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 centres in Third World countries to make the trials look good. Also the trials were being favourably 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.”
“And KVH has offices in Vancouver.”
“Big offices. Their third biggest facility in the world after Basel and Seattle. So they could watch me. Which was the object. To put a muzzle on me and to control me. I signed the stupid contract and went to work with a good heart. Last year I completed my study. It was extremely negative. I felt it
necessary to inform my patients of my opinion concerning the potential side-effects of Dypraxa. As a doctor, I have a sacred duty. I also concluded that the world medical community must be informed by means of publication in an important journal. Such journals do not like to print negative opinions. I knew this. I knew also that the journal would invite three distinguished scientists to comment on my findings. What the journal did not know was that the distinguished scientists had just signed rich contracts with KVH Seattle to research biotechnical cures for other diseases. They immediately informed Seattle of my intentions, who informed Basel and Vancouver.”
She hands him a folded sheet of white paper. He opens it and has a chilling sense of recognition.
COMMUNIST WHORE. GET YOUR SHITCOVERED HANDS OFF OUR UNIVERSITY. GO BACK TO YOUR BOLSHEVIK PIGSTY. STOP POISONING DECENT PEOPLE’S LIVES WITH YOUR CORRUPT THEORIES.
Large electronic capitals. No spelling mistakes. The familiar use of compounds. Join the club, he thinks.
“It is arranged that Dawes University will participate in the worldwide profits of Dypraxa,” she continues, carelessly snatching the letter back from him. “Staff who are loyal to the hospital will receive preferential shares. Those who are not loyal receive such anonymous letters. It is more important to be loyal to the hospital than loyal to the patients. It is most important to be loyal to KVH.”
“Halliday wrote it,” Amy says, sweeping into the room with a tray of coffee and biscuits. “Halliday’s the preeminent bull-dyke of the Dawes medical mafia. Everybody in the faculty has to kiss her ass or die. Except me and Lara and a couple of other idiots.”
“How d’you know she wrote it?” Justin asks.
“DNA-d the cow. Picked the stamp off the envelope, DNA-d her spit. She likes to work out in the hospital gym. Me and Lara stole a hair from her pink Bambi hairbrush and made the match.”
“Did anyone confront her?”
“Sure. The whole board. Cow confessed. Excess of zeal in execution of her duties, which consist solely of protecting the university’s best interests. Humbly apologised, pleaded emotional stress, which is her word for salivating sexual envy. Case dismissed, cow congratulated. Meanwhile they trashed Lara. I’m next.”
“Emrich is a Communist,” Lara explains, relishing the irony. “She is Russian, she grew up in Petersburg when it was Leningrad, she attended Soviet colleges, therefore she is a Communist and anti-corporate. It is convenient.”
“Emrich didn’t invent Dypraxa either, did you, honey?” Amy reminds her.
“It was Kovacs,” Lara agrees bitterly. “Kovacs was the complete genius. I was her promiscuous laboratory assistant. Lorbeer was my lover, therefore he claimed the glory for me.”
“Which is why they’re not paying you any more money, OK, honey?”
“No. It is a different reason. I have broken the confidentiality clause, therefore I have broken my contract. It is logical.”
“Lara’s a prostitute too, aren’t you, honey? Screwed the pretty boys they sent her from Vancouver, except she didn’t. Nobody at Dawes fucks. And we’re all Christians except the Jews.”
“Since the drug is killing patients I would wish very much that I had not invented it,” says Lara softly, choosing not to hear Amy’s parting sally.
“When did you last see Lorbeer?” Justin asks when they are alone again.
Her tone still guarded, but softer.
“He was in Africa,” she said.
“When?”
“One year ago.”
“Less than a year,” Justin corrected her. “My wife spoke to him in the Uhuru Hospital six months ago. His apologia, or whatever he calls it, was sent from Nairobi several days ago. Where is he now?”
Being corrected was not what Lara Emrich liked. “You asked me when I last saw him,” she retorted, bridling. “It was one year ago. In Africa.”
“Where in Africa?”
“In Kenya. He sent for me. The accumulation of evidence had become unbearable to him. ‘Lara, I need you. It is essential and very urgent. Tell nobody. I will pay. Come.’ I was affected by his appeal. I told Dawes my mother was ill and flew to Nairobi. I arrived on a Friday. Markus met me at Nairobi airport. Already in the car he asked me: ‘Lara, is it possible that our drug is increasing pressure on the brain, crushing the optic nerve?’ I reminded him that anything was possible since basic scientific data had not been assembled, although we were attempting to remedy this. He drove me to a village and showed me a woman who could not stand up. Her headaches were terrible. She was dying. He drove me to another village where a woman could not focus her eyes. When she went out of her hut the world went dark. He related other cases to me. The health workers were reluctant to speak frankly to us. They too were afraid. ThreeBees punishes all criticism, Markus says. He also was afraid. Afraid of ThreeBees, afraid of KVH, afraid for the sick women, afraid of God. ‘What shall I do, Lara, what shall I do?’ He has spoken to Kovacs, who is in Basel. She says he is a fool to panic. These are not the side-effects of Dypraxa, she says, they are the effects of a bad combination with another drug. This is typical Kovacs, who has married a rich Serbian crook and spends more time at the opera than in the laboratory.”
“So what should he do?”
“I told him what was the truth. What he is observing in Africa is what I am observing in the Dawes Hospital in Saskatchewan. ‘Markus, these are the same side-effects that I am documenting in my report to Vancouver, based on objective clinical trials of six hundred cases.’ Still he cries to me, ‘What must I do, Lara, what must I do?’ ‘Markus,’ I tell him. ‘You must be courageous, you must do unilaterally what the corporations refuse to do collectively, you must withdraw the drug from the market until it has been exhaustively tested.’ He wept. It was our last night together as lovers. I also wept.”
Some savage instinct now took hold of Justin, a root resentment he could not define. Did he grudge this woman her survival? Did he resent it that she had slept with Tessa’s self-confessed betrayer and even now spoke tenderly about him? Was he offended that she could sit before him, beautiful and alive and self-obsessed, while Tessa lay dead beside their son? Was he insulted that Lara displayed so little concern for Tessa, and so much for herself?
“Did Lorbeer ever mention Tessa to you?”
“Not at the time of my visit.”
“So when?”
“He wrote to me that there was a woman, the wife of a British official, who was putting pressure on ThreeBees regarding Dypraxa, writing letters and making unwelcome visits. This woman was supported by a doctor from one of the aid agencies. He did not mention the doctor’s name.”
“When did he write this?”
“On my birthday. Markus remembers always my birthday. He congratulated me on my birthday and told me of a British woman and her lover the African doctor.”
“Did he suggest what should be done with them?”
“He feared for her. He said she was beautiful and very tragic. I think he was attracted to her.”
Justin was assailed by the extraordinary notion that Lara was jealous of Tessa.
“And the doctor?”
“Markus admires all doctors.”
“Where did he write from?”
“Cape Town. He was examining the ThreeBees operation in South Africa, privately making comparisons with his experiences in Kenya. He was respectful of your wife. Courage does not come easily to Markus. It must be learned.”
“Did he say where he’d met her?”
“At the hospital in Nairobi. She had challenged him. He was embarrassed.”
“Why?”
“He was obliged to ignore her. Markus believes that if he ignores somebody he will make them unhappy, specially if they are a woman.”
“Nevertheless he managed to betray her.”
“Markus is not always practical. He is an artist. If he says he betrayed her, that can also be figurative.”
“Did you reply to his letter?”
“Always.”
“
Where to?”
“It was a box number in Nairobi.”
“Did he mention a woman called Wanza? She shared a ward with my wife in the Uhuru Hospital. She died of Dypraxa.”
“The case is not known to me.”
“I’m not surprised. All traces of her were removed.”
“It is predictable. Markus told me of such things.”
“When Lorbeer visited my wife’s ward, he was accompanied by Kovacs. What was Kovacs doing in Nairobi?”
“Markus wanted me to come to Nairobi a second time but my relationship with KVH and the hospital was by this time bad. They had heard about my earlier visit and were already threatening to have me expelled from the university because I lied about my mother. Therefore Markus telephoned to Kovacs in Basel and persuaded her to come to Nairobi as my substitute and observe the situation with him. He was hoping she would spare him the difficult decision and herself advise ThreeBees to withdraw the drug. KVH in Basel was at first reluctant to allow Kovacs to go to Nairobi, then they consented on condition that the visit remained a secret.”
“Even from ThreeBees?”
“From ThreeBees that would not have been possible. ThreeBees were too close to the situation and Markus was advising them. Kovacs visited Nairobi for four days in great secrecy, then returned to her Serbian crook in Basel for more opera.”
“Did she file a report?”
“It was a contemptible report. I was educated as a scientist. This was not science. This was polemic.”
“Lara.”
“What is it?” She was staring combatively at him.
“Birgit read you Lorbeer’s letter over the telephone. His apologia. His confession. His whatever he calls it.”
“So?”
“What did it mean to you—the letter?”
“That Markus cannot be redeemed.”
“From what?”
“He is a weak man who looks for strength in the wrong places. Unfortunately it is the weak who destroy the strong. Maybe he did something very bad. Sometimes he is too much in love with his own sins.”
“If you had to find him, where would you look for him?”