We shook hands, Noble’s long-fingered grasp swallowing my hand while barely squeezing at all.
“How about we talk in the cafeteria?” Noble suggested, and lowered his voice. “The less people that see us, the better.”
Harry’s expression bent into his trademark scowl. “Nobody seems to like having me in their company. I’m starting to take it personal. Such things take their toll, you know.”
“I’m buying,” Noble offered.
“Not so personal anymore, then.”
* * *
• • •
The lunchtime rush had ended, the tables cleared off and wiped down. I grabbed some tea and a muffin, just coffee for Harry and Arthur Noble, poured from big urns running along a half wall.
“My favorite brand,” Harry said, setting his cup on a Formica table set far back in the rear of the room.
“What’s that?” I asked him.
“Anything that comes with free refills.”
Arthur Noble finally joined us after paying. “So what can a simple bureaucrat do for America’s favorite mystery writer?”
“You’re much too kind, Mr. Noble.”
“That’s not what I heard.”
“He means from me,” Harry interjected.
“No wonder it’s an exaggeration.”
“Harry tells me you had some questions about clinical trials. What would you like to know?”
“Could we start with everything?” I asked him.
“That would take some time, Mrs. Fletcher.”
“Ching-ching,” intoned Harry. “That was my cash register jangling.”
“How about the general parameters of how a trial happens and progresses?” I suggested. “Just the broad strokes.”
“Then you’re talking about the clinical-research stage.”
I looked at Harry, who was no help at all. “I suppose so.”
“Well then,” Noble said, extracting a set of trifolded, stapled pages from his suit jacket, “I brought you a document that summarizes the four stages of a typical clinical trial.”
I opened the pages and gave them a cursory glance. “This looks like something you’d use to hand out in schools.”
Noble grinned. “Precisely what I normally use them for. Just the broad strokes, of course, but something you can refer back to when you’re writing.”
“What if I wanted to probe a bit deeper than those broad strokes?” I asked him.
“As in . . .”
“As in, how are specific hospitals or treatment centers chosen to participate in such trials?”
“Oh, any number of factors, most notably size and experience to ensure a wide-ranging staff capable of overseeing the testing and appropriately analyzing the results. It’s normally based on the existing relationships the drug company in question maintains with the participating institutions.”
“Then drug companies choose their own test site?”
“More or less. That’s not what you assumed, obviously.”
“I assumed the FDA supervises all the studies.”
“We do, but more from afar than up close and personal. Essentially, we serve as a data-collection and analytics clearinghouse. Based on the results provided by the testing facility, we make the determination whether to advance the study or stop it, approve the drug or suspend it.”
“Quite a responsibility, Mr. Noble.”
“At every level, and one we take very seriously, since lives are at stake: both those that can be saved if the drug reaches market and those who might be harmed in the research process leading up to that.”
Now I leaned forward. “Can I cut to the chase now?”
“Absolutely.”
“Can the system be corrupted?”
“I’m not sure if I understand your question, Mrs. Fletcher.”
“Can the system be gamed?”
“As in,” he said again.
“How might a clinic or hospital that’s just starting up become eligible to hold clinical trials?”
“By proving themselves over time.”
“How long?”
“Years, decades even. It should come as no surprise that the bulk of most groundbreaking clinical trials have been held at the likes of the Mayo Clinic, Boston’s Brigham and Women’s Hospital, Cedars-Sinai out in Los Angeles, the Cleveland Clinic, the Lahey. . . . The list goes on from there, and, especially for the latter phases of the trial, such institutions are the only ones with the kind of resources to conduct them.”
“So a relatively small, private hospital that’s been open barely a year . . .”
“Would stand little or no chance of landing such a trial until it had been open far longer than that. It takes time to build up relationships of trust with the drug companies that make the ultimate decisions as to placement. But, even then, the participating clinic or hospital would have to be cleared by us, and, absent a track record, it would be extremely problematic to grant such approval.”
I glanced at Harry before responding. “So, Mr. Noble, theoretically this office would have a record of every single ongoing clinical trial in the country.”
“More than theoretically, Mrs. Fletcher. Our oversight is exacting and never compromised under any circumstances. There’s just too much at stake. We may not be able to achieve one hundred percent certainty with any given drug, but we strive to come as close to that as we can.”
“So, also theoretically, if I gave you the name of this upstart clinic, you’d be able to tell me which clinical trials they’re conducting and currently have ongoing.”
Noble hedged. “Well, I’d be able to confirm or deny the fact of their involvement, but I couldn’t share with you the nature of the specific trials.”
“Good enough,” I told him. “Does the Clifton Clinic ring any bells?”
Chapter Fifteen
“Not off the top of my head,” Noble told me, “but I wouldn’t expect it to. There are currently nearly three hundred thousand clinical trials progressing through various stages in fifty states and more than two hundred countries.”
“Did you say three hundred thousand?”
No wonder the Clifton Clinic didn’t register immediately for Arthur Noble, given that the FDA was involved in every one of those at some level. But he promised to check his records and get back to Harry with his findings.
We headed back to the Metro and then Union Station, so I could catch the next train back to Boston and then Cabot Cove. I wouldn’t be getting home until almost midnight, meaning I’d be covering sixteen hours of travel for a single twenty-minute meeting. It hadn’t produced much, besides educating me on the minutiae of the clinical-trial process, but I’d also opened a door that could prove crucial to figuring out how the pieces of the mysterious puzzle that was forming back home all fit together.
We were entering Union Station when I got a call from Seth Hazlitt.
“How’s Washington?” he greeted.
“Hot as blazes.”
“Not the usual sea breeze you’re accustomed to up in these parts?”
“No breeze at all. The air just hangs there getting hotter and hotter.”
“Next time an investigation takes you down there, better hope it’s wintertime. I’ll be at the station to pick you up when you get in.”
“I didn’t ask you to do that.”
“Didn’t have to, Jess. What are friends for? Mort and I flipped a coin for the honor.”
“Who called it?”
“He did. Heads.”
“I’d check that coin to make sure it’s not heads on both sides. At least you don’t call me Mrs. Fletcher.”
“Mort start in on that again?”
“I thought I’d broken him of the habit. Maybe he makes an exception whenever we’re investigating a murder.”
“Which is pretty
much all the time, isn’t it?”
I moved to the ticket window, checking the schedule to find the next Boston-bound train left in only ten minutes.
“Was there something else you called me about, Seth?”
“Oh, yes, of course. I just got the autopsy report on Mimi Van Dorn.”
“And?”
“Well, we’ve now identified the substance the tox screen couldn’t, as if we needed another complication.”
“What’s that mean?”
“Ever heard of a drug called Benzipan?”
“No. Should I have?”
“Can’t think of a reason why you would. Benzipan is the trade name for BEZ741. It acts on a crucial cellular pathway of the immune system, preventing cancerous tumors from reproducing themselves.”
I froze and let the next person in line move before me to the ticket window that had just opened up. “Are you saying Mimi was being treated for cancer?”
“She didn’t have cancer, as also confirmed by the autopsy, but she had a very high clinical level of Benzipan in her system, indicating she’d been taking it for some time.”
“So if she didn’t have cancer . . .”
“Right. If that doesn’t beat all.”
“This makes no sense, Seth.”
“Neither did Mimi dying in the first place,” he said, the bitterness lacing his voice telling me he was still grieving the loss of Mimi.
“Are you saying Charles Clifton was treating her for a disease she didn’t have?”
“Now, Jess, no investigator worth his or her salt would make that claim without proof, but somebody was giving her Benzipan, and it wasn’t me. That sure does make Clifton suspect number one.”
“You tell Mort?”
“I did, and he reacted about the same as you did, ’cept I believe he put in a call to the force down in New York to see if he could get his old job back.”
“He retired ten years ago.”
“Sure did. Took him long enough, didn’t it? I’ll see you at the train station when you get in.”
“It’ll be too late, Seth.”
“I’ll take a nap. One thing good about having less patients these days is less phone calls once I get home.”
“I’ll call you more often.”
“Don’t bother. I’ve come to like the quiet. Gives me an idea what retirement will be like . . . or death.”
“Which?”
“Same thing from my perspective.”
* * *
• • •
“Benzipan,” I said to Harry McGraw, as he walked me to the track after I’d finally gotten back in line and snared my ticket home.
“Benzi-what?”
“Some kind of newfangled cancer drug. Can you ask Arthur Noble about it when he calls you?”
“What makes you think he’s going to call me at all? Be easier for him if he just forgot that meeting ever happened, the way you laid things out.”
“You mean the truth?”
“Not everybody has the same regard for it that you do, Jess.”
“Well, they don’t know what they’re missing. You’ll mention Benzipan to Noble?”
“Sure. I’ll just add it to your bill.”
“Means a bigger tip.”
“Right, what’s twenty percent of nothing?” Harry asked, flashing that scowl.
* * *
• • •
Harry called me about the time the Amtrak train rumbled into Penn Station en route to Boston.
“I’ve got news, Jessica.”
“Good or bad?”
“Well, Arthur Noble wouldn’t give me the names of the drugs the Clifton Clinic is running trials on.”
“Bad,” I noted.
“Not exactly. He wouldn’t give me the names because there aren’t any.”
I tried to make sense of what I was hearing. “Could you repeat that?”
“Sure, to pad my bill. According to the Food and Drug Administration, the Clifton Clinic isn’t conducting a single clinical trial.”
“You ask Noble about Benzipan?”
“He said it rang a bell somehow, but wasn’t sure why. Said he’d check and get back to me.”
“He say when?”
“The whole world doesn’t move at the speed of Jessica.”
“Maybe it should.”
“You want to tell me what you’ve got yourself involved in this time?”
“Right now, Harry, I have no idea.”
* * *
• • •
So I called Seth.
“You in the station already?” he greeted. “What’d you do, teleport from Washington?”
“Can you look up the side effects of Benzipan?” I asked him.
“Way ahead of you, Jess. I was saving it for a surprise.”
“What?”
“Why don’t we wait until later when I pick you up?”
“What’s wrong with now?”
“Suit yourself,” Seth sighed. “According to its manufacturer’s warnings, among the side effects are seizures. And among those advised not to take the drug are those suffering spikes in their glucose levels.”
“Diabetics, in other words. Even at Mimi’s level?”
“She was type two, Jess, rapidly ascending to the promised land of insulin diabetes, regardless of her diet.”
“She was cheating anyway,” I said, recalling those sugar cookies I’d caught evidence of her eating.
“I suspected as much. I wonder if it was one of the reasons she left me for Clifton, since I was very firm in my insistence she needed to make radical changes to her diet and lifestyle to avoid pricking her finger and injecting insulin every day.”
“What troubled you about her lifestyle, Seth?”
“Nothing you’re not aware of already, and I prefer not to speak ill of the dead. But she was driven by shortcuts, and the more I think about it, the concerns you expressed over how she viewed her appearance are very well-founded. I’m worried she may have gone to extreme measures to fight back the effects of aging.”
“Like what?” I asked him.
“Cosmetic surgery stretching well beyond the few minor dermatological procedures she’d had done. She started asking me a lot of questions about the side effects in her last office visits before she fired me.”
“She didn’t fire you, Seth.”
“No? What would you call it, then?”
“Replaced.”
“Same thing.”
“A patient can’t fire her doctor.”
“No, she can betray him for another practice. Again, same thing.”
“I have another question for you,” I told him.
“To change the subject?”
“We’ve exhausted the subject. My question for you now, Dr. Hazlitt, is this: Benzipan is an approved drug, right?”
“It is indeed. Prescribed for the immunological treatment of certain cancers.”
“So it couldn’t be part of an ongoing clinical trial.”
“Where are you going with this?” Seth asked.
“I’m not sure yet. It’s just an oddity, an inconsistency I can’t get out of my mind. Why would Mimi be taking a cancer drug if she didn’t have cancer?”
“I only know one man who might be able to answer that question. Goes by the name of Charles Clifton, and I’ve asked Mort to arrest him.”
“On what charge?”
“Stealing—my patients, specifically.”
“You still going to pick me up at the station, Seth?”
“Of course, Jess, so we can continue this lovely conversation.”
* * *
• • •
I started to nod off, fighting against the sleep I felt descending upon me, in order to continue trying to fit together t
he pieces of what I knew to be the truth before me.
That Mimi Van Dorn had suffered a seizure . . .
That the seizure had likely been brought on by her having taken a cancer drug even though she didn’t have cancer . . .
That the beginning of her treatments at the Clifton Clinic closely coincided with her liquidating the trust paying for her son’s desperately needed care . . .
That she was using an attorney who had rebuffed her son’s request for representation after a still unexplained delay . . .
That she displayed all the symptoms of body dysmorphic disorder . . .
That she’d been murdered two nights ago in Cabot Cove Hospital’s intensive care unit . . .
And the last person to see her had been Charles Clifton. . . .
With all those facts floating in thought bubbles over my head, the one I kept coming back to was the liquidation of that trust at the dire expense of Tripp Van Dorn’s well-being. What kind of mother does that? I thought I knew Mimi well enough to believe her incapable of such a heinous act. And if that was the case, might I be missing something here, something that had forced Mimi to take such a desperate action? If she had been suffering from cancer and needed to pay out of pocket for a drug like Benzipan, everything would make some degree of sense. But she did not, in fact, have cancer, in which case it made no sense that the drug had shown up in her blood at all.
I felt myself falling asleep, unable to resist slumber’s overtures any longer. Next thing I knew, I was being jarred awake in my train seat by the ringing of the phone still tucked in my bag, resting on the free seat next to me. I noticed it was from a blocked number but answered anyway.
“Hello?”
“Mrs. Fletcher, it’s Tripp Van Dorn.”
* * *
• • •
I cleared my throat. “Tripp, it’s so nice to hear from you. I hope I didn’t offend you too much with all my questions in our initial meeting.”
“No, no, not at all.”
There was something . . . off about his voice. He didn’t sound drunk, wasn’t slurring his speech or anything. I thought it might have something to do with his condition, or perhaps some of the medication he was on. But I couldn’t put my finger on exactly what I was hearing.
Murder, She Wrote--Murder in Red Page 11
