Caro Carson - The Doctor's Former Fiancee

Still, she’d have to ask Everson why the p-values hadn’t been clearly listed on the graph itself, where they typically were in medical studies.

“Those numbers are wrong,” Braden said in a tone as certain as if he’d said the sky is blue.

“How can you say that off the top of your head?”

Braden only raised an eyebrow.

Of course, he knew that she knew he was a math whiz. He probably could look at a bar graph and come up with a p-value without touching a calculator, let alone performing a page of equations.

“Never mind.” Lana turned to Dr. Everson, who was looking younger and less reliable by the minute. “Who prepared these slides? Who ran our numbers?”

“Uh, well, I was instructed to do some preliminary work, and then Dr. Montgomery finalized it.”

Dr. Montgomery, who couldn’t stay one more hour to take this meeting. Lana had a sinking feeling. Had Dr. Montgomery been so desperate to keep this funding that he’d do something unethical? Surely not. This had to be an honest mathematical error. An error that just happened to be in their favor.

One that, had it gone unchallenged, would have kept more than one million dollars coming into the hospital.

How badly in debt was her department? How hard would the cancellation of this study hit them? Her?

She was determined not to find out; she was going to save this study.

“Myrna, Dr. Everson. If the two of you could excuse us, I’d like to take the rest of this meeting one-on-one with Dr. MacDowell.”

Chapter Three

Lana had never groveled to Braden, not even when she’d so desperately wanted him to stay in Texas instead of moving across the country to Boston. Now she groveled. Begged.

“Please, give me a day to run these numbers again. I just left Washington, where I was involved in the sister study to this one, the pediatric study. Our results were clearly significant. If the pediatric results were good, then odds are that the adult results are as well, so if you’ll just give me time to calculate—”

“I ran the numbers myself, Lana, before I came here. Personally.”

An old, defensive feeling resurfaced. “Because you knew I’d be here? It’s been years since I needed your help to pass statistics class. I know how to interpret data.”

He cut her off before her indignation could build more steam. “I always run the numbers myself before committing millions of research dollars.”

She couldn’t stay impersonal; the memories were just too bitter. “I should have known it would come down to making a profit for you.”

His expression stayed impassive, but she caught the movement of muscle as he clenched his jaw.

Don’t bite the hand that feeds you—or feeds West Central Hospital.

Lana buried her personal feelings. “I was running that pediatric study in D.C. To be studying migraines in pediatrics was rare enough, but even more unusual, the results were positive. Please, Braden, I’m pleading for a second chance here. Let the second half of the study go forward.”

“There’s no gain in—”

“We’ll gain knowledge. Practically every study has shown that adult migraine medicines work poorly in children. This could be the exception to the rule. Even if the adult trial fails, the significance of a drug working for pediatrics but not adults will be novel and worthy of further research.”

She could recall the individual faces of children enrolled in the Washington study. How miserable they were, in pain. How much happier they were when the drug started working. As their pain receded, their personalities emerged, happy kids who made her laugh. She couldn’t let them down. Losing the adult study here at West Central would hurt her professionally, but keeping the pediatric one funded was personal. Those children, her patients, mattered. Not profits.

“Even if the results are novel, who is going to fund that further research, Lana? PLI isn’t going to.”

“Why not?” She wanted to pound the table in frustration. “I’m telling you, the data in peds is rock-solid.”

“Because there’s no money in treating pediatric migraines.”

No money in it?

She’d told herself a hundred times that the man she’d once loved cared only about profits. That he’d chosen not to practice medicine with her because he’d wanted the bigger dollars offered in the business world. She’d clung to that as her justification for ending their engagement.

Always, he’d protested that money wasn’t his motive for going to Harvard Business School instead of staying with her at West Central. He’d denied that the need to excel in the corporate world was the reason he no longer wanted to open a husband-and-wife family practice in Texas. Some part of her must have believed him after all, because now, to hear him say it himself—there’s no money in treating pediatric migraines—was devastating.

Even after six years.

* * *

Braden watched the light in Lana’s eyes die, the passion in her expression fade. It was the same look he’d seen on the faces of other hopefuls whose dreams he’d had to kill. The fact that it was Lana this time didn’t make it any different.

Braden felt very tired. Too old, too wise to the ways of the world.

“This is the reality of the marketplace,” he said. “Pediatric migraineurs are only a fraction of all patients.”

“You saw these slides. They estimate over twenty-nine million Americans suffer from migraines. Even if only a few percent are pediatric, that’s still a million or more patients. That’s huge.”

“No, it’s not. Only half of your twenty-nine million even know their headaches are migraines to begin with. Only half of those will seek help from a physician, and less than half of those might be prescribed a drug like this one. Another percentage will never fill the prescription. There are barely enough adult sufferers to make a new migraine drug viable. There are not enough children.”

“To make the medicine viable? You mean profitable.”

“I mean viable. Can it begin to recoup the millions—the hundreds of millions—that were spent on bringing it to the local drugstore? I estimate that only one in five drugs that makes it to the public sells enough pills to cover the cost of inventing it in the first place.”

“I’m talking patients here. There may not be a lot of them, but there are children out there who suffer terribly from migraines. They’re in pain, Braden. They can’t play and go to school. What about them?”

At the moment, Braden hated his job with a passion. Why did he have to be the one destroying Lana’s dreams? Let someone else disillusion her.

She kept championing her cause. “The adult medicines don’t work well to relieve the pain for children. Most of the treatments aren’t even FDA approved for pediatric use—”

“As it should be. They don’t work well in pediatrics. Lana, step back and look at the big picture. When the first one or two migraine medicines ran pediatric studies, they failed. They didn’t work. Why should the other drugs in the same class throw time and money down the same drain?”

“Money. Always money. What about the patients?”

“I am thinking about patients. There is only so much money out there. What should we spend it on? Who needs it most?” He’d heard her words a dozen times before. She’d always maintained that if he cared about people, he’d be a physician, not a corporate executive.

He felt himself sucked into a time warp of sorts. Felt himself once more losing the woman he loved as she accused him of placing money before all else.

As he had a dozen times before, he tried to make her understand. “This is what I do, Lana. These are the life-and-death decisions I make now. Should I fund a pediatric migraine study that might—and I emphasize might—improve the quality of life for a fraction of a percent of all children? Or should I take those same funds—because by God, there are only so many dollars out there—should I take those same funds and invest them to develop a cardiac medicine that could prevent millions of deaths?”