It was also understood that Nick’s rejection of the Klander Report could mean the end of Nick’s participation in the trials, his funding, the support for the MRI lab—a financial and image loss to the hospital. But institutional politics and fiduciary health was not what this was all about. “With all due respect, I think the Klander Report is bullshit.”
“Then you’re all alone, Nick,” Dr. Rubell said.
For the first time that night Jordan Carr raised his hand. “Look, Nick, we’ve worked together on this for a long time. And for the most part we shared the analysis and interpretation of the data. But I’ve studied the Klander Report, and I must say that I am comfortable with its conclusions. We’ve treated hundreds of people with dementing conditions, and most have been brought back from inevitable oblivion. That’s confirmation enough for me.”
“Hear, hear.”
“More than that, behavioral anomalies are to be expected in such a wide-ranging population.” Then Jordan thumbed through the report to its core argument. “It’s a proven fact that during the deterioration of the brain, connections are repatterned, while good ones become dominant. Which is why AD patients sometimes have sudden recall and forgotten talents—like sitting at the piano and playing the Moonlight Sonata when we thought there was little left inside. This is precisely what occurs with these flashback victims.”
And he continued in his smooth high-reasoned tone as he quoted statistics. When Carr finished, the others applauded. And Jordan flashed Nick a smile that could barely disguise the “gotcha” glow. René was right about him: He was a self-serving chameleon who said all the right things if it advanced his cause.
“If I may quote Mark Twain,” Nick said when the place quieted down, “‘There are three kinds of lies: lies, damned lies, and statistics.’ What we did was hire the Klander Group to give us what we wanted to hear: That Memorine is a miracle cure with no side effects. Period. Frankly it’s disingenuous of us to claim that this report offers a fair and neutral evaluation of our data. And I won’t be part of it.”
“I don’t like what you’re suggesting.”
“What, that money talks? Well, that’s what’s happened. And I cannot live with myself were I to vote to accept this report and, thus, make what I assume will be a unanimous endorsement of our application.”
“Nick, we’ve got spectacular results, and you’re harping on some minor problems. Just what do you propose?”
“That we request an extension of up to two years before approaching the FDA.”
“But we have a deadline,” someone shouted over the protests.
“Yes,” Nick said, “a deadline of GEM Tech’s marketing department, but not the health needs of people suffering from Alzheimer’s disease.
“Let’s say we accept the report and Memorine hits the market. What happens if we get another suicide or murder? Remember the multimillion-dollar settlement against GlaxoSmithKline after a man shot his wife, daughter, and granddaughter? The jury decided there was enough scientific evidence that it was the Paxil he was on. Do we want GEM taken over by the courts?
“What happens when caregiver complaints over flashbacks force the FDA to put a hold on distribution? And while we scramble to figure out what to do, millions of victims begin to slip away again. Meanwhile lawsuits fall from the sky like hail, and GEM Tech stocks won’t be worth the paper they’re printed on.
“And what happens when outside medical studies conclude that GEM Tech clinicians cut corners and pulled strings to get FDA approval? GEM Tech and every one of us in this room would be litigational toast. And the only ones celebrating would be the lawyers and the competition.”
Jordan spoke up again. “Nick, for the sake of argument, let’s say that some of these flashbacks are the direct result of the drug. So what? The alternative is dementia and death. But if the flashbacks don’t intrude, don’t threaten anyone, why not live with them? Look at Louis Martinetti—his Mini-Mentals are over seventy percent. That to me is a miracle.”
More chants of “Hear, hear.”
“I say we vote to accept this report while initiating an aggressive demographic profiling of patients who may have such seizures. This way we determine susceptible target groups.”
“You mean we conduct a demographic screening after approval?” Nick asked.
“Yes,” Jordan said. “And that population with a propensity for flashback problems would be warned to avoid the drug, and at the same time GEM could offer a free test to screen for it.”
“But that’s putting the cart before the horse,” Nick said. “I think it makes better sense to make those determinations before we submit our application. Even if it takes a year or so, it’s to everybody’s advantage to determine which patients might be susceptible to these flashbacks. The alternative is a dangerous rush to market that is unacceptable to me.”
“The other option is a black box,” Paul Nadeau threw out.
Nick chuckled. A black box was the warning that the Food and Drug Administration required in a drug’s labeling—nothing a pharmaceutical company welcomed. “Sure: ‘If you don’t want your elderly patients to play Ding Dong School all day or attack the postman because he took your marbles, then this drug may not be for your dementia patient.’”
Nobody else found that amusing.
“What you are asking, Nick,” said Rubell, “is that we tell millions of people out there that they’ll have to let the fog close over them while we work out these little details. In my book there’s no crueler punishment—show them the light, then blow it out. We are simply not going to stop this train.”
“I agree,” said Jordan.
“Well, then,” Nick concluded, “I have to say that I cannot in clear conscience vote to allow this report to go to the FDA without a disclaimer statement. It’s a whitewash job that feeds false hope to sufferers and caregivers. And I refuse to contribute to the perception that we researchers are so embedded with GEM investors that we have collectively voted to look the other way.”
Hard eyes beamed at him, as heads bowed together in judgment. And for a second, Nick felt like the centerpiece of Leonardo’s The Last Supper.
“That being said, I will write my own letter of recommendation that the FDA postpone review until further tests are conducted.”
A gaping silence filled the room as the blank ballots were passed around. Two minutes later the count was made: twenty-two in favor, one opposed.
Nobody said anything to Nick as he left the room and took the elevator upstairs to his room.
74
TWO THOUSAND MILES AWAY JACK KORYAN lay in his bed thinking about his biological father’s remains lying in a grave somewhere in a Cranston, Rhode Island, cemetery.
75
A LITTLE AFTER NINE THAT SAME evening, Gavin Moy called Nick to join him at the bar downstairs. “I didn’t see you at dinner.” Moy was sitting alone in a private booth at the dimly lit rear of the room.
“I had room service.” Nick was tired and wanted to go back up to bed.
They shared a bowl of mixed nuts. “You ate all the almonds,” Moy said. “All you left me are friggin’ peanuts.”
Nick swirled the bowl with his fingers and pulled out an almond. “Here’s a friggin’ almond.”
Moy took it and popped it in his mouth and crunched it down. They sat quietly sipping their drinks for a few moments. Then Moy said, “I heard what happened this afternoon.”
“I said what I’ve said all along. No surprises.”
“Except that your dissenting report will be a major setback for us.”