Alan E. Nourse - The Fourth Horseman

by Alan Edward Nourse

  Vaccine, of course, was the major weapon to create immunity and prevent people from becoming infected at all. Antibiotics with which to treat the ones already sick, the ones exposed and never immunized—which was to say, virtually the entire mass of population—was- another matter altogether. One of Carlos's team of CDC people already had a rundown of drugs immediately available, size of the stockpiles, some tentative plans for additional shipments. Carlos leafed through the report, went back through it again and then looked up. "This is all just delightful," he said, "but what about the new Sealey 3147 antibiotic?"

  "You mean the new drug you were testing out in Colorado?"

  "Yes, of course."

  The young man blinked at him. "Well—you heard about the side effects, didn't you?"

  "I know it made a lot of people throw up," Carlos said. "But it also stopped the plague infection, and one bad side effect of this plague infection is sudden death. ..."

  "Well, I just talked to Atlanta ten minutes ago," the young man said, "and / heard there wasn't going to be any more 3147. They said that Sealey was withdrawing it."

  "Good Christ." Carlos turned back to the telephone, got a line open and finally made connection with Ted Bettendorf's office. "Ted, for God's sake, what's going on with my drug supply?" he wailed. "I can't get any information out of the vaccine people—"

  "Neither can I," Ted Bettendorf said. "They're playing that new vaccine veiy close to the vest, and I can't make them budge."

  "Well, what do they want?"

  "They want three months' worth of testing, plain and sim-pie," Ted said. "They're scared of the new vaccine, and they're scared of what's going on, and they want to cover their asses. And the way people have been suing everybody in sight for bad vaccine results, you really can't blame them. I'm working on it, but I don't see a breakthrough at this point."

  "Then what about the Sealey antibiotic?" Carlos demanded. "What's their problem?"

  "That's a little hard to say." Ted paused for a long moment. "There's something funny going on there. All of a sudden Sealey is very upset about those side effects out in Canon City."

  "You mean the vomiting?"

  "More than that. The later side effects. Vision disturbances and tremors."

  "Well, I saw a little of that," Carlos admitted, "but who says it was the drug? Monique ran all kinds of tests at Fort Collins—biochemical tests, in vitro tests, multiple animal studies. She found no problems at all, and we gave the stuff in quantity to over three hundred people."

  "Well, a couple dozen of those people have checked in with late side effects, and more are turning up all the time. It's not the sort of medicine we want to scatter broadside into the population unless we have to. The strange thing is that our lab people here have repeated Monique's test studies right down to the letter and have gotten bad results with the Sealey drug. Clearcut evidence of neurotoxicity, including a roomful of Parkinsonian guinea pigs."

  "You really think Monique could have screwed up on something like that?"

  "I don't know what to think," Ted said. "But all of a sudden Sealey Labs are pulling back. They want to take it back to the lab, and ordinarily I wouldn't argue with them."

  "Well, God damn it, they're cutting off my right leg," Carlos snapped, "and the vaccine people are gnawing on the other one. What the hell am I supposed to stand on? This isn't 'ordinarily,' Ted, it's a long old way from 'ordinarily.' We've got a live disease in this town. I need a preventive vaccine, and I need an antibiotic that kills the germ, and I need both of them fast. Now, somebody has got to break those things loose for me somehow, and if that means using some political heat, then let's fire up the stove."

  Muttering Spanish vulgarities under his breath, Carlos retired the phone and glared up at a startled-looking CDC aide. Carlos looked sheepish. "So now we'll see," he muttered. "Let's go find Jack Cheney. We've got a night's work to do."

  33

  The meeting took place on a hot, steamy morning in early September, a gummy, sticky day with barely a breath of heavy air moving off the Potomac—one hell of a day for major policy decisions, Ted Bettendorf thought as he loosened his shirt collar under his tie. He and Mandy had flown up from Atlanta very early that morning, using the plane flight for a final review of the drug-utilization statistics from Canon City, figures Mandy had spent all week rooting out since Carlos never had had time to complete a final report. It had taken Ted most of that week to get the meeting set up; there had been distinct reluctance in Washington to bite the bullet that had to be bitten, and Ted had had to exhaust every other possible approach before the thing could be brought out on the table officially. He had stuck to it because he had to. Carlos had to have the Sealey drug one way or another, and fast, and it didn't really look as bad from the toxicity standpoint as the earliest figures had suggested. Bad enough, God knows, but not intolerably bad. . . .

  They'd made Washington in time for a two-hour wall-banging session with Larson, an Undersecretary for Public Health in the Department of Health and Human Services, and then he had taken them over to the paneled White House meeting room in plenty of time for the 11:17 a.m. appointment—the Boss from HHS could come over later if it turned out that she were needed. A representative from the Food and Drug Administration was already there, a man named Tamisher, and Ted's heart sank—from many previous scrambles, Ted knew him to be a typically useless FDA functionary, possessed of impeccable biomedical credentials and an absolutely fantastic inability to come up with a really clean-cut recommendation about anything whatsoever. Well, we shall overcome, just the same. . . . The other party present was John Mancini, Vice-President in charge of Production at Sealey Labs, a short, broad man Ted had talked to endlessly on the phone but never had met, built rather along the lines of a granite headstone or a Mexican pig, Ted thought, not somebody you'd want to run into vn the road at any high velocity. . . . Mancini was flanked by a round, gray person named Lunch, who carried a briefcase, and a couple of others who kept to the background and took notes. And then, punctual to the second, the President, looking cool and relaxed on this fearsome hot morning, his smile engaging as ever, his California tan resplendent. "Now, then, gentlemen, let's get to it. Appreciate your coming out this morning, John. Can't be any hotter than Indianapolis, eh? You've met Bob Larson from Health and Human Services? Ted Bettendorf from CDC in Atlanta?" The President looked at Larson. "You got an answer on the vaccine thing, right?"

  "They'll bend the testing protocol a little if Tamisher will send them a letter. That'll speed things up a little."

  "Hear that, Ted? I told you you were worrying too much. Now, about the antibiotic—Bob, why don't you lead off?"

  Larson nodded. "To be brief, we've got a bit of a problem with this thing going on in Savannah."

  "Terrible thing," Mancini said. "I trust you people have got your thumb on it by now."

  "Not exactly," Ted Bettendorf said. "As you may have gathered from the newscasts."

  "But with a little help from your people, John, we're quite sure we can," the President added.

  Mr. Lunch whispered into Mancini's ear, and the Sealey man nodded. "Of course, of course. Anything we can do—within our rather severe limitations."

  "Specifically," Bettendorf said, "we need to expedite a field supply of Sealey 3147."

  Mancini frowned. "Dr. Bettendorf, I'm aware that you seem to have a great deal of interest in 3147, and this may perhaps be unfortunate. You're aware, of course, that the drug is still very much investigational—that is to say, experimental." (Whisper, whisper from Mr. Lunch.) "Make that highly experimental. You people know that—yet we seem to be encountering unprecedented pressure to turn this substance loose on a city of three hundred thousand people."

  "John," the President said, "I understand the circumstances are extraordinary."

  "But there are other antibiotics for controlling Yersinia. Streptomycin, chloramphenicol—why not use them?"

  "Because they don't work very well against this new strain of Ye
rsinia, " Bettendorf said. "That's why. We used 3147 in Colorado, and it worked."

  "That's delightful, but we also have a question of toxicity, some rather unfortunate long-term side effects. I can't imagine the FDA authorizing mass distribution at this point."

  "Well, now . . ." The FDA man coughed. "Dr. Betten-dorf's figures don't seem so alarming. With the administration's support, there are possibly some ways we could, um, authorize more, um, widespread clinical testing, even in the field—"

  "In a city of three hundred thousand people?"

  "Well, um, we'd have to review this veiy carefully, of course, exercise very close controls—"

  "You're not going to make any friends turning Savannah into an experimental drug farm, Mr. Tarnisher," Mancini said. "But assuming you're not interested in making friends, let's get down to cases: could you get me formal approval of a clinical testing protocol for 3147 down there within, say, forty-eight hours?"

  "Well, now—there'd be a great deal of red tape to be cut through, but—I—I—" Tarnisher glanced nervously at the President. ' 'I'm sure it could be done if we had a great deal of cooperation on all sides."

  "Fine, then that settles it," the President said, beaming and rising from his chair.

  "Not quite," Mancini said. "From Sealey's point of view it doesn't settle a thing."

  "What's the problem, John?" "Liability."

  "But surely if you have authority from the legally constituted Federal regulating agencies—"

  "Oh, that would be nice, but it really doesn't even approach the problem. That's why I drew Mr. Tarnisher into a commitment, which my associate Mr. Lunch here has duly noted down—I wanted to demonstrate how completely irrelevant government regulations are to the question. There's no problem providing the drug—we already have a considerable quantity in stockpile. But the problems of making it available are formidable. Dr. Bettendorf can confirm the difficulty of obtaining truly informed consent from any of the people who might receive this drug—under conditions of plague and panic. How's that?" He bent down to Mr. Lunch. "Oh, yes, a legally ironclad informed consent that would hold up anytime anybody might come back to us anytime in the future."

  Bob Larson cleared his throat. "These are not ordinary circumstances, Mr. Mancini. We're talking about a large number of people dying."'

  "Ah, yes, I know, and believe me, we'd like nothing better than to be more outreaching to those people. There was a time when people recognized that even the best of medications might occasionally have unfortunate side effects for some. That was simply considered the price we all paid to have the medication available for the vast number who might benefit, with no thought of making somebody pay when a bad effect did occur. Well, those were the days of innocence, gentlemen. Today Sealey Labs is being sued for alleged damages a forty-year-old man now claims to be suffering because the company may have manufactured a medicine that his mother took for excessive weight gain on two occasions while she was carrying him. He doesn't even know what company made the medicine; all he can establish is that Sealey is one that might have made it. Yet on the basis of his claim, Sealey is now involved in a class-action suit demanding a total settlement of—what was that figure, Mr. Lunch?—$600 million. And if that case is decided in favor of the plaintiffs, as it may well be, regardless of any merit to the claim, you will not have to worry about Sealey Laboratories cluttering up the market with new antibiotics because

  Sealey Laboratories will be in receivership. And if that occurs, since Sealey is a privately held company, we will simply destroy our development records and retire to the Caribbean somewhere, out of reach of the court. Our new-development drugs will go to no one."

  There was a long silence. Then Bob Larson said, "You couldn't license 3147 to be manufactured by some company less concerned about this problem? Perhaps someone abroad?"

  "That wouldn't change things a whit. If we license it, we're liable. And we oppose licensing new-drug patents to anybody unless forced to do so."

  "So what is it going to take to get 3147 to Savannah?" Ted Bettendorf asked.

  "Not much," Mancini said. "Just legally binding indemnification of Sealey Laboratories against any and all claims that might arise—retroactive to Colorado, as Mr. Lunch insists. We must be held totally harmless, with absolute guarantees, in advance, or Sealey 3147 stays on the shelf."

  " And I'm supposed to do this by executive order?" the President said. "No way."

  "There are precedents. The Swine Flu business ..."

  "Yes, and now we know better. There's no way I could do this without an Act of Congress."

  "Then there's no way Sealey could either," Mancini said, rising and gathering up his papers. "Plague or no plague."

  After they had gone, Ted Bettendorf looked around. "Mr. President?"

  "Mm?"

  "We need that drug," Ted said. "How do we get an Act of Congress passed?"

  In a small, expensive flat off Rittenhouse Square in Philadelphia, at two in the morning, Sally Grinstone suddenly sat bolt upright in bed, wide awake, staring into the darkness. "Just hold it a minute!" she said.

  Her companion, still not recovered after a full hour, stirred beside her. "Whazzat?"

  "Not you, dummy, go back to sleep. I've got to think."

  Think she did, and never more clearly than when she'd just been laid. She lit a cigarette in the darkness, brushed a spark off her naked belly and clasped her arms around her knees. As an investigative reporter for the Philadelphia Inquirer, and a very good one indeed, Sally Grinstone was one of those rare people who survived almost exclusively on the product of her subconscious. She read voraciously and omnivorously and never forgot anything she read, watched innumerable movies, gorged on TV at all hours and talked to anybody who would hold still to be talked to. All the time, she was "shoving it into the garbage can," as she put it, and when her subconscious shoved something back out at two in the morning, she had long since learned to pay attention—because this was where the red meat was going to be found.

  Sometimes, like now, she didn't know what she was after. Something was wrong with something she had seen or heard or read—so often, in the past her first clue to a really juicy morsel, but always hard to pin down. Something she'd read. Several hours earlier, before Teddie had gotten her turned on and distracted, she'd been reading about things going on in Savannah—God, what a mess! She'd been following this plague business extra closely since her trip out to Colorado, everything she could find about it, because she was dead-eye certain there was going to be a big story turn up there if she could just get hold of it. Sure as God wiped up the floor with reporters, there was going to be a big story there—but she couldn't see it yet. So what was her head trying to tell her now?

  Every cell in Sally's chubby, bouncy little body told her it was something important. Something to do with the plague, that was sure. Medicine was her special bailiwick; she had a dozen major newsbreak exposes to her credit in that area, two of them had won prizes and brought cascades of indignant denial from the medical establishment and the government and supportive howls of indignation from her readers, and even, in one or two cases, some real prosecution and some real legislation, and man, was there going to be an expose somewhere in this plague thing!

  She hopped out of bed, naked and sweaty in the close air of the flat, and went into the little alcove office off the living room. Something she'd read or remembered, but not directly connected with Savannah. There'd been a meeting in Washington, at the White House—no statement from the President, just a Press Secretary's report. Sally rooted around on her desk, a four-inch-deep clutter of junk beside her typewriter. Yes, here it was, Bernie'd sent it over, dear guy, or she'd have missed it completely. The President, some underling from H2S she'd never heard of before, an FDA advisor, and Mr. John Mancini—that was it! On the scene in Colorado, she'd seen him there, Vice-President in charge of production at Sealey Laboratories, Makers of Fine Pharmaceuticals, now in Washington talking to the President, flanked by a certa
in Mr. Lunch—ah, yes, she knew about Mr. Lunch from other sources. An indecisive meeting: the President urging FDA and H2S and Mr. Mancini to get together and resolve their differences and find ways to get around some awkward testing regulations on new drugs, on an emergency basis, of course, in order to get a new antiplague antibiotic drug on line fast, because they needed it in quantity in Savannah yesterday, not tomorrow. Odd that the President was doing the urging personally, that was what he had H2S around for in the first place, but that's what it said. Mancini's response was very indecisive for a drug man with a potential hot one on his hands. Some unfortunate problems, Mr. President. Some untoward side effects that turned up in preliminary animal testing made them very cautious about rushing into production— (Production? Preliminary testing? Wait a minute. They must have done their preliminary testing long since, they'd been using that drug on people in Colorado, from what CDC relief people had told her . . .). The President assuring Mancini of administration cooperation in any possible way to speed up resolving these problems—and then Mancini springing his trump: federal indemnification against all claims in perpetuity if they released the drug now in a "major population center," i.e., Savannah. An impossible demand, of course, what could the President say? More indecisive talk. End of report.