WASHINGTON – 11 APRIL
‘And, there we have it,’ Professor Alan G.F. Milton proclaimed, finishing with a trademark flourish across the bottom of his diagram on the board. ‘The A to Z of ear, nose and throat infections in the twenty-first century.’
Polite applause rang out around the lecture hall at Washington University, where the final year medical students were reaching the end of their first term.
Bit of a show-off, thought a student in a middle row as he shoved his notes into his bag. Still, you don’t get to be a world authority on anything without being able to sell yourself.
Professor Milton acknowledged the applause with a wave and pushed back a few locks of blond hair from his face. People had often told him that his hair reminded them of Robert Redford. His chair at the university was a reasonably lucrative and prestigious one and he made sure that he fulfilled his requirements to personally deliver six lectures each term. Now a fit and well-groomed fifty-four-year-old, life was good for Professor Alan G.F. Milton. Despite the couple of unfortunate incidents with some particularly attractive final-year students over the years, his ever-loving and adoring wife Sylvia continued to provide him with a comfortable and secure home life. They had even survived that mix-up with the au pair at the holiday villa in France, when he certainly hadn’t intended to encourage the girl’s advances. Sylvia had forgiven him his dalliances and they were well able to work around her only condition that he would no longer provide tutorage to undergraduates at their house.
Christ, if she only knew the half of it, Professor Milton had often thought to himself. But with each passing year, and with his wandering eye and hands slowing somewhat, the risk of any further catastrophic disruption to what was a satisfactory marriage seemed to diminish. Sylvia, despite his disappointment at what he saw as her low sex drive, had provided him with two fine sons, both now practising as lawyers in Washington.
Professor Alan G.F. Milton had enjoyed the money that flowed from private practice and the lifestyle that went with it. In 2010 he’d earned over one and a half million dollars, his best year to date. But the pressure of work was severe and he had jumped at the offer of Professor of Otolaryngology, the ear, nose and throat speciality at the university, with its promise of less stress, longer holidays and plenty of admiration from colleagues and students. What he hadn’t fully reckoned on were the difficulties that went with surviving on a salary of three hundred thousand dollars, plus a few fees from the medical lecture circuit and some small-scale research work. The mortgage on the country house had still not been cleared and the boys’ college fees had hit hard. He and Sylvia found it hard to eliminate the luxury lifestyle items to which they had become accustomed. Suddenly, money had become a new source of tension between them.
Then, out of the blue, one chilly December day, he had received a letter from one Tsan Yohoto, chief executive of Yamoura Pharmaceuticals in Tokyo. Mr Yohoto had expressed enormous admiration for Professor Milton’s research papers and had complimented him on the high standard he had established for medical graduates from the university. Mr Yohoto was particularly interested in Professor Milton’s speciality in the ear, nose and throat area; a field in which Yamoura worked tirelessly to help the many people around the world suffering from pain and discomfort. Coincidentally, Yamoura was organising a high-level medical convention in Hawaii in mid-January, where leading international specialists would share their knowledge on how to help unfortunate people with sinus, throat and lung complaints. Mr Yohoto was wondering if Professor Milton and his wife would like to attend the conference at the Sheraton, for five days. Professor Milton would be invited to attend a workshop at the convention and Mr Yohoto would also be honoured to host Professor and Mrs Milton at dinner on the second night. Attached to the letter was a brochure on the hotel and an itinerary for the five days, which included dinners, sightseeing trips, complimentary use of the hotel spa and, Professor Milton noted, first-class flights. Sylvia had been most impressed at the news and he had emailed their acceptance that day.
It had been a magnificent trip. Yamoura were excellent hosts. Nothing was any trouble. The dinner with Mr Yohoto had been a highlight. They had never enjoyed such good food and such fine wines. Mr Yohoto had turned out to be extremely knowledgeable about the whole area of ear, nose and throat infection. He was convinced that there were many people suffering chronic headache and discomfort, but who were undiagnosed – owing to a lack of knowledge of this complex speciality. Professor Milton couldn’t agree more. Mr Yohoto had suggested that Professor Milton might help them with some further research in the area, as he was one of the world’s most eminent experts on the subject. Again, Professor Milton couldn’t have agreed more. He had almost fallen off his chair when, a week after they returned, a letter had arrived from Mr Yohoto asking that he further research the subject and report on the high level of missed diagnosis that was due to lack of information on the topic. For a fee of a quarter of a million dollars. Professor Milton was also encouraged to involve any other of his leading medical contemporaries, who were like-minded in their desire to see cutting-edge healthcare information made properly available. For his work in coordinating any other supporting contributors, he would be paid a further quarter of a million dollars and his contributors would be also paid directly by Yamoura at up to one hundred thousand dollars per head.
Professor Milton had contacted three of his contemporaries in universities around North America and they had pooled their knowledge and research data on the level of undiagnosed bronchial and ENT infection. They pointed out a whole range of symptoms, which merited the earlier use of medication, in a paper that was published widely in medical journals throughout the US and in The Lancet in the UK. They had spoken at several conventions on the topic and the medical community agreed that this was a problem that was not receiving proper recognition at GP level. A series of guidelines was put forward which advised doctors to instigate aggressive intervention at an earlier stage of diagnosis. Indeed, patients presenting with coughing and headache symptoms, on two occasions, should be treated over a period of up to one year, to eradicate the condition entirely.
Yamoura Pharmaceuticals had been delighted with the work and had issued payment of six hundred thousand dollars to Professor Milton, which included a further hundred thousand-dollar bonus. He had paid off the outstanding loan on the country house and had bought Sylvia a convertible BMW. Even better was promised when Professor Milton accepted an annual retainer of one hundred and fifty thousand dollars to make himself available for occasional consultation to Yamoura, and to attend their annual convention.
Doctors’ surgeries around the world were bombarded with glossy leaflets on the new level of concern at this increasingly prevalent illness and the suggestion that this was a result of a fast-moving and stressed-out twenty-first-century lifestyle. The leaflets suggested that climate change and deterioration in air quality had greatly increased the numbers of people at risk. It happened that the leading drug for the treatment of these problems, Davratin, was produced by Yamoura Pharmaceuticals. Sales of Davratin increased by 325 per cent in the year after Professor Milton’s findings and stayed at that level, adding approximately five hundred million dollars to Yamoura’s annual profits.
Everyone was delighted. The only irritant had been the carping of a couple of crank doctors in Australia, who questioned the research findings and pointed out that lowering the threshold at which the medication should be prescribed, to two periods of occurrence, had brought at least ten million people, previously thought of as suffering tension headaches, into a new category requiring prescription medication. But these snipes were swiftly drowned out by a deluge of articles that approved Professor Milton’s conclusions.
*
‘How are you, my dear friend?’ The phone call to Professor Milton’s house had come at about nine on a Friday evening. The voice on the other end of the line was that of Tsan Yohoto himself.
‘I’m great, thank you, Tsan, and how are you?’
‘Beginning to feel my age, I’m afraid,’ replied Tsan Yohoto.
‘Ah, unfortunately, the evolution of medicine has not yet found a pill to halt the advance of time.’
‘Yes, indeed, but we have had some great news from our research and development team.’
‘Oh?’ replied Professor Milton. He had an idea that this call was going to end up swelling his bank balance.
‘Yes,’ continued Yohoto, ‘extraordinary really, somewhat of a fluke. One of our teams has discovered some very positive unexpected benefits from patients taking our cephalosporin antibiotic tablets . . .’
‘For throat and sinus complaints?’
‘Yes, of course. And for bowel inflammation, bronchitis, soft tissue infections, you name it. We have carried out significant trials and there is no doubt that patients are reporting increased energy levels and alleviation of headaches.’
‘Really?’
‘Yes, and what’s more, there is definite evidence of suppression of the appetite. Many overweight patients are reporting long-term weight loss and improved general health after a few courses of cephalosporin.’
‘How fantastic!’
‘We have amassed considerable clinical evidence from our trials in Japan. What we would like you to do is to assemble a small team of US experts who will review our research material and advise us whether you think these results are reliable.’
‘With pleasure, especially if –’
‘Also, because all our trial patients have been Asian, can you please give us an opinion on whether these beneficial side effects are likely also to benefit westerners?’
‘Because of the difference in diet?’ asked the professor.
‘Exactly,’ continued Yohoto. ‘We are planning a major relaunch of our cephalosporin brand in the US and I believe we can bring better health to the American people. Especially to those who have trouble losing weight or who have low energy levels.’
‘Marvellous,’ said Professor Milton. He paused. ‘So, what’s the next step?’
‘We’re so excited about this breakthrough that we wish to relaunch our brand in six weeks or so.’
‘Six weeks!’ Milton said, and the surprise in his voice was genuine.
‘Yes. We have stepped up production already here in Tokyo. Will you be in a position to chair a panel of experts to review our research and to have your findings in, say, four weeks?’
‘Four weeks, but –’
‘In recognition of this demanding timescale, Professor, if you can meet the deadline, your own fee will be a minimum of five hundred thousand dollars. A further five hundred thousand dollars will be made available to the experts you select. And if you thought our success-related bonuses in the past generous, I can assure you that a successful relaunch of this product will see all previous figures surpassed. I envisage a potential bonus for your good self of at least two million dollars.’
Professor Milton had to steady himself with a hand on the fireplace.
‘Do you think you can be of assistance, Professor Milton?’ Yohoto asked, in a tone that suggested there would be no second chance.
‘Absolutely, Tsan, my friend. It will be an honour to be involved in such a major project, bringing such benefits. I am humbled.’
Tsan Yohoto smiled to himself. The words ‘humbled’ and ‘Professor Alan G.F. Milton’ did not sit naturally together, in his experience.
‘Excellent,’ replied Yohoto. ‘Will you consider consulting Professor Kolsen in Dallas?’
‘Almost certainly,’ replied the professor, sensing that would be the favoured option. Both the professor and his caller knew that Professor Kolsen at the JFK Memorial Hospital in Dallas was on a healthy retainer from Yamoura Pharmaceuticals for ongoing advice on product development. He was also on various FDA panels for approving drugs.
‘And Dr Anton Cook in Toronto is a renowned expert in the field of weight loss and lifestyle illness,’ said Professor Milton. Milton knew that Dr Cook was also on the Yamoura payroll.
‘Oh, a superb choice,’ chimed Yohoto, ‘yes, that sounds like a powerful team. I can assure you that our clinical trials have been exhaustive and carried out to the most stringent standards. All the research work will be couriered to your home by tomorrow evening. Perhaps you would let me know in a week that everything is in place?’
‘Absolutely, Tsan, absolutely. I’ll call you late afternoon. Asia-Pacific time,’ he added, reminding himself that Tokyo was thirteen hours ahead of the east coast. He caught a glimpse of himself in the large mirror over the fireplace and smiled.
‘Thank you, Professor. It is so important for us to have the top medical brains in the world helping us with our research.’
‘Oh, my pleasure, Tsan,’ purred the professor. ‘We’ll speak again next week.’
‘I look forward to it. Goodbye, Professor.’
Professor Milton ended the call. Then he turned and delved into the drinks cabinet. If ever there was a good reason for that bottle of vintage Bollinger, this was it. ‘Sylvia, Sylvia,’ he called out into the hall. ‘Come here, honey – we’re celebrating!’