Pandora's Helix

One

Michael Neef, consultant in paediatric oncology at St George’s Hospital, checked his watch as he descended the spiral steps to the Pathology Department. He was running late but felt he had to respond to a friend and colleague’s request that he ‘pop down’ to the PM suite for a moment. He and pathologist, Frank MacSween had known each other long enough to respect each other’s opinion. If Frank said there was something worth taking a look at, it usually meant there was.

Neef, a tall, well-built man in his middle thirties with swept back dark hair and a handsome face, marred only by the legacy of a broken-nose after a motor cycle accident in his teens, pushed through the swing doors of the path lab and nodded to the duty technician before entering the changing rooms. He helped himself to a green cotton gown and tied it loosely behind him. He didn’t bother with the footwear option, leaving the row of Wellington boots under the wooden bench undisturbed; he wouldn’t be staying long if he could help it.

He didn’t like pathology; he never had. He appreciated it had to be done but that was as far as it went. The sights and smells of the place made him feel claustrophobic and not just the post mortem suite. The dark wooden shelving in the labs with their jars and bottles of hellish contents put his teeth on edge and everywhere there was the sickly sweet smell of tissue fixatives. While the upper world of medicine smelt of antiseptic and ether, the underworld of pathology smelt strongly of alcohol and formaldehyde. He did however, pause to slip on a plastic apron over the gown, always a wise precaution if you were going to be standing close to the table.

Neef entered the PM suite. It was a long, low-ceilinged room, white tiled and lit by fluorescent lighting that gave everyone prison pallor and highlighted every pore on a human face. He saw MacSween at work at the furthest away of four pedestal tables. He was crouching over a cadaver with his spectacles perilously close to the end of his nose but being retained by his mask. His bushy, eyebrows hooded his eyes. Water gurgled down the drain channels of the steel table, preventing him from hearing Neef come in. It wasn’t until he reached up to re-position the overhead lamp that he saw Neef approach.

“Ah, Michael, thank you for coming,” he said, straightening up and putting his gloved hands to the small of his back as if to emphasise his stiffness.

“What have you got, Frank?” asked Neef.

“Put on a mask and I’ll show you.”

MacSween looked down at his subject and for a moment the only sound in the room was that of the extractor fan positioned in the ceiling above the table. There was a fault in it; the even sound of the motor was marred by an intermittent metallic click that defied syncopation. The fan stooped briefly then started again.

MacSween said, “This is Melanie Simpson, aged thirteen.”

Neef looked at the child’s body. “I’m sorry, I don’t seem to...”

“No, she’s not one of yours. She was brought over from University College Hospital. They’re short-staffed in pathology at the moment; Eddie Miller’s not well.”

MacSween looked up briefly and caught Neef’s eye. They both knew that Eddie Miller, one of the pathologists at University College Hospital, had a serious drink problem but he was close to retirement and his colleagues were covering for him. The general view was that a career of over thirty years in pathology deserved a dignified end. A black tie dinner, a crystal decanter presentation, speeches of appreciation, a bouquet for his wife, the whole bit. In the meantime his workload was being channelled towards routine post-mortems. Pathology on the living — the screening of biopsies and urgent tissue samples from the theatres, was carried out exclusively by his more sober and competent colleagues. Eddie seemed to have accepted the situation. He had no choice. Any attempt to concern himself with a live patient and he would hit the pavement, thirty years or not.

“So what’s the problem?”

“I’ve never seen anything quite like this,” said MacSween. “Melanie had severe pneumonia. Both lungs.”

“Pneumococcal? Klebsiella?” asked Neef.

“Surprisingly neither. It wasn’t bacterial at all so they assumed it was viral.”

“Unusual for viral pneumonia to be this virulent.”

“It is,” agreed MacSween, “but that isn’t why I called you. Look closely at her lungs. She should have been one of your patients.”

Neef looked at the lungs which had been removed and were lying in two adjacent steel dishes.

“Good God,” whispered Neef. “They’re covered in small tumours. Have the lab examined them?”

“I’ve just had Charlie Morse do some quick sections; they’re malignant all right. “If the pneumonia hadn’t killed her, the lung cancer would.”

Neef picked up a probe from the tray at the side of the table and examined the lungs more closely. “Strange,” he murmured. “No obvious candidate for a primary focus. What about her other organs?”

MacSween shook his head and said, “Only the lungs are affected. That’s why I called you down. I’ve never come across this in a child. As you say, it clearly wasn’t just a case of a single tumour and then metastasis. There are multiple primary foci but all in the lungs.”

“So what do you think?” asked Neef, still mesmerised by the sight of the diseased lungs.

“I was hoping you were going to come up with a suggestion,” said MacSween. “You’re the cancer expert.”

“Neef shook his head. “It clearly wasn’t spontaneous. Apart from anything else, kids this age simply don’t get lung cancer. And the degree of tissue invasion suggests that some powerful carcinogen must have been involved or maybe even a radiation source.”

“Like an atom bomb in the High Street, you mean,” said MacSween wryly.

“I take your point,” said Neef, “Radiation sources capable of causing this amount of damage are few and far between so my best guess would be intimate contact with some powerful carcinogenic chemical.”

“And they’re not so few and far between.”

“Unfortunately not. It seems like every day we hear about a new one.”

“Thirteen years old, look at her. She was just a bairn.”

Both men looked at the ivory white face of the dead girl, eyes closed, her blonde hair held tightly behind her by the head block on the table. Her cheeks were unblemished and translucent giving her an ethereal appearance. She wouldn’t have looked out of place on a stain glass window.

“She didn’t even have a taste of life, damn it,” muttered MacSween.

Neef glanced sideways at him and saw his eyes were moist. “You’re not supposed to think like that,” he said as a friend. “You’re a pathologist, remember? You’re supposed to stand at the table eating your sandwiches and being cynical, like they do on television.”

“Sod television,” said MacSween.

Neef gave a shrug as if possibly embracing the philosophy and MacSween gave a slight grin. “So what do we do?”

“We’ll have to call the Public Health people in on this,” replied Neef.

“You don’t want to wait until the lab have had a chance to identify the carcinogen?”

“It’s too serious,” said Neef. “They’re going to have to trace the source so they might as well start looking while the lab do their tests. This is going to make some epidemiologist’s day.”

“We’ll have to tell University College. She’s one of their patients, remember? We don’t want to stand on anyone’s toes.”

Neef nodded. “It’ll be interesting to hear what Public Health say,” he said thoughtfully. “It’s hard to think what carcinogens a thirteen year old schoolgirl could possibly come up against to cause this much damage.”

“She’d have to have had a Saturday job stripping blue asbestos out of factories single-handed to warrant it,” said MacSween.

“Our present government would probably call that, ‘work experience’,” smiled Neef.

“Sod them too,” said MacSween.

“I’ve an awful feeling that before too long I might be adding the gentlemen of the press to your list,” said Neef, looking at his watch.”

“Problems?”

“The Torrance case. A reporter’s coming to see me.”

“Oh yes, ‘Little Tracy’, I read about that. You’re on a hiding to nothing, laddie.”

“Tell me about it,” said Neef wryly. “I’d better go.”

Neef’s secretary, Ann Miles, came into his room as soon as he returned. She was looking anxious. “Ms Eve Sayers is here from The Evening Citizen,” she said. “I don’t think she’s too pleased about being kept waiting. She kept reminding me that her appointment was for three o’clock.”

The clock on the wall of Neef’s office said eight minutes past. He shrugged and said, “Let’s keep it quiet or someone will come up with a charter about it...”

Ann Miles smiled conspiratorially and said, “Shall I show her in?”

Neef nodded.

A confident young woman in her late twenties, slim, good figure and wearing smart but casual clothes came into the office. She looked about her as if the occupant of the office was of less interest than the decor. As Neef’s room was a plain, standard issue, NHS consulting room with little in the way of furnishings save for a desk and two filing cabinets, this gambit was doomed to failure. Neef assumed this was her way of showing her displeasure at being kept waiting. He waited until he had her attention before smiling and saying, “I’m Michael Neef. What can I do for you, Ms Sayers?” He indicated that she sit down in a chair in front of his desk.

The reporter sat down and swung her shoulder bag round to rest it on her knees while she extracted a small tape recorder; she placed it on the desk in front of her.

“Whatever happened to shorthand?” smiled Neef.

“Does it bother you?”

Neef shook his head.

“Tell me why you and your colleagues are not doing all you can to help little Tracy Torrance, Doctor Neef. My readers would like to know.” The voice was cool, confident, even intimidating.

Neef eyed the good-looking woman in front of him for fully five seconds before saying, “Tracy Torrance has an incurable condition. My colleagues and I have done all we can for her. To suggest otherwise, as her mother did recently through the columns of your paper, is really quite irresponsible.”

“Isn’t it true that money was a consideration in your decision not to offer little Tracy further treatment?” snapped the journalist.

“No,” replied Neef bluntly.

“My information is that there is a further treatment for Tracy’s condition but you decided against it because it cost too much. What’s your response to that, Doctor?”

Neef swallowed his anger and steeled himself to keep calm. He watched as Eve Sayers fiddled with the recording level control on her tape machine. “I would say that was a gross distortion of the facts.”

“Are you denying the existence of the treatment I’m referring to?” demanded the reporter, looking down at her level indicator again.

“I know exactly which treatment you are referring to. It is not appropriate in Tracy Torrance’s case.”

“Not appropriate?” repeated Eve Sayers challengingly.

“Not appropriate, as in, won’t have any effect.”

“How can you be sure, Doctor?”

Neef shrugged and opened his palms in a gesture of concession. “No one can be absolutely sure of anything in a case like this. None of us have a crystal ball to look into. I had to make a decision based on professional expertise and experience and that told me after much consideration that the treatment you refer to would not benefit this particular patient.”

“But if you admit you can’t be absolutely sure, surely it’s worth giving it a try. What have you got to lose?” asked Eve Sayers. “What has Tracy got to lose?”

“The treatment is very expensive. It would be a waste of resources. Other patients would suffer because of it.”

“So money does come into it?” said the reporter, making another adjustment to her recorder.

Neef was finding the constant fiddling with the tape machine annoying. It was as if the woman wasn’t talking to him at all. She was trotting out questions like a speak-your-weight machine while her mind was on something else. This time he did not reply until she looked up and he felt he had her attention.

“Doesn’t it?” she repeated.

“In that sense, of course it does,” Neef replied. “My unit, like every other, has finite resources. We have to work within our means.”

The reporter’s face took on a look of triumph. She said, “So little Tracy will not get the treatment that could save her life because you have to work within your means. Isn’t that what you are saying, Doctor?”

“No,” replied Neef coldly, “Tracy Torrance will not get the treatment you refer to because I don’t think it would do her any good.”

“Ah yes,” replied the journalist. “Inappropriate.”

“Precisely,” said Neef, fixing Eve Sayers with a cold stare.

“Well, I think it only fair to tell you, Doctor that my paper has decided to finance private treatment for Tracy. We will be running the story in tomorrow’s edition.”

Neef shook his head slightly and shrugged. “You people have no idea of the damage you do, have you?”

“What damage? It seems quite straightforward to me, Doctor. Tracy can’t get the treatment she needs on the NHS so my paper will give it to her privately.”

“Come with me,” said Neef, suddenly getting up out of his chair. He came round the other side of his desk and took the reporters hand, almost dragging her out of the door.

“Where are you taking me?” gasped the woman.

“You’ll see.”

Neef led the reporter up one flight of stairs and opened the door of a ward marked, ONCOLOGY ONE. There were some surgical gowns hanging up on pegs behind the door. He handed one to her and told her to put it on.

The reporter did as she was told and followed Neef through the ward.

“There are sixteen kids here at the moment,” said Neef. “All of them have tumours of one sort or another. How many others would you and your paper like to treat while you’re at it?”

“Now, wait a minute,” stammered Eve Sayers. Little Tracy is a...”

“Special case?” interrupted Neef. “No she isn’t. There are lots of children here in the same position. So come on, how many?”

The reporter held up her hands as if warding off Neef’s attack. “We are a newspaper. It’s not our job to provide treatment that should be provided as a matter of course in our view. We can only afford to highlight the occasional case in the public interest. We couldn’t possibly afford to...”

“You mean money comes into it?” interrupted Neef, feigning outrage. “You mean, your resources are finite, Ms Sayers? You have to work within your means? Good Lord, what an admission and when children’s lives are at stake.”

“All right, you’ve made your point,” said Eve Sayers quietly.

“I haven’t finished,” said Neef. “Take a good look.”

Eve Sayers looked at the children in the ward through the glass walls of the cubicles. They looked so vulnerable, like refugees from some distant war. Many had no hair, a side effect of drugs and radiotherapy. The posters of Disney characters on the walls and the toys lying around served only to accentuate their isolation from normal childhood.

“Come and meet Neil,” said Neef. He led the way to a small side room where a little boy of about four years old was playing with a toy fire engine. He had his back to them when they entered. “Hi Tiger!” said Neef softly and the boy turned round. Eve Sayers took in breath sharply when she saw the huge, disfiguring tumour on the left side of his face. It extended from above the cheek bone to the jaw line and pulled his mouth out of alignment. “Hello,” she smiled, regaining her composure. “What have you got there?”

The boy tried to say ‘fire engine’, but the words were malformed by the pressure of the tumour on his mouth. Eve pretended he had said it anyway and repeated the words. She got down on her knees to admire the toy and wheeled it back to him. There was a pause while the boy appraised the stranger then he giggled and pushed the toy towards Eve again. The game continued until a nurse came in and interrupted proceedings.

“Time for your sweeties, Neil,” she announced. “Are you going to be a good boy and eat them all up?”

Neil gave a slow silent nod and got to his feet. The nurse fed him his medication and praised him with a cuddle when it was over.

Neef indicated to Eve that it was time to go. “See you later, Tiger,” he said to Neil and ushered Eve out of the room.

“Bye, Neil,” said Eve, looking backwards.

Neil made a gurgling sound.

“Why did you do that?” demanded Eve through gritted teeth as soon as they got outside the ward and were standing on the landing.

“Upset you, did it?”

“I was thinking of the boy,” retorted Eve. “I wasn’t prepared for it. He must have seen the reaction on my face.”

Neef paused for a moment before saying, “Well that’s something in your favour. It was his feelings you were concerned about, not your own.”

“You haven’t answered my question,” insisted Eve.

“You came to see me about a patient called Tracy Torrance,” said Neef.

“Yes.”

“But you didn’t call her that did you? You constantly referred to her as, ‘little Tracy’.”

“Well, that’s what the readers of the paper have come to know her as.”

“Thanks to you.”

“What are you getting at?”

“I mean you and your paper have been hitting the cuddly bunny button from the word go and you knew exactly what you were doing.”

“I accept that there’s been a certain emotional aspect to...”

“What about kids like Neil or should I say, ‘Little Neil’ or maybe, ‘Baby Neil’. Do you think he’d fit the bill?”

Eve Sayers became uncomfortable as she searched for an answer.

“Maybe not,” Neef continued. “Neil doesn’t have a mother to call the papers on his behalf and he doesn’t look very pretty, does he? He’s been in care since he was two years old, ever since his mother’s boyfriend threw him at a wall when he dared to cry through a televised football match. And now he’s got a tumour that’s going to kill him before he’s five. Not much of a life, Ms Sayers. Not much of a crowd pleaser?”

Eve Sayers shook her head. “Surely there’s something that can be done for him?” she said. “If it’s a question of money perhaps it might be possible to...”

“And the others?” interrupted Neef, with a wave of his arm in the general direction of the children behind him.

Eve shrugged her shoulders but didn’t say anything.

Neef waited a moment then said, “Well, we’ve established that your paper has limited resources just like my unit and we both have to make decisions. I make mine on medical grounds while you and your paper prefer cuddly star quality. Tracy Torrance did not get a further course of treatment because I and my colleagues thought it medically inappropriate. The Press, in the form of your paper, have decided she will get it because she looks adorable and will appeal to their readers. They, like you, can conveniently ignore all the other children. I and my staff cannot. We have to do our best for all our patients in this unit, Ms Sayers, and now if you’ll excuse me, I’ve got a lot to do.”

Eve Sayers turned on her heel and left without saying anything further. Her heels clicked on the stairs as she descended to the main corridor and gradually faded off into the distance as she followed the exit signs. Neef stood for a moment on the landing, pretending to look out of the window at the courtyard below. He felt no sense of satisfaction over what had happened, just a kind of numb sadness. He returned to his office where he sat down at his desk and rested his arms in front of him. Ann Miles came in and put down a cup of coffee in front of him. “I thought you might need this,” she said.

“Thanks,” said Neef.

“Can I take it Ms Sayers has gone?”

Neef said, “Yes.”

Ann Miles sensed Neef’s demeanour and said, “Things didn’t go well?”

“I lost my temper,” said Neef.

“Oh dear.”

“Oh dear, indeed,” sighed Neef. “Now we’ll have to wait and see how much damage she’s going to do to us.”

“You think she will?”

Neef shrugged uncertainly. “She came to do a cuddly bunny story about Tracy Torrance. You know the form, penny pinching doctor condemns baby to death. Local paper rides to the rescue accompanied by the cheers of its readers.”

“I hate when they do that,” said Ann Miles. “Surely they can’t really believe that anyone would allow a child to die to save money.”

“I don’t know what they really believe,” confessed Neef. “Maybe they do it without thinking. I don’t know.”

Ann Miles looked at the clock on the wall and said, “You’re not going to thank me for reminding you but you have a meeting with management at four.”

“Jesus,” sighed Neef. He saw that it was three minutes to four.

The monthly hospital management meeting had become an unpleasant fact of life as far as Neef was concerned. Administrators seemed to have blossomed like weeds after rain over the past few years. This was partly due to changes in political philosophy but mainly down to the fact that the hospital had taken NHS Trust status under government guidelines. They were now responsible for their own finances. Individual Consultants had to fight their corner in order to achieve the funding they needed for their own units but tended to form alliances against the ‘suits’ — non-medical managers brought in from outside to run ‘the business’ of purveying medicine to the sick. The situation often reminded Neef of the constantly warring factions of Renaissance Italy.

“Ah, Michael,” said Tim Heaton, the hospital chief executive as Neef entered and saw that he was the last to arrive. As always, Heaton was dressed immaculately, dark suit, dazzlingly white shirt and trendily patterned silk tie. This always made Neef aware of his own sartorial shortcomings. The mere sight of the man made his suit feel uncomfortably old and his trousers more than a little baggy. Another thing that Neef noticed was that, at whatever time of day one met Heaton, he always looked as if he had just shaved. His perennially tanned skin never betrayed a hint of stubble. He had come to the Trust from the business world, having been chief executive of a large engineering firm with extensive overseas contracts. Although loathe to admit it at first, Neef had come to concede that the man had ‘people skills’. He was a good administrator.

“I think we’re all here now,” said Heaton.

Neef took his seat at the table with ten others including Heaton. He smiled briefly in the general direction of everyone and gave a special nod to Frank MacSween. Relevant papers for the meeting had been placed in front of him. Neef noticed that this appeared as a minor triumph of desk-top publishing. Laser printed text and a brand new logo for the hospital — healing hands lightly holding a dove, done in pastel blue — had taken over from the Xeroxed, typewritten, much-Tippexed scripts of the past.

Heaton turned to his left and said, “I’m going to call upon our finance director to make his report, just in broad general terms if you would, Phillip?”

Neef gave silent thanks for the ‘broad general terms’ rider. Phillip Danziger had an accountant’s love for figures that he found hard to share. In the red or, in the black, was really all he wanted to know.

The tall, gangly accountant got to his feet and donned a pair of horn rimmed glasses before nodding to Tim Heaton and saying, “Of course.” He shuffled some papers before beginning, “Basically, ladies and gentlemen, we’ve got problems.”

There were groans around the table.

“We’re holding our own for the moment but the future doesn’t look good.”

“But what about the extra business we took from the old General when it closed?” asked Carol Martin, director of nursing services.

“Our financial position has been artificially sweetened by the closure of our nearest rival but patient projections seem to suggest that we may lose much of the extra business when the new surgical centre at University College Hospital comes on line in November. As usual, their marketing has been excellent and it looks like being a big success. GPs will be falling over themselves to get what they see as the newest for their patients.”

“Doesn’t mean the surgery will be any better,” said Mark Louradis, consultant surgeon, his Mediterranean features betraying irritation.

“Of course not,” said Heaton, “but image is important. We have to face it; University College has been extremely successful in promoting itself as a hospital at the very cutting edge of medical science.”

“True,” conceded Neef. “There’s scarcely a week goes by without some newspaper doing a feature on them. Last week, their Lithotripsy programme, this week, their new surgical facilities. Pharmaceutical companies must be queuing up to pour money into the place in the hope of reflected glory.”

“They don’t even do transplants,” said Louradis.

“The trouble is that the public are no longer intrigued by transplant surgery, Mark. The newspapers have exhausted all the angles and the chattering classes have become bored with it. We need new treatments to bolster our image and capture their imagination.”

Frank MacSween gave a slight snort.

Louradis said with a tight-lipped smile. “It’s getting to the stage when we’ll be spending more on advertising and marketing than we do on nurses,” he complained.

“A slight exaggeration, I feel,” said Tim Heaton, “But I say again, image is important. We are a big hospital and we’re good but we can’t afford to rest on our laurels. We have to move with the times, think of new ways of projecting ourselves, new ways of generating income.”

As usual, this kind of talk left Michael Neef feeling bemused. He had been a reluctant convert to NHS Trust philosophy. In the beginning he had wanted to shout, we’re a hospital not a bloody supermarket but time had mellowed him and he had come to accept that things had changed in medicine and this was the way they were going to be in future. Ironically he had given up a lucrative appointment in the United States and come home to England because he wanted to return to ‘real medicine’ instead of finance-oriented treatment. A revolution had occurred during his three year absence; a service had become a business.

It had been like that from the beginning in the States of course, where he had been Chief of Paediatric Oncology at Gregor Memorial Hospital in New York. His initial sense of freedom at having apparently unlimited resources and the best of equipment to practice medicine as he saw fit had been gradually eroded by the knowledge that it was not available to all those who needed it. His patients were those whose families could afford to pay for it. His initial belief that personal health insurance, which most people had, was just an alternative to the national system at home had to be modified in the light of what happened when such personal cover ran out, as it almost invariably did where terminal illness was concerned. Family grief was too often compounded by financial ruin as parents struggled to do their best for dying children.

Danziger continued with his report, outlining which requests for ex-budget equipment had been approved and which had been declined for the moment — put on hold, as Heaton liked to say. Each unit in the hospital was allocated an annual budget but it was accepted that medical advances or simple circumstances might dictate that requests for special funding outside this budget might have to be made. Neef had not lodged any request for equipment in the past few months but he had made out a case for special funding for a new chemotherapeutic drug. There were several new ones coming on to the market and he was keen to try this one after reading the clinical trial results in the journals.

Danziger looked at Neef and said, “Michael, I’m afraid we’ve had to decline your request that the new American drug, Antivulon, be made available to your patients en masse. The sub-committee took the view that benefits would be marginal and at this moment in time, the considerable extra costs could not be justified.”

Neef turned his pen end over end on the table for a moment while he considered his response. This was shaping up to be one awful day.

“I see,” he said. “Perhaps I can remind the sub-committee that I have been particularly restrained in my requests for new chemotherapeutic agents. I do not routinely request every new preparation that becomes available because I do my homework on them first. If I think the benefits will be marginal I do not ask for them. However,” Neef paused for effect. “If I do ask for a drug to be made available it is because I do believe that the benefits to my patients would be tangible. Antivulon has shown itself to be thirty percent less toxic to normal tissue cells when used against tumours and is much less distressing in terms of side effects. This is a very important factor where children are concerned.”

“We understand your disappointment, Michael, believe me,” said Heaton. “But with so many competing causes...”

“I will re-lodge my request this month,” said Neef.

“As you wish,” said Heaton anxious to defuse the situation. He looked across the table and said, “Perhaps our commercial contracts manager will have something to cheer us up. Andrew?”

Andrew D’Arcy, a small, puckish man wearing a blue pin striped suit and a pink bow tie smiled and said, “I have two pieces of good news.”

“Thank God for that,” said Frank MacSween in a stage whisper.

“The pharmaceutical company, Werner Mann, have requested that we carry out the clinical trial work on their new third generation, cephalosporin. They feel it will be particularly effective in clearing up urinary tract infections. The package offered by the company seems especially generous and could lead to further collaboration.”

“Excellent,” said Heaton. “I take it our consultant urologist knows all about this?”

“Peter is giving a seminar in Manchester today,” replied D’Arcy, “but the deal has his full approval.”

“Good. What about your second piece of news?”

D’Arcy looked at Michael Neef before saying apologetically, “Unfortunately I haven’t had time to discuss this with Michael beforehand. I understand he was tied up with the Press when I rang him but I’ve had a call from a biotechnology company called, Menogen Research.”

The name did not appear to mean anything to anyone at the table.

“This is a small local company, funded by venture capital some ten years ago. They’ve been developing gene therapy strategies for tumour treatment. They feel that they are now at the stage of moving to human clinical trials and would like to begin discussions along these lines.”

Heaton beamed and said, “Gene Therapy! Genetic Engineering! Now that would capture the public imagination. The Sunday papers are always full of it. This sounds exactly like the sort of thing we need to raise our profile. What do you think, Michael?”

“I think we need to know an awful lot more about Menogen Research before they get anywhere near our patients but I’d certainly like to talk to them.”

“Excellent,” said Heaton.

“I do have to stress that there’s not going to be much in the way of financial gain for the Trust in this but, as Tim says, it’s a high profile project. We could get lots of media attention.”

“It’s also a high risk area,” said Frank MacSween. “University College Hospital got involved in it last year with a Cystic Fibrosis trial that didn’t do terribly well as I remember.”

“But it got them a lot of attention,” said Heaton.

“And that’s the main thing,” said MacSween, under his breath. He gave Neef a furtive smile.