The Suicide Effect (2 page)

Sula clicked off the recorder and re-pocketed it. Anxiety shot through her in waves. She had to get away. Before she could backtrack, Rudker strode toward the opening. She lunged away from the door, dropping her notebook. As she scooped it up, Rudker stepped out to the balcony.

“What are you doing out here?” His pale face had gone pink.

“I was looking for you and Dr. Warner.” Sula glanced at her watch. She had been out here three and a half minutes. It felt more like fifteen.

His gray eyes bored into her, and Sula’s stomach turned to mush. She began to chatter. “I’m putting together a press release about the acquisition. I was hoping to get a statement from you and Dr. Warner. We had a meeting scheduled.”

“You were listening.”

“No. I was just hoping to get your attention from here.” Heat surfaced in her face, but her armpits had gone clammy.

With lizard-like quickness, he reached out and snatched her notebook.

“Hey.” It came out more of a squeak than a protest.

Rudker glanced at the blank page, then stared with expressionless eyes. “Do not fuck with me. You will regret it.”

Sula stared back. It was all she could do. She didn’t know what to say and her legs trembled too much to walk away.

Finally, the CEO turned and strode back into the conference room. Sula’s heart, which had been strangely quiet during the encounter, started to pound. Anxiety churned in her stomach and she fought the urge to empty it. Sula forced herself to move, to walk purposefully back to her office and sit down. It wasn’t enough. She lowered her head to her lap and breathed deeply to calm herself. As a child, she had been afraid of many things. As a teenager, all of them had happened to her. Now, she had only one significant fear, and it wasn’t her boss. Yet today he had scared her, and she was having a mild panic attack, or as her counselor called it, “a post traumatic stress episode.”

Sula fought for control, and after a few minutes her journalistic instincts kicked in. She grabbed her pen and notepad, and with a shaky hand recreated the argument from the beginning as best she could.
The two people who had committed suicide in Puerto Rico were cousins.
She hadn’t even known they had conducted trials there.
I may have found a genetic marker.
How many people with depression had that marker?

Eleven million people in the United States took antidepressants, including her. If Nexapra became a global blockbuster, hundreds, maybe thousands, of lives could be at stake. How much money was involved for Rudker? she wondered. How many lives was he willing to sacrifice to improve his net worth? Sula knew the drug was potentially worth billions to JB Pharma and its stockholders. She had seen the analysts’ forecasts.

Anger pushed away her anxiety. How could Dr. Warner walk away from a problem of this magnitude? Someone had to stop the clinical trials. People with mental health concerns needed protection. They needed medication that would help them, not send them over the edge. Sula felt powerless to do anything. She wasn’t a scientist or a manager. She didn’t have access to the data. Rudker’s warning echoed in her thoughts. If she did anything to undermine Nexapra, he would fire her…at least.

Losing her job was unthinkable right now. She could not do anything that would jeopardize her chances of getting Tate back. After years of struggling to pull her life together, she had finally worked up the courage to file a custody petition for her son. The hearing was three weeks away. To prevail against his foster parents, a middle class couple who seemed to have everything, she not only had to be employed, she had to be perfect.

Sula felt lightheaded. It was all too much to think about. She forced herself to take long slow breaths. The oxygen helped quiet her mind and she decided she would talk to Warner. Maybe the doctor could be persuaded to take the suicide data to the research people at JB Pharma. Or even to the FDA. Sula told herself she did not have to get involved. She glanced at her watch. It was 3:40. Her visitation started in twenty minutes. She would see Dr. Warner first thing in the morning.

Chapter 2

Monday, 3:05 p.m.

Diane Warner strode toward her office in the research building. Rage propelled her forward and kept her from seeing anything. If people had spoken to her along the way, she hadn’t been aware. The anger burned off the bone-deep fatigue she’d been feeling for months. Karl Rudker was an asshole and a social Neanderthal. But if she fought him—after five years of twelve-hour days spent coaxing this amazing little molecule along—she would be cast out and made to scramble for a new position at the age of fifty-five. She had no desire to move again. She liked Eugene and was tired of relocating. Moving back to New Jersey where most of the pharma industry was headquartered would be depressing.

She didn’t trust Rudker not to screw her either way. Even if she kept quiet about the data, he was likely to dismiss her when the merged company downsized. Nexapra would proceed through development without her. Without a genetic screening test. The thought made her ill. She was certain the two Hispanic men who had killed themselves shared a gene that produced a protein that interfered with serotonin.

Now that Rudker knew the suicide response was genetic and mostly likely ethnic, he would try to exclude minorities, particularly Latinos, from the Phase III clinicals. That meant once the drug hit the general population, the death toll could be horrendous before the adverse reaction reports triggered a withdrawal from the market.

If they even triggered a withdrawal. It was almost impossible to prove a cause-and-effect relationship between medication and suicide, especially with depressed patients. Nor did the act of killing oneself leave a physical trail of evidence pointing out what went wrong, the way a liver, for example, would show a buildup of statins.

Diane slumped at her desk. She felt compelled to resolve the situation, but she wasn’t sure what move to make. Her soon-to-be new boss, JB’s chief executive officer Gerald Akron, was notoriously inaccessible. The competitive intelligence reports she’d gathered said the company was facing generic drug competition and desperate to acquire a potential blockbuster. So JB Pharma’s board of directors would not be receptive to the idea that Nexapra needed to be put on hold while they partnered with a diagnostics company to develop a screening test. No one would want to hear it. Five years down the road when the lawsuits started pouring in, they would look around for someone to blame.

Diane had no idea what she would do in the long run. But short term, she intended to violate scientific protocol for the first time in her life and make copies of patients’ files to take home with her. The patients, Miguel and Luis Rios, no longer needed privacy protection.

If she didn’t preserve a record of their Nexapra use and consequent death, their files might be permanently erased from the database. First she would make backups of their DNA testing. Diane logged on to the R&D portal and began to burn files to a compact disk.

Rudker retreated to his office near the executive lounge and stood in front of the window. His view of a sloped hillside ruined by an abandoned computer-chip manufacturing plant only added to his irritation. First Warner, then that damn PR person, whatever her name was. Why did they insist on challenging him? He was in charge because he had the business skills to make these decisions.

Very soon he would have an office twice this size. One that looked down on the city of Seattle from the tenth floor of JB Pharma’s corporate headquarters. Although only 288 miles north, his new position would be a long way from the sandal-wearing, tree-hugging inhabitants of Eugene. He’d been here too long and it had made him sluggish and dull. He should have moved on after his divorce, but his son had been going through a rough patch then and it hadn’t been right to leave. Now the boy was older and they didn’t have much to say to each other. It was time to step up and expand his opportunities.

Rudker plopped down at his desk with its familiar piles of papers. His resume, his life, his power base, was about to change. As part of the merger deal, he had asked for a seat on the board of directors in addition to the executive vice-president position. He was confident he would get what he wanted. JB badly needed a blockbuster like Nexapra and he held the cards.

Rudker’s skin tingled thinking about the numbers. The global mental health market was a bottomless pocket, and Nexapra could become the best selling drug ever. Bigger than Prozac. Bigger than Prilosec. They should give it a brand name that started with
Pr
just for luck. Preva. Precor. Preven. No, Preven sounded too much like prevent. FDA would never allow it. He made a mental note to check with Prolabs’ marketing director to see if they had started testing brand names with focus groups yet.

If they could get the drug approved in the next eighteen months, it could hit peak sales by mid 2013—just in time to prevent a bloodletting from the drop in sales after Altavar went off patent. The merger was happening just in time to keep Prolabs from going under. JB Pharma needed a new blockbuster and Prolabs needed a new source of R&D cash.

In fact, it needed a whole fresh start. Rudker would be glad to see the name Prolabs disappear. The company had been through its share of problems since he came on board in 2003. The manufacturing irregularities, the FDA fines, and the privacy invasion lawsuits over some foolish marketing tactics—it had been one fiasco after another. To keep the company afloat while they developed Nexapra, Rudker had put in sixty- and seventy-hour weeks for years.

It hadn’t been enough. He and Neil Barstow, the company’s chief financial officer, had been forced to create two phony holding companies that allowed Prolabs to borrow from itself. They had also given themselves sizeable stock options that had never been declared as a business expense. Without a merger, Prolabs would eventually collapse on itself from the weight of all its debt. Rudker could feel the twinge of a migraine coming on, but he couldn’t stop thinking about his situation. Prolabs was on the edge of the abyss, but the white knight was in sight. He just had to hang for a while longer.

If only he hadn’t borrowed so much money for personal projects—especially the llama ranch in Lorane that was intended to keep his new wife happy. It had cost him nearly $2 million. For fucking llamas! Now those loans were overdue and he couldn’t shuffle the paperwork to hide the debt much longer.

If Nexapra was FDA-approved by the time JB’s accountants sorted out the bookkeeping mess, his transgressions wouldn’t matter. The new owner would write it all off as a merger expense. If the product was delayed, or the merger fell through, he would be financially devastated. Maybe even unemployable. He could not let anything slow Nexapra down.

Rudker rubbed his temples. He would have to deal with Warner. She could be trouble. He suspected he had not heard the last of her genetic test idea. Warner was a neurologist who had come over to the pharma industry out of the frustration of not being able to help her patients. She thought like a doctor, not an MBA. He wondered if she had any dirty secrets he could use against her.

Rudker reached for his Imitrex. He washed down two tablets with the bottled water he kept at his desk. And that damn PR person! How much had she heard? He had been so startled to find her standing there. Maybe she would have to go away too. He could not take any chances.

He took another swallow of water, then logged on to the company’s enterprise software system and entered the clinical trial database. Only a certain level of R&D employees could access the information, but as CEO he had right of entry to all the systems—sales, marketing, patient registries, and pipeline progress. He entered 1299, the drug’s R&D number, into the search field, then scanned down the page for the Puerto Rico research site.

In a few minutes, he located the files of the patients who had died. They had signed up for a study in San Juan that had ended last year. Actually, that section of the trial had never really got going. Right around the time of the suicides, the clinic’s lead investigator had quit because of family problems. The research center had been having a difficult time recruiting patients, so they abandoned that arm of the trial. The suicides had never even been reported, and the results from the parallel studies in Eugene and Portland had provided enough positive data for FDA to greenlight the large Phase III that would lead to approval.

Rudker scanned the data. Both subjects had been diagnosed as clinically depressed and had tried a total of seven medications between the two. Miguel Rios was forty-one. His cousin Luis, thirty-four. An image of the two of them, sitting at a picnic table in a backyard filled with family, food, and noise flashed in his brain.

Rudker deleted the image, then deleted the first file.

Gone. As if Miguel Rios had never been in the study. Before Rudker could trash the second set of data, a popup screen notified him that another system user was trying to access the file.

Warner! It had to be. Damn her. What was she doing? Looking at the data again? Rudker waited for the message to disappear, then quickly erased the file. Of course, there was a paper back-up somewhere in the R&D building, and there was probably another set of paperwork in the clinic in Puerto Rico. Eventually, he would find and destroy all of it. At the moment, he had a million things to do before he left for Seattle tomorrow. The first was to prepare for a meeting with JB’s board of directors. Rudker buzzed his secretary.

Minutes passed. The wait made him irritable and he began to pace. A voice in his head began to rant about the stupidity and slowness of the average person. It caught him off guard. He usually only heard the voice when he was driving, or sometimes when he worked late. Rudker reminded himself to take his daily dose of Zyprexa as soon as he got off the phone.

He hated the damn stuff. It made him feel sedate. It also kept his paranoia in check and his relationships civil. Most people couldn’t handle his natural energy and directness. He’d learned that the hard way in his early twenties. After doing a few months in jail on an assault charge—which wasn’t his fault—he’d made himself swallow his meds and keep most of his thoughts in check.