by Ken Brigham
He looked around the table. The others nodded tentatively but didn’t say anything. What appeared to be a wry smile crossed Mitchell Rook’s face. Cy noticed that, but a wry smile was Mitchell Rook’s default expression so that Cy wasn’t sure whether Rook was reacting to the conversation or not. Cy had thought for a while that he should keep a closer eye on the dapper lawyer.
“You know, Rory,” Cy responded, “ordinarily, I’d agree with you, but these results are truly extraordinary, like nothing I’ve ever seen. And I’ve been dealing with Alzheimer’s patients for almost twenty years now. Bear with me for a few minutes, Rory. You may find yourself sharing some of my excitement.”
Cy switched on the laptop and Beth, on cue, got up from her chair and dimmed the lights in the room. The multicolored slide was titled Cognitive Function Over 3 Months in a Single Patient With Moderately Severe Alzheimer’s Disease. The figure was a line graph that ascended dramatically from its starting point, forming an essentially straight line connecting the dots at baseline with the progressively higher dots at one, two, and three months. Cy didn’t speak for several seconds, just stood apparently mesmerized, staring at the graph. The others also stared at the graph, although they appeared less rapt than their host.
Finally, Cy said, “You will pardon me, gentlemen, if I seem to get emotional about this, but understand, these results are unique. Such dramatic improvements in brain function just don’t happen in this disease. Not only am I certain that this subject was taking RX-01, but I am tempted to believe that the drug may not only stabilize the disease as we thought from the animal studies. Gentlemen, RX-01 could be a cure for Alzheimer’s disease. I don’t need to spell out what that means for human suffering and, of course, for the marketplace value of the drug.”
He advanced to the next slide. It was a similar graph except the changes it showed were in the concentrations of a blood protein that he maintained was a biochemical marker of Alzheimer’s disease activity. This line plummeted from the baseline value through months one and two to near zero at month three.
Cy said, “These biomarker results are entirely consistent with the improvements in cognitive function. This fortunate gentleman may be the first person in human history to be cured of this dreadful disease.”
He switched off the computer. Beth got up from her chair and raised the lights again. The melodramatic presentation quieted the group for a few minutes.
At last, Will Hadley said, “Well, Cy, this is indeed exciting. But aren’t you overdoing it a bit? Shouldn’t we wait for some more results before getting so overheated? I mean, this subject still has three more months in the study, and his final six-month data will be critical. Not to mention results from the other subjects.”
“Of course, you’re entirely correct, Will. I apologize if I’ve gotten carried away about this. But it is just that I have never seen anything like it before. And the possibility of a cure, I mean a cure! Well, if I’m overreacting, please indulge me a bit. Time, of course, will tell.”
“So, Cy,” Mitchell Rook said, “when will you move on this, start trolling for big pharma interest? Waiting for more results is a risk. If what you’ve shown us isn’t supported by the additional studies, the value of our investment may be at its peak right now.”
“Damn straight,” Rory Holcomb interjected. “Damn straight, Cy. What do you plan to do? How can we realize something out of this, something real and green?”
“Well,” Bartalak responded, “here is what I suggest. If this subject’s six-month data continue to show such dramatic improvements, I’ll take the data to the DSMB…”
Rory interrupted, “What in hell is the DSMB?”
Cy answered, “Sorry, Rory. That’s the Data Safety Monitoring Board. It’s a group of experts who have to approve any move like this. They can be a pain, but they’re necessary.” “If you say so,” Rory grumbled.
Bartalak continued, “I’ll see whether the board will agree to breaking the code for this subject and whether they might be inclined to start thinking about stopping the study early because of the strikingly beneficial effects. That would depend on results from other subjects as well, but if we could do that, we’d be sitting pretty with Big Pharma negotiations.”
“So,” Rory said, “this guy’s six-month results will decide the thing?”
“Yes,” Cy answered. “Well, those and the results from the other subjects. Those will be coming along over the next few months as well.”
“A whole lot riding on this guy’s six-month tests,” Rory mused aloud, scanning the faces of the others.
Rory’s gaze paused at Beth as their eyes met for a moment.
Three months later, when Beth first saw the results of the final studies on subject number one, that lunch meeting was still clear in her mind. Although she had shared Cy’s excitement at the time, she thought he went overboard in the presentation. She didn’t question that, of course. Cy would not have liked having his judgment questioned and Beth did not do things that she knew would displease her husband. But Beth was very uncomfortable with that lunch meeting. As a result of that meeting, she had been anxious to see the six-month results from the first subject. When she first saw the data, she was shocked and confused about what course she should take. Because of the way the study was structured, Beth was the only person who had access to the data and could connect it with a specific study subject. The six-month studies on subject number one showing marked deterioration in cognitive function and a marked increase in the blood protein that indicated disease activity were her private knowledge. She agonized about what to do with that knowledge.
Beth pondered her dilemma as she ran through Warner Park early in the afternoon. Dark clouds hovered overhead, and a warm soft rain clattered gently through the leafy canopy. Birds twittered among themselves oblivious to the lone figure intruding on their private space. Beth liked running in the rain. She relished the feeling of solitude that the rain lent to the experience. And the cleansing sensation of fresh water falling from the heavens washing over her. The exertion and the cleansing rain purged her body and cleared her mind.
As she ran, she remembered something her father often said about rules. “Rules,” he said, “are arbitrary. They are not boundaries, but just the place where you begin negotiations.” Beth liked that idea. And even Cy had said many times that smart people create their own reality. “Perception is reality,” was a favored mantra of his.
It would not be difficult for her to create a favorable perception of how subject number one had responded to the drug. She had exclusive control of the data. She could just replicate the three-month data with enough modifications to make it credible and present those as the results from the final six-month studies. Cy need not know about her little ruse. He wouldn’t question the data. What was it he said, “Don’t ask questions if you don’t want to know the answers?” He wouldn’t question results that confirmed his expectations. And he trusted her. She was sure of that. Trusted her to see that his expectations were realized. She wouldn’t disappoint him.
But if subject number one really was deteriorating as badly as the tests indicated, that was likely to be discovered. That bitch Katya Karpov was responsible for the final clinical examination and for following the subjects after conclusion of the formal study; she would surely recognize the situation. If this really was a delayed toxic effect of the drug on the brain, it would be impossible to hide forever. Of course, it was only necessary to maintain the perception long enough to cash in on the investment. Whatever happened after that was immaterial. But if Cy was to cash in, he would have to know the real situation before anyone else did. And Beth knew that Cy needed plausible deniability. She could manage that.
As she loped down the hill toward the park gate, a brilliant flash of lightning illuminated the park’s green expanse and a crash of thunder ushered in a sudden torrential downpour. She picked up her pace, sprinting face-on into the driving rain down the boulevard to their home and collapsing breathless in he
r wet clothes in the foyer. As she sat there, her breath coming in short gasps, she decided what she had to do. It was subject number one’s brain that was the problem.
Beth still sat on the foyer floor, pondering her next move when the ringing phone interrupted her thoughts. She was tempted to ignore the phone, but after several rings decided to answer it.
“Bartalak residence,” she said.
“Beth,” a vaguely familiar voice responded, “this is Rory Holcomb. How are you?”
Beth assumed that Holcomb must want to speak with Cy for some reason; she said, “Oh, hi Rory. I’m fine, thanks. But Cy isn’t here just now.”
“Actually I wanted to talk to you, Beth.”
“Me?”
“Does that surprise you?”
“Yes, it does. What did you want to talk about?”
“Well, Beth,” Rory answered, “it’s been about three months since that lunch meeting where Cy was so worked up about the results from the first subject in the drug study. I was wondering whether the follow-up studies were done yet. And I figured that you were the person who would be most likely to have that information. Thought it might be best to get the info directly. Your husband can get a little heavy with the sales pitch. And it seems there’s a lot riding on those results. What can you tell me?”
Beth didn’t respond immediately. Damn, she thought. She wasn’t going to tell Rory or anyone else anything about those results. Probably not even Cy. She was going to take care of that situation herself.
Finally, Beth said, “Well, the lab studies were done, Rory, but we are still analyzing the data, and the final clinical exam hasn’t been done, so there’s not much to tell yet. I’m certain Cy will inform all the stakeholders as soon as we’re sure of the results.”
“Not even a hint? How much analysis do you need to do? Aren’t the measurements pretty straightforward? Either the guy is still getting better or not. Which is it?”
There seemed to be an urgency in Holcomb’s voice that troubled Beth. Did he suspect something? She didn’t see how that was possible. No way could Holcomb know that Bonz Bagley had been that first subject. And even if he did, he couldn’t have suspected how bad the test results were. Holcomb did know Printers Alley, owned most of it was the rumor. So she guessed that he might have some connection with Bagley. Maybe he had seen some change in the old man’s behavior or something. Damn!
“It’s just not that straightforward, Rory,” she finally responded. “I’m certain that Cy will fill you in just as soon as we have the answers you’re looking for.”
“Well, he damn sure better fill me in, Beth,” he paused for a moment and then added. “You’re not hiding something, are you? That wouldn’t be very smart, you know.”
“Of course not, Rory,” Beth answered. “Of course not. You’ll get the information. Cy will fill you in at the right time.”
“See that he does, Beth,” Rory said and hung up.
If Beth had harbored any doubts about what she had to do, that conversation with Rory Holcomb laid them to rest. She would go about the task with all the meticulous care that she devoted to any task that she took on. She would do what had to be done.
Chapter 15
Dom Petrillo walked the six blocks down Broadway from the United States Attorney’s office to the Batman Building. The US attorney’s office was housed in a nondescript building near Broadway and Eighth Avenue. The building was named for Estes Kefauver, the former Tennessee senator and one-time vice-presidential candidate who was remembered mainly for the trademark coonskin cap that he wore when campaigning. That fact amused Petrillo. He wondered if there was another federal building in the country named for someone with so pedestrian a public memory. Of course he knew that the answer to that question was yes. There were probably several.
When he exited the front of the building, he always looked to his left toward the grand old Post Office building, transformed compliments of the prodigious monetary rewards of for-profit medicine, into the Frist Museum. And across the corner sat the pale gray stone façade of what was still Hume Fogg High School, alma mater of Dinah Shore. “See the USA in your Chevrolet,” he hummed to himself.
Petrillo looked up at the twin spires of the Batman Building as he made his way from Broadway up to Commerce Street toward what had become in the few years since its construction an iconic feature of the Nashville skyline. The thirty-three story skyscraper was built in 1994 with what was then South Central Bell as the anchor tenant. It became officially the AT&T building when the Baby Bells re-coalesced into the original megabusiness that determined how most Americans communicated with each other. Whether the deliberate creation of an architect with a sense of humor or the result of an accident of design, the building’s silhouette—twin spires joined by a black arced roof—was strikingly similar to the familiar Batman logo. So the building was known from the time of its completion as the Batman Building regardless of what company’s logo adorned its facade.
Petrillo was amused by the building as he was amused by much about this oddly idiosyncratic town. It was a town, not really a city. Petrillo grew up in Brooklyn and still missed the excitement of life in The City, in his view the only city worthy of that designation that Americans had managed to build. His assignment to the federal prosecutor’s office in Nashville was not his choice. He was sent there. But he had been delighted to discover on arriving that his old friend, Mitchell Rook, the smartest person it had ever been Petrillo’s privilege to know, had established himself as one of the cities foremost business lawyers. Rook had done a brief stint in the Washington federal attorney’s office about the same time that Petrillo was resigning himself to a career as an indentured servant of the federal government. They had become quite good friends for a while before Rook decided to return to his hometown, enter private practice and enjoy the monetary benefits of attending to the interests of the high rollers, forsaking the much less lucrative business of finding ways to lock up bad guys. Rook and Petrillo reconnected in Nashville. That still seemed an unlikely locale for their reunion to Petrillo. Maybe serendipity. Their reunion had turned out to be fortuitous.
Petrillo entered the soaring atrium of the building at 333 Commerce Street, aware of the click of his shoe heels on the terrazzo floor as he walked to the bank of express elevators that bypassed the first twelve floors. He waited with an expanding clot of faceless people for what seemed like five minutes before a car arrived that was going up. He edged his way into the elevator, elbowing aside an overweight man with red braces and a red bowtie showing beneath his unbuttoned pinstriped suit jacket; a lawyer, no doubt. Petrillo leaned over and punched the button to floor fifteen, retreating to the rear of the car as the Batman Building express sped skyward.
The offices of Rook, Lipchitz and Associates, LLC, occupied floors fourteen and fifteen. The main reception area was on the fourteenth floor, but Rook’s office was on fifteen, and Petrillo chose to bypass Sarah, the lovely receptionist with an incongruous British accent who greeted the firm’s clients on fourteen, and go directly to his old friend’s office on the floor above.
During the ascent, Petrillo recalled the sequence of events that brought him there. The attorney general had called from Washington directly to the head of the US attorney’s office in Nashville with the request. Warren Hedgepath, senior senator from Texas, had contacted the attorney general. It seems that a close friend of the senator had been a major investor in a startup company that a well-reputed academic psychiatrist, Cyrus Bartalak, had founded in Houston when he was on the faculty at a university there. The company was founded to develop a new antipsychotic drug that Bartalak had discovered. Based on very promising preliminary clinical data, Bartalak had struck a deal with a major pharmaceutical company to continue developing the drug. When Bartalak moved from his position in Texas to Nashville, he had sold his interest in the startup company to Hedgepath’s friend, claiming that since the company was a subsidiary of the university in Texas with which Bartalak was no longer affiliated
, it would not be proper for him to maintain an interest in the company. The drug looked so promising at the time that Bartalak sold his interest at a premium. However, since Bartalak’s departure, further clinical studies of the drug didn’t go so well, and the value of the startup was plummeting. The senator’s friend strongly suspected that Bartalak knew something that he didn’t reveal in the transaction, and he was livid. “The guy is a crook,” were his words to the senator. Hedgepath had total confidence in his friend and if this Bartalak guy was a crook, the attorney general ought to nail him!
Senator Warren Hedgepath was a very powerful man who had recently taken on what he saw as corruption in academe as a cause celebre. He and his sizeable staff were ferreting out every detail of industry-academic relationships, scrutinizing the finances of allegedly underpaid professors who seemed to live too well. His people busied themselves chasing the sources of the money that supported the incongruous affluence of those few members of the tightly knit academic medical community who apparently considered themselves protected by an impervious shroud of presumed academic integrity and therefore immune to the scrutiny of headline seeking politicians. “Bullshit,” Hedgepath said. He had used the power of his office to demand detailed information from universities in a number of cases, information that raised serious questions about the time-honored mantle of presumed academic integrity. Bartalak was a big fish. If they could nail him, it would “bode very well for the stature of the Department of Justice” in the senator’s words.
So when his boss chose to drop this hot potato in Petrillo’s lap, he was delighted. He had instigated a quiet investigation of the professor, taking care not to tip his hand. While he hadn’t uncovered anything specific, he had found that some of Bartalak’s colleagues were not complimentary. Off the record, some even strongly suspected that Bartalak was less than completely honest. And he did live very well, way better than his university salary could explain. When Petrillo found out that Bartalak was founding another startup to develop yet another drug that he had discovered, he proposed the sting operation to his superior.