Chapter 11
This is the internal medicine ward at Stanford.
The dean of Stanford Medical School, Professor Rich, sat in a corner of the ward station, pitifully picking at something to eat.
Avoiding the nurses' eyes.
He looked like he'd worked late last night.
I greeted him, and Professor Rich startled before fiddling with his bow tie.
“Good morning, Professor.”
“You're in. How are you finding the internal medicine residency?”
I nodded.
It was much better than my residency in Korea. The training and work culture in the U.S. were relatively advanced.
That didn't mean there were no overnight shifts or anything, though...
“It's been good.”
Nurses bustled around the station. Hospitals in the 1970s had several times as many staff as modern Korean hospitals.
The dean looked at me.
“Why did you choose internal medicine?”
“Because it offers the most opportunities.”
I answered shamelessly.
Professor Rich was an internist, too. He looked at me and laughed in disbelief.
“Right. That's the kind of person you are.”
It was true that internal medicine was the best specialty for becoming a hospital director, but that wasn't the real reason. What good was a fancy title to a doctor?
The reason was simple.
“I like seeing patients, and I like thinking up new drugs and treatments. I figured internal medicine would let me do both.”
The dean fell silent in thought.
“I heard you wrote a paper on treating another rare disease. Professor Hollis was involved, but apparently you were the one who came up with the diagnosis and treatment?”
“Oh, that. That's right.”
That paper had been accepted by The Lancet.
Kawasaki disease wasn't yet well known in America, and its treatment had yet to be properly established.
“How did you manage it this time?”
The process itself was simple.
“Since Kawasaki disease is a relatively recently discovered syndrome, I figured there must be many cases misdiagnosed as other illnesses despite the risk of serious complications. When I pointed that out...”
Professor Rich furrowed his brow.
“So that's why they fast-tracked it.”
That's why The Lancet had fast-tracked my paper. The information needed to get out immediately for the sake of Kawasaki patients.
“It's because the paper is practical.”
One of the distinctive features of medical research.
Research that can be used in clinical practice to save lives is often written up and published very quickly.
Especially in the 1970s.
“It couldn't have been easy to get past the barrier of The Lancet.”
Professor Rich let his voice trail off.
The Lancet was one of the most prestigious journals in the world. It was difficult to get published, but it had a separate section for case reports.
This case was certainly good enough for publication.
We'd researched a new disease and even found an effective treatment for it, after all.
In the original timeline, an effective treatment for Kawasaki disease wasn't discovered until ten years later.
And so.
Professor Rich finished looking over the medical records, picked up the patient list, and stood.
“Let's go see the patients on the ward.”
I nodded.
Professor Rich specialized in endocrinology.
You could think of it as the field that dealt with hormones.
I was walking down the endocrinology ward corridor with Professor Rich, checking the room numbers on the patient list.
“Since we're on the subject, do you know what the most important disease on the endocrinology ward is?”
“Diabetes.”
“What's the most important drug for diabetes?”
A difficult question.
Insulin was obviously the most dramatic treatment, but not many diabetic patients actually used it. It was only for severe cases.
“Insulin.”
“You mean the stuff extracted from animal pancreases?”
“Oh.”
I stopped walking.
Something had just occurred to me: the genetic recombination technology being researched at Stanford a few years ago, and bacterial restriction enzymes.
In the 1970s, no one had yet succeeded in making human recombinant insulin.
Maybe we could bring forward the discovery of recombinant insulin! Ah, this was something I needed to submit a letter about to a journal, too.
My mind began racing.
Maybe Professor Berg or Professor McDevitt could help with producing recombinant insulin.
I looked back at the professor.
“The day will soon come when we can make insulin in a test tube. That's what Professor Berg and I were working on—the editing of genes.”
“Another research project? I don't know much about molecular biology, so there isn't a lot I can do to help.”
The dean had long since stepped away from frontline research. These days, he focused on clinical work and administration.
The professor sighed again.
“It feels like you only enrolled yesterday. Now you're already a doctor, and you've achieved research results that would take other doctors ten years to achieve.”
“Thank you.”
“I chose well... You were sure to become an excellent doctor. You were the most outstanding student I ever had.”
I nodded solemnly.
***
This is Lab 8 at Stanford Hospital.
The date I'd arranged with the Weisman Foundation was fast approaching. You know, the one when they'd give me a chance to pitch my invention to a pharmaceutical company.
I was sitting in the lab with the EpiPen blueprint I'd drawn up before spread out in front of me.
It was the EpiPen I'd used at the banquet the other day.
The EpiPen was already more or less complete. I'd had the design ready for years. In the end, it was a simple mechanism, no bigger than a pen.
I planned to use commercially available subcutaneous epinephrine injectors for the medication inside the EpiPen.
I'd already filed the patent.
It hadn't been as difficult as I'd expected.
Maybe the patent had gone through more easily thanks to Stanford's name. Maybe it helped that Stanford was already known for technology.
The important thing now was persuading the pharmaceutical company representatives I'd be meeting soon...
‘What's the best way to do this?’
How could I persuade the pharmaceutical company to make and supply the EpiPen?
We could say we wanted them to do it to save patients' lives, but that was the sort of thing doctors and patients would say.
Pharmaceutical companies were a different matter.
What could I say to convince the people at the pharmaceutical company? That this medicine and invention were worth investing in?
I turned the pen over in my hands.
The plan was this.
The EpiPen wasn't just a new way to administer medication. It was a new direction that could change a pharmaceutical company's profits or its position in the market.
It was also a matter of productivity.
Whether the benefits justified the investment.
If they wanted to do something charitable, they could also think about publicity and corporate image. Though pharmaceutical companies usually didn't care much about that?
What would I have to argue to make the pharmaceutical company believe me and mass-produce the EpiPen?
***
And then, the next day...
Lieselotte and one of her attendants were waiting for me in front of the campus gate.
She'd said she'd come in person.
Lieselotte was dressed more ordinarily than I'd expected. A brown outfit, a white shirt, a newsboy cap pulled low as if to avoid attracting attention, and yellow-tinted glasses.
Of course, bringing an attendant along made it seem like her attempt to avoid attention had failed.
Was it retro fashion?
Oh, right. In this era, it was just ordinary clothing.
When I waved to her, Lieselotte lowered her glasses slightly with one hand and looked at me.
“You said you were going to meet with a pharmaceutical company?”
“Yes.”
“Before that, I thought we should buy you a suit. If there's time, I'd like to go straight to Syntex's conference room, too...”
Lieselotte covered her mouth and laughed.
“Thank you.”
“It's a gift from the Weismans. You can't just walk into a conference room wearing any old thing.”
I walked beside Lieselotte for a while.
The weather in California was lovely. It was like spring or fall all year round.
“Have you decided what you're going to say? It's hard to find anyone more closed-minded than pharmaceutical company people.”
I nodded.
You couldn't sell medicine just because you wanted to—or because you'd managed to make it.
There were plenty of hurdles to clear.
Approval from medical associations, research, FDA approval. And even after all that, most drugs weren't sold directly to patients; doctors prescribed them.
It was an extremely difficult system to take risks in.
“Since it's something people buy and carry before they get sick, there's potential to expand the market from the sick to the healthy. It could be placed in public spaces and first-aid kits in advance...”
“That sounds good.”
Lieselotte tilted her head.
“Couldn't we lobby the government to change the law so emergency medicines like the EpiPen have to be kept in restaurants and public places? Like defibrillators or bandages.”
The so-called easy-money strategy.
It shouldn't be difficult for an American pharmaceutical company.
“You really do think like a pharmaceutical company.”
“Well... I think it's unrealistic to expect people to carry EpiPens around. It'd be better to keep them in public places.”
People with severe allergies really did carry them around every day, though.
Lieselotte turned her head.
“We need to get you a suit today, so we can't have one custom-made. We'll buy one at Armani. And I'll pick out the clothes myself...!”
She looked at me and smiled.