Chapter 6

It was 9.30am. Andrew was in a hurry. He was late. He had taken the shortcut through the research department, turned the corner almost running when he collided with a tall, be-speckled balding man in a white lab coat.

‘Excuse me, I’m sorry,’ he said.

‘It’s okay. No damage done… Andrew?’

Andrew looked up at a familiar face. A face from somewhere in his past which he could not immediately place.

‘Andrew. Andrew Marshall. It’s me, Roger, Roger Marsden. From 6A1. Chemistry prac. You almost gassed a whole class. Remember?’

Of course, it came back to him in a flash. Roger Marsden. He was his chemistry prac partner at Melbourne High School. Good God, how long ago was that. Andrew recalled that Roger had gone into science. He vaguely remembered that he had majored in mathematics. The two had lost contact years before.

‘Good to see you Roger,” he said, ‘Of course I remember. And if the gas in the chemistry lab was anyone’s fault, it was yours partner.’

They both laughed. Andrew continued, ‘What are you doing here? Don’t tell me you work here.’

Roger Marsden looked at the door behind him, Andrew looked and saw the sign “Roger Marsden – Senior Statist­ician.”

‘Well, I guess you do work here. I’m amazed we haven’t run into each other before.’

‘I know I should have got in touch,’ Roger said. ‘I had heard that you were back at Prince Charles. To be honest, I wasn’t sure that you would remember me. And then I just assumed we would eventually run into each other. And we did.’

‘Roger, we must get together and talk. I can’t now, I’m running late. Perhaps one evening after work. We can meet for a drink. Is that okay? I mean, are you married, maybe you prefer a different time.’

‘No, that’s fine Andrew. I was married, I’m divorced. After work is fine. My time is my own, what about tonight. I finish at 6, we could meet at 6.30? The Rum Bar. Do you know it? It’s in Fitzgibbon Street, about five minutes by car.’

‘Done. See you there at 6.30.’ Andrew replied and with that he was off.

Being a Wednesday it was one of his half days in his private practice. This was conducted from rooms in the Neuroscience Department. The hospital provided the room, the secretary and took care of all the administrative details. All Andrew had to do was see the patients and receive the private fees. The meeting with Roger had delayed him even more and it was almost 10am when he called in his first patient. Mrs Williams’ appointment was at 9.15 and she was not pleased. Andrew apologised profusely, gave as an excuse a hospital emergency which seemed to placate her. Sarah Williams then wasted no time launching into her myriad symptoms.

Private practice paid the bills but had little more to offer than that. Andrew’s training prepared him for the complexities of the nervous system and the seemingly endless list of disorders. But what came in through his door were the physical manifestations of anxiety, stress and general human hopelessness. He spent more time reassuring patients that there was nothing whatsoever wrong with them than diagnosing or treating real diseases. And what’s more, because of Prince Charles’ reputation for the treatment of gliomas, every man, woman and child with headache, dizziness or virtually any other symptoms affecting the anatomy above the neck seemed to be beating down the door, convinced they too had a glioma and seeking a cure. And such was the sophistication of the general public in matters medical, that all these neurotics were demanding an MRI scan to diagnose their lesion and would not be satisfied with anything else.

Andrew had long ago given up arguing and acquiesced to the wishes of the masses. He had lost count of the normal MRI scans he had ordered. At least some of these patients would be reassured and some even cured of their symptoms by the knowledge that their brain was normal.

It was a busy morning’s consulting and having started late he finished late, grabbed a sandwich for lunch and raced immediately to the ward where the Registrar and Resident were waiting to start the ward round.

It was Andrew’s month on ward duty and the ward as always was full and there were ten patients boarded in other wards and six consultations to see around the hospital. At 6.15 he finally left the hospital, headed towards his car planning to pick up a pizza on the way home which he would eat while watching TV and then crash from total exhaustion. He was already driving towards home when he remembered having to meet Roger at the bar. He looked down at the clock on the dashboard. It read 6.35. So much for a quiet night at home. It took another ten minutes of backtracking and another five of getting lost before he pulled up in front of the Rum Bar, just in time for someone to pull out of the parking spot directly outside.

Andrew parked his car and went in. It took him a minute or so to adjust to the gloom and another minute to spot Roger in a corner booth nursing a drink. He joined him, slightly out of breath from all the rushing.

‘Sorry Roger. I hope you haven’t been here too long. I got held up at the hospital. What are you drinking?’

‘Scotch and ice and its okay Andrew. I know you clinicians can’t control your hours as well as we scientists can. Settle down, catch your breath and get a drink.’

The waitress was over taking Andrew’s order, a dry martini. Roger ordered a second scotch. They spent a few minutes reminiscing about old times, each filled the other in on the intervening years and both agreed that it was a pity that they had lost touch.

‘I never would have thought that I would end up in the medical field,’ said Roger. ‘It was the furthest thing from my mind. I never liked the sight of blood. I once fainted in the biology prac. Mind you, I’m not sorry. It is an exciting field, especially at Prince Charles with everything that has been happening the last few years. You know it was Jeffrey Harris who first recruited me or at least it was someone on his behalf. I was quite happily working for IBM. It was a bit mundane but secure. I suppose I must have been a little restless or I would not have even considered the offer. It was just after my divorce, probably a good time for a career change.’ Roger took a sip of his scotch and continued. ‘It was a good offer. Chief Statistician for a drug trial that had the prospect of curing brain tumours. Mind boggling stuff for an eager young man whose greatest challenge until then had been beating the computer at chess.

Roger took another sip of his scotch.

‘I had no medical training of course. And I never fully understood the jargon and could never really get a handle on the clinical stuff, but I knew my stats. And no trial gets off the ground these days without the stats. That much I knew. Gone are the days when some bright young researcher gets a good idea, does a trial and then comes to the statistician to find out if the results are significant. They now come to us first. They tell us what the hypothesis is, what sort of results they are looking for and we tell them how many patients are required in each arm of the study. Then, whatever the result, positive or negative, at least the stats are right. Trials are too expensive to do any other way. You know as well as I do that a double blind trial is still the gold standard in any investigation, so it has to be done properly or it’s meaningless.

Roger was obviously warming to his subject. Andrew could detect a note of pride in Roger’s voice. And why not. His work would have been critical in getting the Amaradine trial up and running and ensuring that the result was valid.

Roger by then had finished his second scotch, presumably on an empty stomach as he appeared to be a little tipsy. When he continued, his speech was slightly slurred.

‘I shouldn’t be telling you this Andrew, this is just between you and me, but it was the statistics that nearly sank the initial trial. The trial was almost finished. We broke the code. By ‘we’, I mean the statisticians. We are allowed to. The clinicians involved were not and of course we would never disclose any information. Anyway, the stats at the time were line-ball. The treatment group were doing better than the placebo group but just. The difference was not statistically significant. And you know what that means, not proven, the drug does not work. Had that been the final result, then Amaradine would have ended up on some back shelf at WH Pharmaceuticals, another promising treatment but of no proven benefit. It would have been a disaster knowing what we know now.’

‘But how is that possible?’ asked Andrew. ‘Amaradine obviously works. There is hardly a patient that doesn’t respond. I can’t understand why the trial was so equivocal.’

‘Yes, but what dose do you use now?’ asked Roger.

‘One gram daily of course,’ Andrew replied.

‘And what dose was being used initially?’

Andrew looked blank.

‘You don’t’ know? Jeffrey Harris’ first patient got 200mg per day. In the trial 400mg was used. No one knew the right dose. The drug had only ever been used for Parkinson’s disease and 200mg was the dose for that. So they doubled it for the glioma trial figuring that brain tumours must be at least twice as tough as Parkinson’s disease. At that dose only the most sensitive tumours responded. The others did not and that’s why the results were coming out the way they were. Anyway, the trial was looking like a flop. WH were getting restless and threatening to pull their money out and everyone was pretty depressed. It was a pretty tense time I can tell you. And then, thank goodness, we got another batch of patients, twenty I think in all. All in a period of five weeks. It must have been an epidemic or possibly other hospitals had heard of the trial and were referring their patients. Whatever the reason, those extra patients swung the statistics in the direction and the rest is history.’

Roger leaned back in his chair, a satisfied look on his face.

‘That’s an incredible story Roger,’ said Andrew. ‘I thought I knew everything about the trial but that bit of information never came out, at least not to me.’

Andrew, who by then had had three martinis, was feeling somewhat woozy. It was an incredible story. But something bothered him. He couldn’t put his finger on it and the martinis didn’t help at all. He wondered about other drugs that may have been found to be useless because of some quirk of statistics. Or theories that remained unproven because the figures did not come out right. There would have been no way that an obscure drug such as Amaradine would have ever been tested again if the trial had ended up negative. What a waste that would have been. What a terrible injustice. But that was how the system worked. The correctness of a hypothesis or the effectiveness of a drug demanded proof beyond a doubt. And the gold standard of that proof where drug treatment was concerned, was a double blind controlled trial. It was a tough standard this gold standard but it was what set the scientists apart from the charlatans.

Andrew glanced at his watch. It was 8.30. He realised he should have something to eat. At the same time Roger realised that he had a date. He stood up, apologised for his sudden departure and called for the bill.

‘This one’s on me. I really enjoyed it Andrew. We have to do it again. I promise not to bore you with statistics next time.’

Roger paid the waitress and left, leaving Andrew to order his meal, a medium rare fillet steak and garden salad which he washed down with copious amounts of mineral water and followed by two cups of black coffee to sober him up for the drive home.

Lying in bed he made an attempt at reading a journal but couldn’t concentrate. The evening left him feeling uneasy. He attempted to watch TV but soon gave that up too. He turned off the light, tried to go over the details of the evening in his mind but before he got very far he was fast asleep.