gauge the effect. But Tara’s expression remained guarded.
“The drug was withdrawn from testing. But it emerged late the following year, in a drastically lowered dosage, reformulated for another purpose: a muscle relaxant.”
Disbelief returned to Tara’s face. “Scolipane?”
“One-milligram tablets. The original fifty-milligram formulation is also available, but prescribed only in very rare circumstances, under close observation.” He pushed his cup aside. “Remember that call I made just before leaving your office? That was to a friend of mine in the Phoenix field office. I asked him to send somebody to the Thorpes’ house, check on their meds. Lindsay’s prescription for scolipane was on the night table beside her bed. But the dosage had been increased from one to fifty milligrams. In capsule form, she didn’t notice the difference.”
Tara frowned.
“Somebody changed her dosage. Somebody who knew about the side effects of scolipane in its original formulation. Somebody who knew scolipane wouldn’t set off any alarms in the autopsy blood work. Somebody who also knew—probably from her application form—that Lindsay Thorpe was taking an antihistamine.”
“What are you talking about?”
“When I first began investigating the deaths, I had a talk with Lindsay’s father. He mentioned she had dermatographia. It’s a benign b
ut irritating skin condition that causes itchiness. The recommended treatment is a histamine antagonist. Over time, chronic users of such drugs can develop high-copper histapenia—low levels of histamine in the blood, causing an accumulation of copper.”
Lash was increasingly alarmed by her continued disbelief. “Don’t you understand? When Lindsay Thorpe took that huge dose of scolipane, coupled with her high blood copper, she unwittingly re-created—exactly—the conditions that caused such high suicide in the initial drug trials. Think of the terrible mental ordeal she must have gone through, made all the worse for being sudden, inexplicable. Hostile voices in her head. Acts of psychotic deviance: she found herself playing music she detested on the stereo. Lindsay Thorpe hated opera, you see, but she was listening to opera when she died. All this would be followed by black despair, overwhelming homicidal and suicidal urgings . . .” He paused. “She loved her husband dearly. But the impulses were irresistible. Still, I think she carried them through with as much dignity, as little pain, as possible.”
When she said nothing, he went on. “I know what you’re thinking. Why did she kill her husband? She didn’t want to. But she had to. Yet even as the flood of brain chemicals drove her half mad, her love for Lewis Thorpe remained. And how do you kill somebody you love? As painlessly as possible. And you would go together. That’s why the deaths happened at night: Lindsay could slip a dry cleaning bag over the head of her sleeping husband before slipping one over her own. She probably waited for him to fall asleep in front of the TV. Same with Karen Wilner. She was a librarian, she would have access to scalpels in the book repair lab. A fresh scalpel is so sharp you wouldn’t even feel it opening your vein—not if you were asleep, anyway. But I’ll bet she sliced her own wrist more hesitantly, that’s why it took her longer to die.”