"I haven't seen the pharmaceutical companies standing in line to file for bankruptcy."
"With the price regulation the president's talking about, you may. But profits aren't the point. At least not the whole point. I'm speaking of an enormous waste of resources. And a tremendous human cost as beneficial drugs sit unrecognized while their useless brothers go through exhaustive animal trials only to be discarded because they are ineffective in humans; and even when the useful compounds are identified, they sit on the shelf, beyond the reach of the people they could help, while their paperwork drags through the quagmire of the approval process. For every 10,000 investigational compounds, only ten—ten!—make it past rodent and primate studies. That's an enormous loss in and of itself. But then consider that of the ten surviving compounds, only one makes it through human studies and gets to market. A one in ten thousand success rate, Mr. Brown. A ninety-nine point ninety-nine percent failure rate. What's your gambler's opinion of those odds, Mr. Brown?"
"Sort of like dropping a marble off the edge of the Grand Canyon and trying to hit a particular ant on the bottom."
"Precisely. And people wonder why new drugs cost so much. That lone surviving compound has only ten years to make up all the negative costs of the 9,999 compounds that didn't make it, plus show enough profit to convince the stockholders that this research and development merry-go-round is worthwhile. But without R&D, there'd be no new drugs at all."
"Isn't the answer obvious?" Tim said "Lengthen the patent life for new drugs."
Alston's smile was sour. "A few lucky compounds do get an extension, but it's a form of noblesse oblige, rather than a legal right. The pharmaceutical companies have spent decades lobbying for more time...to no avail."
"Then get the FDA to speed the approval process."
"We're already paying for extra staff at the FDA—to keep the line moving, as it were. Any futher suggestions?"
Tim thought a moment, bringing his economics courses into play. "Only one other way I can see: narrow the field."
"Meaning?"
"Find a way of weeding out the useless compounds earlier in the process. That will cut your front-end expenses."
Alston grinned and clapped his hands. "Mr. Kleederman would be proud of you! Exactly his solution! Running an investigational compound through the endless mandatory animal studies only to learn later that it's completely worthless in humans is a sinful waste of time and money."
"So what are you talking about? Trying it on humans first?" He was afraid of the answer.
"Of course not."
"Good. For a moment there—"
"We run it through some rodents and primates to make sure it's not toxic, then we try it on humans."
Tim stared at him, not wanting to believe this.
"The problem, of course," Alston went on, "is the supply of human subjects—sick human subjects. Obviously we can't evaluate a drug's efficacy against disease by giving it to healthy people. That's where The Ingraham graduates come in."
Tim saw a mental image of the "Where Are They Now" board and the pieces began to fall into place.
"All those inner-city clinics, the nursing homes..."
"Precisely. The inner cities especially are loaded with disconnected people of no social significance who do not care for their health and are consequently rife with diseases—some of them might be described as ambulatory pathology textbooks. We needed a way to funnel those patients to the Kleederman medical centers where investigational compounds from Kleederman Pharmaceuticals could be tested on their many and various conditions. Since we could not count on enough run-of-the-mill physicians to come through for us, no matter how much of a bounty we offered them, the Foundation decided to produce a custom-designed model of physician to serve its needs. And the only way they could see to do that was start their own medical school. They bought Laurel Hills hospital, turned it into a top medical center, built a medical school adjacent, and voila, The Ingraham."
"So you admit it, then!" Christ, it was true. No reason for Alston to make this up. "You have been brainwashing us!"
"Brainwashing is such a loaded term, Mr. Brown. Attitude adjustment is much more palatable. You see, with its well-connected board, the Foundation had access to all sorts of government agencies. The Vietnam war was going full swing then, and one such agency developed something called a subliminal learning and indoctrination unit for use on U.S. troops before they went overseas—to give them the proper attitude toward the war effort and their Viet Cong enemies. But the SLI proved impractical for that use. It worked, but it took years to achieve its maximum effect, so the project was defunded. The Foundation saw a use for the SLI units and intercepted them on their way to the scrap heap. They hired the original designers and technicians to perfect them and retool them to the Foundation's needs, and the units have been in use at The Ingraham with great success for almost two decades now."
"That's brainwashing," Tim said. "Pure and simple."
"No. Attitude adjustment. We don't wash your brain, we don't change who you are, we simply mold your attitudes concerning the appropriateness of certain sickly individuals reimbursing society for all the benefits they have reaped but never contributed to; or of allowing other individuals with but a few useless years left to help make this world a better place as they take leave of it. We also incite in you a desire to practice where you are most likely to run across such patients. And when you do find a disconnected individual suffering from one of the more common ailments that afflict mankind, you feel a compulsion to refer that individual to the nearest KMI medical center."
Tim thought of Dorothy, the cadaver he shared with Quinn. Her doctor had been an Ingraham graduate who referred her to the medical center next door. She didn't leave it alive. Had she been a human guinea pig? And he thought again of all those Ingraham graduates working the inner city clinics across the country, all connected to KMI medical centers. This was big.
He swallowed his loathing.
"So all this talk about rationed medical has been a smoke screen."
"Not completely. Rationed care is on the way, I guarantee it. But that was merely a vehicle to introduce the concept of social tiering to your conscious minds while the SLI units were whispering it to your unconscious."
"How? I've never heard of a subliminal method that's a hundred percent effective."
"None is. But The Ingraham system works—not by chance, but by careful selection of its students."
Dr. Alston pulled a chair closer and sat a few feet before Tim, leaning forward, his face and hands more animated than Tim had ever seen them. An air of suppressed excitement crackled around him. He was really into his story now.
"The special entrance exam is the key. Because The Ingraham is the so-called '24-karat medical school,' all the best pre-med students in the country apply here. From those applications we choose the brightest and most outgoing, and we invite them here to spend the day and night before the entrance exam—actually, we insist on it, but we're euphemistic about it. While they're asleep in the dorm the night before the exam, we introduce them to the SLI unit by implanting information in their unconscious minds about a non-existent formula called the Kleederman equation. In the exam the following day, we ask them three questions about the Kleederman equation. Those who answer them correctly reveal themselves as being susceptible to the SLI's influence. In one fell swoop we've identified the susceptible subgroup out of our applicant population. We choose our students exclusively from that." He barked a laugh. "Isn't it brilliant?"