Bad Medicine

by Geoffrey M Cooper

  That done, I composed an email to all MTRI tenured faculty, reminding them that we had a meeting scheduled to consider the tenure cases of Mark Heller and Carolyn Gelman. We would discuss and vote on both cases Friday afternoon at two o’clock. I figured that a business-as-usual email would be good for Orlov’s boss to read.

  Desk cleared, I settled in for the more interesting task at hand. Checking the original medical records of Heller’s aloxinor trial. I hoped they matched the data he had reported—a response rate of around eighty percent. But given the discrepancy with Carolyn’s observations, I needed to verify Heller’s claim.

  The records were all in the institute’s patient database. I groaned when I saw the enormity of the file. There had been nearly four hundred patients enrolled in the trial, half of whom had been treated with aloxinor and half—the control group—with the standard treatment. Meaning that I’d have to examine a couple of hundred records to verify the outcomes of those patients who had received aloxinor.

  Well, I wouldn’t finish until I started…

  Luckily, once I began reviewing the charts, it wasn’t as difficult as I’d feared. The first page of each patient’s file summarized the outcome as either response or no response, with response meaning at least a fifty percent reduction in tumor mass for a month or more. Unfortunately, the responses were almost always followed by relapse when the cancer developed resistance to the drug—the problem that both Carolyn and Heller now hoped to deal with.

  I made two columns on a sheet of paper: Response and No Response. Then I started scanning the files, making a mark under the appropriate column as a running count of Roman numerals.

  It was relatively quick going to just scan the first pages of each file, so I got through the set of aloxinor-treated patients in a couple of hours. Then I added up the score.

  Response, 173 patients.

  No Response, 42 patients.

  A quick calculation told me that was a response rate of approximately eighty-one percent. Just as Heller had reported.

  I sat back, feeling puzzled. The data analysis was no surprise. Of course, the raw data matched the published results. But how to explain the difference between this and what Carolyn had observed?

  Idly, I started flipping through the chart of one of the patients who had responded, looking at the detailed record of his doctor visits. Suddenly, I did a double take. The patient’s tumor had shrunk after aloxinor treatment, but only by thirty-two percent. Not the fifty percent reduction that was required to qualify as a response to treatment. The classification of this patient as a response was in error.

  I looked at a second patient’s records. This patient’s tumor had shrunk by over seventy percent and had remained there for almost two months. Fine, a legitimate response. The next patient I looked at was also a legitimate response, so I started to relax. Maybe the misclassification of the first patient had been a clerical error.

  But then I looked at a fourth. This patient’s tumor had shrunk by just over fifty percent. Okay, good enough. But then I saw that it had grown back after only two weeks, not the month required for it to be called a response.

  Having two out of four patients misclassified as responders was a bit much to accept as accidental error. I kept going. It was slow work, but three hours later I’d made it through the detailed records of forty patients that had been placed in the responder category. Of those, only twenty-five were properly classified as responders.

  I did a quick calculation. If that applied to the whole data set, it meant that only sixty-two percent of the so-called responders were legitimate. Which would reduce the number of responders from 173 to 107. That was just about half of the 215 patients who had received aloxinor. Meaning the real response rate was around fifty percent, as Carolyn had observed. Not the eighty percent that Heller had claimed.

  I stared at those numbers in shock and disgust. I still needed to go through the rest of the patient records, but it was clear enough.

  Heller had faked the data to get his drug approved.

  Aloxinor wasn’t without effect, but it was no better than the standard treatment. By pretending that it was, Heller had committed the cardinal sin of medical science. He was guilty of a fraud that put the lives of patients at risk for his own personal advancement.

  I gripped the edge of my desk and took a deep breath. What I wanted to do was storm into his office and wring his scrawny neck. At least figuratively, by throwing him out of MTRI and bringing his career to the disgraceful end he deserved. Likely followed by prison time for this.

  But I held back. If he’d done this, was he also Orlov’s boss? His possible motive for sabotaging Carolyn’s career, even poisoning her patients to fake toxicity, was now clear enough. He had to stop her from discovering that aloxinor didn’t work as advertised. And if he was willing to endanger patients’ lives by faking clinical data, I wouldn’t put murder past him.

  This was potentially much more than scientific misconduct, and I needed to bring Karen in on it before I acted precipitously. Besides, she could help me work through the rest of the files.

  I called Karen to tell her I was on my way home. And that we had a lot to talk about.

  ***

  Karen had made a trip to Fisherman’s Catch and was waiting with clam rolls, a side order of onion rings, and a bottle of wine when I got home. No way she was going to miss dinner two nights in a row. It was almost seven, so we ate and had a glass of wine while I told her the news.

  When I finished, she polished off the last of the onion rings and regarded me pensively.

  “I’m impressed. You’ve done a good day’s work. Would anyone else have checked the patient records like you did?”

  “You mean like the IRB? They would have verified the number of patients that responded, but probably not have gone all the way back to checking the individual patient visits. I just stumbled into doing that by accident.”

  She shook her head. “Well, you’re right—I think Heller will see the inside of a cell for this. But the question still is whether he’s the one who directed Orlov.”

  “It looks pretty good to me that he is. Stopping Carolyn’s study before she wound up discovering that aloxinor didn’t work as advertised is certainly a strong enough motive.”

  “Agreed. I’m just not sure I picture him in that role. But you think we should go through the remainder of the files?”

  I sighed. “Yes, I think we should. Just to be complete.”

  “All right, let’s get to it then. We can talk more about Heller when we’re done.”

  I made a pot of strong coffee and gave Karen access to the files on her laptop. Then we split them up and started going through the remaining 175 patients that had been classified as responders. Even with both of us working, it took several hours, and it was nearly two in the morning when we finished.

  I added up the numbers. “Altogether, we have 112 patients who responded. Not the 173 that Heller claimed. And 112 is just over half of 215, putting the response rate at fifty-two percent. Similar to what Carolyn was seeing.”

  Karen nodded, then yawned. “Okay, so Heller’s a fraud. But is he a killer? I’m not convinced.”

  “What’s holding you back? This is the first time we’ve seen anyone with a motive that was strong enough to make sense.”

  “No argument with that. But I guess I’m having two problems. First, I’m not convinced that Heller’s sophisticated enough to hire someone like Orlov. You remember Orlov said he was initially contacted by Yuri Derkach, the biggest player in the Russian mob? How would someone like Heller be able to get Derkach working for him?”

  I stretched, trying to relieve the pain in my back from being hunched over the computer for hours without a break. “I don’t know, but that doesn’t seem sufficient to rule Heller out. Maybe he has Russian relatives, or an uncle who’s in the mob and has overseas connections. You can’t just assume he’s a nerd scientist.”

  Karen smiled. “Fair enough. But there’s another th
ing. Orlov told us that his boss had him do a couple of hits on drug dealers, in addition to his major job of taking down Carolyn. That doesn’t sound like Heller, either.”

  I thought about that one. Reluctantly, I had to admit she had a point. “Okay, guess I have to agree. So you think Heller’s fraud is just a coincidence?”

  She gave me a tolerant smile. “A coincidence? You know how much I like coincidences. No, I’m sure you’ve uncovered the motive. I’m just not convinced that Heller’s our man, at least not the major player. But I think I know how to find out.”

  “Yes? Don’t stop there.”

  “Not yet. I need to sleep on it and work through the details.” She got up and kissed the top of my head. “Let’s get some rest and talk about it in the morning. Don’t worry, I have a leading role in mind for you.”

  40

  It had been another long night, and I slept late. The clock said nearly eight when I woke up, and Karen was nowhere in sight. I slipped on bathing trunks and a T-shirt and made my way downstairs to the kitchen. I could just catch a glimpse of Karen and Rosie sitting on the beach. At least I assumed it was Karen underneath the enormous straw hat that pretty much obscured her face.

  Coffee was ready and a box of scones was sitting on the kitchen counter, so I filled a mug, grabbed a scone, and headed down to the water. Rosie ran up to me in greeting, and I sat down on the blanket next to Karen.

  “Morning, you’re up early.” I held up the scone. “Even made a trip to the bakery already.”

  “Glad you’re awake, lazy bones. Afraid my mind was running too fast to sleep in with you. And I had to call the Bureau to do a little quick prep work.”

  I took a bite of the scone, dropping some crumbs that Rosie pounced on. “Mm, this is good. Blueberry?”

  “I got some blueberry and some peach. Both good. Are you ready to hear the plan, or do you need to have your coffee first?”

  “Go ahead, I can listen and eat at the same time.”

  “I want you to start by sending Heller an email asking him to meet with you. Make it a nice email for Orlov’s boss to read, just in case it isn’t Heller after all. Then, when Heller’s in your office, I’ll have Orlov call the contact number. If Heller takes the call, he’s our man.”

  Maybe I needed the coffee after all, but I didn’t see how this was going to work. “He’s not going to take the call while he’s with me. He may not even have the phone with him.”

  She rolled her eyes. “You think I’m stupid just because I have this ridiculous hat on? Of course he’s not going to answer while you’re there. Although he probably does carry the phone, since Orlov said he immediately returns calls to the contact number.”

  “So you figure I’ll hear it ring?”

  “Maybe, but more likely he keeps it in silent mode. That’s what I had to call the Bureau about this morning. While he’s in your office, we’ll bug his, so we’ll hear if he returns the call from there after your meeting. And I’ll have watchers posted to keep an eye on him when he leaves, so we’ll see if he goes somewhere else.”

  I smiled approvingly. “Got it. Good to know your head’s still working underneath that monstrosity. What are you going to have Orlov say when he gets a return call? Just in case it’s not Heller.”

  “Just that his first try at taking us out didn’t work, but he’ll take care of us in the next couple of days.”

  ***

  The email I sent Heller almost made me gag. A career in the upper reaches of academic administration had forced me to be less than honest all too often—but this was perhaps the worst.

  Dear Mark -

  Could we meet at eleven this morning for a half hour or so? As you probably know, the faculty meeting to consider your tenure case is scheduled for Friday afternoon. Your record is of course overwhelmingly positive, and you can rest assured that I don’t expect any problems. I’d just like to spend half an hour or so with you to make sure that I have everything straight. All my ducks in a row, as they say.

  Brad

  Heller arrived promptly, and I sent Karen a quick text to let her know he was here. She was at York Hospital with Orlov, and this would be her signal to have him make the call.

  I waited expectantly for his phone to ring as I waved Heller over to my conference table. But no such instant gratification. As Karen had said, he probably had the phone on vibrate and would wait until after we finished to return the call. Meaning that I’d have to go through with this ridiculous charade of a meeting.

  He put his laptop on the table as he sat down. “Thanks for meeting with me. I appreciate the opportunity to fill in any gaps you need to present my case. How can I help you?”

  I needed to keep him here for half an hour to give Karen’s agents time to bug his office and get into position to tail him when he left. But the last thing I felt like doing was having a bullshit conversation with him for that long. Fortunately, the laptop he’d brought with him suggested a way out.

  “I don’t have any specific questions. As I said, your record is quite clear and convincing.” I was afraid he’d notice that I almost puked at that. But it seemed to go right by him, so I continued. “I think what I’d like is just a refresher overview of your recent work. And I see you brought your laptop, so maybe you could just give me a quick rerun of your tenure seminar. I don’t need you to repeat the whole thing, but maybe just thirty minutes or so of the high points.”

  He smiled happily and dove right in. I was able to tune out and let him tell me again how wonderful he was. All I had to do was smile, nod, and make occasional encouraging noises until he ran out of steam forty minutes later.

  I stood up and offered my hand. “Perfect, that was just what I needed. I’m sure there won’t be any problems tomorrow, but now everything’s fresh in my mind, just in case any questions come up. And don’t worry, I’ll be in touch to let you know the results of the vote as soon as the meeting’s over.”

  I resisted the urge to go wash my hands when he left. Instead, I texted Karen again.

  He just left my office. No ringing phone. Let me know what he does now.

  I sat back to wait. It would take a few minutes for Heller to get back to his office and return the call.

  But Karen’s text came in immediately.

  Orlov’s boss returned his call fifteen minutes ago. It’s not Heller.

  41

  Orlov lay manacled to the hospital bed, plotting and fuming. The lawyer—AUSA Markham—had turned out to be a prick. A man of no honor, like prosecutors everywhere. To have the balls to storm in here and say the deal’s off because their trick didn’t work out. I could have told them Heller wasn’t the boss. He’s just another jerk scientist, not someone with the money and connections to know Derkach.

  It was time to get out, escape from this small-town confinement. Before the bastard Markham made good on his threat of life imprisonment.

  The two state troopers guarding him were both stationed in the room. At all times, except when they wanted to eat and one of them went to the cafeteria to get food. Which would be soon. Their shift had started at three, and it was now approaching six o’clock.

  As if on cue, the smaller of the two looked at his watch. “I’m hungry. We’ve been at this for three hours. Want something to eat?”

  “Sure, bring me some of whatever delicacy the cafeteria’s serving up tonight. I’ll stay here with our boy.”

  “You’ll be okay alone with him?”

  The second trooper laughed. He was a big man, six-two and solid muscle. “A little pipsqueak like that? Take your time, I’ll be fine.”

  Orlov waited a few minutes after the first trooper left. Then he moaned and curled up in the bed. “Help me, I’ve got to get to the bathroom.”

  “Oh, for Christ’s sake. Here, I’ll get your bedpan. You can piss in that.”

  “No, my stomach’s cramping. I’m going to shit all over. Quick, I can’t hold it much longer!”

  “All right, all right. Hold on.”


  The trooper came over and, with his gun in one hand, unlocked the handcuffs from the bedpost. Orlov didn’t hesitate. He ignored the gun and chopped the trooper viciously across his throat. Orlov watched him crumble to the floor, his windpipe crushed. Then he broke the trooper’s neck to finish the job.

  Using the trooper’s key, Orlov finished removing the cuffs. Then he put on the trooper’s clothes. They were too big by far, but he rolled up sleeves and pant legs so at least he wouldn’t trip over himself on the way out. Awkward but it would have to do.

  He was able to make his way to the front entrance before anyone noticed. Then the second trooper came out of the cafeteria and saw him. He yelled and went for his gun, but Orlov used the dead trooper’s gun to shoot him first. Then he ran to the parking lot, where a woman was pulling up in a Mercedes sedan. He roughly shoved her to the ground and took the car.

  They’d be after him, of course, but he wasn’t worried. He’d pulled off escapes before, from much tougher and better policed places than southern Maine. His safe house—an isolated cabin about a hundred miles north—was waiting. He’d set it up when he first arrived in Maine, taking advantage of the state’s large amount of sparsely populated forest area. Everything he needed was there. Money, clothes, a new passport, and weapons. He’d trade cars soon and use the back roads. Once there, he’d fix himself up with a wig, a beard and mustache, and colored contacts to change his brown eyes to blue.

  When he was ready, it would be an easy run north to the Canadian border. And from there to the Cayman Islands to pick up his money.

  But there was something he had to do first. A debt that had to be paid.

  42

  The waiter brought our second round of margaritas as Karen and I finished off an appetizer of steamed clams. We had a window table at Hobbs Harborside with a stunning view of Wells Harbor. It was one of our favorite places, and Karen had suggested we come here to enjoy the evening rather than brooding over our failure to trap Heller. It was only partially working—but then we were still waiting for our baked stuffed lobsters.