I don’t know what possessed me to take one of the capsules. I had half a dozen left of my own, and Packard had shrugged when I’d asked if I should finish them, and said that it couldn’t do me any harm.
There was no aftertaste
. Every time I’d swallowed my own, within minutes there’d been a bitter aftertaste.
I broke open a second capsule and put some of the white powder on my tongue. It was entirely without flavour. I ran and grabbed my own supply, and sampled one the same way; it tasted so vile it made my eyes water.
I tried, very hard, not to leap to any conclusions. I knew perfectly well that pharmaceuticals were often mixed with inert substances, and perhaps not necessarily the same ones all the time—but why would something
bitter
be used for that purpose? The taste had to come from the drug itself. The two vials bore the same manufacturer’s name and logo. The same brand name. The same generic name. The same formal chemical name for the active ingredient. The same product code, down to the very last digit. Only the batch numbers were different.
The first explanation that came to mind was corruption. Although I couldn’t recall the details, I was sure that I’d read about dozens of cases of officials in the health care systems of developing countries diverting pharmaceuticals for resale on the black market. What better way to cover up such a theft than to replace the stolen product with something else—something cheap, harmless, and absolutely useless? The gelatin capsules themselves bore nothing but the manufacturer’s logo, and since the company probably made at least a thousand different drugs, it would not have been too hard to find something cheaper, with the same size and colouration.
I had no idea what to do with this theory. Anonymous bureaucrats in a distant country had killed my sister, but the prospect of finding out who they were, let alone seeing them brought to justice, were infinitesimally small. Even if I’d had real, damning evidence, what was the most I could hope for? A meekly phrased protest from one diplomat to another.
I had one of Paula’s capsules analysed. It cost me a fortune, but I was already so deeply in debt that I didn’t much care.
It was full of a mixture of soluble inorganic compounds. There was no trace of the substance described on the label, nor of anything else with the slightest biological activity. It wasn’t a cheap substitute drug, chosen at random.
It was a placebo.
I stood with the print-out in my hand for several minutes, trying to come to terms with what it meant. Simple greed I could have understood, but there was an utterly inhuman coldness here that I couldn’t bring myself to swallow. Someone must have made an honest mistake. Nobody could be so callous.
Then Packard’s words came back to me. “Just look after yourself as you normally would. Don’t do
anything
out of the ordinary.”
Oh no,
Doctor
. Of course not,
Doctor
. Wouldn’t want to go spoiling the experiment with any messy, extraneous, uncontrolled factors…
I contacted an investigative journalist, one of the best in the country. I arranged a meeting in a small café
on the edge of town.
I drove out there—terrified, angry, triumphant—thinking I had the scoop of the decade, thinking I had dynamite, thinking I was Meryl Streep playing Karen Silkwood. I was dizzy with sweet thoughts of revenge. Heads were going to roll.
Nobody tried to run me off the road. The cafe was deserted, and the waiter barely listened to our orders, let alone our conversation.
The journalist was very kind. She calmly explained the facts of life.
In the aftermath of the Monte Carlo disaster, a lot of legislation had been passed to help deal with the emergency—and a lot of legislation had been repealed. As a matter of urgency, new drugs to treat the new diseases had to be developed and assessed, and the best way to ensure that was to remove the cumbersome regulations that had made clinical trials so difficult and expensive.
In the old “double-blind” trials, neither the patients nor the investigators knew who was getting the drug and who was getting a placebo; the information was kept secret by a third party (or a computer). Any improvement observed in the patients who were given the placebo could then be taken into account, and the drug’s true efficacy measured.
There were two small problems with this traditional approach. Firstly, telling a patient that there’s only a fifty-fifty chance that they’ve been given a potentially life-saving drug subjects them to a lot of stress. Of course, the treatment and control groups were affected equally, but in terms of predicting what would happen when the drug was finally put out on the market, it introduced a lot of noise into the data. Which side-effects were real, and which were artifacts of the patients’ uncertainty?
Secondly—and more seriously—it had become increasingly difficult to find people willing to volunteer for placebo trials. When you’re dying, you don’t give a shit about the scientific method. You want the maximum possible chance of surviving. Untested drugs will do, if there is no known, certain cure—but why accept a further
halving
of the odds, to satisfy some technocrat’s obsession with derails?
Of course, in the good old days the medical profession could lay down the law to the unwashed masses:
Take part in this double-blind trial, or crawl away and die
. AIDS had changed all that, with black markets for the latest untried cures, straight from the labs to the streets, and intense politicization of the issues.
The solution to both flaws was obvious.
You lie to the patients.
No bill had been passed to explicitly declare that “triple-blind” trials were legal. If it had, people might have noticed, and made a fuss. Instead, as part of the “reforms” and “rationalization” that came in the wake of the disaster, all the laws that might have made them illegal had been removed or watered down. At least, it looked that way—no court had yet been given the opportunity to pass judgement.
“How could any doctor
do that
? Lie like that! How could they justify it, even to themselves?”
She shrugged. “How did they ever justify double-blind trials? A good medical researcher has to care more about the quality of the data than about any one person’s life. And if a double-blind trial is good, a triple-blind trial is better. The data is guaranteed to be better, you can see that, can’t you? And the more accurately a drug can be assessed, well, perhaps in the long run, the more lives can be saved.”
“Oh,
crap
! The placebo effect isn’t
that
powerful. It just isn’t that important! Who cares if it’s not precisely taken into account? Anyway, two potential cures could still be compared, one treatment against another. That would tell you which drug would save the most lives, without any need for placebos—”
“That is done sometimes, although the more prestigious journals look down on those studies; they’re less likely to be published—”
I stared at her. “How can you know all this and do nothing? The media could blow it wide open! If you let people know what’s going on…”
She smiled thinly. “I
could
publicize the observation that these practices are now, theoretically, legal. Other people have done that, and it doesn’t exactly make headlines. But if I printed any
specific
facts about an actual triple-blind trial, I’d face a half-million-dollar fine, and twenty-five years in prison, for endangering public health. Not to mention what they’d do to my publisher. All the ‘emergency’ laws brought in to deal with the Monte Carlo leak are still active.”
“But that was twenty years ago!”
She drained her coffee and rose. “Don’t you recall what the experts said at the time?”
“No.”
“The effects will be with us for generations.”
It took me four months to penetrate the drug manufacturer’s network.
I eavesdropped on the data flow of several company executives who chose to work from home. It didn’t take long to identify the least computer-literate. A real bumbling fool, who used ten-thousand-dollar spreadsheet software to do what the average five-year-old could have done without fingers and toes. I watched his clumsy responses when the spreadsheet package gave him error messages. He was a gift from heaven; he simply didn’t have a clue.
And, best of all, he was forever running a tediously unimaginative pornographic video game.
If the computer said “Jump!” he’d say “Promise not to tell?”
I spent a fortnight minimizing what he had to do; it started out at seventy keystrokes, but I finally got it down to twenty-three.
I waited until his screen was at its most compromising, then I suspended his connection to the network, and took its place myself.
FATAL SYSTEM ERROR! TYPE THE FOLLOWING TO RECOVER:
He botched it the first time. I rang alarm bells, and repeated the request. The second time, he got it right.
The first multi-key combination I had him strike took the work station right out of its operating system into its processor’s microcode debugging routine. The hexadecimal that followed, gibberish to him, was a tiny program to dump all of the work station’s memory down the communications line, right into my lap.
If he told anyone with any sense what had happened, suspicion would be aroused at once—but would he risk being asked to explain just what he was running when the “bug” occurred? I doubted it.
I already had his passwords. Included in the work station’s memory was an algorithm which told me precisely how to respond to the network’s security challenges. I was in.
The rest of their defences were trivial, at least so far as my aims were concerned. Data that might have been useful to their competitors was well-shielded, but I wasn’t interested in stealing the secrets of their latest haemorrhoid cure.
I could have done a lot of damage. Arranged for their backups to be filled with garbage. Arranged for the gradual deviation of their accounts from reality, until reality suddenly intruded in the form of bankruptcy—or charges of tax fraud. I considered a thousand possibilities, from the crudest annihilation of data to the slowest, most insidious forms of corruption.
In the end, though, I restrained myself. I knew the fight would soon become a political one, and any act of petty vengeance on my part would be sure to be dredged up and used to discredit me, to undermine my cause.
So I did only what was absolutely necessary.
I located the files containing the names and addresses of everyone who had been unknowingly participating in triple-blind trials of the company’s products. I arranged for them all to be notified of what had been done to them. There were over two hundred thousand people, spread all around the world—but I found a swollen executive slush fund which easily covered the communications bill.
Soon, the whole world would know of our anger, would share in our outrage and grief. Half of us were sick or dying, though, and before the slightest whisper of protest was heard, my first objective had to be to save whoever I could.
I found the program that allocated medication or placebo. The program that had killed Paula, and thousands of others, for the sake of sound experimental technique.
I altered it. A very small change. I added one more lie.
All the reports it generated would continue to assert that half the patients involved in clinical trials were being given the placebo. Dozens of exhaustive, impressive files would continue to be created, containing data entirely consistent with this lie. Only one small file, never read by humans, would be different. The file controlling the assembly line robots would instruct them to put medication in every vial of every batch.
From triple-blind to quadruple-blind. One more lie, to cancel out the others, until the time for deception was finally over.
Martin came to see me.
“I heard about what you’re doing. T.I.M. Truth in Medicine.” He pulled a newspaper clipping from his pocket. “ ‘A vigorous new organization dedicated to the eradication of quackery, fraud and deception in both alternative and conventional medicine.’ Sounds like a great idea.”
“Thanks.”
He hesitated. “I heard you were looking for a few more volunteers. To help around the office.”
“That’s right.”
“I could manage four hours a week.”
I laughed. “Oh, could you really? Well, thanks very much, but I think we’ll cope without you.”
For a moment, I thought he was going to walk out, but then he said, not so much hurt as simply baffled,
“Do you want volunteers, or not?”
“Yes, but—”
But what
? If he could swallow enough pride to offer, I could swallow enough pride to accept.
I signed him up for Wednesday afternoons.
I have nightmares about Paula, now and then. I wake smelling the ghost of a candle flame, certain that she’s standing in the dark beside my pillow, a solemn-eyed nine-year-old child again, mesmerized by our strange condition.
That child can’t haunt me, though. She never died. She grew up, and grew apart from me, and she fought for our separateness harder than I ever did. What if we had “died at the very same hour”? It would have signified nothing, changed nothing. Nothing could have reached back and robbed us of our separate lives, our separate achievements and failures.
I realize, now, that the blood oath that seemed so ominous to me was nothing but a joke to Paula, her way of
mocking
the very idea that our fates could be entwined. How could I have taken so long to see that?
It shouldn’t surprise me, though. The truth—and the measure of her triumph—is that I never really knew her.
* * * *
AXIOMATIC
‘. . . like your brain has been frozen in liquid nitrogen, and then smashed into a thousand shards!’
I squeezed my way past the teenagers who lounged outside the entrance to The Implant Store, no doubt fervently hoping for a holovision news team to roll up and ask them why they weren’t in school. They mimed throwing up as I passed, as if the state of not being pubescent and dressed like a member of Binary Search was so disgusting to contemplate that it made them physically ill.