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Oliver said, “It’s an antirejection drug, whatever that means.”
“You know what Azor Sparks is noted for, don’t you?”
“Heart transplants,” Marge said.
“Yes.” Decameron looked upward. “Heart transplants. The man is…was one of the greatest surgeons ever to land on our fair planet. Even I can’t joke away his genius.” He gazed at Marge. “Because Azor was a genius in every sense of the word. Terrible. For someone to cut him down…and with his death, dies all his skill and knowledge. Too bad Azor didn’t live long enough to set up a protocol for a brain transplant.”
Decameron cocked a hip.
“Now that might have been interesting. His brain in my body.”
“That would have been obscene!” Heather muttered.
Decameron rolled his eyes. “Curedon was just one of Azor’s many contributions to medical science. One in which I was privileged enough to participate. May I sit?”
Marge pointed to an empty upholstered chair. “Please.”
Decameron sat. “How to explain this.” He thought. “Whenever a transplant of any kind is effected, the human body has a natural tendency to reject it.”
Oliver said, “I’m lost.”
“Our bodies are amazing inventions. It almost makes you believe in God.” Decameron paused. “Almost. We have a wonderful invention called the immune system. It recognizes the Huns out there, the invaders of our bodies, and wipes them out. Any foreign substance-a virus, a bacterium, a cancer cell-will eventually be discovered as an interloper and destroyed if one has a properly functioning immune system. A very good thing. Without it, we’d all take the route of AIDS patients.”
Decameron looked at Oliver.
“Okay, so far,” Oliver said. “Go on.”
“Well, sometimes you can have too much of a good thing. Sometimes the immune system is overactive. For most of us, if we get an irritant up our noses or get a bee bite, we might sneeze a bit…or swell up locally. But eventually everything settles down. A few unlucky souls have immune systems that overreact-send out droves of histamines to fight off a little interference. Cellular walls break down, fluid is poured into the tissues, and the body swells up.”
“An allergic reaction,” Marge said.
“Exactly,” Decameron said. “The most dangerous sequela of an allergic reaction is in the lungs. The breathing apparatus can become so inflamed that often air can’t pass through.”
“So what does this have to do with Curedon?” Marge asked. “It prevents an allergic reaction?”
Decameron nodded. “In a sense, that’s what it does. When a heart is transplanted into a body, the body’s in-place immune system doesn’t recognize the heart as a necessary part of the body. It sees it as a foreign substance, and sends out white cells to destroy it.”
Oliver said, “So it’s like the patient has an allergic reaction to his or her new heart.”
“Essentially, yes,” Decameron said. “Without proper medication, the immune system would eventually eat the heart away.”
Marge said, “I thought that transplant patients are tested to make sure there’s a fit between the new heart and the old body.”
“Of course, we type-match, Detective. We do the best we can. But often it isn’t enough. There’s a sad shortage of hearts and lots of people with heart disease. We have to make do. That being the case, we have to work around the immune system. We have to undermine it. Hence, the class of drugs known as immunosuppressants. Cortisone for example.”
“You give heart transplant patients cortisone?”
“No, but surgeons give them related immunosuppressants. Like prednisone. The most commonly used drugs are Imuran and Cyclosporin-A. With severely compromised renal patients, surgeons often use the more experimental class of immunosuppressants-Orthoclone or OKT3-and the other Ks like FK506. Sorry to bore you with details, but it will help you understand the importance of Curedon.”
The room fell quiet. Marge wrote as fast as she could.
“Curedon has a completely different chemical structure from the other immunosuppressants. The way it binds and interacts with T-cells through the production of interleukin 2…Curedon seems to subdue the immune system without suppressing it. What that means is, we see far less unwarranted side effects. This is very, very important. Because transplant patients are on immunosuppressants for life.”
“Forever?” Oliver asked.
“Ever and ever,” Decameron said. “We put them on as minimal a dose as possible. But even so, there are side effects.”
Marge asked, “Such as?”
Decameron ticked off his fingers. “Pulmonary edema, ulcers from mucosal sluffing, chills, nausea, fever, dyspnea.” He shook his head. “It’s a long road for these patients, and our goal, as members of the healing arts, is to make them as comfortable as possible. Curedon is as close to any miracle drug as I’ve ever seen in my twenty years as a physician and researcher. Azor had worked years on it. I learned more about 2.2 resolutions and X-ray crystallography than I’d ever wanted to.”
Decameron fell quiet.
“But I did learn.” His eyes became moist. “I did learn. And it was an honor for me to be part of something so cutting edge.”
“What’s going to happen with Curedon now that Dr. Sparks is gone?” Oliver asked.
“Not much probably. The initial trials of Curedon have been quite successful in general.” Decameron’s smile was tight. “Although we have had a few ups and downs lately. That’s why I was so pleased when I saw Azor’s data coming through his fax. I just couldn’t wait for him to come out of surgery. But it was wrong. An invasion of his privacy.”
Marge tapped her pencil against her pad. “What do you mean ‘ups and downs’?”
Decameron looked pained. “A small rise in the mortality rate-”
“That’s death rate in common folk language,” Marge interrupted.
Decameron smiled. “Yes. Death rate.”
“With Curedon.”
“Yes, with Curedon.” Decameron looked at Marge pointedly. “The patients aren’t dying from the drug, they’re dying from heart and renal failure. The sharp rise is puzzling, but kinks aren’t uncommon. Ah, the glamorous life of a research physician. Probably data error. Or a transcription error…or, alas, it could actually be a problem with the drug.”
“And if it is a problem with the drug?” Oliver asked.
“We’ll work it out. Curedon’s been a marvel. Too good to be true. Some bumps are inevitable. But mark my words. The drug will come on the market within the next five years.”
He paused.
“For Azor not to see the fruits of his labors…that is a tragedy of Greek proportions.”
Oliver asked, “Who do you do the trials on?”
“Actually, our team doesn’t run the trials. The FDA-Food and Drug Administration-analyzes the numbers in conjunction with Fisher/Tyne, which actually runs the trials.”
“Wait a minute.” Marge turned to Heather. “I thought you said Fisher/Tyne bought the drug from Sparks.”
“They did buy it from Sparks,” Decameron stated. “I don’t know how much they paid for it. But I do know Sparks received a huge initial cash deposit and was promised a percentage of the profits after the drug hit the marketplace.”
“Who will get Sparks’s percentage now that he’s dead?” Marge asked.
“I don’t know,” Decameron said. “Certainly not me. Effectively, Fisher/Tyne owns the rights to produce and market Curedon. Those rights were sold to them by the cash deposit.”
Oliver looked over his notes. “I’m confused about something.”
“Sorry. Teaching isn’t my forte.”
Oliver asked, “What do you mean when you say that the FDA is testing the drug in conjunction with Fisher/Tyne?”
“Fisher/Tyne, under our guidance and protocol, is ru
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