CHROMOSOME 6 by Robin Cook, MD. G P Putnam's Sons, New York, 460 pages, 1997. Berkley Edition, 1998. Putnam Berkley Audio Group, Inc, Tapes, read by Boyd Gaines, 4 cassettes, 6 hours, 1997.
LIFE SUPPORT by Tess Gerritsen, Pocket Books, New York, 1997. Simon & Schuster Audio Books, read by, Megan Gallagher, 2 cassettes, 3 hrs.
Dr Robin Cook, on leave from the Massachusetts Eye and Ear Infirmary, has had an unbelievable series of medical suspense novels (15 best sellers). Each book has been well-researched and in Chromosome 6, Cook again provides his reference material, giving his work credibility. His scholarship is secondary, though, to the large ethical questions he tackles. The plot in Chromosome 6 centers on genetics. It specifically describes how organs are engineered to grow in primates that can be harvested for use in humans. In Cook's hands, this premise uncoils into a rich and riveting story.
Carlo Franconi, a notorious underworld figure, is gunned down, and his body is stolen from the medical examiner's morgue before the autopsy is completed. The next day a "floater" is brought in from the bay without head or arms. When a recently transplanted liver is found in the body, without immune response or anti-immune drugs in the body, the scene is set for chromosomal analysis. The transplanted liver proves to be from a primate, created by introducing human genes from chromosome 6 into primates. The yield is a reservoir of matched organs for those able to afford them--mafia chieftains, for example, who have a double engineered to cheat the reaper should they meet with a little accident.
The forensic investigation leads you to a research laboratory where chromosome 6 of certain wealthy individuals are crossed with the chromosome 6 of bonobos, a type of chimpanzee. The resultant chimeras have organs that can be transplanted into the human. But such meddling with DNA leads to inevitable disturbances and unexpected fallout. As the experiment plays out, the highly peaceful bonobos morph into a more savagely human-like species. They begin living in caves, making fires. They develop a language, invent weapons and kill each other. If only the bonobos original pacific nature could bleed into their human hosts. Cook unravels the tangle with his usual masterful craft.
Dr Tess Gerritsen, an internist who left her practice to write Harvest, (reviewed in Sacramento Medicine, Jan 98) has now published her second novel, Life Support, which measures up to expectation. In Life Support, Dr Gerritsen addresses a number of medical issues--peer review, hospital discipline, doctors as owners of free-standing surgery centers, and just plain ruthless hospital medical/administrative politics. She entertains us with a plot that features an outbreak of Creutzfeldt-Jakob disease that does not turn out to be mad cow disease, and fetal brain multiple pituitary tissue transplantation, with the twist of impregnating call girls in order to harvest fetal products to benefit the wealthy patients of a medical retirement community.
When one batch of pituitaries is contaminated, the CJD outbreak makes the medical business establishment and their doctors cover tracks fast. The doctors have difficulty handling some of the deaths that occur, but when the administrators force the research neurosurgeons to eliminate other doctors (who were simply trying to diagnose their patients as they arrived in the Emergency Rooms), they realize the slight trading on ethics came to a point of no return as they become felons.
We have set up structures such as peer review that prove lethal. In Life Support, Dr Toby Harper leaves a disoriented patient she thinks went to have a CT in x-ray to attend to a CPR secondary to tamponade in the next ER room. The hospital holds her responsible for the disappearance of the disoriented patient transferring hospital responsibility to a doctor in order to remove her privileges. In Chromosome 6, the surgery suite is moved offshore where the hospital administrator more simply disposes of non-compliant doctors.
Cook & Gerritsen both trade on the strong desire and recurring theme that humans want to live forever. Gerritsen explores the research into pituitary growth and, therefore, body rejuvenation through fetal pituitary transplants into the sella turcica while Cook explores organ supply. The drive for immortality is so urgent that ethics become distorted; physicians commit crimes at the fringes of medicine.
Surgical pathology came into being as a quality issue to make sure that organs and specimens removed from bodies have surgical justification. A high autopsy rate similarly kept those of us on the medical side of practice honest, since we knew there would be an accounting. In both novels, it is the autopsy that brings abuse to light and then to justice. Post mortem examinations are the ethical proving ground.
These medical thrillers by physicians are a call to perceptive examination and exposure of some of the questionable, institutionalized practices in modern medicine. Cook and Gerritsen both train their sights on this formidable opponent. Their goal is ambitious and entirely necessary--a return to ethical behavior.
Del Meyer, MD