"But that suit will surely be dropped now that homicide is suspected," Jack said.
"Maybe so," Lou said, "But I wouldn't count on it, since the perpetrator was in the hospital's employ."
"So, what's the state of the investigation at this point?" Laurie asked.
"There's a very active hunt for the Jasmine Rakoczis at these other institutions where a similar pattern of deaths has occurred.
The hope is to nab one and have that individual turn state's evidence. If that happens, maybe the whole house of cards will tumble down."
"Have there been any indictments so far from the hit man's testimony?" Laurie asked.
"Only Robert Hawthorne, who isn't talking and is in fact out on sizable bail," Lou said. "Unfortunately, the hit man was not really apprised of the whole operation. All he knew was that his boss, Robert, was a frequent visitor to the law firm. He didn't know whom he saw or what was ever talked about."
"Nobody in the AmeriCare hierarchy has been indicted?" Jack asked plaintively.
"Not yet," Lou admitted. "But we have our fingers crossed."
"What a nightmare," Laurie said with a shudder, remembering something of her ordeal in the hospital.
"Hey!" Lou said, eyeing the bubbles rising in the flute next to his water glass as if it were the first time he'd seen them. "This is champagne." He reached out and lifted the bottle from the ice bucket. "I don't know why I'm looking at this. I wouldn't know one brand from the next." He nestled the bottle back into the ice. "What is this, some kind of celebration?"
"Sort of," Laurie said with a smile. She looked at Jack, who raised his eyebrows as if there was a secret.
"Okay, out with it!" Lou commanded. He looked from one to the other.
"Well, it's not that big a deal," Laurie said. "I had a medical test today, which wasn't very pleasant I must say, but the result was reassuring. Apparently, the reason I had an ectopic pregnancy was because I had an abnormal or damaged oviduct. The test I had today showed my remaining oviduct is perfectly normal."
"That's great!" Lou said. He nodded a few times. He again looked back and forth between his two friends, both of whom were avoiding eye contact by looking down and swirling their drinks. "Well," Lou added. "Does this favorable result mean you two are planning to put this oviduct to the real test?"
Laurie looked up at Jack and said, "Unfortunately, at the moment, it just means it could be put to the real test."
"Too bad," Lou commented. "Well, if you need any volunteers to test that duct, I'm available."
Jack laughed and looked up at Lou and then Laurie. "Why do I have the feeling you two are ganging up on me?"
"Hey, I'm just trying to be a good friend," Lou said while raising both hands to profess his innocence.
"Well, good friend," Jack said, putting his arm around Laurie. "In the oviduct-testing business, I think Laurie and I can manage just fine."
"I'll drink to that," Lou said, raising his glass.
"Me, too," Laurie said.
author's note
The announcement of the completion of the first draft of the human genome's 3.2 billion base pairs was made with great fanfare in June of 2000, and included the participation of two heads of state, President Bill Clinton and Prime Minister Tony Blair. Although the media's excitement could be measured by coverage on both the network evening news as well as prominent front-page space in all the major newspapers on the following day, the public greeted the event with vague interest, a touch of bewilderment, and varying degrees of ennui, then quickly forgot about it. Despite glowing promises of future benefits, the subject apparently was too esoteric. Perhaps because of the public's reaction, the mass media soon forgot about it as well, except for a few follow-up articles on the colorful personalities of the leading scientists of the two competing organizations that carried out the painstaking work and the almost soap opera-like race to the finish.
The public's disregard for this landmark achievement has continued, even though the involved science and technology have been charging ahead, and reporting startling discoveries, such as the surprising fact that we humans have only about twenty-five thousand or so genes-a far cry from the hundred thousand experts had predicted not too long ago-and not that many more than an organism as comparatively simple as a roundworm! (This discovery is a blow to humanity's hubris equivalent to the Copernican revelation that the earth revolved around the sun, instead of vice versa.) In short, the decipherment of the human genome and the avalanche of research cascading from it has disappeared from most everyone's radar except for those working in the two new and related endeavors of Genomics and Bioinformatics. Genomics, in simple terms, is the study of the flow of information in a cell, while Bioinformatics is the application of computers to make sense of the enormous amount of data coming from Genomics.
In my mind, this lack of interest or apathy or whatever it might be called is startling; I believe the decipherment of the human genome might be the most important milestone in the history of medical science to date. After all, it gives us all the letters of the "book of life" in the right order, despite our having, as of yet, imperfect understanding of the language or the punctuation. In other words, in a cryptic form that is now being decoded with gathering speed, we have access to all the information nature has amassed to make and run a human being! As a consequence, the knowledge of the human genome will change just about everything we know about medicine, and some of the changes are going to happen sooner rather than later.
Like every major discovery/milestone in science, this one will have both good and bad consequences. Consider the consequences stemming from research into the inner structure and workings of the atom. We didn't do so well in that instance, as evidenced by current events, and we have to do better with the decipherment of the human genome, since it behooves society to consider all consequences of major leaps in science and technology and deal with them in a proactive manner rather than on a reactive, ad hoc basis.
Marker deals with one of the negative consequences-i.e., the negative impact of the ability to predict illness when confidentiality is breached and the information is obtained by or otherwise falls into the wrong hands. Unfortunately, the chances of this occurring will be high, since microarrays as described in Marker already exist, with the ability to test with ease for literally thousands of markers linked to deleterious genes with a single drop of blood. (A marker is a point alteration in the sequence of nucleotide bases forming the rungs of the ladder of the DNA molecule. Markers have been mapped throughout the human genome.) The microarray slides are read automatically by laser scanners, and the results, thanks to Bioinformatics, are fed directly into computers armed with appropriate software such that risk and hence cost can be predicted with rapidly advancing speed and accuracy. The end result will be that the concept of health insurance, which is based on pooling risk within specified groups, will become obsolete. In other words, risk cannot be pooled if it can be determined.
From my perspective, the implications of this developing state of affairs are prodigious. As a physician, I have always been against health insurance except for catastrophic care and for those financially unable to pay. The doctor-patient relationship is the most personal and rewarding for both the patient and the physician when a clear, direct fiduciary relationship exists. In such a circumstance, in my experience, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important detail, and a higher level of compliance-all of which invariably results in a better outcome and a more rewarding experience.
With the power of Genomics and Bioinformatics obviating the pooling of risk within defined groups, I have had to revamp my position, which has resulted in my switching from one extreme to the other. I now feel that there is only one solution to the problem of paying for healthcare in the United States, indeed for all developed countries in this global economy: to pool risk for the entire nation. (Under the rubric of healthcare I mean preventive care, acute care, and catastrophic care.) Although I never thought I'd be advocating this, I now believe that the sooner we as a nation move to a government-sponsored, obviously nonprofit, tax-supported single-payer plan, the better off we will be. Only then will we be able to pool risk for the en- tire country, as well as decide rationally how much we should spend on healthcare in general. One of the other effects of Genomics on healthcare will be the opportunity to individualize care. The entire pharmacological basis of therapeutics will be changing, thanks to another new field: Pharmacogenics, which will tailor-make drugs for individual patients according to their unique genomic makeup. The benefits of such care will be enormous, but so will the costs. Since we already spend over 15 percent of our GDP on healthcare, this has to be an important consideration.