• • •
Archibald’s office, on the top floor of the facility’s administrative section, looked as if it had been designed by machines, instead of populated by them. All steel and glass with nary a piece of wood anywhere in evidence. It was open and sparsely furnished—it seemed to focus on an entire wall of windows, which overlooked a small pond, currently featuring a large family of ducks swimming about. I had to admit it was indeed a pleasant view, though not one worth giving up all notion of traditional furnishings, in my mind.
“Please, Mrs. Fletcher,” Archibald said, offering me one of two matching chairs that looked salvaged off a decommissioned NASA space shuttle.
I sat down, both chairs angled to take advantage, you guessed it, of that peaceful pond view beyond the wall of glass.
“Now that I’ve bored you with the technology behind the drug business,” he started, “what is it you really came here to learn?”
I fished a notebook from my bag, honestly intending to make notes, since I didn’t trust my normally reliable recall for a subject with which I was so unfamiliar. “Cold White Death deals quite a bit with clinical trials.”
I hesitated there. If my statement had rattled Jeffrey Archibald, he wasn’t showing it in the least. His relaxed expression hadn’t changed at all.
“I was wondering if you could share some of the high- or lowlights from your experience with them.”
“Well, let’s start with the fact that more than nine of every ten drugs that even make it as far as the clinical research phase fail in human testing and thus never reach market. Not many baseball players, I’d venture to say, would have much career security if they batted only a hundred.”
“True enough.”
“It’s remarkably frustrating, because you begin development of any drug with only the highest expectations in mind. You know what I say the most in describing what it’s like to work in this industry? That you need to have a pair of both rose-colored and dark glasses. Rose-colored to see the miracle you believe you’re creating and dark to hide the tears when the miracle fails.”
“An apt way to put it, I suppose,” I said.
“The challenges posed by the clinical-research phase make this business a study in rejection and failure.” Jeff Archibald leaned back casually in his chair. “But you’re not here to listen to me ramble on and on.”
“I’m here for insight into your industry in general and the whole business of clinical trials in particular. For instance, in the book, in Cold White Death, I focus a bit on what happens when a hospital is conducting trials no one even knows exists, including the FDA. Might such a thing be possible?”
Archibald didn’t look bothered at all by my question. “You’re talking about rogue studies. And they do happen from time to time, very rarely, usually when a company like LGX gains distribution rights for a drug, say, manufactured in Sweden or France. A rogue study might be commissioned in advance of entering into an agreement, to at least confirm the drug’s efficacy before making a major marketplace commitment to it. I can’t say it’s something I support or would entertain myself, Mrs. Fletcher, but it does happen.”
I thought of Mimi Van Dorn dissolving the trust dedicated to her son’s care, how Seth Hazlitt suggested the reason behind her doing so might be her body dysmorphic disorder.
“What about paid studies, Mr. Archibald?”
That got a slight rise out of him, kind of like a shock to his spine. “You mean, as in a potential subject buying their way into a trial? It’s virtually impossible, given the breadth of the oversight involved.”
“With a standard trial, sure,” I elaborated. “But what if the trial in question was one of those rogue studies you mentioned?”
“I can tell you it happens more than anyone realizes. Take for-profit stem cell clinics, for example, that are known to charge patients to get experimental ‘treatments’ that have not been proven to be safe or effective. But it doesn’t stop here, Mrs. Fletcher. Also pertaining to stem cell clinical trials, the FDA occasionally permits the institutions involved in the research to charge patients, especially if an approved drug is being tested for a not-yet-approved use. It’s kind of a gray area.”
“Murky, at best,” I agreed.
“You’d be surprised to learn just how often the FDA grants permission to charge patients for trials involving more than just experimental therapies like stem cells. And that, of course, raises its share of ethical questions. Should someone, even if that someone is an academic clinical researcher, be able to charge a patient a large access fee to be in a clinical trial in which that patient will be subject to an experimental therapy that could ultimately prove to be unsafe and ineffective? The general term for this is ‘pay-to-participate’ trials, and they’re becoming more and more common as drugs are being made available, especially for terminally ill patients, on an increasingly open basis without the safeguards and oversight that used to be the norm. What do these patients have to lose, right? The problem is the industry, as a whole, stands to lose plenty, because those kinds of lax practices tend to filter down to more established clinical research. In for a penny, in for a pound, as they say. Because of that, the National Institutes of Health has begun to clamp down on that practice.”
The sun streaming through the glass was in my eyes now, and I shifted in the chair to find an angle that might block it. “What if the FDA wasn’t in a position to grant permission for one of these pay-to-participate studies?”
“I don’t think I understand your question.”
“That is, if the hospital in my book was dispensing unapproved drugs to patients willing to pay for them under the auspices of a clinical trial.”
“Well, they’d have to get the drugs in question from the pharmaceutical concern that manufactured them.”
“That’s what I was thinking—in which case, the manufacturer and the hospital would have to be in league with each other.”
“You mean, like a conspiracy?”
“Does such a thing happen, Mr. Archibald?” I asked him, holding a hand up to shield my eyes from the sun’s glare, so I might be able to better follow his reaction and body language.
“Only in the minds of writers, Mrs. Fletcher.”
“But such a thing wouldn’t be possible without the knowledge and participation of the drug company in question.”
“Theoretically.” Archibald smiled, but it didn’t look as engaging or sincere as the previous ones he’d flashed. “In your book, that Big Pharma company’s corrupt CEO could have been forced into the game, because he’s being blackmailed, or maybe to save his failing companies.”
“Ah, a desperate man, then.”
“A staple of the mystery genre, I’d imagine.”
“Desperation is indeed, Mr. Archibald. But it wouldn’t have to be the CEO, right? It could be another high-level executive, somebody with the power and access to make the drugs in question effectively disappear. The perpetrator might then split some percentage of the profits with the hospital conducting the study. Such a practice could be quite lucrative, I imagine.”
Archibald nodded his agreement. “Do the math, Mrs. Fletcher. If there were a hundred people in this paid study, just multiply the access fee by a hundred. In the case of someone desperate to reap what the drug might be able to give them, that could amount to a very significant sum.”
“Stretching into the six figures, I imagine, even seven.”
“Again, do the math.”
I did, in my head. A hundred thousand dollars times a hundred patients would be ten million dollars for one study alone.
I thought of Mimi Van Dorn’s broken trust.
I thought of the desperate plight that had brought George Sutherland to the Clifton Clinic. How much would people of limited means like Jean O’Neil be willing to pay to extend their lives, however modestly? I imagine savings would be drained, bank accounts emptied. A mo
nstrous practice, but one that would have no problem finding willing participants, if handled properly and discreetly.
The way Charles Clifton would be handling it, in other words. Reflecting on his part in this reminded me that this clinic was envisioned as the flagship of a nationwide chain.
Do the math. . . .
I tried. Several ongoing rogue trials at each facility, involving dozens of patients on a fee basis to gain access and acceptance, a fee potentially of the order requiring that a trust be broken or maybe a house be sold. It was difficult to even calculate the potential profits to be split between the hospital and the manufacturer slash supplier.
“How close do your books come to real-life scenarios like this?” Archibald asked me.
The sun must’ve dipped behind part of the steel framing supporting the wall of windows, allowing me to meet his stare, which had gone cold and distant. “It’s all about justice,” I told him. “Stopping a villain who’s already claimed at least one victim before he can claim any others.”
Archibald managed a smile. “Are we talking about Jessica Fletcher or J. B. Fletcher?”
I met his gaze, unable to glean the message behind it. “To tell you the truth, sometimes I don’t know myself.”
“Well, Mrs. Fletcher, here’s something I know. You might have a negative opinion about paid clinical trials, but what do you call it when an insurance company fails to provide a desperately needed drug because the cost is deemed too exorbitant?”
“Unfair.”
Archibald nodded. “Indeed. That leaves the patient with the choice to either accept a far cheaper drug, certainly not to be nearly as effective, or to pay for the superior drug out of pocket. Then consider all that treatment would be subject to the patient’s ridiculously high deductible and eighty percent of hospital costs. You really see a lot of difference between that scenario and paying to receive a drug that might be the only thing that can save a person’s life?”
“You mean, besides the fact that one’s legal and the other plainly isn’t?”
Archibald was about to respond when the double doors to his office opened and a woman entered, grinning from ear to ear.
“I’m sorry to intrude, but I just couldn’t help myself.”
She made a beeline toward me, and I realized this must be Jeffrey Archibald’s wife.
We both rose.
“I was just helping Mrs. Fletcher with her next book.”
Her jaw practically dropped. “No? Really?”
“Tell Allison the title, Mrs. Fletcher.”
“Cold White Death.”
“I love it!” She started to reach into a tote bag she’d slung over her shoulder. “I hope you don’t mind I brought a few books for you to sign.”
“It would be my pleasure,” I told Allison Archibald.
“Make that one out to my husband.”
“Sure thing.” I met Archibald’s gaze as I started scrawling with my trusty Sharpie. “For Jeff,” I recited, “who made my next book possible.”
Chapter Twenty-two
I spotted Harry McGraw standing outside his rental car when I finally emerged from LGX Pharmaceuticals.
“You took your sweet time in there,” he groused. “Good thing the meter’s running.”
“Keep it running. There’s another stop we need to make.”
“I do have a life, you know.”
“Really?”
“No, but don’t rub it in. Your chariot awaits, my lady. Where to next?
“A memory-care facility where Big Al McCandless currently resides.”
“Who’s Big Al McCandless?”
“Former police chief of Marblehead, Massachusetts.”
“Do I want to know why you need to see him?”
“I’m not sure myself yet. Just a feeling.”
“Ah, one of those . . .”
“It’s called Briarcliff Gardens and it’s in Johnston, Rhode Island, pretty close to where we are now. That’s what made me think of it. You okay with extending your chauffeur’s duties long enough for me to pay a visit?”
“So long as you don’t leave me there,” Harry said, climbing back behind the wheel.
* * *
• • •
I couldn’t get out of my mind what Tom Grimes, Alvin McCandless’s successor as police chief in Marblehead, had said about driving Mimi Van Dorn to Massachusetts General Hospital in the wake of her son’s car accident. How she’d been on her cell phone practically the whole time, speaking to someone in too hushed a tone for him to discern even her end of the conversation. And though all the revelations of the past few days had made me wonder how well I actually knew Mimi, such behavior didn’t seem even remotely possible for a mother confronted with the tragedy that her son might never walk again.
Grimes may not have been in a position back then to know any of the other particulars about that night, but Big Al certainly was, although it might test the limits of his beleaguered recall.
“Learn anything helpful in there?” Harry asked me as we reached the on-ramp for Route 146, heading from Lincoln to Johnston, Rhode Island.
“I’m not sure.”
“What happened to yes or no?”
“LGX’s CEO is a tough guy to read.”
“Even for you?”
“I think he knew more than he was saying, even though I can’t pin down what makes me feel that way.”
“Maybe because everybody knows more than they say.”
I looked across the seat at Harry. “I don’t think the Clifton Clinic could be carrying out rogue clinical trials with drugs manufactured by LGX without him, or somebody else high up in the company, knowing.”
“And what’s that say?”
I reached inside my bag for my cell phone. “That George Sutherland needs to know exactly what he’s dealing with here.”
But George’s phone went straight to voice mail, and it would now be evening before I got back to Cabot Cove to check on him in person. If my suspicions were correct, Mimi Van Dorn had liquidated her trust to pay for an experimental antiaging drug that was part of an off-the-books study. And since LGX also manufactured the drug George would be receiving in another of those potentially illegal studies, it stood to reason that he, too, had paid for his place.
Franklin Roosevelt once said, “When you reach the end of your rope, tie a knot and hang on.” In a predicament like George’s and even Mimi’s, though, sometimes you keep slipping to the point that you’re willing to grasp for any modicum of hope, no matter how slight. Their situations were entirely different, of course, but Mimi’s condition would’ve rendered her equally desperate for a drug that could impact how she looked in the mirror.
All that made sense, to some degree anyway. I couldn’t find the sense, though, in the murder of Tripp Van Dorn, to the point where I began to question my own conclusions. I was basing my suspicions solely on the back of his hair having been smoothed into place, to cover the slight bruise I was certain a closer examination would reveal. If that was all there was, though, maybe my power of observation had deceived me and Tripp’s hair had lost the depression through entirely mundane means, like memory foam.
“Oh my,” I said just loud enough for Harry to pay attention.
“Oh my, what?”
“Tripp Van Dorn.”
“The crippled kid?”
“It was missing.”
“What was missing?”
“The family picture. It was on the wall when I came to see him, but was nowhere in evidence when he was found dead.”
Harry started to change lanes, until a big truck already there honked its horn and chased him back. “So the kid was killed because of this missing picture?”
“More likely, the killer took it with him for reasons I can’t see yet.”
“You sure can pick ’em, Jessi
ca,” Harry said, shaking his head.
“People?”
“Cases.”
“I’ve come to the conclusion that they pick me.”
“And if I was any kind of friend, I wouldn’t be driving you to see Alvin McCandless. I think you’re driving yourself crazy with all this.”
“All writers are a little crazy, Harry.”
“But this is a lot crazy.”
* * *
• • •
Big Al McCandless was still big. Just ask anyone who tried to change the channel on the flat-screen television in the Briarfield Gardens lounge when he was watching an old cop show on one of those nostalgia stations.
“Can I ask you a few questions, Chief McCandless?” I said, taking the chair next to his, while Harry hovered back in the doorway.
He seemed to perk up at being referred to that way. “Not yet. Bad guys to catch. Can’t you see?”
And he returned his attention to the screen, where I thought I recognized an episode of the classic Untouchables playing.
“Do you remember catching bad guys, Chief?”
“I can’t remember because it hasn’t happened yet. Never does until the end of the episode.” He gave me a longer look. “Are you my wife?”
“No, Chief.”
“Do I have a wife?”
“I believe you do.”
I realized a commercial was playing, explaining Big Al refocusing his attention on me, looking suddenly wary. “If you’re not my wife, who are you?”
“My name is Jessica Fletcher.”
“Are we friends?”
“We’ve never met before.”
“Then why are you here, Ms. Ness?” he asked, confusing me for the Eliot Ness character on the TV show he was watching.
“I wanted to ask you about a tragic car accident that happened while you were still chief of police.”
“Chief of police for what?”
“The town of Marblehead.”
Big Al shook his head, starting to refocus his attention on the flat-screen, as if knowing the commercial was going to end. “Nope, I worked in Chicago,” he said, pointing at the screen. “See, there. Windy City, they call it, home of the Bears and Cubs.”
Murder, She Wrote--Murder in Red Page 16