Chapter Thirty-Five
Messick walks across the street the short distance from the parking garage to the front of the 24-hour café where he stops, looks at his watch, and then glances up and down. When not a soul is in sight, he turns, walks through the café door and looks around at the smattering of patrons. Not many people awake at midnight, or maybe they’re just not hungry.
At the far end of the rectangular room, he sees an older Japanese man sitting at a booth. The man looks back at Messick and bows slightly.
“Dr. Kyoto?” Messick asks as he approaches.
The man nods and motions for Messick to join him. The waitress has followed Messick to the booth, so as soon as he is seated, he orders.
“Coffee for me, with cream.” As the waitress leaves, he sees that Dr. Kyoto already has a pot of hot water for tea.
“Thank you for meeting me, Mr. Messick, especially at this late hour. I have been following your trial with great interest, and I felt it was time I speak with you about certain things.” Kyoto’s voice is quiet and peaceful, quite a contradiction to the urgency with which he requested the appointment. Maybe it wasn’t Kyoto himself who called.
“Dr. Kyoto, I should tell you up front that it is probably too late to add any witnesses to our case. I am sorry you have come so far, but you insisted. And I’m not sure I understand why we couldn’t meet during the day tomorrow.”
The waitress appears with more hot water for Kyoto and the coffee and cream Messick ordered.
“I have to catch a plane again in a few hours.” Perhaps Dr. Kyoto thought that would satisfy Messick and explain the midnight meeting, but it only made Messick more curious. Why fly, how many hours from Tokyo, 12, 14 maybe, to talk to me for an hour or two and then fly back? Why not tell me over the phone, or fax me, or e-mail me, or something? What’s so damn important that it had to be done in person?
“Well, I do not want to waste your time, Mr. Messick, so let me begin.” Kyoto pauses to decide where to start. “Mr. Messick, you have been pretty hard on Dr. Gallo during this trial.”
Messick is pissed. You get me to come down here in the middle of the night to criticize me and defend that bastard? Bullshit. I don’t have to listen to any more of this, no matter how far you’ve come. He puts down his coffee and starts to get up to leave.
“Dr. Kyoto, let's not waste each other's time. Dr. Gallo dug his own grave many years ago.”
Kyoto bows in apology. “Please, Mr. Messick, I agree. Please...please sit back down and hear me out.”
For some reason, mostly curiosity, Messick settles back into the booth and Kyoto starts over.
“I didn't say you had been too hard on Dr. Gallo...but like him, I am a virus hunter, and perhaps I empathize with Dr. Gallo's predicament.” When Messick doesn’t respond, Kyoto takes a sip of tea and then continues. “Are you familiar with a disease called SMON?”
“No, not really,” he said, although he had remembered bits and pieces after the phone conversation with his team.
“That's not surprising. Hardly anyone has heard of it outside of Japan. But it killed over 11,000 Japanese between 1959 and 1973. It was a horrible epidemic. I was in charge of trying to find the cause. It was not an easy job.”
“I assume the empathy for Dr. Gallo doesn't stop there, or you wouldn't have flown twelve hours to sit with me and drink tea.”
“You are very right, Mr. Messick. Let me start at the beginning, and you will see just how similar the epidemics of AIDS and SMON are, and how close you are to finding the real cause of AIDS in the direction you are looking. I am hoping that our conversation will bring you added clarity.” Kyoto bows slightly.
The waitress appears with a coffee pot. Messick knows that with such few people in the café to wait on, she could be at their booth interrupting them every few minutes – maybe because she really cared about her job and wanted to give them good service, or maybe because she was hoping for a bigger tip to make the night worthwhile. Or was it just to rescue her from the boredom? Whatever the reason, he decides to make sure that won’t happen. “Could you possibly leave us the pot of coffee so that you don't have to keep checking on us? We'll be fine, and we'd appreciate some privacy. Thanks,” and he hands her a $5 bill.
The waitress shrugs, takes the tip and leaves the pot of coffee on the table.
“All right, Dr. Kyoto. You have the floor, as we say in America.”
Dr. Kyoto takes a sip of his tea and begins what will become a long and unexpected story.
“It was 1959. I was studying the poliovirus when I was called in to consult on some patients who had developed a progressive paralysis that continued into a slow, miserable death. It looked like polio, but it wasn't. In the next five years, Mr. Messick, we had seven major regional epidemics, numbering 161 new cases a year by 1964 – stomach pains or diarrhea leading to nerve damage.”
“And no one knew what was causing it?”
“Our first thought was that it was infectious and being spread by insects, because cases increased in the late summer. But there were many contradictions and problems. For example, the majority of patients were middle-aged women, but hardly any children. And the blood tests for all these patients were normal. They also did not have any fevers, rashes, or other signs of some invading, infectious germ. I should have known then not to be looking for a virus. But I say again, I am a virus hunter, like Dr. Gallo. I assumed there must be a new, undiscovered virus causing this disease.”
“Did you ever find one?”
“That is getting ahead of the story, Mr. Messick, but the answer is No. Not that I didn't try; I tried very hard indeed. A commission was created to investigate this disease, which we called SMON – Subacute Myelo-Optico Neuropathy. I was appointed to the Commission, along with several other virologists, and that meant that our major focus would remain on finding a virus as the cause. Does this remind you of anyone or anything?”
Messick could see all the similarities to Gallo and AIDS. He even thought he might know already how this story would end, but he’d be polite and let Dr. Kyoto tell it. “Continue, Dr. Kyoto.”
“A colleague of mine, Dr. Masahisa Shingu, thought he had discovered such a virus, in 1965, I believe. It was what is called an ‘echovirus,’ which is known for infecting the stomach or intestines, and Dr. Shingu had found evidence of this echovirus in various SMON patients. Unfortunately, I could not agree with him. Unlike Dr. Gallo, I believed in Koch's Postulates.”
He’s been watching the trial on TV!
“I tried for three years to make Dr. Shingu's virus meet those criteria as the cause of this disease. But in 1967, I had to address a symposium on SMON and announce the bad news – that I had failed to be able to isolate this echovirus from patients, and I could not even find indirect evidence that the patients had previously been infected with the virus. As much as we all wanted the answer, I could not support the claim that we had found the cause of SMON. No one was very happy with me, but they at least listened, and stopped believing in this fantasy.”
“Were you right?” Messick is sure he knows the answer, but he wants to give Kyoto the opportunity to take some credit for his work.
“It took another four years before other researchers confirmed what I had found, but yes, I was finally proven right, thank you very much.”
Dr. Kyoto takes a minute to stop and drink some more tea. Messick fills his coffee cup as well and Kyoto picks up where he left off.
“This SMON commission was dissolved that same year, a failure. We still had 2,000 cases of the disease unsolved. Well, actually, someone had found the cause, but we didn't know it at the time, and it was...how do you say...swept under the rug?”
“You had found the cause? What was it?”
“A drug. That same year, 1967, Dr. Mackawa, who headed up the SMON Commission, had almost accidentally discovered that about half of the victims had been prescribed a drug called Entero-vioform. And the other half had been given a different drug called Emaform. Both dr
ugs were given to relieve symptoms of stomach pains, intestinal problems, and diarrhea. But because the Commission was so focused on a virus as the cause, and still believed the disease to be contagious, no one paid any attention to this. Besides, it was foolish to think that two different drugs could cause the same disease. Instead, reports were published in 1968 claiming a new virus was found in the tissues of SMON patients. Unfortunately, this new virus also turned out to be a false alarm. Since this epidemic kept getting worse, in 1969 there was a new SMON Research Commission created and I was made the chairman. After 10 years of failing trying to find a virus as the cause, I was not so sure any more. So I split the Commission into four parts. I headed up the virology group. But I also had three of the top scientists in Japan looking in other areas. We tried to find a bacterium instead of a virus. This, too, failed. So now it is 1970. Two thousand more people had died in 1969. For almost twelve years we had been looking for a germ, a microbe, with no results.”
Messick can see the anguish in Kyoto’s face as he talks, reliving the shame of failure. “It must have been painful for you.”
“It was more than painful. It was a disgrace.”
“How did you finally solve your problem?”
“Dr. Beppu actually solved it. Dr. Beppu was a pharmacologist. He made the same discovery Dr. Mackawa's team had made three years earlier about the drugs Entero-vioform and Emaform. But he took it one step further and discovered that both drugs were essentially clioquinol, a generic drug commonly prescribed for diarrhea and dysentery. Dr. Beppu fed clioquinol to experimental mice, trying to see if it would cause nerve damage and paralysis and therefore be the cause of SMON. But his mice kept dying. He was very disappointed. It actually took another year before we on the SMON Commission recognized the significance of what Dr. Beppu had found – that clioquinol was a highly toxic drug that could indeed cause nerve damage and, in higher quantities, death. But it was hard for us to believe the facts, even when they were staring us in the face.”
“Why?”
“Because clioquinol was being used to treat the very abdominal symptoms found in SMON...”
Messick finishes the sentence, “…and because the doctors treating the patients didn't want to believe that what they were prescribing was making things worse instead of better – the drug was doing more harm than good?”
“Yes. On top of that, one of the side effects of clioquinol was constipation and abdominal pain. When a patient would complain of these symptoms, they would be given more clioquinol as a treatment. The doctors were ignorant of the true side effects of clioquinol and assumed the stomach pains came from the primary sickness, and therefore kept increasing the dose. It became a deadly, vicious cycle.”
“Was there any other proof that clioquinol was the culprit?”
“There was a whole list of things. For example, the number of SMON cases was directly proportional to the sales of clioquinol, and the epidemic itself had begun shortly after approval for pharmaceutical companies to start manufacturing the drug in Japan. It turns out SMON wasn't contagious at all. The tendency to appear in hospitals, the family clusters, the heavier occurrence in late summer – all these were again directly related to the sales of clioquinol.”
Messick adjusts his seat in the booth. “So what happened?”
“In September of that year, the Japanese government finally banned the use of clioquinol, and the epidemic was over.”
“I am beginning to understand now why you see such a similarity to the AIDS epidemic in the U.S.”
“Oh, my dear Mr. Messick, how do you say...you have not heard anything yet.”
Messick looks at him astonished. Okay, you’ve got my full attention now. He waves to the waitress for a new pot of coffee and more hot water for Kyoto and sits back to listen some more.
“Well, the most disturbing aspect was probably the drug company that manufactured clioquinol in Japan, Ciba-Geigy.”
“Why?”
“First of all, it was discovered that Ciba-Geigy had received warnings about these side effects of clioquinol years before the Japanese epidemic broke out and 11,000 people were killed. And they ignored them, and suppressed them.”
“They knew all along that clioquinol could cause nerve damage, paralysis and death? And they did nothing about it?”
Kyoto nods. “And I can say that with certainty because of the successful lawsuits later filed against Ciba-Geigy, where this was proven.”
“Dr. Kyoto, did you know that there have also been a number of successful lawsuits filed in the United States by individual AIDS patients or their families against Burroughs Wellcome, and then Glaxo Wellcome, claiming that AZT was the cause of AIDS, and therefore responsible for the resulting illnesses and deaths of their loved ones?”
“I had heard rumors.”
“And that’s probably all anyone will ever hear, Dr. Kyoto, because every single case was settled out of court to prevent having a public record, and every single settlement – which was often in the millions of dollars – contained the requirement that nothing public could ever be said about the case or the settlement would be forfeited by the plaintiffs.”
“That makes sense.”
I like this man. It somehow rekindled Messick’s faith in mankind to realize that not all top scientists were as obnoxious and arrogant as Robert Gallo. Is it just we Americans? He wonders.
“Dr. Kyoto, why haven’t we in the U.S. heard this clioquinol story before now?”
“I think there are two answers to that question. One has to be the U.S. preoccupation with viruses, to the extent that your medical and scientific research community almost refuses to look at any other answer. And two, the power of the pharmaceutical industry in your country. Your current President, for example, and his political party received an obscene amount of money from the drug companies in the last couple of elections, and he has since gone out of his way to support anything the pharmaceutical industry wants. What they certainly do not want are any stories about drugs causing diseases and killing large numbers of people.”
That was about as close to anger or any other emotion that Dr. Kyoto would get, but it showed just how deeply he cared about his own profession and how he lamented its demise.
“Mr. Messick, I believe I remember you saying something in the beginning of this trial about ‘show me the money’?”
He was watching it all on TV…I thought so.
“Well, the money is in the drug companies. But not only do they now control your political system, just look at how they control the media these days, by buying hundreds of millions of dollars of advertising. If the drug companies don't want you to know something, you won't know it because the media won’t risk telling you the truth.”
Both Kyoto and Messick sit quietly for a minute, letting this reality sink in.
“Do you understand better now why I see such similarities between me and Dr. Gallo, Mr. Messick?”
Messick did, and only wished Gallo had the integrity of Dr. Kyoto. “But you kept an open mind enough to eventually find the real cause and stop the disease.”
“Perhaps,” he says, with humility.
Kyoto looks at his watch. “I’m sorry, Mr. Messick, I must go.” He begins to collect the few papers and things he brought with him, in case. “Excuse me while I call a taxi.” He consults his notes and dials his cell phone.
Messick finishes his coffee. He looks at the empty coffee pot. I’ll be awake for a week! When Dr. Kyoto finishes, Messick has an afterthought. “Dr. Kyoto, I have some colleagues I work with on this case. I would like to discuss everything you have told me with them. I think it is very important that the jury hears your story, but I will need to find a way to get you on the stand. Can you stay for a few days? I could try to get you on the stand on Monday, and you’d be back in Tokyo by Tuesday.”
“Mr. Messick, I’m sorry. I cannot. I have appointments I cannot break in Tokyo tomorrow. But I would come back in a couple days, if you want to arrange it.”
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br /> “I will see what I can do. And I am very grateful that you would come all this way to help us.”
“Mr. Messick, I was not able to help 11,000 of my own people who died from SMON while we chased a virus. The least I can do is try to help 300,000 AIDS victims in your country who died from a similar...what shall we call it, mistake…by a very misguided research scientist.”
Messick nods his understanding. I really like this man, and I think the jury will, too.
The two men walk out of the café and stop just outside the door, waiting for Kyoto’s taxi. They don’t say much, as if both are exhausted from all that’s already been said. When the cab shows up, Kyoto offers Messick a ride.
“Thank you, no. My car is just across the street,” pointing toward the parking garage.
They shake hands, and Kyoto bows. As Dr. Kyoto gets into the taxi and Messick turns and walks away, another car comes around the corner. It appears to be full of drunken men, yelling loudly. Just as it passes the café, one of the men pulls out a rifle. Three shots ring out in the early morning silence, and Benjamin Messick is killed instantly. Kyoto watches through the rear window of the taxi as it speeds away, a horrified look on his face.
Wrongful Death: The AIDS Trial Page 46
