Alan E. Nourse - The Fourth Horseman (23 page)

"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
Yersinia, "
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?